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^^"'•A  L.  ...^ ,  ^GUNTY 

MEDICAL  LIBRARY 

LOANED  BY 


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HISTORY  OF 

AMERICAN  RED  CROSS 

NURSING 


f^)^ 


THE  MACMILLAN  COMPANY 

NEW  YORK   •    BOSTON  •     CHICAGO  •    DALLAS 
ATLANTA   •    SAN   FRANCISCO 

MACMILLAN  &   CO.,  Limited 

LONDON    •     BOMBAY    •    CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


I'liotn.   hy  Harris  and  I'.uing 


Jane  A.  Delano 


HISTORY  OF 

AMERICAN   RED   CROSS 

NURSING 


BY 
LAVINIA  L.  DOCK,  R.N. 

Former  Secretary,  International  Council  of  Nurses 

SARAH  ELIZABETH  PICKETT,  B.A. 

Former  Assistant  to  the  Director,  American  Red  Cross  Nursing  Service 

CLARA  D.  NOYES,  R.N. 

Former    General     Superintendent     of    Training    Scliools,     Bellevue    and     Allied     Hospitals, 

New    York    City;    Former    I'rcsident,    National    League    of    Nursing    Education; 

Former    President,    American    Nurses'    Association;    Director,    American 

Red   Cross   Nursing   Service 

FANNIE  F.  CLEMENT,  B.A.,  R.N. 

Former   Superintendent,    American   Red  Cross  Town   and   Country    Nursing   Service 

ELIZABETH  G.  FOX,  B.A.,  R.N. 

President,    National    Organization    for    Public    Iloaltli    Nursing;    Director,     American    Red 
Cross   Public   Health   Nursing   Service 

ANNA  R.  VAN  METER,  B.A.,  M.S. 

Former  Professor  of  Home   Economics,   Ohio  State  I'niversity;   Former   Assistant  Director, 
American  Red  Cross  Nutrition  Service 


ILLUSTRATED 


il5eto  gotft 

THE  MACMILLAN  COMPANY 

1922 

All  riphts  reserved 


PBINTED  IN   THE  UNITED   STATES   OF  AMESICA 


m 


Copyright,  1922, 
By  the  MACMILLAN  COMPANY. 

Set  up  and  electrotyped.     Published  December,  1922. 


^=Ff=?P 


Press  of 

J.  J.  Little  k  Ivps  Company 

New   York,  U.  S.   A. 


To 

AMERICAN  RED  CROSS 

NURSES 


CONTENTS 

CHAPTER  I. 

Early  Growth 1 

Origin  of  the  Eod  Cross  Idea — Florence  Xiglitingale — 
Nursing  in  the  Civil  War — Clara  Barton. 

Lavixia  L.  Dock 

CHAPTER  II. 

The  Episode  of  the  Spanisji-Amehican  War    ....       25 

Organization  of  the  Red  Cross  in  1898 — The  Red  Cross 
Sisters — Xnrsing  under  the  Government — Red  Cross 
Auxiliary  No.  3. 

Lavinia  L.  Dock 

CHAPTER  III. 

Affiliation   of   the    American   Red    Cross   with   the 
Nurses'  Association G7 

The  Army  Nurse  Corps — Reorganization  of  the  Red 
Cross  in  1905 — The  American  Federation  of  Associated 
Alumnae  Accepts  Affiliation  with  the  American  Red 
Cross — Development  of  the  Nursing  Service — Partici- 
pation in  Disaster  Relief. 

Lavinia  L.  Dock 

CHAPTER  IV. 

The  Mercy  Ship 139 

The  S.S.  Bed  Cross  Sails — Paignton.  England — Pau, 
France — Kief,  Russia — Gleiwitz,  Germany — Kosel,  Ger- 
many— Vienna.  Austria — Budapest,  Hungary — Belgrade, 
Serbia — Gevgeli,  Serbia — Yvetot.  France — La  Panne, 
Belgium — American  National  Red  Cross  Headquarters 
— Close  of  the  Early  Foreign  Relief  Program. 
Sarah  Elizabeth  Pickett 
V  i 


viii  CONTENTS 

CHAPTER  V. 

Mobilization 229 

National  Headquarters  Reorganizes — The  National  Com- 
mittee on  Red  Cross  Nursing  Service — The  Committee  on 
Nursing  of  the  Council  of  National  Defense — Special 
Courses — Special  Groups — The  Army  School  of  Nursing 
— The  Nurses'  Drives— Surgical  Dressings — The  Nurs- 
ing Surveys. 
Lavinia  L.  Dock  and  Sarah  Elizabeth  Pickett 

CHAPTER  VI. 

The  Relation  of  the  Nursing  Service  to  the  Army  .     .     310 

Organization  of  Units — Base  Hospitals — Hospital  Units 
— Emergency  Detachments — Training  School  Units — 
Special  Units — Cantonment  Zone  Service — Mexican  Bor- 
der Service — Equipment  and  Insignia. 

Sarah  Eliz^vbeth  Pickett 

CHAPTER  VII. 

The  European  War 387 

Cantonments  of  the  New  Armies — Embarkation — With 
the  American  Expeditionary  Forces  in  Great  Britain — 
With  the  British  Expeditionary  Forces  in  France — The 
Zone  of  the  Base,  A.E.F.  in  France — Tlie  American 
Red  Cross  Commission  for  France — Nurses'  Equipment 
Shop,  Paris — With  the  French  Service  de  Sante — 
Emergency  Hospitalization,  A.E.F.  in  France — The 
Zone  of  the  Advance,  A.E.F.  in  France — With  the 
American  Expeditionary  Forces  in  Italy — With  the 
American  Expeditionary  Forces  in  North  Russia. 

SAiLiii  Eliz^ujeth  Pickett 

CHAPTER  VIII. 

Service  with  the  Navy 685 

Organization  of  Units — T'ni forms  and  Insignia — Navy 
Nursing  Service  in  the  United  States — Navy  Nursing 
Service  at  Foreign  Stations — Detached  Service  of  Navy 
Nurses. 

Sarah  Elizabeth  Pickett 


CONTENTS  ix 

CHAPTER  IX. 

Nursing  Service  to  the  Civilian  Population  of  the 
Allies 75G 

The  Children's  Bureau  in  France — The  Refugee  Bureau 
in  France — The  Tuberculosis  Bureau  in  France — The 
Commission  for  Italy — The  First  Commission  for  Rou- 
mania — The  Commission  for  Palestine — The  Commission 
for  Siberia. 

Saiuii  Elizabeth  Pickett 

CHAPTER  X. 

At  National  Headquarters 953 

Auxiliary  Nursing  Service — The  Summer  Months  of 
1918 — The  Influenza  Epidemic — The  Armistice  is 
Signed. 

Sailvii  Elizabeth  Pickett 

CHAPTER  XI. 

Demobilization 983 

^Miss  Delano's  Death — The  Close  of  the  Military  Pro- 
gram Overseas — Bureau  of  Information  for  Nurses — 
Nursing  Service,  U.  S.  Public  Health  Service — Casual- 
ties among  Nurses — ^lemorials  to  Nurses — Red  Cross 
Aides — Educational  Projects — Military  Rank  for  Army 
Nurses. 

Sarah  Elizabeth  Pickett 

CHAPTER  XII. 

The  Close  of  the  Foreign  Emergexcy'Relief  Program  .  1077 

The  Commission  for  Europe — The  Commission  for  Po- 
land— The  Commission  for  the  Balkan  States — The  Con- 
traction of  the  War  Organization. 

Sarah  Elizabeth  Pickett 
CHAPTER  XIIl. 

PxfvTICIPATION    IX    IXTKIiXATIOXAL    NlRSIXG    EdUCATIOX       .     1133 

League  of  Red  Cross  Societies — Schools  of  Nursing — 
]\Iiss  Noyes'  Trip  Overseas — Child  Health  Centers — 
Xursiug  Activities  in  Insular  and  Foreign  Possessions  of 
the  I'nited  States. 

Clara  D.  Noyks 


X  CONTENTS 

CHAPTER  XIV. 

From  Eural  Nursing  to  the  Public  Health  Service    .1211 

Outline  of  Early  Growth — Kequirements  for  Applicants 
— Affiliation  Principles  Adopted — Growth  of  Central  and 
Branch  Units — Early  Affiliations — The  Interruption  of 
War — Scholarships, 

Lavinia  L.  Dock  and  Fanxie  F.  Clement 

CHAPTER  XV. 

Eed  Cross  Public  Health  Nursing  after  the  War    .     .  1293 
Elizabeth  G.  Fox 

CHAPTER  XVI. 

Class  Instruction  for  Women 1352 

Lavinia  L.  Dock 

CHAPTER  XVII. 

The  Dietitian  Service 1375 

Class  Instruction  in  Home  Dietetics — Red  Cross  Dieti- 
tians' Service  in  the  European  War — The  Nutrition 
Service. 

Anna  R.  Van  Meter 

Appendix 1443 


ILLUSTRATIONS 

Jane  A.  Delano Frontispiece 

PACING    PAOE 

A   Group   of   American   Red   Cross   Sisters   who   Served  at 

Siboney  during  the  Spanish-American  War     ....       28 

Indoor  Uniform,  Gray  Dress,  Apron,  Brassard  and  Cap,  of  an 

American  Ked  Cross  Xurse 104 

Insignia 116 

Clara  Dutton  iSToyes 232 

Outdoor  Uniform  of  an  American  Eed  Cross  Nurse     .      .      .     358 

American  Red  Cross  Xurses  Washing  Their  Clothing  in  an 
Improvised  Laundry  Set  up  at  American  Red  Cross 
Evacuation  Hospital  Xo.  110,  Coincy,  France     .      .      .     366 

(Above)  A  Recreation  House  Built  by  the  American  Red 
Cross  for  the  Xursing  Staff  of  the  U.  S.  Army  Base 
Hospital  at  Fort  ^IcHenry,  ^laryland.  (Below)  Xurses' 
Mess,  Camp  Devens,  Massachusetts 398 

A  Xurses'   Parade  Held   in   Chicago   in   1918  to   Stimulate 

Enrollment  for  ^Military  Duty 420 

(Above)  Xurses  on  the  Balcony  of  the  American  Red  Cross 
Xurses'  Club,  London,  Overlooking  the  Gardens  of  Buck- 
ingham Palace.  (Below)  Colebrook  Lodge,  a  Conva- 
lescent Home  for  American  Army,  Xavy  and  Red  Cross 
Xurses  Established  at  Putney,  near  London,  by  the 
American  Red  Cross 438 

Xurses  of  a  U.   S.  Army  Base  Hospital   Marching  off  the 

Docks  at  Brest,  France 486 

An    Airplane    View    of    Savonay    Hospital    Center,    ^ledical 

Corps.  A.E.F.  in   France 512 

A  Corner  of  a  Surgical  Ward  of  American  Red  Cross  Mili- 
tary Hospital  Xo.  1  at  Xeuilly.  France 536 

(Above)  American  Red  Cross  ^lilitary  Hospital  Xo.  5  at 
Auteuil,  near  Paris.  (Below)  The  Interior  of  a  Tent 
Ward  at  Auteuil 602 


xii  ILLUSTRATIONS 

FACING    PAGE 

A  Poster  by  Robert  Reid,  Planned  by  the  American  Red 
Cross  to  Stimulate  the  Enrollment  of  Nurses  for  Military 
Service  but  Withheld  from  Distribution  at  the  Request 
of  the  W^ar  Department 622 

A  U.  S.  Army  Hospital  Train 636 

U.  S.  Army  Evacuation  Hospital  Xo.  6,  at  Souilly,  France     64:() 

The  112th  Field  Hospital,  A.E.F.,  Cohan,  France,  August 

12,  1918 656 

(Above)  Stretcher-Bearers  Bringing  in  a  Wounded  Soldier 
to  a  First  Aid  Station.  (Below)  First  Aid  Station, 
168th  Reg.  Infantry,  A.E.F 6G4: 

(Above)  Looking  Across  the  Frozen  Dvina  River  to  the 
American  Red  Cross  Hospital  at  Archangel,  Russia. 
(Below)  Two  Types  of  Ambulance  Used  by  the  American 
Expeditionary  Forces  in  North  Russia 682 

The  U.  S.  S.  Relief 702 

An  American  Red  Cross  Child  Welfare  Nurse  with  Her 
Charges  in  the  Grounds  of  the  Orphanage  and  Conva- 
lescent Hospital,  Chateau  des  Ilalles,  near  Lyons,  France     780 

(Above)  A  Group  of  Patients  at  an  American  Red  Cross 
Children's  Dispensary  in  Paris.  (Below)  An  American 
Red  Cross  Children's  Dispensary  in  a  Small  Town  in 
France 80-1: 

(Above)  A  Tuberculous  Refugee  Child  Who  Died  in  an 
American  Red  Cross  Children's  Hospital  in  France. 
(Below)  A  Child  Who  Lived 852 

(Above)  Ozjnzio  Marino,  an  American  Red  Cross  Hospital 
for  Children  Suffering  from  Bone  Tuberculosis,  at  Val- 
doltra,  near  Trieste,  Italy.  (Below)  A  Patient  of  the 
Ozpizio  Marino 866 

Refugees    Waiting    at    the    Doors    of    a    Relief    Station    in 

Jerusalem 896 

(Above)  American  Rod  Cross  Nurses  and  Surgeons  En  Route 
to  Vladivostok.  Siberia.  A'isit  the  lyeysaii  Temple,  Nikko, 
Japan.  (Below)  Nurses  of  the  Siberian  Commission  Go 
Shopping  at  a  Market  of  Manchuria  Station      .      .      .      930 

Sick   Nurses"   Quarters,   U.   S.    Navy   Base   Hospital   No.    1, 

Brest,  France 1031 


ILLUSTRATIONS  xlii 


TXCISQ    PAOE 


(Above)  A  Ward  of  the  Vilna  Military  Surgical  Hospital, 
Vilna,  Poland.  (Below)  The  American  Red  Cross  Or- 
phanage at  Liskow,  Poland 1092 

(Above)  An  American  Red  Cross  Nurse,  Jeannie  Frasier, 
Instructing  Two  Pupils  of  a  Little  Mothers'  Class  in 
Elementary  Nursing  Procedure,  Podgoritza,  Monte- 
negro. (Below)  An  American  Red  Cross  Nurse  and 
Her  Interpreter  Giving  a  Lesson  in  Home  Hygiene  and 
Care  of  the  Sick  to  a  Group  of  Refugees  in  Tirana, 
Albania 1106 

(Above)  The  Open  Sewers  of  Tirana,  Albania.  (Center)  An 
American  Red  Cross  Dispensary  in  Albania.  (Below) 
A  Mosque  of  Tirana 1110 

Three  Types  of  Ambulance  in  the  Balkans 1122 

(Above)  Roumanian  Refugees  Living  in  Mud  Dug-Outs  in 
the  Devastated  War  Zones.  (Below)  An  American  Red 
Cross  Nurse  Serving  Soup  to  Roumanian  Refugees  .      .    1126 

(Above)  First  Class  of  the  School  of  Nursing,  Warsaw,  Po- 
land, Established  by  the  American  Red  Cross.  (Below) 
Exterior  of  the  School  of  Nursing,  Warsaw,  Poland     .   1162 

Gray  Dress,  Cape  and  Straw  Hat  Worn  by  American  Red 

Cross  Nurses 1212 

An  American  Red  Cross  Public  Health  Nurse  on  Her  Rounds  1340 

A  Rural  Red  Cross  Class  in  Home  Hygiene  and  Care  of  the 

Sick  Gathers  at  a  Cross-Roads  Meetiner-Place     .      .      .    1372 


FOREWORD 

Perhaps  of  no  other  figure  in  American  tradition  have  there 
been  more  stories  written,  pictures  painted,  songs  sung  than 
of  the  American  Red  Cross  Nurse.  She  has  personified 
courage,  sympathy  and  gentle  strength  in  contrast  with  the 
brutality  of  war.  Yet  of  her  actual  character  and  work  little 
is  generally  known. 

Here  is  her  own  story.  The  experiences  of  many  thousands 
of  nurses,  selected  from  personal  letters,  reports  and  official 
correspondence  and  recorded  in  this  history,  make  it  both  a 
source  book  of  vital  professional  significance  and  a  profoundly 
human  document.  For  the  first  time  there  is  properly  char- 
acterized and  described  the  magnificent  contribution  of  Amer- 
ican nurses  in  aid  of  human  suffering,  not  only  on  the 
battlefield  but  in  all  the  heretofore  hidden  places  where  human- 
ity was  miserable  because  of  war. 


President,  American  National  Red  Cross. 
The  White  House, 
Washington, 
Nov.  1,  1022. 


INTRODUCTION 

Since  its  establishment  in  1909,  the  American  Red  Cross 
Nursing  Service  lias  been  the  grateful  recipient  of  consider- 
able interest  from  the  nursing  profession  and  from  the  laity, 
^lany  requests  have  come  to  National  Headquarters  for  data 
regarding  its  origin,  its  purposes,  its  organization  and  accom- 
plishment. To  the  answering  of  these  requests,  Miss  Delano 
and  her  assistants  gave  especial  care,  feeling  that  the  Nursing 
Service  could  repay  this  interest  only  by  courteous  and  intelli- 
gent acquiescence.  Nevertheless,  the  gathering  together  of  such 
data  involved  the  frequent  repetition  of  painstaking  research 
and  correspondence. 

During  and  after  the  European  War,  such  requests  were 
greatly  multiplied.  Nurses  and  laywomen  in  increasing  num- 
bers wrote  to  Headquarters  to  ask  for  information  needed  for 
preparing  papers  for  club  meetings,  speeches  or  personal  nar- 
ratives. Organizations  compiling  war  records  asked  for  his- 
tories of  Red  Cross  nursing  accomplishment ;  chroniclers  of  the 
War  Department  called  upon  the  Red  Cross  for  extensive  chap- 
ters to  inchule  in  the  Government's  records.  Then,  too,  the 
national  officers  of  the  Red  Cross  shared  with  the  Nursing 
Service  the  opinion  that  a  comprehensive  history  of  Red  Cross 
nursing  service,  of  which  no  adequate  account  had  hitlierto 
l)(>en  written,  should  be  compiled  for  the  use  of  individuals  and 
Cha])tcrs.  Thus  the  undertaking  which  now  reaches  fruition 
in  the  publication  of  this  book,  was  launched  in  1919. 

The  outstanding  editorial  policy  in  shaping  tliis  compilation 
was  the  desire  to  have  an  authentic  history  which  would  recount 
the  metliods  of  work  as  well  as  the  w'ork  itself.  I^y  far  the 
greatest  amount  of  material  previous  to  tlie  European  War  lay 
in  Red  Cross  archives,  in  tlie  Library  of  Congress  and  in  tliat 
of  the  Medical  Department  of  the  Army,  and  the  first  step 
taken  was  to  engage  an  expert  in  research,  to  assenil)le,  analyze 
and  classify  the  voluminous  records.  R)eatrice  C()])l(\v  fiiow 
^frs.  Ralph  Cha}>man),  M.A.,  of  the  ITuiversity  of  Tlliiiois. 
came  from  Chicago  to  perform  this  service  and  our  especial 

xvii 


xviii  INTRODUCTION 

thanks  and  recognition  are  due  to  her  for  the  admirable  way 
in  which  she  carried  on  her  task. 

It  was  felt  that  the  nurses  who  had  made  history  in  the  field 
should  be  the  ones  best  fitted  to  edit  this  book  which  records 
the  work  done.  Early  in  1919  an  editorial  committee  whose 
membership  was  largely  that  of  the  National  Committee  on 
Ked  Cross  Nursing  Service  was  invited  to  read  and  criticize 
the  material.  No  one  refused  to  share  the  responsibility.  The 
members  of  the  committee  are:  Mabel  T.  Boardman,  Anna  C. 
Maxwell,  M.  Adelaide  Nutting.  Annie  W.  Goodrich,  Dora  E. 
Thompson,  Julia  C.  Stimson,  Lenah  S.  Higbee,  Lucy  Minni- 
gerode,  Martha  M.  Russell,  Carrie  M.  Hall  and  George  B. 
Chadwick. 

As  the  writers  to  whom  the  different  chapters  were  entrusted 
completed  their  pages,  each  section  was  submitted  to  those  of 
the  Editorial  Committee  who  had  been  most  closely  related  to 
the  work  under  discussion.  While  they  in  no  way  directed  the 
treatment  of  material,  they  gave  it  most  carefr.l  critical  read- 
ings and  their  suggestions  were  helpful  in  the  extreme.  Their 
corrections  and  revisions  were  for  the  most  part  scrupulously 
incorporated  in  the  text  and  thus  the  American  Red  Cross  is 
able  to  guarantee  the  fidelity  of  this  text  to  the  truth  in  so  far 
as  it  is  humanly  possible  to  interpret  it. 

The  efforts  of  the  authors  have  been  met  by  an  intelligent 
and  enthusiastic  spirit  of  helpfulness  from  nurses  and  lay- 
women  alike.  To  Miss  Boardman,  who  as  secretary  of  the 
society  was  designated  by  the  Central  Committee  to  read  and 
judge  the  manuscript  in  its  entirety,  we  are  deeply  and  sin- 
cerely grateful  for  much  patience,  encouragement  and  aid. 
Erom  Dr.  Anita  Newcomb  jMcGee  we  have  received  especial 
assistance  in  the  matter  of  verification  of  official  footnotes  and 
of  details  toucliiug  u])on  her  relation  to  the  War  Department 
in  the  Spanish-American  AVar.  To  ]\Iarv  S.  Fergiisson,  a 
member  of  the  National  Headquarters  editorial  staff"  and  a 
woman  of  searching  intelligence  and  keen  powers  of  criticism, 
whose  work  on  tliis  history  was  interrupted  early  in  1922  by 
deatli,  we  acknowledge  our  affectionate  and  heartfelt  gratitude. 
To  ]\Ir.  Chadwick,  whose  editorial  aid  followed  the  history 
through  its  many  pages,  through  complexities  of  securing  a 
publisher  and  through  much  official  '^red-tape,"  we  express  our 
many  tlianks. 

]\Iany  others  have  given  us  editorial  assistance,  conspicuous 


INTRODUCTION  xix 

among  whom  are  Dr.  Anna  Hamilton  of  France,  Mrs.  Richard 
Aldrich,  Miss  Laura  Drake  Gill,  General  Merritte  W.  Ireland, 
Dr.  Taliaferro  Clark  and  Dr.  Albert  Ross  Hill. 

In  giving  ns  data  from  correspondence  and  from  their 
wealth  of  personal  recollection  and  memories,  we  acknowledge 
onr  indebtedness  to  ^Irs.  Whitelaw  Reid,  whose  secretary,  Mr. 
Irving  Rlake,  by  her  direction  opened  to  ns  her  war  nursing 
records,  to  Dr.  Monae  Lesser,  Mr.  Allen  Wardwell,  Jr.,  and 
many  nurses.  We  also  owe  recognition  for  valuable  assistance 
in  supplying  records  to  the  Librarian  of  the  Library  of  Con- 
gress and  to  the  Army  Medical  Library.  In  gathering  our 
illustrations  we  were  helped  by  the  Signal  Corps,  U.  S.  A.,  the 
Air  Service,  U.  S.  A.,  and  the  Information  Section,  Naval 
Intelligence,  Navy  Department. 

To  the  hundreds  of  nurses  who  have  answered  our  requests 
for  information  and  material  and  to  those  whose  written  ex- 
periences constitute  the  original  sources  of  this  history,  we 
offer  this  volume  as  our  best  endeavor  to  thank  them  adequately 
for  their  services  in  this  as  in  all  enterprises  of  the  Nursing 
Service. 


National  Headquarters, 
Washington, 

November  11,  1922. 


r 

Chairman,  Editorial  Committee. 


HISTORY  OF  AMERICAN 
RED  CROSS  NURSING 


CHAPTER  I 


EARLY    GEOWTII 


Origin  of  the  Red  Cross  Idea — Florence  Nightingale — Nursing 
in  the   Civil   War — Clara  Barton 

THE  Red  Cross  spirit,  the  motive  prompting  the  work  of 
the  International  Red  Cross,  is  simply  the  instinct  of 
compassion  and  mercy  in  a  pure  form.  Such  a  spirit 
might  be  traced  down  from  the  beginning  of  history  if  a 
genealogical  Red  Cross  tree  were  desired.  In  every  age 
illuminating  instances  of  direct  or  collateral  relationship  could 
be  found.  It  is  possible,  however,  to  wander  too  far  atield  in 
a  search  of  this  kind  and  a  slight  sketch  will  suffice  to  introduce 
the  history  of  the  American  Red  Cross  Xursing  Service.  We 
need  not  go  farther  back  than  to  the  Good  Samaritan,  who 
typified  all  the  classic  characteristics  of  the  Red  Cross,  the 
spontaneous,  voluntary  helpfulness  of  the  private  citizen ;  com- 
passion and  aid  extended  freely  on  the  sole  ground  of  common 
humanity;  practical  skill  and  intelligence  in  binding  up  the 
wounds  of  the  thieves'  victim ;  efficient  relief  work  in  leaving 
the  wounded  man  to  be  nursed  at  the  inn  and  in  paying  for  him 
there. 

Though  Red  Cross  nursing  was  first  developed  in  connection 
with  war,  not  all  war  nursing  in  history  can  be  looked  upon  as 
rudimentary  Red  Cross  service.  It  has  often  been  solely  for 
the  furtherance  of  military  projects.  The  presence  of  the 
impersonal  spirit  of  pity  for  and  the  desire  to  relieve  alike  both 
friend  and  foe  is  the  essential  characteristic  of  the  T?cd  Cross 
idea,  as  it  is  also  the  true  ideal  in  nursing.  Hiere  Ia  no  assur- 
ance that  the  heroic  women  of  the  Gaelic  and  I'eu tonic  tribes, 

1 


2       HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

skilled  as  they  were  in  medical  and  surgical  nursing,  who  always 
followed  their  men  in  war  to  bind  their  wounds,  would  rescue 
as  readily  a  stricken  enemy, — though  it  may  be  that  it  was  so. 
Haldora,  the  Dane,  in  the  year  1000  A.D.  stands  forth  as  a 
true  forerunner  of  Florence  Nightingale  and  Henri  Dunant, 
for  she  assembled  the  women  of  her  household  after  a  fierce 
battle  and  said  to  them,  ''Let  us  go  forth  and  dress  the  wounds 
of  the  warriors,  he  they  friend  or  foe."  ^  She  herself,  it  is 
recorded,  found  the  enemy  chieftain  desperately  wounded  and 
tended  him  long  and  skillfully  until  he  was  healed. 

In  the  medieval  orders  of  the  Knights  Hospitallers  with 
their  women's  branches,  are  to  be  found  the  first  organizations 
on  a  grand  scale  for  nursing  and  relief  work  of  the  Red  Cross 
type  and  it  is  quite  possible  that  their  practice  and  principles 
may  have  become  familiar  to  Isabella  of  Spain,  who  was  the 
first  on  record  among  queens  to  take  an  intelligent  interest  in 
the  sanitary  and  hygienic  care  of  her  nation's  soldiers. 

Those  knightly  orders,  too,  imprinted  their  influence  on  the 
German  women,  who  in  the  War  of  Freedom  (1813)  formed  the 
first  modern  women's  societies  for  organized  war-relief  work 
by  volunteers.  The  armies  of  Napoleon,  on  their  side,  had 
the  nursing  service  of  the  Sisters  of  Charity  of  St,  Vincent  de 
Paul — the  first  trained  and  discipliMcd  nurses  of  the  later 
medieval  period  to  be  officially  assigned  to  the  care  of  sick 
and  wounded  men  in  war. 

All  the  heritage  of  the  past  and  the  promise  of  the  future 
met  in  Florence  Nightingale,  whose  career  was  opened  to  her 
by  the  Crimean  War.  Not  only  did  she  there  give  a  complete 
pattern  of  the  many  branches  of  service  later  developed  under 
the  Red  Cross,  but  also  by  what  she  did  she  inspired  Henri 
Dunant,  the  founder  of  the  International  Red  Cross  Committee, 
to  his  far-reaching  achievement.  Then  by  her  later  efforts  slie 
created  the  modern  army  of  skilled,  secular,  professional  women 
from  whose  ranks  the  Red  Cross  Nursing  Service  is  now  drawn. 
It  will  be  essential,  therefore,  to  preface  this  record  of  American 
Red  Cross  nursing  by  recalling  in  some  detail  the  demonstra- 
tion given  by  ^liss  Nightingale  in  the  Crimea. 

Her  first  efforts  were  of  course  for  the  organization  of  an 
emergency  nursing  service.  For  this  she  had  a  mixed  com- 
pany— at  first  of  forty  women,  some  of  whom  were  Sisters  of 
Religious  Nursing  Orders  and  others  hospital-taught  women  of 

'Mrs.  Xorrie  in  "A  History  of  Xiirsing,"  Vol.  II,  p.  313. 


EARLY  GROWTH  3 

the  old  school,  not  trained  in  the  modem  way,  but  experienced. 
In  all,  about  two  hundred  nurses  belonged  to  Miss  Nightingale's 
staff, — a  small  group  compared  with  the  thousands  of  n\irses 
mobilized  during  the  recent  World  War,  but  a  group  historically 
potent  and  unique. 

The  nursing  service  having  been  appointed  in  its  place  and 
assisted  by  orderlies  and  convalescent  patients.  Miss  Xightin- 
gale  next  organized  a  laundry  service  by  renting  outside  build- 
ings and  employing  soldiers'  wives  for  the  laundry  work.  Diet 
kitchens  arose  under  her  hand  from  which,  for  the  first  time, 
the  wounded  men  were  served  with  nourishing  food,  and  through 
her  efforts  the  entire  kitchen  department  of  the  army  hospitals 
was  systematically  remodeled  by  the  famous  8oyer.  The  dis- 
organization and  inetiicient  management  had  been  such  that  to 
Miss  Nightingale  fell  the  task  of  purveying  much  of  the  daily 
supplies  and  clothing  of  the  patients  under  her  care.  In  a 
letter  to  Mr.  Herbert,  she  wrote  (Jan.  4,  1855)  :  "I  am  a  kind 
of  general  dealer  in  socks,  shirts,  knives  and  forks,  wooden 
spoons,  tin  baths,  tables  and  forms,  cabbage  and  carrots,  operat- 
ing tables,  towels,  soap,  fine  tooth  combs,  precipitate  for  de- 
stroying lice,  scissors,  bedpans  and  stump  pillows."  ^  Presently, 
because  kits  had  been  thrown  away  during  a  march,  she  re- 
clothed  a  large  part  of  the  English  army.  To  provide  for  an 
expected  intlux  of  wounded  at  Scutari,  she  undertook  on  her 
own  authority  to  remodel  some  abandoned  wards,  engaged  two 
hundred  workingmen,  paid  them  out  of  her  private  resources, 
outfitted  the  wards  and  had  eight  hundred  additional  beds  ready 
when  the  need  came.  To  have  done  this  through  military 
channels,  at  that  time,  and  under  the  system  then  in  vogue, 
would  have  taken  months.  Miss  Nightingale's  biographer  tells 
us  that  this  particular  feat,  more  than  any  other  one  thing  that 
she  did,  electrified  the  "red-tape  men"  and  spread  a  sensational 
legend  of  the  ''Nightingale  Power."  She  was  both  fiercely 
criticized  and  greatly  praised  for  this  daring  piece  of  initiative, 
but  Parliament  later  refunded  the  money  it  had  cost,  thus,  in 
effect,  endorsing  her  action.  Miss  Nightingale  urged  and 
planned  in  minute  detail  the  sanitary  engineering  works  later 
carried  out  in  the  hospitals  of  Scutari.  She  herself  considered 
this  her  best  piece  of  work,  for  hospitals  which  had  formerly 
been  deathtraps,  were  thereby  put  on  a  level  with  the  best,  in 
ventilation,  drainage  and  cleanliness.     These  sanitary  reforms, 

» "Life  of  Florence  Nightingale,"  by  Sir  Edward  T.  Cook,  Vol.  I,  p.  200. 


4       HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  conjunction  with  her  other  improvements  in  nursing  and  in 
the  hospital  dietary,  reduced  the  army  death  rate  from  42  per 
cent  to  22  per  thousand  of  cases  treated. 

Though  Miss  Nightingale  dared  greatly  on  her  own  initiative 
when  life  and  death  were  in  question,  yet  her  habitual  order  of 
discipline  was  strict  in  the  extreme  and  she  was  punctilious, 
as  a  rule,  in  allowing  her  private  stores  to  be  used  solely  on  the 
requisition  of  the  medical  officers.  Her  funds  for  supplies  came 
from  her  own  income,  from  other  private  sources  and  from  the 
Royal  Bounty.  The  needs  of  the  allied  armies  were  not  over- 
looked by  her.  She  sent  wines  and  other  supplies  to  the  French 
Sisters  of  Charity.  When  the  Italian  Sisters  suffered  a  loss 
of  their  stores  through  fire.  Miss  Nightingale  dispatched  a 
consignment  of  supplies  to  them.  These  were  friends.  Did 
Miss  Nightingale  also  help  the  foe  ?  The  rules  of  war  often  set 
a  limit  to  the  merciful  impulse,  but  we  may  surmise  what  her 
spirit  was  from  the  story  told  of  the  Russian  boy  prisoner  who 
was  under  her  care  and  who,  when  asked  where  he  would  go 
after  death,  replied  confidently,  "I  shall  go  to  Miss  Night- 
ingale." 

In  social  service.  Miss  Nightingale  opened  new  paths,  hitherto 
as  wholly  untrodden  in  the  army  as  had  been  those  of  her  hos- 
pital reform.  Her  nurses'  families  at  home  were  systematically 
visited  and  helped  by  her  friends  at  her  request.  She  brought 
about  reforms  in  the  pay  of  invalided  soldiers,  and  kept  in  her 
bedroom  much  of  the  officers'  money,  because  if  they  offended  the 
purveyor  or  the  commissary,  they  were  likely  not  to  get  it. 
She  established  reading  rooms  for  the  convalescent  patients ; 
opened  a  post  office  and  encouraged  the  men  to  send  their 
money  home.  She  combated  drunkenness,  to  the  great  derision 
of  the  military  chiefs.  To  counteract  it  she  opened  a  coffee 
house  for  the  men  and  set  on  foot  reading  and  class-rooms  for 
them.  She  had  school-masters  sent  out  from  England  to  teach 
and  lecture,  and  provided  maps,  books,  papers  and  games.  It 
was  said  of  her  that  she  was  the  first  person  who  ever  taught 
officials  to  treat  the  soldiers  as  Christian  men.  Nor  did  she 
forget  the  soldiers'  wives,  many  of  whom  had  followed  the 
army.  She  organized  a  lying-in  hospital  and  secured  work  for 
them,  choosing  friendly  visitors  to  go  among  them  and  help 
them  as  needed. 

The  war  over.  Miss  Nightingale,  as  all  the  world  knows,  with 
the  gift  in  money  made  to  her  by  the  grateful  British  public. 


EARLY  GROWTH  5 

founded  the  Nightingale  Training  School  for  Nurses  at  St. 
Thomas'  Hospital  which  was  the  parent  of  the  modern  system 
of  nursing.  From  her,  therefore,  we  may  well  date  the  story 
of  the  nursing  service  of  the  American  Red  Cross. 

After  the  World  War  a  woman  of  national  prominence  who 
had  worked  through  the  Civil  War  was  asked  to  point  out  the 
greatest  difference  between  the  two  wars  in  the  methods  of 
participation  by  the  civilian  population  ;  her  answer  was :  "In 
the  nursing."  This  was  Louisa  Lee  Schuyler,  whose  part  in 
the  organization  of  the  School  of  Nursing  at  Bellevue  Hospital 
in  1873  lends  a  special  interest  to  the  following  extract  from 
a  letter  written  by  her  to  Miss  Clara  D.  Noyes  on  the  eve  of 
the  entrance  of  the  United  States  into  the  World  War : 

In  these  days,  at  the  age  of  seventy-nine,  when  I  can  not 
do  very  active  work,  my  thoughts  go  back  to  the  early  days 
of  the  Civil  War  and  of  what  we  are  trying  to  do  and  did 
do  then  on  a  very  small  scale  compared  with  today.  We 
wanted  nurses  for  our  wounded  and  sick  and  there  were  none 
to  be  had.  There  were  no  trained  nurses  in  those  days,  as 
you  know.  In  our  Xew  York  Brancli  of  the  L'nited  States 
Sanitary  Commission  it  was  as  easy  to  get  supplies  as  it  is 
with  the  I?ed  Cross  today.  They  poured  in  from  all  over  the 
country.  Our  receiving  and  shipping  business  was  enormous. 
Many  a  time  did  our  loaded  wagons  take  the  boxes  on  short 
notice  on  Sunday  down  Broadway  to  a  steamer  starting  for 
a  southern  port.  We  were  notified  by  the  Sanitary  Com- 
mission of  battles  to  come  that  hospitals  and  hospital  supplies 
might  1)6  ready.  Alas !  no  trained  nurses  to  be  had.  Our 
doctors,  Elizabeth  and  Emily  Blackwell,  provided  one 
month's  hospital  training  for  100  selected  women  who  vol- 
unteered to  go  as  nurses.  It  was  most  elementary,  but  it  Avas 
better  than  nothing  and  many  of  them  turned  out  finely  and 
did  magnificent  work  later  on,  and  now  the  Red  Cross !  So 
much  to  be  thankful  for  if  war  must  come.^ 


Not  only  had  the  United  States  no  trained  nurses  during 
the  (Mvil  War,  but  even  the  International  Committee  of  the 
Red  Cross  did  not  yet  exist.  It  was  in  IS*).'}  that  Henri  Dunant 
laid  his  proposals  for  a  relief  society  before  the  Society  of 
Public    Utility   of   Geneva   and   in    ISGI   that   the   Articles   of 

'Annual  Report  of  Tlic  National  League  of  Nursing  Kdueation.  1917, 
pp.  227  22S. 


6       HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Convention  touching  the  treatment  of  the  wounded  in  war  were 
signed  at  Geneva.  To  this  convention,  known  as  the  Inter- 
national Red  Cross  Treaty,  the  United  States  Government  gave 
its  accession  in  1882.  In  the  meantime,  however,  the  name 
Red  Cross  alone  was  lacking  during  the  Civil  War,  for  in  the 
work  of  relief  carried  on  by  the  United  States  Sanitary  Com- 
mission a  demonstration  of  efficiency  in  civilian  aid  in  war- 
time was  given,  which  was  nothing  less  than  extraordinary 
for  a  young  nation  waging  its  first  war  on  a  grand  scale. 
Stille  in  his  ''History  of  the  Sanitary  Commission"  gives  the 
credit  for  originating  Civil  War  relief  work  to  women.  "It  is 
hardly  necessary  to  say,"  he  writes,  "that  the  earliest  move- 
ment that  was  made  for  any  relief  was  begun  by  the  women  of 
the  country." 

The  United  States  Sanitary  Commission  grew  out  of  a  mass 
meeting  held  in  Cooper  Union,  Xew  York  City,  on  the  26tli  of 
April,  1861,  which  had  been  called  by  the  Ladies'  Relief  Com- 
mittee. This  committee  was  the  work  of  Dr.  Elizabeth  Black- 
well,  who  had  held  an  informal  meeting  of  women  and  men  at 
the  New  York  Infirmary  for  Women  and  Children.  The  local 
New  York  group  took  the  name  "Women's  Central  Association 
of  Relief"  and  was,  in  effect,  during  the  whole  war  the  most 
powerful  and  important  branch  of  the  Sanitary  Commission. 
Its  leading  executive  officer  was  Louisa  Lee  Schuyler.  One  of 
the  purposes  of  the  association  was  "to  open  a  bureau  for  the 
examination  and  registration  of  nurses." 

Dr.  Blackwell  was  personally  intimate  with  Miss  Nightingale 
and  through  her  friendship  she  had  a  clearer  idea,  perhaps,  of 
what  a  nurse  might  be  than  others  had  at  that  time.  She 
labored  devotedly  in  selecting  and  sending  numbers  of  volunteer 
nurses  to  Bellcvuc  Hospital  for  a  month  of  such  training  as  they 
could  get  there.  As  the  training  school  for  nurses  was  not  yet 
founded,  that  experience  could  have  had  but  slight  value,  yet 
about  one  hundred  of  those  hastily  trained  women  entered  the 
army  hospitals  and  gave  useful  aid,  many  of  them  continuing 
in  the  service  throughout  the  war.  Miss  Nightingale  was  in 
close  correspoudoncc  with  Dr.  Blackwell  and  others  on  the 
Sanitary  Commission  and  gave  them  bountifully  of  her  counsel 
and  advice.  She,  indeed,  in  private  letters  expressed  a  desire 
to  come  personally  and  help  them;  but  this  her  fragile  health 
prevented.  A  letter  written  to  the  Secretary  of  War  (^lay  18, 
1861)  bv  the  "Women's  CVnitral  Association  of  Relief  for  the 


EARLY  GROWTH  7 

Sick  and  Wounded  of  the  Army,  acting  in  conjunction  with  the 
Advisory  Committee  of  the  Boards  of  Physicians  and  Surgeons 
of  the  Hospitals  of  New  York  and  the  New  York  Medical 
Association  for  Furnishing  Hospital  Supplies  in  aid  of  the 
Army"  speaks  of  nursing  as  follows : 

The  committee  represent  that  the  Women's  Central  As- 
sociation of  Kelief  have  selected  and  are  selecting  out  of 
several  hundred  candidates  one  hundred  women,  suited  in  all 
respects  to  become  nurses  in  the  general  hospitals  of  the 
Army.  These  women  the  distinguished  physicians  and  sur- 
geons of  the  various  liospitals  in  New  York  have  undertaken 
to  educate  and  drill  in-  a  most  tkorougli  and  laborious  manner 
and  the  committee  ask  that  the  War  Department  consent  to 
receive,  on  wages,  these  nurses,  in  such  numbers  as  the 
exigencies  of  the  campaign  may  require.  It  is  not  proposed 
that  the  nurses  should  advance  to  the  seat  of  war  until 
directly  called  for  by  the  Medical  Bureau  here,  nor  that  the 
government  should  be  at  any  expense  until  they  are  actually 
in  service. 

In  this  letter  it  was  stated  that  the  Commission  for  whose 
recognition  the  combined  associations  were  pleading,  would, 
among  other  things,  ''incpiire  into  the  organization  of  military 
hospitals,  general  and  regimental,  and  the  precise  regulations 
and  routine  through  which  the  services  of  the  patriotic  women 
of  the  country  may  be  made  available  as  nurses."  As  a  result 
of  this  correspondence  and  of  the  efforts  of  a  delegation  sent  to 
Washing-ton  to  represent  the  associations,  official  mistrust  of 
civilian  volunteer  aid,  which  at  first  had  been  obstinate,  was 
allayed :  the  Surgeon  General's  attitude  of  opposition  was 
altered  to  one  of  reluctant  cooperation  and  the  formal  organi- 
zation of  the  Sanitary  Commission  proceeded.  For  nursing, 
the  services  of  religious  Sisterhoods,  which  were  promptly 
volunteered,  were  the  first  to  be  accepted.  There  were  nu- 
merous convents  of  Sisters  of  Charity,  Sisters  of  Mercy,  Sisters 
of  St.  Vincent  and  others  where  emergency  hospitals  were 
opened,  and  from  whose  staffs  Sisters  and  ]\rother  Superiors 
were  supplied.  Throughout  the  war  a  great  deal  of  hospital 
service  was  borne  by  Catholic  Sisters,  among  wliom,  as  espe- 
cially distinguished,  were  ]\rotlier  Anthony  O'Connell  of  Cin- 
cinnati, ^fother  Francis  of  Cliicago,  ]\rother  Angela  of  .Mound 
City  and  Mother  Gonzaga  of  Philadelphia.     Tlic  Holy  Cross 


8       HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Sisters,  an  Anglican  order,  conducted  important  hospital  work 
at  Annapolis  and  Chester  and  Sister  Adeline  Taylor  had  a 
war  nnrsing  record  of  great  variety. 

Much  light  is  thrown  on  the  condition  of  hospital  nursing 
during  the  war  by  the  following  intelligent  commentary  taken 
from  Katherine  P.  Wormeley's  small  book  on  the  "Sanitary 
Commission."  As  one  who  served  with  the  Commission 
throughout,  Miss  Wormley  has  written : 

And  here  a  few  words  may  be  said  on  the  work  that  might, 
— we  dare  to  say  should — belong  to  women  in  general  hos- 
pitals. If  women  comprehended  their  true  work  and  had  the 
patience  to  show  that  they  do  comprehend  it,  the  deep  preju- 
dice against  them,  in  the  minds  of  the  Army  surgeons,  would 
be  removed.  Indeed  it  has  been  removed  in  many  instances. 
But  women  have  not  as  a  general  thing,  seen  their  place  or 
their  duty.  It  is  hard,  perhaps,  to  do  so.  It  is  hard  to 
realize  that  even  benevolence  must  be  obedient.  And  it  is 
for  this  reason  that  Sisters  of  Mercy,  so  far,  have  been  pre- 
ferred as  nurses  by  the  surgeons  of  the  Army.  It  could, 
however,  be  shown  that  the  work  of  women  belonging  in  the 
world  would  be  more  useful  than  even  the  work  of  the  Sisters 
if  such  women  could  learn  their  true  place.  And  if  they 
learned  it  and  kept  to  it,  the  result  would  be  that  in  the  end 
they  would  have  all  the  power  of  benevolence  that  even  they 
would  ask.  For  here  it  may  be  said,  in  deep  conviction  of 
its  truth,  that  the  surgeons  of  the  Army  of  all  grades  are,  as 
a  rule,  desirous  of  doing  well  by  those  under  their  charge 
.  .  .  they  are  conscientious  and  faithful  men.  It  is  believed 
and  is  perhaps  capable  of  proof  that  if  a  lady  (by  which  is 
meant  a  gentlewoman  holding  a  certain  social  position)  and 
one  fitted  for  the  work  could  be  placed  in  charge  of  what  may 
be  called  the  women's  department  in  a  hospital  .  .  .  namely, 
the  nursing  of  the  very  sick  men,  the  special  diet  and  the 
linen  department,  with  a  body  of  nurses  under  her  charge,  a 
benefit  to  the  hospital  would  follow,  and  the  surgeons,  far 
from  complaining  of  it  would  in  the  end  welcome  it  with 
sincerity. 

As  to  the  quality  of  women's  work  as  a  whole,  Dr.  Bellows, 
president  of  the  Sanitary  Commission  wrote : 

The  distinctive  features  of  women's  work  in  this  war 
were  magnitude,  system,  thorough  cooperativeness  with  the 
other  sex,  distinctness  of  purpose,  business-like  thoroughness 


EARLY  GROWTH  9 

in  details,  sturdy  persistency  to  the  close.  .  .  .  Everywhere 
started  up  women  acquainted  with  the  order  of  public  busi- 
ness: able  to  call  and  preside  over  public  meetings  of  their 
own  SOX ;  act  as  secretaries  and  committees,  draft  constitu- 
tions and  bylaws;  open  books  and  keep  accounts  with  ade- 
quate precision  ,  .  .  enter  into  extensive  correspondence, 
cooperate  in  the  largest,  most  rational  plans.  .  ,  . 


During  the  progress  of  the  Civil  War  nursing  assumed  two 
general  types :  one,  a  fairly  systematic  routine  under  govern- 
ment direction ;  the  other,  an  original  spontaneity  of  action 
which  took  its  own  course  and  obtained,  usually,  first  the  acqui- 
escence and  finally  the  help  of  the  Government.  Of  the  former 
type  Dorothea  L.  Dix  was  the  official  head,  having  been  ap- 
pointed as  Superintendent  of  Female  Nurses  by  Secretary 
Cameron  in  June,  18G1.  Of  the  latter  type  was  Clara  Harlowe 
Barton,  the  founder  in  after  years  of  the  American  Red  Cross. 

It  is  said  that  Miss  Dix  was  one  of  the  first  to  do  actual  war 
nursing,  as  she  took  care  of  some  of  the  soldiers  who  had  been 
wounded  in  the  Baltimore  riots.  Her  long  and  remarkable 
career  as  a  reformer  of  prisons,  almshouses  and  insane  asylums 
(as  they  were  then  called)  throughout  the  entire  country  and 
her  lofty  character,  made  her  seem,  probably,  as  precisely  the 
one  woman  to  direct  the  war  nursing,  as  Miss  Nightingale  had 
so  seemed  in  England.  Miss  Dix,  however,  was  not  a  nurse,  nor 
had  she  had  experience  in  nursing  administration  and  her  work 
in  this  episode  of  her  life  was  not  on  a  par  with  her  earlier  dis- 
tinguished labors.  As  her  character  and  personality  have  been 
described,  she  seems  to  have  been  in  many  ways  like  Miss 
Nightingale.  She  was  slight,  delicate  looking,  graceful,  had 
been  in  her  youth  beautiful  and  had  a  soft  musical  voice,  with 
winning  manners.  It  was  said  that  her  gentle  and  persuasive 
tones  had  a  remarkably  controlling  influence  over  the  fiercest 
maniacs.  She  was  exceedingly  quiet  and  retiring  in  her  deport- 
ment and  her  success  with  legislatures  was  due  to  gentleness  and 
mildness  covering  an  unyielding  persistence.  She  cared  nothing 
for  praise  or  fame.  She  preferred  not  to  be  talked  about.  She 
had  private  means,  which  she  lavished  on  her  work,  and  her 
labors  for  the  Government  were  throughout  unpaid.  Her 
standards  were  exceedingly  rigid  and  her  individualism  was 
intense,  alienating  many  of  those  with  whom  she  had  to  work 
in  a  field  where  almost  everything  depended  upon  suasion.     For 


10     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

our  Government  gave  Miss  Dix,  at  first,  duties  but  insufficient 
authority  and  when  later  her  authority  was  extended,  no  penalty 
was  attached  for  disobedience.  Many  of  the  surgeons  resented 
her  position.  They  called  her  arbitrary,  opinionated,  severe 
and  capricious.  Without  a  doubt  she  was  somewhat  severe. 
She  mistrusted  the  young  and  it  was  said  that  a  woman  must 
be  "mature  in  years,  plain  almost  to  homeliness  in  dress  and 
by  no  means  liberally  endowed  with  personal  attractions,  if  she 
hoped  to  meet  the  approval  of  Miss  Dix." 

The  second  type  of  Army  nurse  has  been  thus  described  by 
Dr.  Bellows: 

Of  the  labors  of  women  in  the  hospital  and  in  the  field  .  .  . 
this  sort  of  service  cannot  be  recorded  in  the  histories  of  or- 
ganized work.  For,  far  the  largest  part  of  this  work  was 
done  by  persons  of  exceptional  energy  and  some  fine  natural 
aptitude  for  the  service,  which  was  independent  of  organiza- 
tions, and  hardly  submitted  itself  to  any  rule  except  the 
impulse  of  devoted  love  for  the  work  .  .  ,  supplying  tact, 
patience,  and  resources.  The  women  who  did  hospital  service 
continually  or  kept  themselves  near  the  base  of  armies  in  the 
field,  or  who  moved  among  the  camps,  and  travelled  with  the 
corps,  were  an  exceptional  class  ...  as  rare  as  heroines 
always  are,  a  class  representing  no  social  grade,  but  coming 
from  all  .  .  .  but  in  all  cases  women  with  a  mighty  love  and 
earnestness  in  their  hearts  ...  a  love  and  pity  and  ability  to 
show  it  forth  and  to  labor  in  behalf  of  it,  equal  to  that  which 
in  other  departments  of  life  distinguishes  poets,  philoso- 
phers, sages  and  saints,  from  ordinary  men.'* 

It  would  be  a  congenial  task,  if  it  were  possible,  to  summon 
before  our  readers  the  army  of  Civil  War  nurses.  There  were 
in  all  about  two  thousand,  of  whom  only  a  few  have  been  re- 
corded with  names  and  histories. 

One  of  the  most  appealing  was  Helen  Louise  Gilson,  of 
Boston,  who  was  so  young,  girlish  and  lovely  that  Miss  Dix 
refused  to  accept  her,  but  who,  nevertheless,  through  family  in- 
fluence, followed  the  Army  of  the  Potomac  through  all  of  its 
battles  save  the  first  and  who  displayed  abilities  that  remind 
one,  often,  of  tlie  young  Florence  Nightingale. 

The  most  nearly  approaching  in  her  training  to  the  Red 
Cross  nurse  of  today  was  Emily  E.  Parsons,  of  Cambridge.    At 

*  "Women's  Work  in  tlic  Civil  War,"  p.  60,  Introduction. 


EARLY  GROWTH  11 

the  outset  of  the  war  Miss  Parsons  entered  the  Massachusetts 
General  Hospital  for  experience  and  remained  in  it  for  a 
year  and  a  half.  There  was  as  yet  no  school  for  nurses  there, 
but  through  her  social  connections  she  was  able  to  receive  spe- 
cial and  careful  instruction  from  the  medical  men  and  surgeons. 

The  story  of  Maria  M.  C.  Hall,  of  Washington,  and  her 
sister,  is  peculiarly  illustrative  of  the  volunteer  character  of 
much  (yivil  War  nursing.  Like  Miss  Gilson,  Maria  Hall  was 
rejected  by  Miss  Dix  as  being  too  young.  She  then  went  to 
Mrs.  Fales,  who  had  gained  an  independent  position  in  Wash- 
ington hospitals.  Her  importunity  finally  won  Mrs.  Fales  to 
throw  open  the  door  of  a  ward,  saying  as  she  did  so :  "Well, 
girls,  here  they  are,  with  everything  to  be  done  for  them.  You 
will  find  work  enough."  The  "girls"  stuck  to  their  job,  with 
no  countenance  from  the  surgeons.  When  a  general  order  was 
sent  out  for  the  removal  of  volunteers  from  the  wards,  Maria 
enrolled  as  a  "nurse"  and  drew  Army  pay,  which  slie  gave  to 
the  men.  She  kept  on  in  this  way  for  a  year  "with  no  recogni- 
tion from  any  official  source"  ! 

As  a  contrast  to  this  breezy  volunteer  there  was  Sarah  Edson 
of  New  York,  who  strenuously  attempted  to  found  a  home  and 
training  school  where  nurses  might  be  prepared  for  the  field. 
She  labored  untiringly  for  this  purpose,  brought  it  before  the 
Sanitary  Commission,  went  to  the  Surgeon  General  and  even 
had  a  bill  embodying  her  plan  brought  to  a  Senate  committee. 
She  may  rightly  be  considered  as  the  first  to  conceive  the  idea 
of  an  Army  School  for  Nurses.  That  she  was  unable  to  bring 
her  plan  to  fruition  in  the  intense  atmosphere  of  war  does  not 
diminish  her  distinction.  The  Sanitary  Commission  regarded 
a  training  school  as  unnecessary,  thinking  that  the  hospital 
experience  itself  was  the  best  training  and  that  the  urgent 
needs  of  the  moment  did  not  admit  of  delay  sufficient  to  pre- 
pare the  amateur  nurses  who  were  so  imperatively  called  for. 
The  Surgeon  General  seemed  at  first  favorably  impressed  with 
JMrs.  Edson's  idea,  but  finally  discouraged  it  and  signified  his 
disa])proval  to  the  Senate  committee  who  had  her  bill  in  charge. 

Every  section  of  the  country  had  its  famous  nurse.  The 
Confederacy  acclaimed  Ella  K.  Xewsom  as  "Dixie's  Elorence 
Nightingale."  She  was  a  wealthy  and  beautiful  widow  when 
the  war  broke  out,  and  spent  her  fortune  in  hospital  and  relief 
work  and  nursing. 

Perhaps  of  all  the  nurses  of  whom  records  are  left,  the  most 


12     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

picturesque  figure  and  the  most  widely  known  is  "Mother" 
Bickerdyke.  Truly  amazing  stories  are  told  of  her  endurance, 
her  remarkable  nursing  and  purveying  abilities,  her  bold 
denunciation  of  rich  "slackers"  who  withheld  their  money  from 
war  work,  and  her  high  hand  with  officials  whose  standards 
were  less  disinterested  than  her  own. 

Finally,  none  was  more  closely  linked  with  the  present  time 
than  Amelia  Barlow,  whose  work  inspired  Captain  James 
Scrymser  to  take  the  initial  steps  that  brought  about  the  build- 
ing of  the  beautiful  Xational  Red  Cross  Headquarters  at 
Washington, 

The  hospitals  of  the  Civil  War  were  sometimes  temporary 
adaptations  of  buildings  at  hand,  sometimes  structures  hastily 
erected  for  the  purpose,  sometimes  public  buildings  taken  over 
for  the  occasion.  The  Capitol  at  Washington  was  once  so  used 
and  hundreds  of  wounded  were  distributed  in  the  Senate,  House 
and  Rotunda,  Hospital  ships  originated  in  the  Civil  War. 
Coast  and  river  steamers  were  used.  Many  such  vessels  plied 
on  the  Ohio  and  Mississippi  rivers  with  their  freight  of  wounded 
men. 

In  spite  of  the  utmost  endeavors  of  the  women  volunteer 
nurses,  Civil  War  hospital  standards  were  far  below  those  that 
would  be  accepted  today.  The  wards  were  overcrowded,  primi- 
tive in  equipment  and  meager  in  provisions  for  operating 
and  for  dressing  cases.  It  has  been  estimated  that  during 
those  four  years  approximately  six  and  one-half  million  men 
were  admitted  to  hospitals  and  of  them  more  than  6,000,000 
were  medical  cases,  no  doubt  largely  preventable,  had  preven- 
tion then  been  understood.     Only  425,270  cases  were  surgical. 

After  the  war  the  Army  nurses  formed  an  association  which 
had  its  headquarters  at  Gettysburg.  They  were  wont  to  meet 
at  the  reunions  of  the  Grand  Army  of  the  Republic  and  some 
of  tlieir  number  survived  the  war  of  1914.  A  roster  of  the 
names  of  the  members  hangs  in  the  present  Red  Cross  National 
Headquarters  building  at  Washington. 

Their  war  work  ended,  the  women  of  the  Sanitary  Commis- 
sion went  their  various  ways  home  and,  inspired  and  strength- 
ened by  their  experience,  many  of  them  threw  themselves  with 
energy  into  the  work  of  reformation  in  civil  hospitals  and  other 
institutions.  What  they  had  seen  liad  made  plain  to  tliem  the 
need  of  instructed,  disciplined  nurses  and  again  with  the  help 
and  eonnsel  of  .Miss  Xiiilitiniiale,  women  and  men  \n  Xew  York 


EARLY  GROWTH  13 

City,  Boston  and  New  Haven  simultaneously  established 
(1873)  schools  for  training  nurses  in  three  large  hospitals: 
Bellevue,  the  Massachusetts  General  and  the  New  Haven. 
Smaller  pioneer  schools  already  existing  in  this  country  and 
Canada  wore  streng-thened  by  this  movement  and  hospitals 
generally  followed  the  example  set  them. 

Whilst  the  new  profession  of  nursing  was  thus  taking  form, 
one  of  the  volunteer  workers  of  whom  Dr.  Bellows  had  written 
the  characterization  quoted  on  a  previous  page  went  abroad 
for  travel  and  there  acquainted  herself  with  the  work  and 
organization  of  the  Rod  Cross.  This  was  ^liss  Clara  Barton, 
a  woman  of  New  England  family,  whose  fixed  purpose  it  then 
became  to  bring  about  the  adherence  of  the  United  States  to 
the  Geneva  Convention.  Upon  her  return  to  her  own  country 
she  was  instrumental  in  forming  a  Red  Cross  organization 
which  was  incorporated  in  the  District  of  Columbia,  under 
the  name  of  "The  American  Association  of  the  Red  Cross" 
and  of  which  she  became  the  first  president.  As  this  country 
had  but  a  small  army  and  was  considered  to  be  on  the  whole 
a  peaceful  nation,  it  was  anticipated  that  the  chief  activity  of 
a  National  Red  Cross  would  be  on  lines  of  relief  and  succor 
in  times  of  disaster  or  natural  calamity.  Two  such  calamities, 
the  yellow  fever  epidemic  in  Florida  (1888)  and  the  Johns- 
town flood  (1880)  brought  American  nurses  for  the  first  time 
into  contact  with  the  Red  Cross  and  one  of  these  nurses  was 
the  woman  who  was  destined  to  become,  in  later  years,  the 
head  of  the  Red  Cross  Nursing  Service. 

It  is  hardly  possible  today,  for  nurses  who  only  know  of 
yellow  fever  as  a  preventable  and  almost  extinct  disease,  to 
realize  its  appaJling  character  before  the  research  and  self- 
sacrifice  of  scientific  men  had  discovered  its  mode  of  trans- 
mission. 

A  suspicion  of  the  mosquito  had,  indeed,  been  put  forth  as 
early  as  1848,  by  Dr.  Josiah  Nott  of  Mobile,  Alabama,  but  no 
experimental  work  had  followed  his  suggestions.^''  The  writ- 
ings of  Dr.  Charles  Finlay,  of  Havana,  Cuba  (1881  and  18SG), 
advanced  afresh  the  clinical  evidence  against  the  mos(iuit()  and 
with  so  much  original  force  that  a  Yellow  Fever  Commission 
was  appointed,  which  brought  its  investigation  to  a  climax  at 
the  time  of  the  Spanish-AmiM-ican  War.  ]\lajor  Walter  Reed 
was  its  head.     Under  his  direction,  at  an  experimental  station 

'"See  Popular  S'cicnce  Monthlii,  Vol.  23,  No.  8,  p.  i'AC).  article  by  King. 


14     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  Cuba,  the  tests  of  1900  were  carried  out  by  Dr.  Jesse  W. 
Lazear,  Dr.  James  Carroll  and  Dr.  Aristide  Agramonti,  which 
proved  the  role  in  yellow  fever  of  a  special  variety  of  mosquito, 
the  Stegomyia  fasciata.  In  those  tests  Dr.  Lazear  sacrificed 
his  life,  but  as  a  consequence  of  that  work,  Havana,  other  parts 
of  Cuba,  and,  later,  the  Canal  Zone  were  freed  from  yellow 
fever  and  it  was  shown  that,  with  proper  sanitation,  the  tropics 
could  be  made  safe  for  white  men. 

But  these  truths  were  still  unknown  when  Miss  Barton's  aidea 
went  to  the  help  of  the  fever-stricken  South  in  1888.  In  every 
epidemic  of  yellow  fever,  scenes  were  enacted  in  Southern  cities 
like  those  of  plague  times  in  medieval  Europe.  The  only  hope 
of  safety  of  medical  men  and  attendants  lay,  it  was  believed, 
in  the  immunity  of  acclimated  persons,  or  of  those  who  had 
survived  an  attack.  It  was  also  believed  that  negroes  were 
especially  immune.  It  seemed  therefore  at  that  time  wise  and 
reasonable  that,  w^hen  the  Red  Cross  Society  of  iSTew  Orleans 
was  formed  (1883),  it  should  have  been  ruled  that  no  un- 
acclimated  persons,  nor  any  non-immunes,  should  be  used  as 
assistants  by  the  Red  Cross.  Miss  Barton's  writings  refer  to 
the  well  known  "Old  Howard  Association"  of  New  Orleans 
that  carried  on  heroic  service  in  epidemics  in  earlier  days 
under  Colonel  F.  R.  Southmayd  and  that  had  united  with  the 
National  Red  Cross  Committee.  When  the  call  came  from 
Jacksonville  for  help.  Miss  Barton  expected  to  supply  it.  She 
wrote : 

It  was  arranged  that  the  Southern  states,  through  this 
society  [the  New  Orleans  Eed  Cross]  should  provide  all  Eed 
Cross  nurses  for  yellow  fever,  and  that  the  northern  part  of 
the  country  should  raise  the  money  to  paj^  and  provision 
them,  "We  felt  this  to  be  a  security,  and  an  immediate  pro- 
vision which  the  country  had  never  before  known.  Fearing 
that  this  might  not^  at  its  inception,  be  fully  understood,  I 
called  at  once  on  Dr.  Hamilton,  then  in  charge  of  the  ]\rarine 
Hospital,  explaining  it  to  him,  and  offering  all  the  nurses 
that  could  be  required,  even  to  hundreds,  all  experienced  and 
organized  for  immediate  action.  Perhaps  it  was  not  strange 
that  a  provision  so  new  and  so  unknown  in  the  sad  history  of 
plagues  and  epidemics  should  have  seemed  utopian,  and  as 
such  have  been  brushed  aside  as  not  only  useless,  but  self- 
seeking  and  obstructive.  Like  the  entire  organization  of 
which  it  was  a  part,  it  has  to  wait  and  win  its  way  against 
custom  or  even  prejudice.  .  .  .  Not  realizing  the  opposition 


EARLY  GROWTH  15 

there  might  be  to  our  nurses,  we  called  upon  their  old-time 
leader.  Colonel  Southmayd,  to  enlist  a  body  of  nurses  and 
take  them  at  once  to  the  fever  district.  He  enlisted  thirty, 
both  men  and  women,  white  and  colored,  and  took  a  part  with 
him,  the  rest  following  next  day.® 

Friction  developed  between  the  corps  of  volunteer  nurses 
raised  bj  Colonel  Southmayd  and  taken  to  Jacksonville  and 
a  little  place  called  MacClenny,  and  the  local  boards  of  health 
with  which  the  ]\Iarine  Hospital  Service  was  cooperating.  The 
clash  between  the  older  system  of  dealing  with  epidemics  and 
the  newer,  more  scientific  methods  of  the  Federal  and  muni- 
cipal health  officers  was  inevitable  and  Colonel  Southmayd  was 
withdrawn.  These  untrained  volunteers,  of  whom  there  were 
about  thirty,  some  of  whom  were  of  the  Negro  race,  were  the 
first  Red  Cross  nurses  in  the  United  States. 

It  would  go  far  beyond  our  limits  to  tell  the  story  of  the 
Jacksonville  epidemic.  In  the  daily^  press  of  that  time  the 
general  picture  of  distress,  terror  and  death  w^as  outlined. 
Through  the  scene  moved  many  figures  brought  there  by  the 
great  need, — many  of  them  ministering  in  faithful  unselfishness 
according  to  their  knowledge,  others  preying  upon  a  stricken 
conmmnity.  The  personal  recollection  of  a  worker  in  that 
emergency  is  that  a  strangely  debased  type  of  adventurer 
came  to  Jacksonville, — immoral,  abandoned  women  and  unprin- 
cipled men.  Many  such  persons  were  on  the  lists  as  nurses 
and  there  were  Xorthern  volunteers  among  them.  The  Red 
Cross  idea  had  been  seized  by  the  popular  mind  and  the  glamour 
of  the  brassard  made  itself  felt.  Many  actors  in  those  scenes 
made  and  wore  on  their  arms  or  shoulders  the  emblem  to 
which  they  had  no  right  whatever.  It  would,  therefore,  be 
unfair  to  judge  the  status  of  Rod  Cross  nursing  even  in  that 
formless  period,  by  the  individuals  who  claimed  to  be  Red 
Cross  workers. 

The  local  health  board  very  properly  deported  objectionable 
characters  to  a  detention  and  quarantine  camp  (Camp  Perry) 
in  charge  of  Dr.  Guiteras,  the  yellow  fever  specialist,  and  items 
of  this  kind  occasionally  ai)peared  in  the  Xew  York  papers:" 

For  very  good  reasons  another  nurse  will  be  forwarded  to 
Camp    Perry    tomorrow,  ...  the    action    of    the    Board    of 

"•The  Rod  Cross."  ])y  Clam  Barton,  p.   147-148. 
'New  York  Tribune,  September  22,   1SS8. 


16     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Health  in  regard  to  incompetent  and  immoral  nurses.  .  .  . 
Two  other  nurses  [their  names  were  printed]  are  at  Camp 
Perry,  sadder  if  not  wiser  women. 

Dr.  J.  Y.  Porter,  who  was  in  charge  of  the  Government 
relief  measures,  also  had  charge  of  Government  nurses.  Few 
of  these  were  trained  as  we  count  training  today,  but  the 
"Bureau  of  Nurses  and  Medical  Attention"  answered,  in  all, 
over  seven  hundred  calls  for  help.  Many  of  the  aides  thus  sup- 
plied were  men  who  had  served  in  various  capacities  in  hos- 
pitals and  were  not  unfamiliar  with  scenes  of  disease  and  death. 
The  theory  of  immunity  seems  then  to  have  been  waived  and 
this  was  especially  so  at  a  temporary  hospital  on  the  pavilion 
plan  which  was  erected  for  the  epidemic  emergency  on  the 
sand  dunes  outside  of  Jacksonville.  It  was  called  the  Sand- 
hills Hospital  and  as  early  as  the  20th  of  August  was  in  charge 
of  Dr.  Sollice  Mitchell,  brother  of  Neal  Mitchell,  then  presi- 
dent of  the  Jacksonville  Board  of  Health. 

It  is  at  this  time  that  Jane  A.  Delano,  who  later  takes  so  im- 
portant a  part  in  this  history,  first  enters  its  pages,  though 
not  through  Red  Cross  channels.  Dr.  Sollice  Mitchell  had 
been  a  Bellevue  interne.  He  had  had  his  surgical  service  in 
the  ward  where  Miss  Delano  had  been  head  nurse  and  through 
his  knowledge  of  her  abilities  she  was  asked  to  come  as  superin- 
tendent of  the  Sandhills  Hospital,  a  position  which  she  filled 
with  distinction  during  her  two  months'  stay.  Two  of  her 
classmates  followed  her  there  as  volunteers,  Wilhelmina  Weir, 
a  Canadian,  and  Lavinia  L.  Dock,  a  Pennsylvanian,  each  of 
whom  had  charge  of  a  ward  in  the  hospital. 

Miss  Delano's  later  distinguished  service  in  the  Red  Cross 
gives  a  special  interest  to  this,  her  first  public  seiwice  after 
her  training.  She  had  been  one  of  the  youngest  of  her  class 
(188G)  and  had  gone  through  the  hospital  so  unobtrusively 
and  with  so  unaffected  a  quiet  and  reserve  that  few  of  her 
classmates  dreamed  of  the  unusual  abilities  she  later  displayed, 
although  all  her  hospital  work  had  been  well  and  easily  done. 
One  of  the  young  internes  of  that  day,  who  rose  to  the  position 
of  Surgeon  General  of  the  United  States  Navy  (Rear  Admiral 
W.  C.  Braisted)  recalled  "a  singularly  clear  keen  intelligence, 
an  abiding  sense  of  duty  and  an  innate  resoluteness  of  charac- 
ter" as  among  her  characteristics. 

Miss  Delano  was  born   in   Watkins,   New  York,   in    1862. 


EARLY  GROWTH  17 

Her  family  was  a  substantial  one  of  o^ew  England  stock.  Her 
father  had  died  in  the  Civil  War  and  though  she  was  too  young 
to  remember  him  personally,  his  memory  remained  with  her 
and  animated  the  intense  interest  that  she  felt,  later,  in  the 
soldiers  and  nurses  of  another  war.  In  appearance  Miss 
Delano,  at  Jacksonville,  was  pleasing  without  being  beautiful. 
She  was  tall  and  of  a  very  calm,  self-contained  bearing,  blue- 
eyed  and  brown-haired,  with  good  teeth  and  a  soft  fine  com- 
plexion. She  was  quiet  and  serious  in  manner  and  spoke  but 
little.  She  wore  the  Bellevue  uniform  of  blue  and  white  seer- 
sucker with  the  cap,  which  increased  her  youthful  look  and,  by 
contrast,  made  her  poise  and  quietude  seem  the  more  impressive. 
She  was  a  disciplinarian,  and  fearless. 

The  hospital  on  the  Sandhills  was  not  long  needed.  After 
a  couple  of  months  the  epidemic  abated  and  the  Northern  nurses 
and  physicians  were  quarantined  and  returned  to  their  homes. 
A  legend  has  arisen  that  Miss  Delano,  in  advance  of  medical 
knowledge,  insisted  on  the  use  of  mosquito  screens  in  the  hos- 
pital. It  was,  indeed,  thoroughly  screened,  and  this  may  have 
been  her  doing.  It  has  been  pointed  out,  however,  that  Dr. 
Finlay's  writings  two  years  before  had  sounded  a  warning 
which  doubtless  made  medical  men  also  suspicious  of  the 
mosquito. 

After  this  emergency  Miss  Delano  had  twenty  years  of  varied 
experience  before  she  came  under  the  Red  Cross  flag.  She 
spent  some  time  in  a  mining  camp  in  Arizona,  persuaded  to 
go  there  by  Dr.  Darlington,  later  Health  Commissioner  of 
Xew  York  City,  who  was  an  old  family  friend.  For  five  years 
she  was  superintendent  of  nurses  in  the  University  of  Pennsyl- 
vania Hospital  with  Miss  M.  E.  P.  Davis  as  head  of  the  hos- 
pital. She  was  one  of  the  first  among  nurses  to  take  the 
Special  Course  in  Philanthropy  founded  by  the  Charity 
Organization  Society  of  Xew  York  City,  and  she  followed  this 
by  two  years'  work  as  head  of  the  Girls  Department  in  the 
House  of  Ivefuge  on  liandalls  Island.  In  1902  she  was  called 
to  be  the  head  of  the  training  school  in  Bellevue,  her  ahna 
mater,  and  held  that  position  for  four  years.  Then  for  several 
years  hov  time  was  broken  by  the  ill  health  and  death  of  her 
widowed  mother.  Absorbed  in  these  cares  ]\liss  Delano  was, 
from  l!)()r»  to  1008,  se(iuestered  from  active  nursing  associa- 
tions. Her  fi'iends  in  the  later  Red  (^ross  work,  however,  know 
that   in   the   Jacksonville   expericMice  she   had   reacluHl   a   clear 


18     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

conviction  of  what  a  nursing  reserve  under  the  Red  Cross  might 
mean  and  of  the  great  usefulness  it  might  have,  and  they  be- 
lieve that  her  special  feeling  for  the  Red  Cross  dated  from 
that  time. 

At  Johnstown  much  of  the  relief  and  all  the  nursing  work 
was  carried  on  under  the  Red  Cross.  Philadelphia  had  a  Red 
Cross  Society  affiliated  with  the  National  Association  and  this 
group  sent  a  staif  of  medical  men  and  nurses  to  work  in  the 
tent  hospitals  which  were  used  for  ill  and  injured  persons.  The 
nurses  in  this  corps  were  rather  of  the  "Staff  Nurse,  Old 
Style"  than  of  the  ultra  modern  school.  They  were,  however, 
well  disciplined  and  accustomed  to  working  under  the  direction 
of  the  physicians  who  had  selected  them.  Before  they  arrived 
Bellevue  Hospital  had  again  sent  a  volunteer  nurse,  Lavinia 
L.  Dock,  who  remained  until  the  others  came.  Miss  Barton 
took  a  part  in  the  work  of  relief,  leaving  the  hospital  manage- 
ment to  the  physicians  in  charge.  After  this  episode  a  number 
of  years  elapsed  without  any  special  awakening  of  nurses  to 
Red  Cross  aims. 

On  the  eve  of  the  war  with  Spain,  which  prepared  the  way 
for  the  present  Red  Cross  Nursing  Service,  it  may  be  well  to 
give  our  readers  an  impression  of  the  advance  of  nursing  after 
1873  and  of  the  main  lines  upon  which  it  had  progressed,  with 
some  touches  of  the  personality  and  characteristics  of  nursing 
leaders. 

The  women  who  had  entered  the  pioneer  field  of  regenerating 
hospitals  and  opening  schools  of  instruction  for  pupil  nurses 
were  women  of  strong  fiber  and  intense  practical  idealism. 
They  entered  a  special  world, — the  old-time  hospital  world, 
where  internal  conditions  of  dirt,  disorder,  immorality  among 
attendants  and  among  patients,  bad  nursing,  coarseness  and 
vulgarity  were  often  hidden  behind  imposing  structures  and 
fine  outward  appearances.  Even  among  those  of  the  best  class, 
where  respectable  attendants  and  a  good  tone  were  found,  re- 
forms were  difficult  enough  because  of  the  grotesquely  long 
hours, — from  twelve  to  eiglitcen ;  the  strange  survival  of  sys- 
tems of  duty  handed  down  from  the  ]\Iid(lie  Ages,  whore  nursing 
attendants  rotated  from  the  wards  to  the  washtubs ;  the  total 
absence  of  teaching  and  training,  and  the  generally  widespread 
state  of  satisfaction  of  medical  men  and  hospital  directors  with 
their  domains;  with  the  resulting  resistance,  often  intense  and 
obstinate,  to  innovations,  even  though  brought  in  the  name  of 


EARLY  GROWTH  19 

Florence  Xi<2;litingale,     It  has  been  said  of  these  pioneers  and 
their  adventures  in  reform: 

"The  women  who  plunged  into  this  puhlic  housecleaning 
were  so  absorbed  in  it  that  to  them,  for  a  time,  the  outer 
world  ceased  to  exist.  It  was  quite  as  adventurous,  quite  as 
exciting,  as  war  nursing.  Nurses  from  different  parts  of 
the  country  met  as  veterans  meet — no  other  introduction 
necessary  than  their  identity  of  experience.  When  order 
had  been  restored  and  time  came  for  constructive  work,  they, 
with  one  accord  the  country  over,  took  up  the  problem  of 
giving  their  pupils  ampler  teaching  and  a  more  careful 
preparation  than  they  themselves  had  had.  It  may  be  con- 
fidently asserted  that  never  in  a  modern  country  has  a  more 
disinterested  and  useful  civic  service  been  performed  by 
women  than  this  regeneration  of  hospitals  by  women's  boards 
and  nurses  during  the  last  three  decades  of  the  Xineteenth 
Century.  In  all  estinuites  of  the  value  of  skilled  nursing  by 
women  of  education  only  half  the  subject  is  considered  if  the 
innnense  moral  uplift  that  they  have  given  to  institutions  be 
forgotten  or  ignored.** 

A  number  of  the  early  nursing  superintendents  had  been 
teachers, — for  instance,  Mary  Snively,  Louise  Darchc,  Irene 
Sutliifc,  Isabel  Hampton  and  Lucy  Drown.  Others  were 
representative  Southern  women  with  a  capacity  for  driving 
work  before  them,  such  as  Ljstra  Gretter  and  Miss  Caroline 
Hampton,  Wade  Hampton's  niece.  By  far  the  most  were 
women  who  had  never  before  undertaken  careers  outside  of 
the  family  life  in  which  they  had  been  schooled  by  circum- 
stances. 

Every^  section  of  the  country  was  represented  among  the 
elders  in  nursing  and  numy  of  the  strongest  figures  came  from 
(\inada,  of  substantial  English  stock,  indomitable,  progressive 
and  serving  well  the  country  in  which  they  found  opportunity 
to  develop  their  talents.  The  methods  and  system  of  training 
and  instruction  in  their  hands  had  been  steadily  rising  since 
187o.  From  the  course  of  two  years'  hospital  work,  with  in- 
struction limited  to  the  first  year,  modeled  upon  Miss  Xight- 
ingale's  pattern  in  St.  Thomas'  Hospital,  American  superin- 
tendents gradually  extcMuhxl  classes  and  lectures  throughout 
the   course,   provided   post-graduate   work    in   special   hospitals, 

*  "A  History  of  Nursing'."  Vol.  III.  p.  117. 


20     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

arranged  for  affiliation  between  two  or  more  institutions  in 
order  to  insure  well-rounded  experience,  lengthened  the  two 
years'  course  to  three,  shortened  hours  as  compared  with  the 
system  of  1860,  fixed  more  exacting  entrance  requirements 
and  made  every  effort  to  raise  the  ethical  and  professional 
plane. 

Organization  on  a  wide  scale  began  in  1893  with  the  forma- 
tion of  the  Society  of  Superintendents  of  Training  Schools 
for  Nurses,  The  superintendents  at  once  began  forming  grad- 
uate nurses  into  alumnse  societies  (only  two  such  societies 
had  been  organized  prior  to  1893)  and  these  in  turn  were 
brought  together  under  the  name  "The  Nurses'  Associated 
Alumnse  of  the  United  States  and  Canada."  Their  first 
regular  convention  was  held  in  Baltimore,  February,  1897. 
There  were  then  two  hundred  and  twenty-one^  training  schools 
in  the  United  States  and  Canada  that  were  regarded  by  nursing 
leaders  as  being  already  good  schools  giving  a  general  training, 
or  as  building  steadily  toward  that  end.  They  were  sending 
out,  yearly,  several  thousand  trained  and  taught  women. 

The  Associated  Alumna?  had  at  first  been  formed  in  a  con- 
servative way  by  the  graduates  of  twenty  of  the  foremost 
schools,  but  it  rapidly  became  inclusive  of  all  on  a  broad  gen- 
eral level.  The  main  subject  of  those  early  conferences  was  the 
protection  and  maintenance  of  good  standards.  For  progress 
was  by  no  means  uniform  and  continuous.  Even  worse  than 
the  direct  conflict  with  the  old  system,  was  a  swift  commercial 
exploitation  of  the  new  one.  Opposition  had  sometimes  given 
place  to  an  imitation  skillfully  clothed  in  the  appearance  of 
reality.  The  attractive  unifomi,  the  plausible  showing  of  a 
well-graded  course  of  instruction  in  print,  and  the  "diploma" 
were  sometimes  cleverly  used  to  disguise  purely  money-making 
institutions,  or  those  of  one  specialty  only,  lacking  in  equipment 
and  teaching.  The  methods  of  the  correspondence  school, 
well  enough  adapted  perhaps  to  some  lines  of  educational 
preparation  for  self-support,  were  beginning  to  reach  into  the 
nursing  field  and  thus  thirty  years  and  less  after  the  opening 
of  the  large  training  schools,  there  were  already  almost  as  many 
different  measurements  by  which  to  test  the  "trained  nurse"  as 
there  were  classes  of  institutions.  Problems  of  this  kind 
brought  nurses  to  consider  two  principles  as  basic;  first,  that 

'  Jane   Ilodson's   book    "How   to    Hcconie    a   Trained    Nurse,"    listed   299 
(1897),  not  including  foreign  or  post-graduate  scliools. 


EARLY  GROWTH  21 

the  minimum  training  must  be  general  (i.  e.,  including  medical, 
surgical,  gynecological  and  obstetrical  experience)  ;  next,  that 
nursing  education  and  administration  must  be  directed  by 
nurses.  These  principles  have  controlled  the  nursing  profession 
in  all  its  subsequent  history. 

Absorbed  then  in  educational  and  disciplinary  problems  and 
in  the  extension  of  their  related  branches,  the  nurses  of  the 
country  had  not  yet  been  called  upon  as  an  organized  body  for 
any  public  service,  nor  had  they  met  any  national  emergency 
up  to  the  time  of  the  war  with  Spain. 

In  her  stay  abroad  after  the  Civil  War,  Miss  Barton  had 
absorbed  the  European  system  of  Red  Cross  nursing  and  war 
relief  work  and  had  accompanied  the  German  ambulances  dur- 
ing the  war  of  1870.  So  deeply  impressed  was  she  that  on  her 
return  to  her  own  country,  she  hoped  and  planned  to  establish 
that  system  here.  It  emphasized  the  volunteer  aid,  as  shown  in 
these  Articles : 

lY.  In  time  of  peace  the  committees  and  sections  shall 
train  and  instruct  volunteer  nurses. 

Y.  In  the  event  of  war,  they  shall  organize  and  place 
volunteer  nurses  on  an  active  footing. 

YI.  The  committees  shall  send  volunteer  nurses  to  the 
field  of  battle. 


In  1893  a  branch  of  the  American  ^National  Red  Cross  was 
organized  in  Xew  York  City  and  through  its  efforts  a  small 
hospital  was  opened  which.  Miss  Barton  hoped,  would  be  the 
first  of  many  similar  institutions  and  would  prepare  Red  Cross 
Sisters  on  the  European  model,  for  service  under  the  Red  Cross 
flag.  This  little  foundation,  at  first  located  in  a  small  rented 
house,  was  formally  opened  in  1893  in  ]\Iiss  Barton's  presence 
and  under  her  direct  auspices.  To  carry  on  the  hospital  work 
and  the  teaching.  Miss  Barton  had  the  aid  of  Dr.  A.  ^lonae 
Lesser  and  his  wife,  who  shared  her  enthusiasm  for  the  Red 
Cross  nursing  of  Germany.  Dr.  Lesser  was  a  skillful  surgeon ; 
his  wife,  Bettina  Hofker  Lesser,  who  was  familiar  with  foreign 
nursing  systems,  was  also  an  American  trained  imrse,  having 
graduated  from  ]\It.  Sinai  Hospital  School  for  Nurses,  Xew 
York  City,  in  1893. 

The  circular  showing  the  organization  plan  of  the  Red  Cross 
Hospital  is  a  real  treasure  from  the  historical  viewpoint. 


22     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Red   Cross   Hospital  &   Training  Under  the  direct 

School  for  Sisters,  New  York,  auspices  of 

233  West  100th  Street  The  American  National 
Red  Cross, 


William  T.  Wardwell,  President,     Rt.  Hon.  Clara  Barton, 
A.  Monae  Lesser,  M,  D.,  President, 

Executive  Surgeon.  Washington,  D.  C. 

In  order  to  become  a  Sister  of  the  Red  Cross  the  applicant 
must  be  of  unquestionable  character  and  qualifications.  Fur- 
ther, she  must — 

1,  Take  the  regular  two  years  and  three  months'  course 
of  training  at  the  Red  Cross  Hospital;  or 

2.  Present  certificates  from  some  reputable  training 
school  for  nurses,  and  take  six  months'  post  graduate 
in  methods  specially  applicable  to  war  or  other  national 
calamity.  At  the  expiration  of  the  course,  upon  giving 
satisfactory  evidence  of  requisite  fitness,  the  candidate 
is  graduated  as  a  Red  Cross  Sister  and  can  thereafter 
act  as  such  either  at  home  or  abroad. 

In  cases  of  emergency  nurses  may  be  enlisted  for  the  spe- 
cial need  upon  presentation  of  their  certificates  and  without 
taking  the  six  months'  course  mentioned  in  2 ;  but  it  should 
be  understood  that  at  the  close  of  the  service  in  question  their 
relation  with  the  Eed  Cross  ceases,  until  they  can  be  gradu- 
ated in  tlie  regular  way.  In  this  connection,  however,  credit 
will  be  given  for  character  of  work  done  during  the  enlist- 
ment-. 

The  certificates  above  mentioned  are : 

a.  A  certificate  of  health  and  character. 

b.  Certificate    (or  a  true  copy  thereof)    of  graduation 
from  training  school. 

c.  The  enclosed  blank  properly  filled  out. 

Candidates  must  have  no  idea  that  there  is  any  romantic 
or  sentimental  attractiveness  in  the  stern  demands  of  war, 
pestilence  or  famine.  The  emergencies  of  the  service  are 
often  trying,  sometimes  involving  privation  and  danger,  and 
only  those  ready  for  such  work  can  be  of  real  use. 

The  Sisters  are  required  to  be  within  call  at  all  times, 
ready  to  respond  to  any  order  authorized  by  the  President 
of  the  American  National  Ped  Cross.  The  institution  is 
absolutely  neutral  and  non-sectarian,  not  in  the  sense  of 
ignoring,  but  of  respecting  every  nationality  and  all  religions. 
The   Red   Cross   is  a   volunteer  institutioji,   guided    by    and 


EARLY  GROWTH  23 

practising  regiilar  military  tactics.  The  Sisters  are  required 
to  devote  their  entire  attention  during  the  period  of  their 
service  to  the  work  to  which  they  are  assigned,  and  must 
cheerfully  obey  the  instructions  of  their  directors. 

No  salary  is  paid,  but  during  actual  service  the  best  avail- 
able provision  is  made  for  the  support  and  requirements  of 
the  Sisters. 

Information  when  and  where  examinations  for  ranks  may 
be  made  will  be  sent  upon  receipt  of  signed  application. 
Should  at  any  time  one  be  found  unfit  for  certain  service  in 
the  field  changes  will  be  made  as  found  proper. 

These  regulations  are  made  for  the  purpose  of  rendering 
best  aid  to  the  sufferer,  best  assistance  to  the  physicians  and 
surgeons  and  to  those  who  devote  themselves  to  attend  the 
sick  and  wounded. 

By  order  of  the 

Eight  Hon.  Clara  Barton,       • 

President  American  Xational  Red  Cross. 
Bettina  a.  IIofkek -Lesser, 

Sister-in-Chief,  lied  Cross  Hospital. 

(For  male  applicants,  read  Male  Attendant  instead  of  Sister) 

In  1870,  when  Miss  Barton  saw  German  nursing,  it  was  by 
no  means  model.  The  deaconesses  were  then  the  best  trained 
and  Eed  Cross  nursing  in  warjtime  was  largely  in  the  hands  of 
titled  amateurs.  Twenty  years  later,  when  the  New  York  Red 
Cross  Hospital  was  opened,  a  number  of  excellent  training 
schools  for  nurses  had  indeed  been  developed  in  German  Red 
Cross  hospitals,  but  the  whole  system  on  which  their  nurses 
were  maintained  and  controlled  was  foreign  to  American  ideas. 
The  founders  of  the  Bellevue  school  had  affirmed  the  principle 
of  economic  and  professional  independence  for  nurses  after 
completing  their  hospital  course  and  this  was  tenaciously  held 
to  by  the  young  profession.  ]\Iiss  Barton  and  the  Lessors  did 
not  perceive  how  much  at  variance  were  their  nursing  ideas 
with  those  which  had  been  firmly  established  around  them. 
Their  hospital  organization  was  destined  to  fail, — not  because 
it  was  of  small  beginnings,  but  because  what  they  were  hoping 
to  do  had  already  been  done  in  a  different  and  more  enduring 
way. 

In  189.'3  when  the  Red  Cross  hospital  in  100th  Street  was 
opened,  there  were  all  around  it  in  the  large  training  schools 
of  the  city,  the  very  women  who  later  took  important  parts  in 


24     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  Spanish-American  War  work  and  still  later  helped  to 
perfect  the  present  Red  Cross  Nursing  Service.  But  Miss 
Barton  was  apparently  oblivious  of  the  army  of  nurses  ready 
trained  and  eager  to  serve.  Older  women,  whose  memory 
reached  some  years  back,  recalled  the  fact  that  even  before 
war  was  thought  of,  but  as  some  incident  or  published  word 
brought  the  Red  Cross  to  the  front,  nurses  had  often  applied 
individually  to  know  how  they  could  "join  the  Red  Cross"  and 
were  invariably  disappointed  at  finding  no  response. 

Yet  with  the  oncoming  of  the  Spanish-American  War,  the 
New  York  Red  Cross  Hospital  with  pathetic  inadequacy  stood 
forth  to  meet  the  emergency.  We  do  not  know  how  many  Sis- 
ters it  had  trained,  nor  how  much  it  was  prepared  to  do  in 
fitting  civilian  nurses  for  war  work,  but  it  is  clear  that  its 
resources  must  have  been  but  slight,  for  in  a  later  report  Dr. 
Lesser  wrote: 

During  the  last  four  years,  from  the  time  Sister-in-Chief 
Bettina  had  introduced  the  idea  of  training  Red  Cross  nurses 
in  this  country,  we  had  labored  with  the  desire  of  having  an 
adequate  number  of  trained  Eed  Cross  Sisters,  well  known 
to  us  and  upon  whose  efforts  and  capabilities  we  might  rely; 
unfortunately  we  met  with  but  indifferent  success,  there  being 
no  thought  of  war  to  stimulate  the  undertaking.^" 

As  the  prospect  of  war  nursing  came  nearer  and  nurses 
offered  their  services  in  various  directions,  some  to  the  War 
Department  and  others  to  the  Red  Cross,  the  Red  Cross  Hos- 
pital enrolled  all  those  of  attested  character  who  applied  to  it, 
listing  some  as  fully  trained,  some  as  partly  trained,  and  others 
as  untrained  but  capable  and  intelligent  volunteers,  and  the 
earliest  contingents  sent  out  from  it  represented  all  of  these 
groups.  A  great  advance  over  the  chaotic  conditions  that  had 
prevailed  in  the  yellow  fever  epidemic  was  even  then  obvious. 
It  has  been  said  that  there  was  "only  one  adventuress"  in  the 
first  large  nursing  expedition  of  the  Spanish-American  War 
that  was  recruited  almost  entirely  by  the  Red  Cross  Hospital, 
and  on  the  other  hand  that  group  included  a  number  of  pro- 
fessional and  volunteer  women  whose  effective  services  in 
action  soon  became  well  and  widely  known. 

"  "Conduct  of  the  War  with  Spain,"  Vol.  V,  p.  2384. 


CHAPTEE    II 

THE    EPISODE    OF    THE    SPANISH-AMEEICAN    WAR 

Organization    of   the    Bed    Cross   in    1898 — The    Red    Cross 
Sisters — Nursing  under   the    Government — Red 
Cross  Auxiliary  No.  3 

WHEjST  the  year  1898  opened,  the  officers  of  the  Ameri- 
can National  Eed  Cross  were:  Clara  Barton,  presi- 
dent ;  George  Kennan,  vice  president ;  Stephen  E. 
Barton,  Executive  Committee  member;  David  L.  Cobb,  coun- 
sel; l)r.  A.  ^lonae  Lesser  and  his  wife  Bettina,  who  were, 
respectively,  executive  surgeon  and  chief  of  hospital  work. 
Before  the  United  States  declared  war  on  Spain,  Miss  Barton 
had  gone  to  Cuba  with  relief  for  the  reconcentrados.  With  her 
was  a  staff  of  workers,  among  them  being  four  Sisters  from 
the  lied  Cross  Hospital.  In  ^[arch,  the  Cuban  Belief  Com- 
mittee chartered  the  steamship  State  of  Texas  and  loaded  her 
with  food,  clothing,  medicines  and  hospital  supplies  for  the 
Cubans.  She  was  a  true  Bed  Cross  Belief  Ship,  sent  under  the 
Bed  Cross  flag  and  in  conformity  with  the  articles  of  the  Geneva 
Convention,  to  be  turned  over  to  the  American  Xational  Bed 
Cross.  Miss  Barton  went  to  a  Florida  port  to  meet  the  ship 
and  go  with  it  to  Cuba,  but  her  plans  were  frustrated  by  the 
declaration  of  war  (April  25,  1898)  and  the  State  of  Texas 
did  not  reach  Cuba  until  she  went  with  the  transports  convey- 
ing the  United  States  Army,  and  entered  the  harbor  of  San- 
tiago. Instead  of  aiding  reconcentrados  ]\lis3  Bart(ui  had  to 
meet  the  desperate  emergency  of  aiding  ill  and  wounded  Ameri- 
can soldiers.  So  far  only  as  the  nursing  story  goes,  her  efforts 
will  be  r(>corded  here,  but  in  any  estimate  of  the  character  and 
extent  of  the  nursing  work  it  must  be  remembered  that  this 
task  was  a  very  ditferent  one  from  that  which  !Miss  Barton  had 
been  authoriz(>d  to  undertake,  and  that  much  of  the  criticism 
put  forth  at  that  tim(>  arose  from  an  imperfect  understanding 
of  this  fact. 

25 


26     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  first  the  Red  Cross  Hospital  functioned  as  its  directors 
had  hoped  and  meant  it  should  do.  At  a  meeting  of  the  Board 
of  Trustees  on  April  23,  1898,  a  committee  was  appointed  to  be 
responsible  for  a  supply  of  nurses  for  the  war.  Sister-in-Chief 
Bettina  (Mrs.  Lesser)  had  a  seat  on  this  committee,  which 
began  at  once  to  plan  for  calls  for  nurses.  We  may  fairly  say, 
therefore,  that  the  Red  Cross  Nursing  Service  was  historically 
anticipated  at  that  meeting,  by  that  committee.  Soon  after- 
wards its  services  were  formally  placed  at  the  disposal  of  the 
Government  by  Dr.  Lesser. 

At  the  same  time  a  wide  reorganization  and  enlargement  of 
Red  Cross  circles  was  under  way  in  New  York  City.  This 
was  initiated  by  Mr.  William  Wardwell,  president  of  the  Red 
Cross  Hospital  and  director  of  the  New  York  Red  Cross 
Society,  who,  foreseeing  the  progress  of  events,  brought  about 
the  formation  of  a  larger  committee  called  the  "American 
National  Red  Cross  Relief  Committee."  This  new  commit- 
tee was  entrusted  by  Miss  Barton  with  the  task  of  inviting  and 
promoting  the  cooperation  of  similar  committees  throughout 
the  country.  Mr.  William  Wardwell  was  one  of  the  vice 
chairmen  of  the  enlarged  body  and  Bishop  Potter  was  its 
chairman.  The  Secretary  of  State  (Wm.  R.  Day)  then  made 
it  known  that  the  American  National  Red  Cross  would  be 
recognized  as  "the  proper  and  sole  representative  in  the  United 
States  of  the  International  Committee,"  ^  thus  fixing  the  offi- 
cial status  of  the  Red  Cross.  Secretary  Day  also  stated  that 
Congressional  action  would  protect  the  insignia  of  the  Red 
Cross  from  use  by  any  unauthorized  person.  This  protection 
had  not  previously  been  accorded  by  the  L^nited  States  Govern- 
ment.- 

The  early  reports  of  the  Relief  Committee  gave  on  the  title 
page  the  names  of  Miss  Barton  and  other  national  officers,  fol- 
lowed by  those  of  the  new  group  in  New  York  City. 

The  American  National  Red  Cross  Relief  Committee  as  its 
first  step  had  appointed  a  "Women's  Committee  on  Auxiliaries" 
charged  with  the  duty  of  organizing  similar  auxiliary  commit- 

*  Letter  from  the  Secretary  of  State  to  the  War  Department,  quoted  in 
"The  Red  Cross  in  Peace  and  War."  p.  377. 

'  Confrress  did  not  take  the  action  promised  hy  ^fr.  Day  until  1900. 
See  Congressional  Discussions  and  Actions  upon  Various  Measures  of 
tlie  Incorporation  of  the  I'ed  Cross  and  the  I'rotection  of  its  Insignia, 
1S94  to  1910.  compiled  by  Ceii.  Ceorge  W.  Davis  with  liis  Notes  on  same. 
Red  Cross  T>ihrary,  National  Headquarters,  Washington,  D.  C. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      27 

tees  of  women  throughout  the  United  States.  Almost  one  hun- 
dred such  auxiliaries  were  formed,  each  one  taking  up  some 
one  special  responsibility.  They  were  designated  by  numbers. 
The  Xew  York  group  was  known  as  Auxiliary  Xo.  3,  but  also 
took  the  name  *'Ked  Cross  Society  for  Maintenance  of  Trained 
Nurses."  Besides  organizing  the  others  it  became  the  central 
agency  of  relief  and  also  through  a  committee  on  nursing,  it 
took  over  and  finally  controlled  the  whole  Red  Cross  nursing 
service  in  New  York  and  influenced  materially  the  general 
service  during  the  war. 

Reference  will  be  made  again  to  the  new  auxiliary's  activi- 
ties after  following  the  Red  Cross  nurses  in  Cuba  and  tracing 
the  early  steps  in  nursing  which  w^ere  taken  by  the  Govern- 
ment. 

Dr.  Lessor's  official  report,  written  after  the  events,  says  of 
the  first  steps  taken: 

Immediately  after  the  declaration  of  war  with  Spain,  I 
received  the  order  from  the  president  of  the  American  Xa- 
tional  Red  Cross  to  the  effect,  "that  the  Eed  Cross  Hospital 
Department  shall  be  ready  for  service  in  the  war."  By  the 
direction  of  the  president  (^liss  Barton)  all  applications 
for  enlistment  and  communications  relating  to  this  service 
were  sent  to  the  Xew  York  Red  Cross  Hospital.  A  certain 
standard  of  experience  and  character  was  established  as  neces- 
sary for  enlistment  on  our  staff.  A  number  of  applications 
from  physicians,  nurses  and  other  assistants  were  received 
.  .  .  and  those  whose  qualifications  and  recommendations 
seemed  satisfactory  were  chosen  and  placed  upon  a  list  for 
further  investigation  and  final  selection.  From  the  large 
number  of  names  of  trained  and  other  nurses  the  Sister-in- 
Chief  and  I  had  selected  men  who  we  believed  would  l)e 
physically  able  to  carry  wounded  soldiers,  also  trained 
nurses  and  gentlewomen  who  seemed  least  susceptible  to 
disease,  .  .  .^ 

When  ]\[iss  Barton  reached  the  Cuban  shore  she  took  her 
ship  to  Siboney,  where  there  was  need  of  supplies  and  aid,  and 
her  representatives  made  their  way  to  the  Army  hospital.  Thev 
were  not  inuiiediately  acce])t(Ml  for  service  tlierc.  so  carried 
their  offers  to  the  Cuban  hospital,  where  they  \vcri>  gratefullv 

^  "rondiu't  of  tlie  War  witli  Sj)aiii."  Surpcon  ricnci-al's  Keport.  Vol.  V. 
p.  •2:iS4.  Sec  also  "Reports  of  the  Auioricaii  Red  Cross  Relief  Cqia- 
mittees."  p.   174., 


28     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

accepted.  Presently  their  assistance  was  asked  for  by  Major  La 
Garde  of  the  American  forces,  in  a  hospital  designated  by  him, 
and  was  given. 

The  Red  Cross  Sisters,  foreign  fashion,  were  called  by  their 
first  names.  Mrs.  Lesser,  who  was  Sister-in-Chief,  was  Sister 
Bettina.  She  and  Sister  Minnie  were  in  charge  of  the  tents ; 
Sister  Annie  with  a  volunteer  assistant,  Mrs.  White,  was  in 
the  Red  Cross  Hospital;  Sister  Isabelle  and  Sister  Blanche 
helped  with  operttions.  The  need  of  nurses  was  already 
acutely  felt.     Dr.  Lesser  said  at  this  point  in  his  narrative: 

News  of  another  battle  was  expected.  Finally  it  was  agreed 
to  request  more  Eed_  Cross  aid  by  telegraph.  A  call  for  one 
hundred  Sisters  was  suggested  and  Mrs.  Lesser  was  consulted 
in  the  matter.  We  had  fifty  trained  nurses  and  assistants  on 
our  lists,  also  women  to  act  as  matrons  to  distribute  nourish- 
ment, etc.,  whom  we  hoped  we  could  rely  upon.  We  promised 
to  send  for  that  number  immediately,  as  we  had  sent  for 
twenty-five  already.* 

The  call  for  the  twenty-five  nurses  here  mentioned  is  of  inter- 
est, as  it  gave  their  names  and  was  signed  by  Miss  Barton.  It 
was  sent  to  Stephen  Barton  and  transmitted  by  him  to  the 
Auxiliary  Xo.  3,  or  to  the  Red  Cross  Hospital.  As  it  arrived 
in  Xew  York  it  was  written  out  as  here  shown: 

Playadeleste, 

July  2,  1898. 

Barton,  Xew  York, 

William  Street. 

Siboney — Send   nurses   nuttell   coffin   shaw   sisters   lavinia 

eva  gard  5  gardner  rutty  bouligney  Anna  nuessing  medora 

alien  strom  fleigge  hilda  olsen  edith  abrams  margaret  mcguir 

doctors  nuns  gill  vogel  two  hundred  fifty  equipped  bed  linen 

towels  clothes.  _. 

Bartox.-* 

Before  completing  the  story  of  the  adventures  of  the  little 
group  of  Sisters  thus  caught  accidentally,  as  it  were,  in  the 
war  current,  it  is  necessary  to  return  to  the  larger  events  in 

*  "Conduct  of  tlie  War  with  Spain."  Surgeon  Gcnoral's  Report,  Vol.  V. 
p.  37. 

=  Files  of  tlie  l\e(l  Cros.s  Society  for  the  Maintenance  of  Trained  Nurses, 
Mav  to  July,  18!)8. 


Cop!/r!;;ht,   1S9S.   hy   Clara   Barton. 

A  ((roup  of  American  Red  Cross  Sistors  wlio  served  at  Siboney  during  the 
Spanish- American   ^^'ar. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      29 

Red  Cross  activity  which  affected  the  Red  Cross  Hospital  serv- 
ice, and  to  trace  the  steps  which  had  been  taken  by  Miss 
Barton's  officers  in  preparation  for  war  nursing. 

In  Jnne,  1808,  the  Departments  accepted  the  offer  of  services 
made  by  the  Red  Cross.     Dr.  Lesser  wrote : 

After  the  Department  of  War  had  approved  and  accepted 
the  services  of  the  Red  Cross  to  supplement  tlie  work  of  the 
Army  ^ledical  Department  in  case  of  need,  I  called,  in  the 
capacity  of  Surgeon-in-Chief  of  the  American  National  Red 
Cross,  upon  Sur<^eon  General  Sternburg  of  the  United  States 
Army.  I  was  accompanied  by  the  Sister-in-Chief.  We  asked 
the  Surgeon  Ceneral  for  information  in  regard  to  field  service 
— in  his  opinion  a  hospital  ship  would  be  the  best  service  that 
we  might  render.  He,  however,  referred  us  to  Colonel  Green- 
leaf,  who,  he  said,  would  have  charge  of  the  field.  After  a 
short  interview^  the  Colonel  said  that  he  felt  there  would  be 
a  land  service  and  that  it  would  be  wise  for  us  to  be  pre- 
pared." 

The  story  now  returns  to  the  place  where  the  Red  Cross 
Sisters  were  left  at  work  with  Dr.  La  Garde.  The  need  of 
nurses  had  grown  steadily  more  urgent  and  finally,  as  already 
recorded,  a  number  w-ere  cabled  for.     Dr.  Lesser  wrote : 

That  morning  Miss  Barton,  with  George  Kennan  and 
several  of  her  staff,  had  gone  to  the  front  and  before  leaving 
Miss  Barton  instructed  her  secretary,  1\>\t.  C.  H.  H.  Cottrell, 
in  the  presence  of  ]\Irs.  Lesser  and  myself^  that  at  our  request 
he  should  cable  in  her  name  for  such  persons  and  material 
as  should  be  needed  in  the  hospital  department.  Since  it 
was  the  wish  of  the  surgeon  of  the  camp,  we  cabled  first  by 
name  and  then  by  special  list  for  fifty  nurses,  ten  assistants, 
a  number  of  immune  jihysicians  and  complete  hospital  equip- 
ment to  make  at  least  live  hundred  patients  comfortable.  The 
wounded  continued  to  arrive  for  four  days.  Surgeon  ^hijor 
La  Garde  did  me  the  honor  of  consulting  me  in  regard  to  the 
nursing  and  I  suggested  that  some  of  the  Sisters  leave  the 
oi)eratiiig  tables  and  take  charge  of  the  ]iatients  in  the  tents. 
The  rows  of  tents  were  then  placed  in  her  (Mrs.  Lessor's) 
charg(>  and  slio  jiortioiuMJ  tbe  work  of  caring  for  them  among 
the  Sisters  assistetl  by  lios})ital  corpsmen.' 

"  l\(>l)(irts.    American    Xaiional    Rod   Cross    Relief    Committees,    p.    177. 
•  ■'C'oiHiuct    of  tlu'   ^^'ar  witli   Spain,"   Surtrcon  Generars  Report,  ^'ol.  V, 
pp.  2;{88-238!»-2;5ni. 


30     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  the  midst  of  this  arduous  work,  July  15,  Dr.  Lesser  and 
all  his  nurses  were  stricken  down  by  yellow  fever.  It  was  sup- 
posed that  their  little  Red  Cross  hospital,  which  had  been  con- 
structed in  a  Cuban  dwelling,  was  infected.  At  the  time  much 
controversy  went  on  as  to  who  was  blamable,  but  since  the  mode 
of  transmission  of  yellow  fever  was  then  still  undemonstrated, 
the  criticism  and  hard  feeling  engendered  by  those  disputes 
were  futile.  Meantime  Dr.  La  Garde  waited  impatiently,  in 
great  need,  for  the  expected  reenforcement  of  nurses.  Still 
they  did  not  come.  They  had,  however,  been  dispatched  from 
New  York  by  the  Auxiliary  No.  3.     Dr.  Lesser's  story  tells  us : 

In  the  meantime  word  from  Assistant  Surgeon  General 
Greenleaf  was  received  at  Siboney,  stating  that  forty-five  Red 
Cross  Sisters,  surgeons  and  other  assistants  had  arrived  at 
Guantanamo,  waiting  to  come  to  us,  and  as  we  returned  the 
same  day  from  the  fever  camp.  Surgeon  Major  La  Garde 
telegraphed  and  telephoned  repeatedly  for  them  to  come,  but 
he  received  no  reply.  Feeling  that  under  existing  circum- 
stances, and  exhausted  from  work  and  illness,  we  could  not 
continue  to  work  without  more  assistance,  I  applied  for  our 
return.^ 

Dr.  Lesser  and  the  Sisters  went  north  on  the  steamship 
Concho  from  Siboney  to  New  York  (about  August  24),  but  no 
record  of  the  Sisters'  subsequent  activities  have  been  found. 
Concealed  at  first  by  the  absence  of  surnames,  it  is  quite  possible 
that  they  returned  into  war  work  under  their  ordinary  titles. 

The  Red  Cross  hospital  had  already  begun  losing  its  preced- 
ence because  of  the  larger  organization  growing  up  around  it. 
xit  the  time  of  Miss  Barton's  entrance  into  Cuba,  Dr.  Lesser 
had  urged  that  twelve  Red  Cross  Sisters  and  several  others 
selected  by  Sister  Bettina  should  be  sent  on  the  State  of  Texas 
to  join  the  four  who  were  awaiting  them  in  the  South,  but  for 
some  (undoubtedly  valid)  reason  they  were  not  sent,  to  his 
great  chagrin.  At  this  point  the  opening  first  appears  of  that 
transition  process  in  the  nursing  system  of  the  Red  Cross  which 
led  from  the  little  group  of  volunteer  Sisters  to  the  highly 
modernized  Nursing  Service  of  1017,'^  and  such  periods  are 

"  '"Conduct  of  the  War  with  Spain,"  Surgeon  General's  Report,  Vol.  V, 
p.  2303. 

*  For  fuller  details  see:  Reports  of  the  American  Red  Cross  Relief 
Committees,  p.  178.  and  "Conduct  of  the  War  with  Spain."  Sur^^eon 
General's   Report,   WA.   \,  p.   "io'St. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      31 

painful  to  those  who  find  themselves  displaced.  One  cannot 
but  feel  that  the  Lessers  did  not  have  a  "good  chance"  and  that 
Sister  Bettina  might  have  administered  easily  the  larger  staff 
of  nurses  that  she  vainly  tried  to  secure. 

To  return  to  Dr.  La  Garde ;  the  failure  of  the  nurses  so 
eagerly  awaited  and  so  much  needed,  to  reach  him,  had  its 
explanation  in  the  unwillingness  of  the  Surgeon  General's 
office  to  send  nurses  into  Cuba  who  were  not  known  to  be  im- 
mune to  yellow  fever,  for  Dr.  Sternberg  was  very  careful  on 
this  point.  Other  reports  of  those  strenuous  days  confirm  Dr. 
Lesser's  story  and  among  several  references  to  the  nursing  situa- 
tion of  that  time  that  are  to  be  found  in  the  report  of  Dr. 
Charles  11.  Greenlcaf,  Chief  Army  Surgeon  in  the  Field,  one 
explains  why  Dr.  La  Garde  did  not  receive  his  reenforcement 
of  nurses : 

On  the  18th  of  July  we  proceeded  to  Guantanamo  Bay,  the 
rendezvous  for  the  Porto  Rican  expedition.  At  this  place 
we  found  a  detachment  of  doctors  and  female  nurses  on  board 
the  steamship  Lampasas  that  had  been  sent  to  work  with 
the  Ked  Cross  Association.  As  they  could  not  go  into  Cuba 
or  land  from  their  own  ship,  I  determined  to  use  them  in 
the  Porto  Pican  expedition,  and  subsequent  events  demon- 
strated the  wisdom  of  this  action,  since  the  increase  of  typhoid 
fever  cases  on  board  the  steamship  Yale  was  very  large,  re- 
quiring the  transfer  of  some  eighty  odd  to  the  ship  on  which 
these  nurses  were  quartered,  which  I  converted  into  a  quasi- 
hospital  ship,  notifying  the  medical  officers  in  charge  of  the 
various  transports  to  send  their  sick  to  it,  and  with  them 
descriptive  lists,  complete  transfer  lists,  and  sufficient  quanti- 
ties of  medical  supplies  and  rations  to  last  during  the  return 
voyage  to  the  States/" 

Later  in  the  summer  a  report  on  this  expedition  was  spnt  to 
the  American  Ixed  Cross  by  one  of  the  party,  Miss  Rutty,  who 
had  been  placed  in  direct  charge  of  the  trained  nurses.  She 
was  not  a  nurse,  but  had  been  efficient  and  practical  and  showed 
gifts  of  management.  Her  report  is  included  at  this  point, 
because  it  is  a  connecting  link  between  the  Ked  Cross  Hospital 
war  work  and  that  of  the  Auxiliary  Xo.  3,  Addressed  to  Sister 
Bettina,  as  still  holding  the  position  of  Sister-in-Chief,  the  re- 
ports of  the  Auxiliary  to  be  given  later  show  that  the  Lampasas 

'""Conduct  of  tlie  \\'ar  witii  Spain,"  Report  of  tlie  Surgoon  General, 
Vol.  I,  pp.  G3t)-638. 


32     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

party,  though  made  up  chiefly  at  the  hospital,  was  merged  in 
the  general  department  of  administration  of  the  auxiliary. 

Eeport  of  the  Eed  Cross  Expedition  Aboard 
THE  S.  S.  Lampasas 

To  Bettina  Hofker  Lesser,  Sister-in-Chief,  American 
National  Red  Cross 

Left  New  York  July  4  in  charge  of  nine  nurses,  one 
surgeon  and  two  assistant  surgeons,  under  orders  to  conduct 
party  to  Cuba.  Miss  Anna  Boligny  according  to  orders 
joined  us  at  Washington.  At  the  Port  of  Tampa  we  joined 
Miss  Gill  and  her  party,  and  under  instruction  from  Mr. 
Stephen  Barton  put  up  at  Tampa  Bay  Hotel,  and  waited  for 
transportation.  The  conduct  of  the  nurses  while  at  Tampa 
was  especially  commended  ])y  the  officers  of  the  Army  and 
Navy  with  whom  they  came  in  contact.  On  the  night  of 
July  7,  Major  Carter  of  the  Divisional  Hospital^  General 
Snyder's  Camp,  Picnic  Island,  asked  for  nurses  for  typhoid 
nursing.  For  this  service  two  night  nurses  and  two  day 
nurses  were  detailed  for  duty  during  our  stay  in  Tampa. 
July  8  we  boarded  the  S.  S.  Lampams,  and  on  July  12  sailed 
from  the  Port  of  Tampa,  Miss  Gill  having  given  into  my 
hands  all  matters  pertaining  to  the  finances  of  the  combined 
parties.  Arrived  at  Key  West  evening  of  July  1-1.  At  Mr. 
Cobb's  request  I  went  ashore  to  cable  to  Xew  York  for  funds. 
Ship  sailed  before  answer  came.  We  were  instructed  to  re- 
main on  board  the  JMmpasas  at  Santiago  until  Red  Cross 
orders  came.  Sailed  into  harbor  of  Santiago  morning  of 
July  19.  Colonel  Black  having  gone  ashore  for  orders,  re- 
ported that  notbing  could  be  learned  of  the  Red  Cross 
authorities;  that  on  account  of  the  presence  of  yellow  fever, 
anchor  would  be  weighed  at  once,  and  all  communication 
would  be  cut  off.  As  we  were  under  orders  not  to  leave  the 
ship  until  so  instructed,  we  sailed  to  Guantanamo.  On  the 
morning  of  the  'ZOih  gave  orders  that  the  Red  Cross  party 
was  to  l;e  ready  to  leave  the  ship  at  noon.  Orders  from 
General  Miles  that  we  go  on  board  the  Oregon  and  return  to 
Santiago.  An  interview  being  had  with  (Jeneral  ^liles,  he 
autborized  us  to  remain  on  board  while  awaiting  orders,  and 
such  orders  failing  us  said  he  would  gladly  utilize  us  at  the 
front.  An  additional  order  came  from  General  ^liles  that 
all  inmiune  nurses  sliould  be  detailed  for  work  at  Santiago. 
Mrs.  P)ull.  tbe  only  immune  in  our  number,  was  transferred  to 
tlie  (Jrr//on   in  company  willi  Miss  Wbeeler  wlio  had  s})ecial 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      33 

permission  to  join  her  father.  Colonel  Black  kindly  put  me 
ashore,  where  1  cahled  to  Mr.  Stephen  Barton  explanations, 
and  asking  for  funds  and  supplies.  Colonel  Greenleaf  had 
stated  that  the  sup])lies  at  hand  were  only  adequate  for  the 
needs  of  their  own  surgeons.  Kumor  reached  us  at  this  time 
that  Dr.  aiid  Mrs.  Lesser  were  very  ill  with  yellow  fever,  and 
Miss  Barton  liaving  failed  to  respond  to  a  message  sent  hy 
Mrs.  Xutall  in  cliarge  of  the  party  on  the  Nueces  and  no  word 
reaching  us  from  Dr.  Barton,  we  sailed  for  Porto  Rico.  Hav- 
ing learned  that  it  was  absolutely  necessary  for  our  future 
usefulness  that  an  organization  be  formed,  the  nurses  and 
doctors  held  a  mass  meeting  on  July  22  and  elected  me  direc- 
tor and  Sister-in-Cliarge.  Sailed  into  Guanica  July  25  and  on 
same  afternoon  received  sixteen  patients  from  Comanche. 
Following  morning  fifty-seven  came  from  Yale.  Anchored 
off  Ponce,  evening  of  28.  Quarantined  by  Dr.  D.  R.  Burns 
on  account  of  three  cases  of  measles  and  pemphigus.  Re- 
moval of  quarantine  on  31st.  On  July  31  we  were  asked  to 
proceed  north  with  our  patients.  Colonel  Greenleaf  did  all 
in  his  power  to  assist  us  and  requested  me  to  proceed  to 
Washington  to  report  to  Surgeon  General  Sternberg  at  the 
earliest  possible  op])ortunity.  Sailed  August  1st  leaving  Miss 
Chanler  and  ^liss  Boligny  at  Ponce  at  their  special  request, 
and  with  General  Miles'  sanction.  According  to  instructions 
we  landed  our  one  hundred  and  two  patients  at  the  general 
hospital.  Fortress  ^Monroe,  August  7.  From  Fortress  Monroe 
I  proceeded  to  Washington  and  delivered  Colonel  Greenleaf's 
letter  to  Surgeon  General  Sternberg,  going  thence  to  Xew 
York  and  reporting  to  Red  Cross  authorities  on  August  9. 
We  now  await  further  orders.  Special  mention  should  be 
made  of  Mary  F.  Gladwin,  whose  management  of  the  diet 
kitchen  merits  the  greatest  credit  and  appreciation  on  the 
part  of  those  who  worked  with  her  and  also  of  the  Xational 
Red  Cross.  Beatrice  Aon  Ilomrigh  was  most  efficient  in 
systematizing  the  nursing  on  a  plan  which  has  been  placed 

0^^  ^'^^-  Respectfully  submitted, 

IsABELLE   F.   Rutty, 

Sister-in-("harge. 

!Miss  Shaw,  a  young  Bollovue  trained  nurse  who  had  applied 
at  the  Jvod  Cross  Hospital,  was  included  in  this  group  and  her 
recollections  are  lively  enough  to  deserve  more  space  than  we 
can  give  them.     She  said  of  the  stay  in  Tampa : 

Typhoid  fever  was  raging  there  and  the  nurses  wished  to 
care  for  the  sick  men,  but  there  was  great  difficulty  in  getting 


34.     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

permission  to  do  this,  as  there  seemed  to  be  no  organization. 
One  never  knew  what  would  become  of  one  next.  All  one's 
service  seemed  haphazard. 

Miss  Shaw  told  how  the  nurses  were  repeatedly  transferred 
from  one  location  to  another,  '"always  obeying  the  last  order, 
no  matter  how  conflicting  with  the  preceding  one." 

Her  recollection  was  that  an  engineering  corps  was  about 
to  leave  for  Cuba  on  the  Lampasas  and  that  the  nurses,  on  their 
own  motion,  persuaded  the  captain  to  take  them  also.  To  gain 
his  consent  they  had  to  agree  to  relinquish  temporarily  the 
protection  of  the  Red  Cross  and  accept  all  the  hazards  of  war 
on  a  war  ship  sailing  under  military  orders  in  hostile  waters. 
When  they  arrived  in  Santiago  Harbor,  the  sailors  on  the  ships 
in  the  harbor  turned  spy-glasses  on  them  and  shouted  "Skirts !" 

This  picturesque  but  somewhat  adventurous  expedition  of 
the  Lampasas  in  the  early,  chaotic  period  of  the  first  war  con- 
ducted by  this  country  since  18G4,  though  much  criticized  at  the 
time,  cut  a  path  for  later  Red  Cross  nursing  service  and  won 
many  friends  for  nurses.  Dr.  Charles  R.  Greenleaf,  Chief 
Surgeon  in  the  Field,  wrote : 

The  service  rendered  by  the  members  of  this  detachment 
of  Eed  Cross  people  has  been  invaluable,  and  they  are  entitled 
to  great  credit  for  their  devotion  to  dut}',  their  zeal  and 
their  unremitting  care  of  the  sick  under  circumstances  that 
were  peculiarly  trying.  I  shall  be  glad  indeed  to  welcome 
them,  should  they  return,  and  I  can  always  find  suitable 
work  for  them  in  the  base  field  hospitals. ^^ 

Later  in  the  summer  Dr.  Greenleaf  wrote  to  Dr.  Sternberg: 

Porto  Eieo,  August  28th. 
Cabled  you  to-day  for  Miss  Rutty  and  thirty  nurses.  I 
know  her  to  bo  a  good  administrator  and  valuable  woman  and 
if  she  can  bring  with  her  the  nurses  who  were  on  the 
Iximpasas  I  shall  be  mucli  pleased  and  you  will  be  sure  of 
good  service.' - 

With  this  episode  the  immediate  connection  of  Miss  Barton's 
staff  with  war  nursing  ends  and  no  further  records  arc  available 
of  the  intrepid  little  group  of  Sisters  and  Sister-in-Chief 
Bettina.     A  nursing  report  written  by  the  latter  and  covering 

"  '■Conduct  of  War  witli  Spain,"  Vol.  I,  p.  576. 
^■Ihid.,  Vol.  I,  p.  G03. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      35 

the  whole  period  ot'  their  serviec  is  alhided  to  in  several  docu- 
ments, hut  cannot  he  found.  It  must  he  conchided  that  it  was 
not  preserved,  an  oversight  that,  from  the  historical  standpoint, 
must  he  deeply  regretted.  For  some  little  time  Dr.  Lesser  con- 
tinued to  enroll  nurses  at  the  Red  Cross  Hospital,  until  the 
complete  organization  of  Auxiliary  No.  3  centered  all  Red 
Cross  nursing  activities  in  its  committee. 

A  few  lines  are  needed  for  the  final  history  of  the  Red  Cross 
Hospital.  As  the  war  went  on,  its  staif  was  depleted  and  its 
regular  work  interfered  with,  but  it  kept  on  in  the  face  of 
difficulties  and  a  certain  number  of  applicants  passed  through 
it,  some  of  whom  made  their  way  directly  into  the  army  service, 
while  others  were  listed  by  the  Auxiliary  No.  3.  After  the 
war  was  over  the  original  New  York  Red  Cross  Society  en- 
deavored to  carry  on  the  hospital  according  to  its  first  plans. 
In  1903  a  special  corporation  was  formed  to  manage  it  and 
in  1907  the  building  at  99th  Street  and  Central  Park  West 
was  erected  and  continued  for  several  years  as  the  New  York 
Red  Cross  Hospital.  Agreements  with  the  National  Red  Cross 
at  Washington  were  made  (1903)  by  which  the  New  York 
Society  was  to  have  two  members  on  the  hospital  board  and 
the  hospital  was  to  be  regarded  as  an  affiliated  body  under  the 
general  jurisdiction  of  the  National  Red  Cross.  It  was  still 
hoped,  in  some  quarters,  that  the  National  Red  Cross  might 
extend  the  work  of  developing  its  own  hospitals  for  the  train- 
ing of  Red  Cross  nurses,  but  with  the  gradual  abandonment  of 
this  idea,  as  the  greater  possibilities  were  perceived  of  building 
up  a  nursing  service  by  the  help  of  the  professional  forces 
already  existing,  the  relationship  of  the  Red  Cross  Hospital 
to  the  National  Committee  ceased  to  have  any  vital  significance, 
and  in  1914  this  relation  was  finally  severed  by  mutual  consent. 
The  hospital  changed  its  name  and  became  the  Park  Hospital. 

At  the  same  time  that  the  Red  Cross  was  organizing  for  aid, 
the  United  States  (lovcrnment  was  preparing  an  official  nursing 
staff  in  the  event  of  war  and  because  of  the  close  relationship 
of  the  Army  Nursing  Service  to  the  Red  Cross,  in  this  as  in 
every  c(Mintry,  it  is  important  for  us  to  follow  here  its  main 
lines.  1'lie  scope  of  this  work  does  not  permit  a  detailed  pre- 
sentation of  the  Army  Nurse  Corps  and  its  activities  at  that 
time,  but  compels  us  to  pass  over  much  of  interest  and  value 
that  belongs  properly  to  a  history  of  a  general,  rather  than  of  a 
specialized  kind. 


36     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

As  early  as  February,  1898,  officers  of  the  Government  be- 
gan to  receive  applications  from  women  who  wished  to  serve 
as  nurses  during  the  approaching  war  and  all  those  letters 
and  papers  found  their  way  to  the  files  of  the  Surgeon 
Generals  of  the  Army  and  Navy. 

So  wrote  the  medical  woman  who  became  the  official  head 
of  the  trained  nurses  employed  by  the  government  in  Army 
nursing  during  the  war  with  Spain,  and  whose  imrsing  staff 
developed  into  the  Army  Nurse  Corps. 

Anita  Newcomb  McGee,  M.  D.,  was  the  daughter  of  the 
distinguished  astronomer,  Simon  Newcomb,  and  inherited  in- 
tellectual powers.  Her  medical  studies  were  taken  in  the 
Columbian  (now  George  Washington)  and  Johns  Hopkins 
Universities. 

She  was  a  woman  of  strong  personality,  attractive  in  appear- 
ance, small,  with  dark  hair  and  dark  blue-gTay  eyes,  of  very 
quick  movements  and  keen,  rapid  mental  processes.  Her  social 
and  scientific  position  naturally  brought  her  into  close  acquaint- 
ance with  Washington's  notables  and  before  war  was  declared 
she  had  conversed  with  the  Surgeon  General  of  the  Army, 
General  George  M.  Sternberg,  upon  the  use  of  trained  women 
in  Army  work.  It  was  his  purpose  if  war  came,  to  employ 
women  as  nurses,  but  it  was  Dr.  McGee  who  dwelt  upon  the 
importance  of  having  them  professionally  well  trained  and  who 
succeeded  in  carrying  this  principle  into  the  service.  She  was 
a  Vice  President  General  of  the  Daughters  of  the  American 
Revolution  and  this  society  at  her  suggestion  formed  a  ''Hos- 
pital Corps  Committee"  of  which  she  was  the  chairman,  wnth 
Mrs.  Amos  G.  Draper  and  ]\[iss  Mary  Desha  as  her  chief  as- 
sistants. Dr.  McGee  offered  the  Government  (April  27)  the 
services  of  this  committee  and  the  offer  was  accepted.  In  July 
at  the  request  of  the  Surgeon  General  Congress  had  authorized 
the  employment  of  contract  nurses  "regardless  of  sex." 

Dr.  Sternberg's  official  reports  and  papers  give  the  following 
account  of  the  creation  of  the  Army  Nurse  Corps  and  a  picture 
of  the  deficiencies  existing  in  the  pre-war  Army  nursing  system : 

The  original  purpose  of  the  ]\Iedieal  Department  Avas  to 
have  all  the  nursing  and  other  work  of  tlie  hosj)itals,  includ- 
ing the  clerical  and  dispensary  work,  done  by  trained  mem- 
bers of  the  Hospital  ('or])s;  but  the  Act  approved  April  22, 
1898,    providing    for    temporarily    increasing    the    Military 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      37 

Establishment,  failed  to  include  Hospital  Corps  privates  for 
the  volunteer  regiments.  The  great  majority  of  the  Hospital 
Corps  men  secured  by  enlistment  and  transfer  had  little  or 
no  proper  training  as  nurses  and  as  a  consequence  were 
largely  inefficient.  At  the  outbreak  of  the  war  nursing  in 
the  Army  was  done  entirely  by  the  men  of  the  Hospital 
Corps;  but  the  employment  of  contract  nurses,  regardless  of 
sex,  was  authorized  by  Congress  in  March,  1898.^^  Before 
the  30th  of  A])ril  almost  a  thousand  applications  had  been 
received  from  women  who  wished  to  serve  as  nurses  but  no 
examination  of  these  ap])licants  had  been  possible.  On  April 
28  the  National  Society  of  the  Uaugliters  of  the  American 
Eevolution  offered  its  services  to  tlie  Surgeon  General  of 
the  Army  in  the  capacity  of  an  examining  board  for  female 
nurses  and  this  offer  having  been  accepted,  the  following  day 
all  applications  from  women  were  referred  to  it  for  examina- 
tion. The  status  of  this  organization  rendered  it  peculiarly 
suitable  to  undertake  this  work.  It  has  headquarters  in 
Washington  City  and  twenty-five  thousand  members  living 
in  every  state  and  territory  of  the  Union  and  as  it  had  no 
affiliations  with  any  hospital  or  body  of  nurses  it  is  entirely 
unprejudiced  in  its  judgment.  Mrs.  Anita  Xewcomb  McGee, 
M.  D.,  a  physician  in  good  and  regular  standing  and  Vice 
President  General,  National  Society  of  the  Daughters  of  the 
American  devolution,  was  designated  as  director  of  the 
"Daughters  of  the  American  Kevolution  Hospital  Corps"'  and 
placed  in  charge  of  this  work.  Her  statement  regarding  the 
method  of  selection  is  as  follows:  "In  accordance  with  direc- 
tions from  the  Surgeon  General^  only  graduate  trained  nurses 


"The  Congressional  authorization  above  mentioned  was  asked  for  in 
April,  and  obtained  in  July.  Special  authority  for  the  employment  of 
women  nurses  in  the  Army  appears  in  Sections  1238,  12.'5!),  1277,  and  1279, 
Revised  Statutes  of  tlie  United  States,  providing  eomi)ensation  at  forty 
cents  a  day  and  one  ration.  These  date  from  the  time  of  the  Civil  War 
and  are  the  outgrowtli  of  that  war. 

Xo  women  nurses  were  emph)\ed  in  tlie  Army  from  the  time  of  the 
Civil  War  until  the  Spanish  American  War.  Under  date  of  April  28, 
1898,  tlie  Surgeon  (ieneral.  by  letter  to  tlie  Secretary  of  War,  recpiested 
authority  to  em])loy  by  contract  as  many  nurses,  male  oi"  female,  as 
might  be  recjuired  during  tlu>  war  with  Spain  at  the  rate  of  lliirty  dollars 
a  month  with  a  ratioti.  The  Secretary  granted  the  authority  asked  for 
imder  date  of  April  ."50,  189S.  No  legislation  in  the  premises  was.  how- 
ever, enacted  until  tli(>  Deficiency  P>ill  of  July  7,  LS9S.  which  autliorized 
the  employment  of  three  Inuulrcd  civilian  niirs(>s  at  tliirty  dollars  a 
month  I'M)  Stats.  703).  Items  for  the  jiay  of  civilian  nurses  without  any 
limitations  of  luimber  or  rates  of  jiay  ap|)ear  in  the  Deficiency  Ajipropria- 
tions  f(ir  the  Medical  and  Hospital  Department  in  the  Deiiciency  Acts 
approved  January   '>,  and  March  3,    1S99    (30  Stats.   778  and   122.3).' 


38     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

were  accepted  by  the  Daughters  of  the  American  Eevolution 
as  eligible  and  they  were  required  to  fill  out  blanks  like  the 
one  appended  hereto.  In  judging  a  nurse,  three  points  were 
considered :  First,  professional  ability :  as  evidence  of  which 
endorsements  from  physicians  were  usually  submitted.  In 
all  cases  the  superintendent  of  the  training  school  from  which 
the  nurse  graduated  was  asked  for  endorsement,  and  when 
this  was  refused,  the  nurse  was  not  accepted.  A  few  women 
physicians  in  good  standing  were  also  accepted  as  nurses. 
Second,  character:  to  establish  which  the  endorsement  of  a 
Daughter  of  the  American  Eevolution  was  requested  (though 
never  exacted).  In  lieu  of  this,  the  signature  of  any  lady  of 
known  standing  was  accepted.  Committees  of  'Daughters' 
were  formed  in  all  large  cities  and  in  many  small  ones  and 
rendered  admirable  service  in  securing  suitable  applicants. 
Third,  health :  as  evidence  of  which  a  physician's  certificate 
was  required.  In  certain  cases,  however,  Avhere  the  need  for 
the  nurse  was  too  urgent  to  admit  of  delay  and  where  there 
was  no  reason  to  doubt  her  health,  this  certificate  was  not 
filed.  Originally  the  nurses  were  required  to  be  between 
thirty  and  fifty  years  of  age,  but  the  large  number  of  desirable 
trained  nurses  who  were  under  thirty  caused  that  limit  to 
be  disregarded.  The  evident  necessity  for  and  importance  of 
the  limitation  of  appointments  to  trained  nurses,  was  neglected 
only  in  the  sending  of  nurses  to  Santiago.  As  it  was  essen- 
tial that  they  should  be  immune,  it  was  impossible  in  all 
cases  to  require  graduation.  The  assistance  of  all  organiza- 
tions that  desired  to  recommend  nurses  was  gladly  welcomed 
and  applicants  who  conformed  to  the  standard  were  accepted 
without  regard  to  creed.  x\lmost  five  thousand  applications 
were  examined  by  my  associates  and  myself  and  about  one- 
fifth  of  that  number  were  accepted  as  eligible  for  appoint- 
ment." This  arrangement  with  the  Daughters  of  the  Ameri- 
can Eevolution  continued  until  September  7,  since  which 
time  Dr.  McGee,  having  been  appointed  acting  assistant  sur- 
geon. United  States  Army,  has  been  on  duty  in  the  AVar 
Department,  in  charge,  under  my  immediate  direction,  of 
matters  pertaining  to  female  nurses. 

In  addition  to  the  contract  nurses,  selected  as  above  stated, 
Mrs.  Xamah  Curtis  was,  on  July  13,  sent  by  direction  of  the 
Surgeon  General,  to  New  Orleans  and  other  cities  to  secure 
the  service  of  colored  immune  women  as  nurses  at  Santiago, 
and  thirty-two  were  selected  by  her.  At  the  camps  at  Mon- 
tauk  and  Jacksonville  the  chief  surgeons  were  authorized 
to  contract  with  nurses  who  might  apply  to  them,  and  at  each 
place  a  small  number  were  enrolled  in  this  way.    Tlic  nursing 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      39 

at  a  few  of  the  Army    hospitals  has  been  done  by  volunteers, 
with  whom  no  contracts  were  made.^* 

Though  in  the  quotation  above,  "directions"  are  attributed 
to  the  Surgeon  General,  it  was  really  Dr.  McGee  who  defined 
the  standards  and  aimed  at  maintaining  them,  for  she  was 
deeply  interested  in  the  success  of  women  nurses  in  the  army. 
Being  a  woman,  she  was  solicitous  for  the  prestige  of  women 
undertaking  a  new  responsibility  and  as  a  professional  woman 
herself,  she  was  eager  to  uphold  the  professional  worth  and 
dignity  of  the  army  nurses.  The  directions  actually  given  by 
General  Sternberg  were,  that  nurses  should  be  chosen  from  all 
parts  of  the  United  States,  if  practicable,  and  that  "political 
pull"  should  be  entirely  ignored. 

In  view  of  the  novelty  then  of  trained  women  nurses  in  Army 
service  it  is  interesting  to  know  how  Dr.  McGee  arrived  at  her 
decisions  in  selecting  her  nurse  corps.  Although  the  first 
printed  regulations  did  not  qualify  the  words  "a  training  school 
for  nurses,"  yet  in  fact  the  best  known  institutions  were  always 
first  applied  to.  In  listing  them,  Dr.  ]\IcGee  consulted  Jane 
Hodson's  book  "How  to  Become  a  Trained  iSTurse,"  and  advised 
with  Georgia  M.  Xevins  (then  head  of  the  Garfield  Hospital, 
Washing-ton),  Isabel  McTsaac,  superintendent  of  the  largest 
training  school  in  the  West,  the  Illinois  Training  School  for 
Nurses,  Chicago,  Sophia  F.  Palmer,  then  chairman  of  the 
Daughters  of  the  American  Revolution  committee  in  Roclies- 

"  "Conduct  of  the  War  with  Spain."  Koply  of  tlio  Siirpcon  Conoral  to  the 
Coinniitteo.     Tlie  Selection   of   Female  Nurses.     Vol.   T,  pp.   725-72G. 
The  question  blank  sent  to  nurses  was  as  follows: 

Xanie  in  full. 

Address  and  nearest  telegraph   station. 

Do  you  desire  appointment  in  Army  or  Navy? 

How  soon  after  receiving  an  appointment  can  you  leave  home? 

Have  you  had  yellow  fever? 

Are  you   a  graduate  of  a  training  school   for  nurses? 

If  so,  wluit  scliool  and  wliat  year? 

W'liat  other  hospital  experience  have  you  had? 

Have  you  nursed  contiiiuously  since  graduation? 

]f  not,  what  has  been  your  occu])ation? 

\Miat  experience  have  you  had   in   invalid  cookery? 

What  is  vour  age?  Date  and  place  of  birth? 

Color?      '  Height?  Weight? 

Are  you  single,  married   or  widowed? 

Are  you  strong  and  iiealthy  and  have  you  always  been  so? 

Have  you  a  tendency  to  any  disease? 

Have  you  been  succt'ssfuUy  vaccinated  and  when? 

What  is  vour   lei'al   residence? 


40     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ter,  New  York,  and  other  superintending  nurses  of  note.  As 
the  war  went  on,  periods  of  great  emergency  arose,  when  women 
possessing  every  qualification  were  not  available  in  sufficient 
numbers  and  at  those  times,  the  less  well-equipped  graduate 
nurses  had  to  be  called  upon. 

The  first  volunteer  offers  made  to  the  Government  had  come 
from  individual  women.  On  the  declaration  of  war  these  were 
followed  by  groups,  or  organized  bodies,  of  which  there  were 
in  all,  as  Dr.  McGee  has  recorded,  no  less  than  eighteen.  Among 
the  earliest  were  the  National  Emergency  Association  of 
Women  Physicians,  Surgeons  and  Nurses,  of  Chicago,  whose 
president  was  Gertrude  G.  Wellington;  the  Graduate  Nurses' 
Protective  Association  of  New  York  State  through  Miss 
Enright ;  an  association  of  the  Connecticut  Training  School 
through  Mrs.  John  Kerrigan ;  the  Metropolitan  Nurses'  Club 
through  Mrs.  Mary  Hatch  Willard ;  St.  Barnabas  Guild  Club 
of  Nurses,  and  many  Catholic  orders. 

The  Associated  Alumnee  (whose  formation  has  been  de- 
scribed) requires  special  mention,  for  this  body  subsequently 
became  affiliated  with  the  lied  Cross  and  later  broadened  into 
the  American  Nurses'  Association.  In  April,  1898,  it  was  in 
session  in  New  York  City  for  its  first  regular  convention  after 
organization  had  been  effected  and  it  there  offered  its  services 
to  the  Surgeon  General.  The  president  was  Isabel  Hampton 
(Mrs.  Hunter)  Robb,  whose  contributions  to  nursing  education 
and  to  organization  are  so  important  and  so  closely  interwoven 
with  our  history  that  we  must  pause  here  to  bring  her  before 
our  readers.  Isabel  Hampton  was  a  Canadian  of  English 
parentage,  of  a  fair  and  stately  type  of  beauty.  Her  presence 
was  both  imposing  and  winning,  for  a  special  graciousness  and 
ardor  shone  in  her  blue  eyes  and  gave  her  sweet  English  voice 
a  vibrating,  electric  quality.  ]\[iss  Hampton  had  graduated 
from  Bellcvue  when  still  below  the  usual  age  of  admission.  She 
had  held  two  important  hospital  positions,  first  as  head  of  the 
Illinois  Training  School,  then  of  the  Johns  Hopkins  School  for 
Nurses,  which  she  organized  and  directed  until  her  marriage. 
She  liad  been  foremost  in  advancing  nursing  education  and  in 
promoting  nursing  organization.  Marriage  did  not  lessen  her 
devotion  to  her  profession  and  she  was,  until  her  death,  its 
chief  spokesman  in  its  various  causes  and  undertakings.  Her 
co-officers  in  the  organization  at  the  time  of  the  war  were  Helena 
Barnard   (Johns  Hopkins),  ]\Irs.  Hawley  (Miss  Horner  from 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      41 

the  Nightingale  School  in  England),  Tamar  Healy  (Brooklyn 
City  Hospital)  and  Jean  A.  Hopkins  (Bellevne). 

^Irs.  Robb  brought  the  war  situation  liefore  the  convention 
and  the  following  telegram  was  sent  to  Surgeon  General  Stern- 
berg: 

The  Associated  Ahimn.T  of  Trained  Nurses  of  the  United 
States  and  Canada,  inchtding  two  thousand  graduates  of 
twenty-four  training  schools,  offer  their  services  for  any  work 
which  the  ^ledical  Department  of  the  Army  may  demand  of 
them  in  connection  witli  the  war  with  Spain. 

By  direction  of  the  delegates  now  in  session  in  New  York 
City, 

(signed)  Isabel  Hamptox  Eobb^  President. 

By  an  error  in  transmission  the  word  "nurses"  was  written 
"music"  and  Mrs.  Eobb's  name  was  misspelled.  The  reply 
received  was  the  usual  courteous  form  of  declining  with  thanks. 
As  a  result  of  this  misunderstanding  the  convention  took  no 
further  action,  for  the  time  of  its  adjournment  had  come,  and 
thereafter  its  members  entered  the  war  service  as  individuals, 
many  through  the  War  Department,  and  others  through  the 
Bed  Cross  Auxiliary  No.  8.  ]Mrs.  Bobb,  however,  went  to 
Washing-ton  and  saw  Dr.  Sternberg  and  Dr.  McGco.  They 
warmly  welcomed  the  offer  of  cociporation,  but  a  definite  mutual 
agreement  was  not  finally  arrived  at,  because  of  different  points 
of  view  as  to  methods.  ^Irs.  Bobb,  with  her  intimate  knowl- 
edge of  training  schools  and  nurses,  would  have  urged  a  some- 
what exclusive  standard  of  requirements,  which  Dr.  ]\[cGee, 
from  her  more  extensive  acquaintance  with  the  War  Depart- 
ment's probable  needs  and  what  it  would  do  officially,  could 
not  promise.  The  Government's  plans  were  already  formulated 
and  well  under  way. 

On  jMay  10,  1,S!>S,  contracts  were  signed  with  the  first  group 
of  six  Army  nurses.  Fi-om  this  date,  then,  one;  may  informally 
reckon  the  beginning  of  the  present  Army  Nurse  (^orps,  while 
its  purely  official  date  will  l)e  met  with  a  little  later.  Two  of 
the  six  were  immunes,  chosen  by  tlu^  Surgeon  (ieneral.  and 
witli  whom  Dr.  ^IcGee  had  nothing  to  do.  The  other  four 
were:  Jolnu^tta  1>.  Sanger  and  ^I.  Agnes  Lease,  both  of  the 
Johns  Hopkins;  Alice  1*.  Lyon  of  the  Hn^oklyn  Homeopathic; 
and    :\rargaret    E.    Scliaifer    of    the    Philadelphia    Hospital.^'^ 

''"  Army  Nurse  Corps  Index,  Sur^^con  General's  oll'u-e,  A.  X.  C.  ]Mv. 


42     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

They  were  selected  by  Dr.  McGee  for  Key  West  but  were  not 
sent  there  immediately. 

The  relation  of  the  nurses  to  the  Government  and  Dr.  Mc- 
Gee, during  the  time  of  her  work  as  Director  of  the  D.  A.  R. 
Hospital  Corps,  is  indicated  below.  The  excerpt  given  also 
shows  how  the  formal  appointment  of  Dr.  McGee  to  an  army 
position  on  August  28,  1898,  was  made.  This  began  the  official 
existence  of  the  Army  N^urse  Corps : 

During  the  summer  all  applications  from  women,  whether 
addressed  to  the  President,  the  Secretaries  of  War  and  iSI^avy, 
or  the  respective  Surgeon  Generals,  were  sent  to  us  for 
examination  and  reply.  We  were,  therefore,  more  closely 
associated  with  the  Government  than  any  other  volunteer 
organization;  but,  on  the  other  hand,  the  limits  of  our  re- 
sponsibility had  always  been  sharply  defined  by  the  Surgeon 
General  of  the  Army.  We  had  no  official  relations  or  com- 
munications with  the  surgeons,  and  our  official  connection 
with  a  nurse  ceused  absolutely  when  she,  having  been 
accepted,  signed  the  army  contract.  But  when  a  large 
body  of  nurses  had  entered  the  service  many  questions  arose, 
necessitating  official  action  in  the  Surgeon  General's  office, 
such  as  the  receipt  of  reports  from  surgeons  and  ordering  of 
transfers  between  hospitals.  As  I  was  the  person  having 
the  greatest  knowledge  of  this  work,  and  as  it  was  impossible 
for  a  volunteer  to  conduct  it,  the  Surgeon  General  appointed 
me  as  acting  assistant  surgeon.  He  then  believed  that  the 
contracting  with  fresh  nurses  was  about  at  an  end,  and  there- 
fore, on  September  7  the  Daughters  of  the  American  Revolu- 
tion were  relieved,  with  thanks,  from  further  duty  in  con- 
nection witli  this  office.  Since  that  time  I  have  been  on 
duty  in  the  War  Department,  my  orders  immediately  on  ap- 
pointment having  been  to  Xew  York  and  Montauk.^*^ 

The  nurses  who  signed  contracts  with  the  Government  were 
classed  as  the  ''Xurse  Corps  (female),"  with  Acting  Assistant 
Surgeon  Anita  Xewcomb  McGee  as  their  superintendent. 
These  titles  were  used  officially  by  Dr.  Sternberg  in  his  reports 
of  that  time  to  the  W^ar  Department,  but  in  signing  papers  Dr. 
McGee  wrote  herself  '"In  charge.  Army  Xurse  Corps."  The 
Corps  was  classified  as  consisting  of  chief  nurses,  nurses  and 
reserve    nurses.      After    they    entered    the    Army    the    title 

"  Dr.  McGee's  testimony,  "Conduct  of  War  with  Spain/'  Vol.  VII,  p. 
3173. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      43 

"Nurse,"  formerly  applied  to  the  enlisted  men  on  ward  duty, 
was  restricted  to  the  women.  The  regulations  governing  their 
appointment  and  defining  their  duties,  pay  and  privileges,  were 
issued  from  the  Surgeon  General's  office. 

After  June  20,  1808,  the  printed  regulations  specified  "two 
years  residence  in  hospital  training  school"  for  applicants  to 
the  Army  Nurse  Corps,  thus  defining  what  had  been  the  actual 
practice.  In  the  late  summer,  with  the  calls  for  the  typhoid 
camps,  the  rules  had  to  be  sometimes  relaxed  and  nurses  were 
then  accepted  from  small  or  special  hospitals.  There  were  also 
four  large  camps  where,  during  the  heaviest  emergency,  the 
chief  surgeons  had  been  authorized  to  secure  women  nurses 
without  regard  to  training.  This  method  did  not  commend 
itself  as  one  to  be  approved. 

In  round  numbers  the  nurses  in  service  were  listed  as  fol- 
lows : 

September,  1898 1,200 

December  30,  1898 686 

July  1,  1899   202 

Total  serving  to  July  1,  1899 1,563 

Number  of  applicants    6,000 

Fatalities :    Trained  nurses    5 

Catholic  Sisters  (out  of  250)   5 

Untrained   (immune)  nurses 3 

(out  of  100) 
All  deaths  but  two  were  from  typhoid. 

After  the  war  was  over  Dr.  McGee  gave  interesting  testi- 
mony before  the  Congressional  Committee,  from  which  a  brief 
section  is  taken: 

Q.  How  many  of  those  nurses  proved  to  be  thoroughly 
well-trained  nurses? 

A.  We  accepted  only  graduates  of  training  seliools  wlio 
were  endorsed  by  the  suj)erintendent  of  their  schools.  There- 
fore less  than  a  dozen  that  we  sent  were  afterwards  found 
to  he  undesirable. 

Q.      Did  they  })rove  to  Ijc  etlicient  in  the  various  liospitals? 

A.  A'ery.  \\'e  have  received  very  satisfactory  reports  from 
all  hospitals. 

Q.  So  far  as  you  know,  has  the  experience  in  this  war 
shown  that  female  nurses  may  be  properly  employed  in  mili- 
tary hos})itals? 


44     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A.     Yes,  sir,  decidedly  so. 

Q.  How  near  to  the  front  have  female  nurses  been  sent; 
in  other  words,  how  near  to  the  moving  column  have  there 
been  female  nurses  in  military  hospitals? 

A.     Female  nurses  went  to  Santiago  in  the  middle  of  July. 

Q.  As  a  result  of  the  experience  in  the  months  just  past, 
do  you  tliink  it  advisable  that  female  nurses  should  be  em- 
ployed in  military  hospitals? 

A.     Yes,  sir,  decidedly. 

Q.  Has  such  opinion  been  expressed  to  you  by  the  authori- 
ties in  the  Medical  Department? 

A.  It  has  been  expressed  to  me  by  a  large  number  of 
surgeons  who  have  been  in  Washington. 

Q.  The  nurses,  then,  numbering  about  one  thousand,  their 
actions  being  satisfactory  to  the  medical  authorities  of  the 
hospital  and  satisfactory  to  the  organization  that  selected 
them,  is  there  any  reason,  think  you,  for  hesitating  to  employ 
female  nurses  in  any  military  hospital  other  than  that  in  the 
immediate  vicinity  of  the  firing  line,  where  I  suppose  no 
female  nurse  can  go? 

A.  1  should  judge  their  presence  was  extremely  desirable, 
as  they  had  a  better  training  than  the  vast  majority  of  the 
men  available  for  the  Hospital  Corps.  This  is  the  chief 
reason.  They  were  employed  in  foreign  armies  and  are  a 
permanent  part  of  the  British  army,  where  their  services  have 
been  very  satisfactory.  You  spoke  in  a  recent  question  of 
one  thousand  nurses.  In  giving  this  number  I  was  speaking 
only  of  those  accepted  by  the  Daughters  of  the  American 
Eevolution. 

Q.  To  what  extent  have  the  religious  orders  been  called 
upon? 

A.     To  the  full  extent  of  their  offer. 

Q.     Will  you  tell  us  what  that  extent  was? 

A.  The  Sisters  of  Charity  furnished  a  few  over  two 
hundred  of  their  Sisters;  the  Sisters  of  Mercy  of  Baltimore, 
thirteen;  the  Sisters  of  tlie  Holy  Cross,  eleven;  the  Sisters 
of  St.  Joseph,  eleven ;  the  Congregated  American  Sisters, 
which  consists  of  Indian  women  from  South  Dakota,  five; 
the  Sisters  of  St.  ^largaret.  which  is  a  Protestant  sisterhood, 
two;  the  St.  Barnalms  Cuild,  which  is  also  an  Episcopal 
organization,  quite  a  inimber.  We  accepted  the  nurses  re- 
gardless of  tlicir  religious  belief  if  they  filed  their  ap})lica- 
tions  in  the  usual  way,  aiul  all  those  Sisters  filled  out  the 
application  blanks  furnished  l)y  the  Daughters,  and  c(>rtified 
their  qualifications  individually  and  all  were  vmder  contract 
and  received  pay  exactly  as  the  other  nurses. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      45 

Q.  As  to  those  less  than  three  hundred  furnished  by  the 
various  orders,  have  the  reports  of  them  been  satisfactory 
to  you? 

A.  Some  of  the  surgeons  prefer  them  to  the  other  nurses 
and  some  prefer  the  others. 

Q.  To  what  extent  have  female  nurses  been  employed  in 
diet  kitchens  in  the  various  hospitals,  either  as  superin- 
tendents or  occupied  in  the  work  of  the  diet  kitchen  ? 

A.  They  have  been  employed  in  a  considerable  number 
of  hospitals  in  charge  of  diet  work.  I  have  had  several  calls 
lately  for  women  to  supervise  that  work. 

Q.  Have  the  reports  that  you  have  received  from  the  diet 
nurses  of  those  occupied  in  the  care  of  the  diet  kitchens 
been  satisfactory  to  you? 

A.     Yes.^^ 

About  the  routine  of  assigning  nurses  Dr.  McGee  said : 

The  original  procedure  was,  when  the  Surgeon  General 
received  requests  from  surgeons  for  nurses,  he  sent  over  to 
me  representing  the  Daughters  of  the  American  Revolution, 
with  my  associates,  for  a  certain  number  of  nurses  to  go  to  a 
certain  place.  1  and  my  associates  selected  the  humber  and 
sent  the  names  and  addresses  to  him.  His  clerks  then  made 
out  the  contracts  and  mailed  them  to  each  nurse  with  a 
transportation  order.  She  then  went  to  the  hospital  to  which 
she  was  ordered.^* 

Dr.  McGee's  testimony  also  makes  clear  in  an  interesting 
way  the  record  of  the  nurses  and  throws  light  on  complaints 
that  were  numerous  at  that  time,  of  undesirable  and  unsuitable 
women  who  entered  in  irregular  ways  through  individual  heads 
of  camps;  but  it  is  needless  to  enter  into  these  mimitia?. 

Surgeon  General  Sternberg  should  be  more  than  a  name  to 
nurses  and  our  readers  may  be  referred  to  his  biography  for 
the  details  of  his  life.'"  His  recognition  of  women  in  their 
professional  capacity  was  very  striking  indeed,  in  comparison 
with  the  general  military  reluctance  of  that  time  to  admit 
women  into  war  nursing,  and  the  more  so,  as  his  own  long  Army 
training  had  made  him  conservative  and  averse  to  innovation. 
He  had  little  knowledge  of  what  women  could  do  and  at  iirst 

""Conduct   of  Iho  War  with   Spain."  Vol.   7,   pp.   316S-3180. 

"Ibid.,  pp.  .•U7;!-:^174. 

"•■A  Hiojrrapliy  of  (k'orjrc  Miller  Sternberg,"  by  Martlia    L.  Sternberg. 


46     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

anticipated  placing  them  only  in  base  hospitals.  He  appeared 
an  anstere  man,  not  easily  approached  nor  readily  persuaded. 
He  was  entirely  free  from  political  opportunism.  "Pull"  -was 
odious  to  him  and  this  was  of  the  greatest  importance  to  the 
nursing  service.    After  the  war,  Dr.  McGee  said  of  him : 

The  Surgeon  General  had  of  his  own  initiative  and  without 
suggestion  from  anyone  asked  from  Congress  and  received 
an  appropriation  for  the  payment  of  contract  nurses,  either 
male  or  female.  Had  he  not  done  this,  the  Xurse  Corps 
could  have  had  no  existence,  and  so  it  should  never  be  for- 
gotten that  however  mucli  the  Surgeon  General  may  have 
been  assisted  by  others,  the  first  and  fundamental  action  to- 
wards the  recognition  of  women  nurses  in  the  army  was 
taken  by  Surgeon  General  Sternberg. 

The  work  that  Dr.  McGee  herself  did  was  pioneer  effort  of 
an  original  and  difficult  kind  and  in  its  execution  she  commands 
the  appreciation  and  recognition  of  the  nursing  body  for  break- 
ing the  ice  of  military  routine  and  opposition  to  women  nurses 
in  the  Army  and  for  the  care  and  regard  she  had  for  good  pro- 
fessional standards.  She  bore  the  brunt  of  heavy  initial  respon- 
sibilities and  difficulties,  with  the  usual  criticism  that  pioneers 
meet,  and  so  made  it  easier  for  those  who  followed  her.  Many 
nurses  of  the  finest  quality  first  entered  the  war  nursing  through 
her  office,  women  who  became  distingnished  and  who  still  hold 
important  places  in  the  Army,  Xavy  and  Ilcd  Cross  services. 
She  was  staunch  and  loyal  to  them,  fair,  kind  and  helpful  in 
her  personal  relations  with  them  and  had  their  strong  regard."*^ 
One  who  knew  her  said  of  her : 

Her  friends  were  devoted  to  her;  those  who  were  hostile 
were  equally  strong  in  their  feelings.  Her  ability  as  an 
organizer  was  considerable;  her  ability  to  carry  her  point  was 
remarkable;  she  kept  in  touch  with  her  chief  nurses,  writing 
often   to   them.      She   had   great   influence   with   prominent 

**In  the  winter  of  1808-00,  Dr.  Mcdee  and  the  menibors  of  the  Army 
Xurse  Corps  founded  tlie  Society  of  Spanisli-Anierican  War  Nurses,  and 
Dr.  McGee  was  for  six  years  its  president  and  hiter  its  honorary  president 
for  life.  The  otlier  officers  in  its  first  years  were:  vice  presidents.  Dr. 
Laura  A.  Hughes,  Mary  J.  McCloud,  Isabel  Jean  Walton,  Dr.  Isabel  Elliot 
Cowman,  Annie  A.  Robl)ins.  Rose  Meiselbacli.  Mary  E.  Dreyer,  Anna 
Elizabeth  McEvoy,  Ysabella  B.  Waters  and  Elizabeth  Porteous;  recording 
secretary,  Leia  Wilson;  treasurer  and  corresponding  secretary,  Harriet 
Camp   Lounsbury. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      47 

politicians   and   all   the   nurses  believed   that  she  had   done 
much  to  help  pass  the  Army  and  Xavy  bills  after  the  war. 

In  the  autumn  of  1900,  when  the  Army  reorganization  bill, 
to  be  referred  to  later  with  more  detail,  was  in  preparation,  iJr. 
McGee  at  the  request  of  the  War  Department  wrote  the  section 
which  made  the  Xurse  Corps,  as  it  had  been  organized,  a 
pernument  part  of  the  Army.  This  marked  the  end  of  the 
pioneer  work  and  brought  a  climax  of  success,  long  hoped  for, 
to  the  first  chapter  of  the  story  of  the  Army  Nurse  Corps.  Dr. 
IVIcGee  then  tendered  her  resignation,  which  took  effect  De- 
cember 31,  1900,  and  selected  Dita  H.  Kinney,  one  of  her  chief 
nurses,  as  her  successor. 

If,  as  has  been  said,  the  present  Red  Cross  Nursing  Service 
was  foreshadowed  by^  the  Red  Cross  Hospital  Committee  on 
which  Sister  Bcttina  sat,  it  is  even  more  certain  that  it  had  an 
advance  demonstration  of  a  prophetic  character  in  the  nursing 
work  of  Auxiliary  No.  '5,  known  also  as  the  Red  Cross  Society 
for  the  Maintenance  of  Trained  Nurses.  On  the  auxiliary 
were  women  who  had  always  been  familiar  with  the  hospital 
and  nursing  conditions  of  New  York  City,  such  as  Mrs.  James 
Speyer,  president  of  tlie  auxiliary  and  of  the  Red  Cross  Hos- 
pital, Mrs.  Bayard  Cutting,  Mrs.  George  H.  Shrady,  Mrs. 
William  Sheffield  Cowles  (Theodore  Roosevelt's  sister)  and 
Mrs.  Lanman  Bull.  Two  women  of  exceptional  character  bore 
the  direct  responsibility  of  the  Committee  on  Nursing.  One 
of  them,  ]\lrs.  Whitelaw  Reid,  by  her  charitable  interests  was 
already  closely  identified  with  the  hospital  and  nursing  worlds ; 
the  other,  ^Mrs.  Winthrop  Cowdin,  had  not  been  in  contact  with 
nursing  matters  up  to  that  time.  i\lrs.  Reid,  who  was  also  the 
auxiliary's  secretary,  was  the  first  chairman  of  the  Committee 
on  Nursing.  An  old  friend  ~^  who  worked  intimately^  with  her 
through  those  days  has  since  written  of  her: 

Elizabeth  ^lills  Keid  is  an  exceptional  woman,  a  possessor 
of  large  woaltli  and  of  long  years  of  social  and  diplomatic 
experience,  osj)ecially  during  the  time  when  lier  husband, 
Mr.  Whitelaw  I'cid.  was  American  Minister  to  France  and 
Ambassador  to  l-'nirland.  Slie  is  a  woman  gifted  with  the 
virtues  of  sim])]i(ity.  of  sym])athy  and  of  loyalty  to  her  ideals 
and  her  frieiKls.  'I'o  any  ohjcct  which  connnands  her  interest, 
she  has  brought  })ractical  business  ability  and  understanding 

="Miss   MalH'l    Hoaidnian. 


48     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

combined  with  clear  vision  and  whole-hearted  devotion.  She 
has  given  not  only  of  her  wealth  but  of  herself  to  the  great 
causes  for  which  she  lal)ored,  prominent  among  which  have 
been  the  American  Eed  Cross,  the  hospitals  she  has  built  and 
aided  and  the  public  health  nursing  service  she  has  done  so 
much  to  support. 

Another  of  the  Spanish- American  war  workers  ^^  of  the  Red 
Cross  wrote  of  Mrs.  Cowdin: 

Lena  Potter  Cowdin,  in  succeeding  to  the  chairmanship 
of  the  Nursing  Committee,  brought  to  it  excellent  administra- 
tive ability  and  some  executive  experience  in  Civil  Service 
Reform  Avork.  She  had  had  neither  previous  special  interest 
nor  experience  in  nursing  matters.  She  had,  though,  the 
broad  human  sympathy  of  her  father,  the  Rt.  Rev.  Henry 
Codman  Potter,  and  very  unusual  qualities  of  mind  and 
spirit.  Her  good  method,  superb  grasp  of  problems  and  power 
to  inspire  loyalty  and  enthusiasm  in  her  staff  made  her  a 
rare  executive.  Personally  spirituelle  and  eager,  she  re- 
sembled, to  her  friends'  eyes,  a  "flying  Victory." 

These  women  naturally  came  at  once  into  close  touch  with 
the  leading  superintendents  of  i^ew  York  City.  Foremost 
among  the  latter  was  Anna  C.  Maxwell,  at  the  Presbyterian 
Hospital,  eminent  by  reason  of  her  great  gifts  and  abilities, 
her  compelling  personality,  stately  presence  and  uncompromis- 
ing ideals  of  nursing.  Anna  Caroline  Maxwell  was  by  birth 
a  New  York  State  woman,  whose  Scotch  clergyman  father 
endowed  her  with  the  strong  qualities  so  notably  blended,  in 
her  character,  with  a  great  charity  of  judgment.  She  became 
interested  in  nursing  and  with  a  ''love  of  difficult  tasks''  took 
the  course  of  training  in  the  early  days  of  the  Boston  City 
Hospital  School.  Following  this  she  was  for  a  time  Matron  in 
the  Xew  England  Hospital  for  Women  and  Children ;  and 
later  was  called  to  the  position  of  superintendent  of  nurses 
of  the  training  school,  Montreal  General  Hospital,  an  ex- 
ceedingly difficult  task  at  which  she  did  not  remain  long.  Later 
she  was  superintendent  of  nurses  in  the  Massachusetts  General 
Hospital  for  seven  years.  She  was  called  from  there  to  St. 
Luke's  Hospital,  New  York  City,  where  she  reorganized  the 
school  of  nursing  and  where  she  remained  for  three  years.  Then 
she  was  invited  in  1891  to  establish  the  School  of  Nursing  of  the 

==Miss  Laura  D.  Gill. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      49 

Presbyterian  Hospital,  also  of  New  York,  where  she  spent 
thirty  years, — an  inmsnal  record  in  this  country, — and  where 
she  built  up  a  school  of  fine  traditions,  of  international  fame, 
distinguished  for  the  high  character  of  its  training  and  ideals. 
She  was  always  deeply  interested  in  the  Red  Cross  and  from 
the  first  an  untiring  worker  in  its  activities.  It  may  be  truly 
said  of  ^liss  ^Maxwell,  that  no  appeal  for  help  that  it  was 
possibly  in  her  power  to  give,  was  ever  made  to  her  in 
vain. 

Another  of  the  New  York  nursing  leaders  who  took  an  im- 
portant part  in  the  war  nursing  under  Red  Cross  auspices  was 
Mrs.  Lucy  W.  Quintard,  at  that  time  head  of  the  school  of  St. 
Luke's  Hospital.  .Mrs.  Quintard  had  graduated  from  the 
Connecticut  training  school  in  X-ew  Haven  in  1890,  with  spe- 
cial honors  (the  "Red  Seal"  indicative  of  an  excellent  record). 
Immediately  afterwards  she  was  appointed  superintendent  of 
nurses  there  and  remained  at  the  head  of  her  alma  mater 
until  November,  1805,  when  she  was  called  to  New  York.  Mrs. 
Quintard  had,  during  the  war,  one  of  the  most  difficult  posts, 
that  at  Camp  Wikofi",  Long  Island,  and  fulfilled  its  duties  with 
great  tact  and  ability.  After  the  war  she  was  called  to  assist 
in  the  reorganization  of  the  civil  hospitals  in  Cuba.  Later 
she  devoted  herself  to  the  Visiting  Nursing  Association  in 
Philadelphia,  where  she  died.  Mrs.  Quintard  was  exceedingly 
earnest,  gentle,  but  firm  in  discipline  and  deeply  religious.  To 
her,  the  war  work  was  a  cross. 

At  the  New  York  Hospital  was  Irene  H.  Sutliffe,  whose 
whole  professional  life  was  identified  with  its  history.  She 
was  trained  there,  was  made  Directress  of  Nurses  and  only 
left  it  for  the  short  period  of  war  nursing,  until  the  time  came 
when  she  finally  retired  from  active  service.  During  her  many 
years  of  authority  there  and  afterwards,  when  she  went  into 
residence  at  the  New  York  Nurses'  Club,  she  had  a  special 
hold  on  the  affections  of  her  pupils.  Of  unassuming  manner, 
great  kindness  and  sympathetic  insight,  her  professional  career 
was  peculiarly  one  of  personal  influence.  Other  New  York 
superintendents,  all  women  of  ability  and  character  and  who 
shared  in  the  responsibilities  of  that  time,  though  less  directly 
drawn  into  the  war  work  than  the  three  especially  mentioned, 
were  Agnes  Lrennan,  at  Px'llevue ;  ]Marv  Samuel,  at  lt(tos(>velt ; 
^liss  Ivvkert,  at  tlu^  Post-Graduate ;  Katheriiu^  Sanborn,  at  St. 
Vincent's;  Mrs,   Dean,  at  Mt.  Sinai,  and  Mary  S.  Gilmour,  at 


50     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  "New  York  City  school.     With  these  nursing  leaders  the 
women  of  Auxiliary  ISTo.  3  formed  a  strong  alliance. 

In  the  early  part  of  the  auxiliary's  activities  Dr.  McGee 
went  to  I^ew  York  to  talk  over  with  its  members  the  Govern- 
ment's plans,  and  was  later  elected  an  officer  of  the  auxiliary. 
The  auxiliary  agreed  to  use  the  application  form  of  the  Daugh- 
ters of  the  American  Revolution  (afterwards  the  Government's) 
and  to  adopt  the  Army  requirement  of  training,  while  Dr.  Mc- 
Gee promised  to  give  official  appointments  to  all  the  nurses 
recommended  by  the  auxiliary.  It  was  then  arranged  that  all 
the  ^ew  York  superintendents  might  direct  nurses  to  enter 
through  the  auxiliary  for  war  work  and  thereafter  the  Wash- 
ington office  made  no  further  investigation  of  the  qualifications 
of  nurses  thus  supplied. 

The  work  of  recruiting  nurses  for  Auxiliary  ]^o.  3  was 
organized  by  Miss  Maxwell.  An  informal  committee  composed 
of  the  jSTew  York  superintendents  established  correspondence 
with  training  school  heads  of  prominence  elsewhere  asking 
them  to  choose  nurses  who  should  hold  themselves  in  readiness 
for  service.  Of  women  thus  carefully  selected,  one  hundred 
and  fifty  at  a  time  were  brought  to  ]^ew  York  and  suitably 
housed,  there  to  be  in  instant  readiness  if  calls  came.  So  un- 
certain and  so  imperative  were  these  calls  that  the  reserve 
nurses  were,  practically,  almost  prisoners  in  their  rooms,  for 
little  more  than  an  hour  could  be  allowed  between  summons 
and  departure.  Kathcrine  ]^.  Pierce,  head  of  the  Samaritan 
Hospital  in  Troy,  Iscw  York,  gave  her  vacation  to  start  this 
recruiting  work  and  after  that  it  was  entrusted  to  Mary  E. 
Wadley,  a  Bellevue  nurse.  ]\liss  Wadlcy  was  a  New  England 
woman  of  great  energy  and  resourcefulness.  Fair  and  sunny- 
faced,  she  was  attractive  and  most  capable.  She  was  already 
successfully  conducting  a  large  registry  for  imrses  at  6  East 
42nd  Street  and  the  war  nursing  service  was  brought  in  to  her 
headquarters.  The  system  was  quickly  reduced  to  a  smoothly 
running  routine.     Telegrams  from  Washing*ton  would  call  for 

so  many  nurses  to  go  at  once  to  .     While  Laura  D.  Gill, 

the  auxiliary  aide,  flew  to  the  station  to  buy  tickets  and  make 
reservations,  ]\liss  Wadlcy  summoned  by  telephone  the  wait- 
ing reserves.  Immediately  when  they  were  off,  calls  went  to 
the  hospital  superintendents  on  her  list  to  fill  up  the  numbers 
that  had  been  sent  out.  This  method  worked  exceedingly  well. 
It  was  expensive  to  maintain  the  waiting  nurses  in  New  York, 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      51 

but  this  was  a  part  of  the  work  of  the  auxiliary,  whose  re- 
sources were  unstinted.  For  speed  the  auxiliary  bought  all 
railroad  tickets  and  these  funds  were  reimbursed  by  the  govern- 
ment. 

The  Woman's  Auxiliary  No.  3  had  a  visiting  agent  of  special 
ability  and  tact  in  Maud  Cromelien,  a  nurse  from  the  Massa- 
chusetts General  Hospital.  In  the  late  summer  when  typhoid 
fever  became  epidemic  in  the  camps,  reports  made  by  Miss 
Cromelien,  who  had  been  sent  to  the  camps  to  offer  the  services 
of  the  Eed  Cross,  and  the  powerful  influences  brought  to  bear, 
as  a  result  of  these  reports,  by  Mrs.  Cowdin  and  Mrs.  lleid  on 
public  officials,  finally  won  out  over  the  Army  conviction  that 
women  should  only  serve  in  base  hospitals,  and  Auxiliary  Xo.  3 
had  the  immense  satisfaction  of  supplying  trained  nurses  from 
its  staff"  for  the  first  time  on  an  organized  system  to  field  hospi- 
tals, ^liss  Cromelien  considered  that  this  marked  an  epoch  in 
the  history  of  nursing,  as  indeed  it  did.  When  this  important 
work  was  undertaken  a  number  of  New  York  superintendents 
went  themselves  to  the  camps  at  the  head  of  nursing  staffs.  Miss 
Maxwell,  who  had  written  many  personal  appeals  to  the  Sur- 
geon General  to  allow  nurses  to  enter  the  camps,  was  sent  to  the 
Sternberg  Hospital  at  Camp  Thomas,  Chickamauga  Park. 
!Miss  Sntliffe  went  to  Camp  Black  and  ^frs.  Quintard  to  Camp 
Wikoff  at  Montauk  Point.  Their  reports  are  full  of  interest 
but  can  be  only  briefly  quoted.  Miss  ]\laxwell's  report,  sent 
in  to  her  Board  of  Hospital  Managers,  follows  in  part: 

Sternberg  U.  S.  Hospital, 
October  31,  1898. 
To  the  Board  of  ^lanagcrs  of 
The  Presljvtcrian  Hospital, 
Xew  York  City. 

Gentlemen : 

On  August  1,  ^Mrs.  Whitolaw  Eeid  and  Mrs.  Winthrop 
Cowdiii.  mi'iiibers  of  the  American  National  Red  Cross, 
Auxiliary  No.  3  for  tlie  ^laintenanee  of  Trained  Xurses, 
asked  if  tlie  Connuittee  of  our  Training  School  would  grant 
me  a  leave  of  absence  to  go  to  Chickamauga  Park  to  establish 
the  work  of  nursing  in  a  Field  Hospital  at  Camp  Thomas. 
^         ^         ^         ^ 

I  at  once  telegraphed  to  all  the  leading  training  schools  of 
the  country  for  irraduatcs  an<l  rec(M\-c(l  most  conlial  and  en- 
eourairini:    responses.  .  .  .  The    valual)le    services    of    Miss 


52     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Frances  A.  Stone  were  secured  as  assistant  superintendent 
and  we  left  New  York  on  x\ugust  7. 

*         *         *         * 

On  August  12  we  went  to  the  Sternberg  U,  S.  Field 
Hospital,  to  begin  the  work  we  had  set  out  to  do.  This 
hospital  .  .  .  was  designed  to  hold  one  thousand  patients. 
The  supplies  were  coming  in  slowly,  but  for  the  first  patients, 
who  numbered  one  hundred  and  thirty-six,  the  only  things 
ready  for  use  were  the  tents  and  beds.  The  supplies  that 
were  on  hand  had  neither  been  unpacked  nor  verified  and  we 
were  helpless  to  pay  the  sick  soldiers  the  necessary  attention. 
It  was  impossible  to  borrow  any  considerable  number  of 
utensils  from  the  neighboring  camps  and  late  in  the  evening 
I  went  to  the  Quartermaster  and  told  him  I  should  stay 
there  all  night,  or  until  the  supplies  were  unpacked.  Tired 
as  we  all  were  we  put  our  "shoulders  to  the  wheel''  and  before 
midnight  we  had  given  out  sufficient  material  for  the  night 
and  had  drawn  on  our  own  resources  for  milk,  ice,  medicine, 
brandy,  hypodermics,  thermometers,  sponges,  basins,  etc., 
provided  by  the  Eed  Cross.  I  was  informed  that  it  was  a 
military  law  that  the  soldier,  sick  or  well,  must  be  on  the 
spot  before  rations  can  be  drawn,  hence  the  supply  of  food 
did  not  arrive  until  the  following  day. 

As  the  tents  were  prepared  and  supplies  provided,  more 
patients  were  admitted;  often  two  hundred  in  a  day.  In 
many  instances  they  were  brought  long  distances,  driven 
through  a  broiling  sun  at  midday,  and  had  to  lie  in  the 
ambulance  from  two  to  three  hours  before  they  could  be 
moved  to  their  beds.  When  you  consider  that  often  as  many 
as  four  men  were  crowded  into  one  ambulance,  sufl:'ering  with 
thirst  and  heat,  scarcely  able  to  move  in  the  cramped  and 
narrow  space  allotted  to  them  it  is  no  wonder  that  many 
suffered  from  shock,  exhaustion  and  convulsions. 

I  am  glad  to  say  tluit  we  found  some  of  the  officers  who 
demanded  an  ambulance  and  canvas  cot  for  each  seriously 
sick  soldier,  but  the  condition  of  the  majority  showed  plainly 
how  meager  had  been  the  nourishment  and  care  they  had 
received.  It  was  certainly  a  most  harrowing  sight  to  see  the 
long  narrow  cots  filled  with  what  had  been  strong,  splendid 
men,  hollow-eyed,  emaciated,  muttering  in  the  delirium  of 
fever,  sores  in  which  dead  flies  were  incrusted  filled  their 
mouths,  making  swallowing  almost  impossible.  Their  bones 
protruding  tiirough  their  skin  and  l)ed  sores  several  inches 
deep  were  not  uncommonly  found  on  hips,  back,  elljows  and 
often  on  the  head  and  ears  and  it  was  here  that  all  the 
energies  and  resources  of  the  trained  nurse  were  called  forth 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      53 

in  making  the  lives  of  these  men  less  wretched  and  in  re- 
storing tiieni  to  health. 

The  course  of  our  work  was  often  impeded  and  made  diffi- 
cult hy  su(;h  stumljling  blocks  as  sanitation  of  the  most  primi- 
tive kind,  insuflicicnt  disinfections^  water  supply  and  accom- 
modations for  washing  utensils,  irregularity  in  furnisiiing 
the  details  of  soldiers  so  that  our  work  could  not  be  done  in 
a  consecutive  way.  Occasional  lack  of  medicine,  milk,  ice 
and  other  supplies.  The  dearth  of  orderlies  more  than  any- 
thing else  handicapped  the  work.  Those  we  had  were  changed 
too  often  or  were  physically  incapacitated  for  work.  Add  to 
this  the  heat,  the  dust,  the  moisture  and  the  flies  and  you 
have  the  picture  complete. 

I  cannot  say  enough  in  praise  of  the  liberality  and 
though tfulness  of  the  auxiliary  of  the  Red  Cross  Society  in 
supplying  us  with  eight  dormitories,  a  bathhouse,  store  rooms, 
kitchen,  dining  room,  housekeeper,  servants  and  "not  only  the 
necessities  but  many  of  the  luxuries  of  life. 

The  Government  sent  us  one  hundred  and  fifty-two  nurses 
and  a  dietitian.  In  this  number  seventy-five  training  schools 
from  all  parts  of  the  Union  were  represented.  Several  of  our 
nursing  staff  were  infected  with  typhoid  fever  and  one,  ]\Iiss 
Greenwood,  died.  The  total  number  of  patients  received  be- 
tween August  15  and  September  10,  the  date  on  which  I  left, 
was  nine  hundred  and  thirty-six.  Four  hundred  and  seventy 
were  furloughed  and  sixty-eight  died.^^ 

The  good  nursing  and  the  admirable  discipline  of  the  staff 
under  Miss  Maxwell  completely  altered  the  Army  officers'  point 
of  view  and  Dr.  Hoff  said  to  her :  ^'I  wondered  when  you  came 
what  we  would  do  with  you.  Now  I  do  not  know  what  we 
would  have  done  without  you." 

Mrs.  Lounsbery  (before  her  marriage,  Harriet  Camp),  who 
followed  Miss  Alaxwell ,  has  written  commentaries  on  the 
nursing  staff  that  may  be  of  interest  to  Army  nurses  today. 
She  had  graduatcnl  from  the  Brooklyn  Homeopathic  Hospital 
and  had  held  for  six  years  th(^  position  of  superintendent  of  the 
training  school.  During  her  stay  both  hospital  and  school 
developed  greatly.  She  was  the  earliest  author  of  professional 
books  among  her  Xew  York  contemporaries  and  wrote  on  ''Xurs- 
ing  Ethics"  and  on  "Alaking  Good  in  Private  Duty."  After 
her  nnirriage  she  was  a  loyal  organizer  of  Red  (h'oss  State  work 
in  West  Virginia,  up  to  the  time  when  this  record  was  written. 

"In    tlio    files   of   Auxiliary    Nu.    3. 


54.     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

She  had  been  married  five  years  when  she  volunteered  in  the 
Spanish-American  war.     She  wrote  of  Chickamauga : 

It  is  very  amusing  to  remember  how  ignorant  we  all  were 
of  Army  ways  when  we  first  went  into  camp.  I  think  I  am 
right  in  saying  we  all  were  influenced  by  the  purest  patriotism 
in  going.  I  know  it  seemed  to  me  a  wonderful  thing  that  my 
country  really  needed  me  and  I  joyfully  went,  anxious  only 
to  help,  I  knew  nothing  of  the  best  way  of  getting  into 
Army  work.  As  I  happened  to  be  in  Washington,  I  went  to 
Dr.  McGee's  office,  signed  the  contract  and  was  sent  off.  The 
contracts  came  for  the  nurses  a  few  days  after  I  had  arrived 
in  camp.  Most  of  the  nurses  had  come  from  the  Xorth  and 
Xorthwest  and  had  never  heard  of  any  contracts.  They  did 
not  know  why  they  should  sign  such  elaborate  papers.  They 
had  come  to  nurse  the  soldiers,  they  were  doing  their  best 
and  were  very  successful.  At  last  they  grasped  the  idea 
that  the  contract  only  meant  that  the  Government  wished 
them  to  be  regularly  recognized  as  a  part  of  the  Army  and 
most  of  them  signed. 

The  thought  that  upon  their  conduct  and  efficiency  then 
and  there  would  be  based  the  action  of  Congress  as  to  whether 
women  should  or  should  not  be  regularly  employed  as  army 
nurses,  be  looked  upon  as  part  of  the  Army  hospital  equip- 
ment, was  urged  upon  them  again  and  again  and  most  of 
them  seemed  to  feel  this  responsibility  and  governed  them- 
selves accordingly. 

It  was  curious  and  interesting  to  see  representatives  of  so 
many  training  schools  working  together.  There  was  always 
much  pride  manifested  in  one's  alma  mater  and  school 
badges  were,  of  course,  very  much  in  evidence.  Nothing 
would  bring  a  nurse  more  quickly  to  a  sense  of  her  duty  than 
to  ask  if  in  her  training  school  she  had  never  been  instructed 
as  regards  this  or  that.  The  different  uniforms  were  also 
interesting;  most  of  them  were  blue,  blue  and  white  stripes, 
checks,  plaid,  plain  blue,  but  pink  was  not  absent.  There 
were  with  us  nurses  from  ninety-one  different  schools  and  but 
two  wore  pink.  The  caps  were  as  diverse  as  the  uniforms. 
Every  kind  was  to  be  seen,  from  a  tiny  square  of  lawn  to 
quite  an  imposing  erection  of  starched  linen  and  quilled 
ruffles.  It  seemed  to  me  that  the  dainty  "Red  Cross"'  cap 
furnished  by  Auxiliary  Xo.  3  was  the  most  universally  be- 
coming.-^ 

^"Reminiscences  of  Sternberg  Hospital,"  American  Journal  of  Xursing, 
Xovciiihcr,  1902. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      55 

The  text  of  the  official  report  of  Auxiliary  No.  3,  as  filed  after 
the  war  in  the  Ked  Cross  records,  shows  very  clearly  the  char- 
acteristic quality  of  lied  Cross  organization.  It  did  not  wait 
to  be  asked,  but  pushed  forward  looking  for  work  and  reiterated 
its  offers  until  they  were  accepted.  There  is  a  very  important 
difference  here  between  the  official  etiquette  of  a  military  hier- 
archy and  the  informality  of  a  civilian  body.  The  former  is 
essential  for  its  purpose,  but  may  be  carried  to  extremes.  The 
latter  may  be  at  times  inconvenient,  but  there  is  in  it  a  life-sav- 
ing power  that  is  precious.  The  report  of  the  auxiliary  is  not 
long,  but  can  only  be  quoted  here  in  brief,  omitting  much  inter- 
esting material,  some  of  which  has  already  been  used,  and 
touching  only  the  few  outstanding  lines : 

RErORT  OF  AUXILIARY  NO.  3,  March  1,  1899 

Shortly  after  the  organization  of  the  Society,  the  president 
appointed  a  Committee  on  Xurses  consisting  of  ^Irs.  White- 
law  Reid,  chairman,  and  Mrs.  W.  Lanman  Bull,  to  select 
nurses  and  arrange  for  their  transportation  and  to  make  all 
final  decisions  as  to  the  relations  of  the  Society  with  the 
Government  in  respect  to  nurses.  On  July  21,  Mrs.  Winthrop 
Cowdin  wa«  added  to  this  committee.  With  the  abandon- 
ment of  the  plan  for  the  hospital  ship,  the  scope  of  the 
Society's  work  was  much  enlarged,  as  it  was  then  decided 
to  place  trained  women  nurses  in  the  Army  hospitals.  It  was 
not  possible  to  follow  the  Red  Cross  rule  of  volunteer  service. 
Competent  trained  women  nurses  were  unable  in  most  cases 
to  work  without  salary,  many  having  others  dependent  upon 
them  for  support;  but  they  all  gave  evidence  of  patriotism  in 
being  willing  to  serve  for  much  less  than  they  would  ordi- 
narily receive  .  .  .  when  the  first  call  came  from  Santiago 
on  June  30,  the  committee  was  ready  to  respond. 

The  lirst  party  of  nurses  sent  by  the  Society  went  to  Tampa 
a  few  (lays  later  iiiwler  the  charge  of  ]\Iiss  Laura  1).  Gill.  It 
consisted  of  twelve  trained  nurses,  one  immune  nurse  and  one 
assistant.  A  second  and  third  detachment  followed,  con- 
sisting of  five  pliysieians,  forty-three  nurses  and  six  orderlies. 
[This  was  the  Lampa.'^as  party  already  described,  sent  in 
answer  to  Dr.  Lesser's  and  Dr.  La  Garde's  request.  Its 
wanderings  have  already  been  told.] 

The  following  letter  from  Colonel  Charles  R.  (ireeideaf 
will  show  how  ellieient  were  the  services  of  these  nurses  and 
how  much  a})preciatcd : 


56     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Headquarters  of  the  Army. 

Office  of  the  Chief  Surgeon, 

Ponce,  Puerto  Eico, 

July  31,  1898. 

Miss  Rutty, 

In  charge  Detachment  of  Nurses 
from  National  Red  Cross  Association, 

Dear  Miss  Rutty : 

I  desire  to  express  to  you,  on  behalf  of  the  Medical  De- 
partment in  the  field,  my  thanks  to  you  and  through  you  to 
the  ladies  under  your  charge,  for  the  services  you  have 
rendered  and  are  still  rendering  to  the  sick  soldiers  on  board 
the  Lampasas.  No  words  of  mine  can  express  my  apprecia- 
tion of  the  self-sacrificing  efforts  you  have  each  and  all  made 
and  your  unflinching  devotion  to  duty.  It  is  a  source  of  deep 
regret  to  me  that  you  should  have  been  surrounded  by  so 
many  discomforts  and  have  had  so  little  material  to  work 
with,  but  you  are  fully  cognizant  of  the  circumstances  under 
which  we  have  been  placed  since  our  sick  were  put  aboard 
the  Lampasas  and  it  is  unnecessary  for  me  to  say  any  more 
regarding  it.  Wishing  you  and  the  noble  association  of 
women  you  represent  every  success  and  hoping  if  my  duties 
are  continued  that  I  may  see  you  again  at  this  post,  I  am. 

Very  respectfully, 

Your  obedient  servant, 
(signed)  Charles  E.  Greexleaf,  Colonel, 

Chief  Surgeon  of  the  Army. 

As  no  more  nurses  were  able  to  go  to  Cuba  on  account  of 
the  outbreak  of  the  yellow  fever  there,  the  Government  only 
accepting  immunes,  the  Society  felt  that  the  next  greatest 
want  was  for  good  nurses  in  our  home  camps  and  Army  hos- 
pitals. The  appearance  of  typhoid  and  other  fevers  was  so 
sudden  and  overwhelming  in  the  different  regimental  and 
division  hospitals,  that  the  orderlies  were  unable  to  give  ade- 
quate service,  while  in  addition  many  sick  men  were  being 
brought  home  from  Cuba  on  the  different  transports.  It  was 
deemed  necessary  therefore  to  get  into  closer  relations  with 
the  Government,  in  orrler  that  our  nurses  might  be  accepted 
in  these  hospitals.  On  July  15  a  Special  Committee,  con- 
consisting  of  Mrs.  Whitelaw  Eeid,  Mrs.  Winthrop  Cowdin 
and  Mr.  Howard  Townsend,  was  sent  to  Washington  to  confer 
with  the  authorities  on  this  matter.  President  ^IcKinley 
considerately  granted  the  committee  an  immediate  interview 
and  very  kindly  arranged  a  conference  at  the  White  House, 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      57 

with  the  Secretary  of  War  and  the  Surgeon  General.  At  this 
conference,  the  committee  was  assured  of  the  cooperation 
of  the  Government.  General  Sternberg  agreed  to  meet  the 
ladies  again  in  New  York  the  next  day;  at  this  meeting  re- 
sults were  reached  which  were  stated  in  a  letter  from  General 
Sternberg  to  Mrs.  Keid  as  follows : 

"I  take  pleasure  in  confirming  by  letter  the  arrangements 
made  at  our  interview  in  New  York  on  the  17th  instant.  I 
am  quite  willing  to  employ  female  nurses  vouched  for  by 
yourself  as  Secretary  of  the  Red  Cross  Society  for  Mainte- 
nance of  Trained  Nurses.  I  had  previously  made  very  satis- 
factory arrangements  for  the  employment  of  trained  female 
nurses  through  a  committee  of  the  Daughters  of  the  Revolu- 
tion. As  I  said  to  you  during  our  interview,  I  recognize  the 
value  of  trained  female  nurses  in  general  hospitals  and  we 
expect  to  make  use  of  their  service  to  such  an  extent  as 
seems  to  be  desirable.  But  I  do  not  approve  of  sending  female 
nurses  with  troops  in  the  field,  or  to  camps  of  instruction. 
It  is  the  intention  to  transfer  the  seriously  sick  men  from 
our  field  hospitals  to  the  general  hospitals  as  soon  as  prac- 
ticable; and  we  wish  our  enlisted  men  of  the  Hospital  Corps 
to  take  care  of  the  sick  in  the  Division  Field  Hospitals  and 
in  camps  of  instruction,  so  that  they  may  be  fully  prepared 
to  perform  the  same  duties  when  the  troops  are  in  active 
operation. 

Among  these  privates  of  the  Hospital  Corps  who  constitute 
the  Eed  Cross  organization  of  the  regular  military  service 
and  who  are  non-combatants  in  accordance  with  the  terms  of 
the  Geneva  Convention,  we  have  many  medical  students  and 
even  graduates  in  medicine.  I  have  made  an  exception  with 
reference  to  sending  female  nurses  to  Cuba,  in  view  of  the  out- 
break of  yellow  fever  at  Santiago,  and  I  am  now  sending 
immune  nurses,  both  male  and  female,  for  duty  at  the  yellow 
fever  hospitals.  In  accordance  with  our  agreement,  you  are 
authorized  to  send  ten  female  trained  nurses,  selected  by 
yourself,  to  the  Leiter  Hospital  at  Camp  Thomas,  Georgia; 
ten  to  the  United  States  General  Hospital  at  Fort  ^lonroe, 
Virginia,  and  two  to  tbe  hospital  at  Fort  Wadsworth,  New 
York,  the  understanding  being  tluit  those  at  Fort  ^lonroe  and 
at  Fort  Wadsworth  shall  be  boarded  and  lodged  outside  of 
the  hospital. 

Thanking  you  very  sincerely  for  your  earnest  efforts  in  be- 
half of  our  sick  and  wounded  soldiers,  I  am, 

Yours  very  truly, 

(ii:oitGE  ^r.  Stkrxrerg. 


58    HISTORY  OP  AMERICAN  RED  CROSS  NURSING 

A  second  letter  enclosed  the  following  request  from 
Charleston : 

To  the  Surgeon  General,  U.  S.  A., 
Washington,  D.  C. 

I  would  recommend  that  twenty  nurses  be  ordered  to  this 
station  for  duty  in  St.  Francis  Xavier's  and  city  hospitals. 
Impossible  for  hospitals  to  obtain  sufficient  help. 
Clayton  Parkiiill, 

Major  and  Chief  Surgeon,  U.  S.  A. 
First  Division,  First  Corps. 

*         *         *         * 

In  answer  to  this  last  order,  twenty  nurses  went  to 
Charleston,  South  Carolina,  on  July  24,  under  Miss  Martha 
L.  Draper  who  showed  great  ability  in  arranging  for  the 
nurses  and  seeing  them  started  in  their  work  in  the  different 
hospitals,  Avhich  were  very  much  overcrowded. 

In  addition  to  this,  three  men  nurses,  graduates  of  the 
Mills  Training  School  -^  at  Bellevue,  were  sent  to  the  Marine 
Hospital  at  Staten  Island ;  and  ^liss  Marjorie  Henshall  went 
with  three  women  nurses  to  the  Post  Hospital  at  Fort  Wads- 
worth.  Additional  nurses  were  sent  to  Fort  Wadsworth  as 
the  need  became  greater,  till  their  number  finally  increased 
to  forty-one,  and  Miss  Henshall  had  two  hospitals  under  her 
care.  In  recognition  of  her  admirable  work  she  was  chosen 
as  the  head  of  the  party  of  nurses  afterward  sent  to  Manila. 

The  rest  of  the  nurses  left  at  Tampa  awaiting  orders  were 
now  sent  to  the  Leiter  Hospital,  near  Chattanooga,  and  ac- 
complished good  work  there,  though  the  service  was  very 
exacting.  Miss  Maud  Cromelien  was  sent  to  inspect  their 
work  and  reported  that  Major  Charter,  the  surgeon  in  charge, 
said  that  ''the  nurses  were  indispensable  to  him."  While 
there  she  visited  Chickamauga  Park  to  examine  the  Division 
Hospitals  at  Camp  George  II.  Thomas  and  reported  as  fol- 
lows :  "One  glance  was  enough  to  convince  me  that  trained 
nurses  were  greatly  needed  to  care  for  the  sick,  most  of 
whom  were  suffering  from  typhoid  fever.  The  majority  of 
patients  were  in  a  wretched  condition  and  needed  skilled  nurs- 
ing to  give  them  even  a  chance  to  recover.  I  called  upon 
Colonel  J.  V.  li.  Iloff,  Chief  Surgeon  in  the  Field,  and  stated 
to  him  that  'the  Red  Cross  is  ready  to  put  nurses  in  at  least 

^  The  school  for  training  men  as  nurses,  then  housed  in  a  fine  building 
given  to  Bellevue  by  Mr.  D.  O.  Mills,  ^Slrs.  Reid's  father,  has  since  been 
discontinued. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      69 

one  division  hospital;  to  erect  the  tents  needed  for  nurses 
and  to  defray  all  expenses,  such  as  provisions,  etc.,  and  to 
provide  them  with  a  competent  matron ;  and  all  to  be  subject 
to  whatever  orders  or  discipline  the  surgeon  in  charge  ad- 
vises.' At  first  it  was  not  considered  wise  to  expose  women 
to  the  hardships  of  life  in  a  field  hospital.  However,  in  the 
end  the  exigencies  of  the  situation  prevailed  and  Colonel  Hoff 
was  kind  enougii  to  recommend  my  statement  to  General 
Sternberg,  Surgeon  General  of  the  Army," 

The  following  letter  from  Major  R.  E.  Griffin,  Surgeon  in 
Charge,  to  ]\Irs.  IJeid  is  a  statement  as  to  the  work  done  by 
tile  lied  Cross  nurses  at  Chickamauga : 

"Dear  Madam: 

The  Ked  Cross  Society  for  the  Maintenance  of  Trained 
Xurses  can  truly  say  'Veni,  vidi,  vici,'  for  without  them 
I  would  have  been  unable  to  have  stayed  the  dread  disease 
that  has  been  raging  in  our  camp.  Their  helping  hand 
came  in  the  hour  of  need  and  the  history  of  the  future  shall 
record  each  and  every  member  of  the  Red  Cross  Society 
as  the  guardian  angels  of  the  Sternberg  Hospital,  My 
experience  of  years  of  hospital  work  has  enabled  me  to  judge 
of  the  abilities  of  nurses,  and  I  am  proud  to  say  that  this 
corps  of  nurses  under  the  excellent  supervision  of  Miss  Max- 
well has  never  before  been  equalled. 

As  to  the  untiring  efforts  of  ]\Iiss  Cromelien  and  her  suc- 
cess after  knocking  at  the  door  of  the  department  for  days  to 
be  allowed  to  admit  your  Society,  words  can  never  express 
the  praise  due  her,  ^liss  Cromelien  was  here  on  the  ground 
the  day  1  put  my  first  tent  at  the  hospital  and  immediately 
began  building  pavilions  for  the  nurses.  .  .  ." 

Miss  Cromelien  said :  "Tlie  work  begun  as  an  experiment 
has  proved  beyond  doul)t  the  ability  of  women  to  work  as 
trained  nurses  in  the  field  hospitals  and  the  small  amount  of 
sickness  among  us  certainly  sbows  that  we  have  the  physical 
endurance  needed  for  such  work  under  such  peculiarly  trying 
circumstances.'' 

Ten  nurses  were  at  first  sent  to  the  General  Hospital  at 
Fortress  M()uro<>  in  charge  of  ]\fiss  Lida  G.  Starr,  but  later 
others  followed  and  at  one  time  tlie  number  maintained  there 
by  the  Society  was  as  large  as  forty-five.  Miss  Starr  re- 
mained at  Fortress  Monroe  until  late  in  January,  when  she 
was  recalled  to  Xew  ^'ork  to  take  charge  of  one  of  the  parties 
of  nurses  sent  to  ^lanila. 


60     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  August  when  the  Government  bought  the  Missouri  for 
a  hospital  ship,  trained  male  nurses  were  offered  to  Major 
Arthur,  the  officer-in-charge.  These  men  were  chiefly  selected 
from  the  Mills  Training  School  and  a  few  with  the  assistance 
of  Dr.  Fisher,  of  the  Presbyterian  Hospital.  They  fully  de- 
served Major  Arthur's  commendation  and  on  the  second  and 
third  trips  their  number  was  increased  to  fifteen. 

Much  good  was  also  done  by  our  representative  at  Fort 
Hamilton.  There  the  work  was  in  charge  of  Miss  M.  E. 
Wood. 

Soon  after  the  first  party  of  nurses  had  been  sent  to 
Fortress  Monroe  and  Leiter  Hospital,  Dr.  Anita  Newcomb 
McGee,  director  of  the  1).  A.  K.  Hospital  Corps,  visited  New 
York  to  consult  with  the  Committee  on  Nurses  as  to  the 
best  means  of  cooperating  with  the  Government  in  regard 
to  the  distinction  between  Government  nurses  and  nurses  sent 
out  by  the  Society  for  the  Maintenance  of  Trained  Nurses. 
It  was  agreed  that  the  Society  would  cooperate  with  the 
Government  in  every  way  and  to  make  everything  absolutely 
clear,  Mrs.  Cowdin,  for  the  Committee  on  Nurses,  visited 
Washington.  After  her  consultation  with  the  members  of 
the  Hospital  Corps,  a  fund  of  $500  was  placed  in  the  hands 
of  Mrs.  Amos  G.  Draper,  the  treasurer,  to  pay  for  immediate 
transportation  expenses  for  nurses,  as  Congress  had  not 
appropriated  any  sum  for  this  purpose.  In  all  $5,425.80 
were  so  disbursed  by  the  Society,  until  the  Government  as- 
sumed all  further  transportation  charges  on  September  6.  It 
was  also  agreed  that  the  Society  would  allow  the  nurses  to 
sign  Government  contracts  when  so  required,  the  Society  to 
pay  their  maintenance  and  transportation  in  some  cases,  in 
others  only  transportation. 

A  field  nearer  home  was  opened  at  Montauk.  By  the 
courtesy  of  the  ^Managers  of  St.  Luke's  Hospital,  Mrs.  Quin- 
tard,  their  superintendent,  was  given  leave  of  absence,  so 
that  she  was  able  to  take  charge  of  this  department.  .  .  . 

Miss  Young  represented  the  Society  at  the  Detention  Hos- 
pital at  Camp  Wikoff,  with  fifty  women  under  her.  .  .  . 

In  all,  Mrs.  Quintard  and  Miss  Young  had  ten  thousand 
patients  under  their  care. 

The  following  is  a  summary  of  the  nurses^  partly  or  wholly 
maintained  by  the  Society : 

Fort  Wadsworth :  Forty-one  nurses  were  maintained  and 

paid  by  the  Society. 
Charleston:  Twenty  nurses. 
Leiter  Hospital :  Ten  nurses. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      61 

Governor's  Island :  Six  nurses. 

Tampa :  Five  nurses. 

The  Convalescent  Home  for  Nurses,  Rowayton,  Connecti- 
cut:  One  nurse. 

Atlantic  Highlands:  Five  nurses  and  one  surgeon. 

On  hospital  cars :  Four  nurses. 

Camp  Black :  Salaries  and  laundry  bills  of  forty-two  nurses 
were  paid  by  the  Society;  the  Government  provided  army 
tents  and  rations. 

Fort  Ilaniilton  :  Salaries  and  laundry  bills  of  twenty-three 
nurses  were  paid  by  the  Society;  the  Government  pro- 
vided army  tents  and  rations. 

Fortress  ]\Ionroe :  Salaries  of  forty-three  nurses  were  paid 
by  the  Government;  the  Society  provided  maintenance 
for  these,  and  salaries  and  maintenance  for  two  lied 
Cross  nurses. 

Hospital  ship  Missouri:  Salaries  of  fifteen  men  nurses  were 
partially  paid  by  the  Society;  these  nurses  were  main- 
tained by  the  Government. 
Bedloe's  Island:  One  nurse  was  paid  by  the  Society  and  re- 
ceived army  rations :  There  was  also  one  vounteer  lied 
Cross  nurse  who  received  army  rations. 

Portsmouth:  Six  men  nurses  were  paid  by  the  Society. 
They  received  army  rations,  but  their  transportation  was 
assumed  by  the  Society. 

General  Hospital,  Montauk  Point:  Almost  all  of  the  one 
hundred  and  fifty  nurses  under  ]\lrs.  Quintard's  superin- 
tendence signed  the  Government  contract.  Mrs.  Quin- 
tard's salary  continued  to  be  paid  by  the  Society,  and 
large  supplies  of  all  kinds  for  the  nurses  were  selected 
by  Auxiliary  No.  3  and  their  expenses  to  Montauk 
paid. 

Sternberg  Hospital,  Chickamauga :  Sixty-four  nurses  sent 
by  the  Society  received  (Jovernment  pay  and  rations. 
Additional  nuiintenance  and  supplies  for  these  and  for 
ninety-six  other  nurses  ordered  there  by  tlie  Government, 
were  furnished  by  the  Society. 

Long  Island  City  belief  Station:  Twcnty-niiio  nurses  and 
two  surgeons  were  paid  by  the  Society  and  maintained  by 
the  Kelief  Station. 

In  the  tents,  ^lontauk  Station:  Owe  iiurse  was  ])aid  by  the 
Society  and  one  volunteer  nurse  was  maintained  by  the 
Relief  Committee. 

One  nurse  was  sui)porte(l  in  Miss  Clianler's  hospital. 

Nassau  Hosjiital  and  Annex,  Hcnijistead:  Twenty  nurses 
were  paid  by  the  Society  and  maintained  by  the  Hospital. 


62     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Home  for  Convalescent  Soldiers,  Sag  Harbor:  Six  nurses 
were  paid  by  the  Society  and  maintained  by  the  citizens 
of  Sag  Harbor. 

Convalescent  Home  for  the  8th  Regiment  at  Hunter's 
Island:  Two  nurses  were  paid  by  the  Society  and  main- 
tained by  funds  raised  by  Miss  Chauncey. 

U.  S.  Transport  Lampasas:  of  the  twenty-nine  nurses  on 
this  transport,  many  were  volunteers,  and  the  salaries 
of  some  and  maintenance  of  all  were  borne  by  the 
Society. 

Nurses  were  also  supplied  on  emergency  calls  to  the  Eighth 
and  Ninth  Regiment  armories.  .  .  . 

With  the  necessity  of  reinforcing  our  troops  in  the  Philip- 
pines came  a  new  opportunity  which  the  Society  was  glad  to 
grasp.  Knowing  that  General  Otis  had  asked  for  nurses  for 
Manila  and  hearing  that  they  were  greatly  needed  there,  the 
Executive  Committee  decided  to  apply  the  funds  remaining 
in  the  treasury  for  this  purpose  and  after  a  consultation  be- 
tween Mrs.  Eeid  and  Secretary  Alger,  the  suggestion  of  send- 
ing nurses  to  the  Pliilippines  was  favorably  received  by  the 
Government.  While  awaiting  the  official  orders  from  Wash- 
ington, a  Committee  on  Nurses  was  appointed  by  the  Presi- 
dent, consisting  of  Mrs.  Whitelaw  Keid,  chairman;  Mrs. 
William  S.  Cowles,  Mrs.  Charles  B.  Alexander,  Mrs.  Edmund 
L.  Baylies  and  Mrs.  James  Speyer,  ex-officio.  A  formal  offer 
was  made  by  the  Society  to  send  nurses  to  the  Philippines, 
and  on  January  8  the  following  letter  from  Adjutant  General 
Corbin  was  received  by  the  chairman  :  .  .  . 

"We  have  determinned  to  take  three  transports  from  here 
to  Manila,  about  eighteen  hundred  men  on  each.  The  Secre- 
tary of  War  approves  your  sending  four  nurses  on  each.  The 
first  ship  will  leave  the  loth,  the  other  tw-o  before  Feb- 
ruary 1."  .  .  . 

No  time  was  lost  in  completing  arrangements  which  had 
already  been  carefully  planned,  so  that  though  for  the  first 
party  the  notice  was  short,  it  was  possible  to  send  the 
nurses  properly  equipped  and  provided  for.  The  latter  were 
most  carefully  selected,  many  of  them  having  already  done 
valualjle  work  for  the  Society  during  the  past  summer.  They 
were  personally  instructed  in  every  case  by  members  of  the 
committee,  as  to  their  duties.  Tlie  transport  was  ins])ected 
by  the  chairman  and  her  committee,  letters  of  introduction 
from  promiiK'iit  men  were  secured  for  the  nurses  and  every- 
thing possible  was  done  for  their  comfort  and  success  on  the 
expedition.     All   signed   contracts  with  the   Society   for  six 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR      63 

montlis'  duty  in  Manila  and  on  the  transports  to  take  care 
of  tlie  sick  in  the  hospital. 

Miss  Ilenshall  sailed  on  the  Grant  January  19,  with  Miss 
Dowliiig,  ^liss  Tov  ne  and  Miss  Ridley.  Miss  Henshall  was 
not  only  in  charge  of  this  division  but  was  the  superintendent 
of  the  entire  party  of  twelve  nurses.  Miss  Starr  sailed  on 
tlie  Sherman,  February  2,  in  charge  of  the  second  detachment, 
taking  with  her  Miss  Betts,  Miss  Sara  Shaw  and  Miss  Agnes 
Shaw.  The  last  transport,  the  Sheridan,  left  February  19 
with  Miss  Gladwin  in  charge  of  the  party  of  nurses,  who 
were  Miss  Stirk,  Miss  Mount  and  Miss  Holmes.^" 

The  report  of  the  committee,  with  the  financial  statement 
for  which  ^Irs.  Speyer  justly  deserved  especial  credit,  was 
cordially  commended  by  President  McKinley  in  letters  to  Mrs. 
Speyer  in  April,  1899. 

Among  the  names  mentioned  in  the  Report  are  those  of 
several  volunteer  aides  of  special  ability  and  usefulness,  and 
two,  whose  work  began  with  the  Lampasas  expedition,  not  only 
accomplished  excellent  things  in  the  general  field  of  auxiliary 
service  but  commanded  the  special  regard  of  nurses  for  the 
strong  influence  they  lent  in  support  of  the  professional  nursing 
staff. 

One  of  the  first  women  to  register  at  the  Red  Cross  Hospital 

**  American  National  Red  Cross  Relief  Committee  Reports,  pp.  41-59. 

The  contract  signed  bv  nurses  in  tlie  Philippines  ran  as  follows: 

THIS  CONTRACT,  entered  into  this day  of 1899, 

at  New  York  City,  in  the  State  of  New  York,  between  the  Red  Cross 
Society   for   Maintenance   of   Trained   Nurses   Auxiliary   No.   3,   and   Miss 

of    in  the  State  of    witnesseth : 

That  for  the  consideration  hereinafter  mentioned,  the  said  Miss   

promises  and  agrees  to  perform  the  duties  of  Nurse  on  United  States 
Transports,  or  in  the  Philippines.  The  minimum  term  of  service  shall 
be  six  months  in  the  Philippines  in  addition  to  the  time  of  transportation, 
unless  otherwise  determined  by  the  Military  Commander,  or  by  the  Red 
Cross  Society  for  Maintenance  of  Trained  Nurses  Auxiliary  No.  3,  as 
represented  by  the  Superintendent  of  Nurses.  The  said  Red  Cross  Society 
for  Maintenance  of  Trained  Nurses  Auxiliary  No.   3  promises  and  agrees 

to  pay,   or   cause  to   be   paid   to  tlie   said  ]Miss    the   sum   of 

■$tK)  per  month,  and  to  furnish  Maintenance,  Laundry.  Medical  Attendance 
during  her  term  of  service,  and  the  assurance  of  means  for  a  suitable 
return  home. 

AND  IT  IS  FURTHERMORE  AGREED  that  tlie  said  Miss 

shall  receive  transportation  while  on  duty,  and  on  departure  from  and 
return  to  her  place  of  legal  residence,  from  the  Government.  She  shall 
agree  to  recognize  the  authority  of  the  Superintendent  of  Nurses  appointed 
bv  the  Auxiliarv. 

Miss   

Signed,  sealed   aTid   dclivei'cd   in   the   jiresence  of    


64     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  executive  service  was  Laura  Drake  Gill,  a  daughter  of  the 
New  England  Pilgrims  and  Puritans.  She  was  a  college 
woman  of  broad  training  and  was  placed  in  general  charge  of 
the  Lampasas  party  by  Mr.  Wardwell.  Later,  she  was  sent  to 
Chickamauga  to  place  the  nurses  in  the  Leiter  Hospital  and  at 
all  other  times,  had  charge  of  all  the  transportation  of  nurses  to 
and  from  New  York,  meeting  and  dispatching  them  by  day  or 
night. 

Another  prominent  aide  was  Margaret  Livingston  Chanler, 
of  Knickerbocker  circles,  who  after  the  war,  married  Rich- 
ard Aldrich.  Both  of  these  aides  gave  strong  support  to  the 
post-war  campaign  of  placing  nurses  permanently  in  army  hos- 
pitals. 

Our  space  allows  no  full  detail  of  the  many  nurses  who  de- 
serve mention  for  their  part  in  the  Spanish- American  War  epi- 
sode, but  a  few  names  must  be  taken  from  the  Army  Nurse 
Corps  Index.  Some  of  these  became  distinguished  in  other 
ways  later  on.  Not  a  few  reappeared  in  subsequent  Army  and 
Navy  nursing  and  Red  Cross  organization.  Two  members  of 
the  Lampasas  party,  Beatrice  Von  Homrigh  and  Mary  E.  Glad- 
win, will  be  met  more  than  once  in  later  pages. 

Esther  V.  Hasson,  who  served  in  1898  on  the  Relief,  became 
Superintendent  of  the  Navy  Nurse  Corps  (1908)  and  Dita 
Kinney,  as  already  told,  of  the  Army  Nurse  Corps. 

There  were  women  of  eminent  distinction  in  training  school 
work  then  and  later, — among  them  Nancy  Cadmus,  whose 
administrative  career  in  hospitals  was  unbroken  for  years, 
except  for  the  war  service ;  Frances  A.  Stone,  associated  with 
Miss  Maxwell  at  the  Presbyterian  Hospital  and  Mrs.  Louns- 
bery,  with  others  already  mentioned. 

Especially  distinctive  was  the  work  of  the  group  of  women 
who,  after  the  war,  carried  out  the  organization  of  modern 
training  schools  in  the  civil  hospitals  of  Cuba  and  Porto  Rico, 
Lucy  Quintard,  Sarah  S.  Henry,  M.  Eugenie  Hibbard,  ^lary  A. 
O'Donnell,  Amy  E.  Pope  and  others.^'''  Mary  J.  McCloud 
organized  a  school  in  the  military  hospital  at  ]\rexico  City. 
Elizabeth  Stack  taught  the  hospital  corps  men  nursing  and  die- 
tetics at  Angel  Island.  On  the  Army  Nurse  Corps  Index,  too, 
one  finds  Yssabella  G.  Waters,  whose  later  compilation  of  public 
health  nursing  agencies  in  the  L^nited  States,  kept  yearly  up  to 
date,  has  become  a  classic  of  its  kind;  Lydia  Ilolman,  one  of 

""History  of  Nursing,"  Vol.  IIT,  Cliap.  VI. 


EPISODE  OF  THE  SPANISH-AMERICAN  WAR     65 

the  earliest  pioneers  in  rural  nursing;  Jane  Hodson,  author  of 
the  well-known  book  previously  mentioned ;  Isabel  Jean  Walton, 
a  New  York  Hospital  nurse  since  then  identified  with  St. 
John's  Floating  Hospital  and  other  public  health  nursing  work. 

Some  of  those  no  longer  living  must  be  named.  Clara  L. 
Maas  was  a  young  Army  nurse  who  during  the  investigation 
of  yellow  fever  transmission  in  1900-1901,  in  Cuba,  insisted  on 
being  allowed  to  volunteer  for  the  experimental  service.  She 
was  accordingly  bitten  by  an  infected  mosquito  and  died  as  a 
result  of  the  too-perfect  demonstration.  She  was  buried  with 
military  honors  and  is  mentioned  with  respect  in  several  official 
records.  Louisa  Parsons,  English  born,  and  a  Spanish-Ameri- 
can war  nurse,  died  in  the  British  Army  service  in  1915. 
Emma  Duensing,  German  born,  died  in  the  same  year  in  the 
service  of  Germany.  Kose  Kaplan,  who  had  become  head  of 
a  hospital  in  Jerusalem,  died  while  caring  for  refugees  in  1917. 
A  little  group  of  Spanish-American  war  nurses  lived  to  serve 
throughout  the  World  War.  They  were :  Samantha  C.  Plum- 
mer,  Edith  Rutley,  Helen  M.  Pickel,  M.  Estelle  Hine  and 
Carrie    L.  Howard. 

After  the  w-ar  there  were  many  testimonials  to  the  usefulness 
of  the  Army  nurse.  It  may  suffice  to  repeat  here  the  conclusion 
reached  by  the  Congressional  committee  appointed  to  inquire 
into  the  conduct  of  the  war.  In  its  report,  among  other  recom- 
mendations was  this  one:  "...  Needed  by  the  Medical  De- 
partment in  the  future;  a  Reserve  Corps  of  selected  trained 
women  nurses."  ~^ 

Its  estimate  of  the  nurses  ran  as  follows: 

In  the  last  twenty  years  the  value,  the  efficiency  and  the 
availal)ility  of  well-trained  women  nurses  lias  been  demon- 
strated and  it  is  much  to  be  regretted  that  this  fact  was  not 
fully  realized  by  the  medical  officers  of  the  army  Avhen  the 
war  conunenced.  It  is  to  be  remembered,  though,  that  in 
.  military  hospitals  in  the  field  women  liad  heen  em])loyed  as 
nurses,  if  ;it  all,  only  to  a  very  limited  extent,  and  there  was 
good  reason  for  questioning  whether  a  field  hospital  with  a 
moving  army  was  any  place  for  a  woman.  Our  recent  ex- 
perience may  justly  he  held  to  have  shown  that  female  nurses, 
properly  trained  and  ])roperly  selected,  can  he  duly  cared  for 
and  are  of  the  greatest  value.  Those  who  have  l)een  serving 
under  contract  in  our  military  hospitals,  and  there  have  been 

*  "Conduct  of  War  with  Spain,"  Vol.  I,  p.   lS!t. 


66     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

about  fifteen  hundred  of  these,  have  with  scarcely  an  excep- 
tion done  excellent  work  and  it  is  to  the  high  credit  of  the 
American  soldier  that  not  a  single  complaint  has  been  made 
by  any  nurse  of  personal  discourtesy.^** 

»  "Conduct  of  War  with  Spain,"  Vol.  I,  p.  171. 


CHAPTER  III 

AFFILIATION    OF    THE    AMERICAN    KED    CROSS    WITH    THE   NUESEs' 

ASSOCIATION 

The  Army  Nurse  Corps — Reorganizaiion  of  the  Red  Cross  in 
1905 — The  American  Federation  of  Associated  Alumnw 
Accepts  Affiliation  ivith  the  American  Red  Cross — Develop- 
ment of  the  Nursing  Service — Farticipation  in  Disaster 
Relief 

THE  war  was  not  yet  over  when  the  idea  of  securing  the 
existence  of  the  Army  Nurse  Corps  by  legislation  was 
agitated  by  various  war  workers.  In  December,  1898, 
Dr.  McGee  went  to  New  York  to  suggest  to  Mrs.  Quintard  and 
other  nurses  with  whom  she  had  been  in  close  touch,  the  wisdom 
of  attempting  such  legislation.  While  she,  as  a  subordinate  of 
the  War  Department,  could  not  initiate  it,  she  would,  she 
promised,  do  everything  in  her  power  to  obtain  Congressional 
approval  of  an  act  that  should  not  be  too  great  a  departure  from 
the  methods  and  ideas  of  the  Army. 

At  almost  the  same  time  Mrs.  Kobb  went  to  New  York  to  lay 
a  similar  proposal  before  nurses  and  Auxiliary  members,  all  of 
whom  received  the  suggestion  with  enthusiasm. 

Tn  view  of  the  Army  Nurse  legislation  of  1920,  a  full  account 
of  that  first  campaign  would  be  interesting,  but  we  must  limit 
ourselves  to  a  brief  summary  of  its  main  features. 

A  committee  of  women,  many  of  them  of  national  distinction, 
with  prominent  nurses,  promoted  the  bill.  ]\rrs.  Winthrop  Cow- 
din  was  its  first  chairman  and  among  those  who,  in  the  course 
of  its  duration,  served  on  the  "Committee  to  Secure  by  Act  of 
Congress  the  Employment  of  Women  Nurses  in  the  Hospital 
Service  of  the  United  States  Army,"  were  Louisa  Lee  Schuy- 
ler, veteran  of  the  Sanitary  (Commission  of  the  Civil  War;  ]\rrs, 
William  Osborn  and  ^frs.  floseph  Hobson,  two  of  the  organizers 
of  the  Rellevue  School  for  Nurses;  ^frs.  Amos  G.  Draper, 
prominent  in  the  Daughters  of  the  American  lievolution  ;  ]\Irs. 

67 


68      HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Wliitelaw  Reid,  unfailingly  helpful  in  nursing  matters  and 
lavish  of  her  influence  and  means ;  Margaret  Livingston  Chanler 
and  Laura  Drake  Gill,  who  had  been  two  of  the  most  hardwork- 
ing of  the  volunteer  aides ;  Mrs.  W.  N,  Armstrong,  of  Hampton, 
Virginia ;  Mrs.  Bayard  Cutting ;  Mrs.  C  K.  Meredith,  Mrs. 
Harriet  Blaine  Beale,  Mrs.  John  S.  T.  Hull,  Mrs.  Hawley 
(the  English  nurse,  mentioned  earlier  as  Miss  Horner  and 
afterwards  married  to  Senator  Hawley  of  Connecticut),  with 
Anna  C  Maxwell,  Irene  H.  Sutlift'e,  Isabel  Hampton  Robb, 
Ellen  ]\L  Wood,  Linda  Richards,  ]\I.  Adelaide  Nutting,  Mary 
F.  Wadley,  Georgia  M.  I^evins  and  Lucy  W,  Quintard.  Miss 
Nutting  was  the  chairman  of  the  committee  of  nurses  and 
directed  the  work  of  informing  the  rank  and  file  of  the  points 
at  issue.  She  was  then  superintendent  and  principal  of  the 
Johns  Hopkins  training  school  where  she  had  entered  as  one  of 
Miss  Hampton's  first  class  and  in  which  she  had  risen  to  the 
position  of  head  of  the  school  on  Miss  Hampton's  marriage. 
Born  in  Canada^  Miss  Nutting's  brilliant  mind  and  untiring 
energy  turned  with  special  attention  to  educational  nursing 
problems  and  she  will  be  met  in  the  forefront  of  such  circles  of 
activity,  as  we  go  through  these  pages.  Her  work  at  the  Johns 
Hopkins  was  so  original  and  effective  that  she  was  called  thence 
to  direct  the  Department  of  Nursing  and  Health  at  Teachers 
College,  where  she  surrounded  herself  with  ardent  young  enthu- 
siasts and  made  an  international  reputation  for  her  department. 
In  the  work  for  the  Army  Nurse  Bill  her  executive  ability  was 
for  the  first  time  shown  outside  of  the  hospital,  for  there  was 
then  no  nursing  journal,  no  close  network  of  central  and  local 
associations  to  facilitate  communication.     She  said,  later: 

One  of  the  things  that  makes  that  correspondence  stand 
out  in  my  memory  is  the  fact  tliat  for  the  first  time  in  train- 
ing school  work  I  had  some  help  from  a  stenographer.  The 
New  Y(jrk  women  insisted  upon  my  using  such  assistance, 
which  I  rather  timorously  did  to  a  small  degree. 

This  was  the  first  time  nurses  had   approached   Congress, 
Miss  Nutting  wrote : 

One  incident  wliich  stands  out  rather  clearly  was  a  hearing 
by  the  Military  Committee  of  the  House  or  Senate,  I  forget 
which,  where  I  had  to  summon  ])y  telegram  Mrs.  Isabel  Robb, 
Miss  Mclsaac,  Miss  Maxwell  and  various  others,  including,  I 


REORGANIZATION  AND  AFFILIATION  69 

think,  Dr.  Billings,  who  gave  us  constant  help  and  advice.  At 
the  beginning  of  the  hearing  in  Washington,  in  walked  Mrs. 
Joseph  Hobson,  who  had  heard  of  it  and  wanted  to  give  her 
point  of  view  on  the  importance  of  good  nursing.  1  remem- 
ber what  an  ordeal  it  was,  because  as  chairman  1  had  to  intro- 
duce each  member  and  explain  who  he  or  she  was  and  why 
his  views  and  opinions  would  bo  entitled  to  respect  and 
when  it  came  to  Dr.  Welch,  who  was  there  and  spoke  splen- 
didly for  us,  I  felt  paralyzed. 

Powerful  yet  intangible  opposition  to  the  bill  was  met  with. 
It  seemed  to  be  especially  directed  against  the  professional 
requirements  asked  for  and  the  stipulation  that  the  head  of  the 
Army  Nurse  Corps  should  be  a  nurse.  The  committee  and  the 
entire  nursing  profession  back  of  them  regarded  these  require- 
ments and  the  claim  for  a  nurse  superintendent  as  fundamental. 
In  the  process  of  overcoming  the  opposition,  Margaret  Chanler 
volunteered  no  less  a  service  than  to  make  a  trip  to  the  Philip- 
pines, to  investigate  persistent  unfriendly  rumors  that  appar- 
ently came  from  Luzon  and  were  brought  to  members  of  Con- 
gress in  depreciation  of  the  morale  of  women  nurses  in  the 
Army. 

There  had  indeed  been  some  unfortunate  selections  made  in 
the  early  part  of  Philippine  war  nursing,  when  western  Red 
Cross  societies  had  unwittingly  recommended  several  women 
of  unsuitable  type,  who  had  been  sent  home  in  disgrace.  But 
when  Miss  Chanler  visited  Manila  (summer  of  1899)  there  was 
only  the  carefully  chosen  staff  of  seventy-five  nurses  sent  out  by 
the  Auxiliary  No.  3,  working  under  Colonel  Grecnleaf,  who 
was  their  staunch  friend.  It  was  clear  that  the  hostility  of 
the  opposition  did  not  then  emanate  from  JNfanila,  and  myster- 
iously enough,  with  Miss  Chanlcr's  visit  it  was  effectually 
silenced. 

The  bill  sponsored  by  the  committee  was  brought  up  in 
Congress  on  January  24,  1899,  but  failed  to  pass.  Kesolute  in 
their  determination,  the  committee  continued  their  work 
through  1900.  They  had  at  first  asked  for  a  "Nursing  Service 
Commission"  and  educational  recpiirements  alike  for  the  entire 
staff,  i.e.,  "General  hospital  training  of  not  less  than  two 
years."  Three  years'  training  was  then  established  in  certain 
large  schools  and  was  being  rapidly  extended.  !Many  nurses, 
too,  were  taking  postgraduate  courses. 

The  contest  ended  in  a  reasonably  satisfactory  compromise. 


70     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  the  committee  finally  agreed  to  accept  a  section  in  the  Army 
Reorganization  Bill  of  1900-1901.  This  was  the  section  pre- 
viously referred  to,  drafted  by  Dr.  McGee,  at  the  request 
of  the  Surgeon  General,  on  what  seemed  to  the  War  Depart- 
ment acceptable  lines.  The  committee  obtained  the  insertion 
of  an  amendment  to  it  specifying  in  part,  for  the  superintend- 
ent, the  educational  qualifications  they  had  wished  to  secure 
throughout  the  staff.  Thus  amended.  Section  19,  as  it  was 
numbered,  read  (omitting  unessential  details)  : 

That  the  Nurse  Corps  (female)  shall  consist  of  one  super- 
intendent, who  shall  be  a  graduate  of  a  hospital  training 
school  having  a  course  of  instruction  of  not  less  than  two 
years,  and  of  as  many  chief  nurses,  nurses  and  reserve 
nurses  as  may  be  needed,  provided  that  tliey  shall  be  grad- 
uates of  hospital  training  schools  and  sliall  have  passed  a 
satisfactory  professional;,  moral,  mental  and  physical  examina- 
tion.^ 

The  bill  was  signed  by  the  President  on  February  2,  1901, 
and  the  nurse  selected  by  Dr.  McGee  to  be  her  successor  was 
duly  appointed. 

Mrs.  Dita  H.  Kinney,  the  new  head  of  the  Army  N^urse 
Corps,  had  had  active  service  during  the  war,  chiefly  in  the 
West  and  Southwest.  She  was  a  New  York  State  woman, 
trained  at  the  Massachusetts  General  Hospital  (class  of  1892.) 
Her  experience  before  the  war  had  been  varied  and  responsible 
and  she  had  carried  on  some  pioneer  work  in  teaching  the 
elements  of  nursing  to  mothers  of  families  on  social  settlement 
lines.  Mrs.  Kinney  had  earlier  shown  her  courage  by  making 
the  first  attack  in  print  on  bogiis  schools  for  nurses. 

^Armv  Reorganization  Act  of  1901— February  2,  1901,  Sec.  19,  Vol.  31, 
U.   R.  Statutes  at  Larj^e.  p.  748. 

Tiie  "Special  Coniniitlee  in  Charpe  of  the  Bill"  during  the  5C)th  Congress 
were:  Miss  ^largaret  T.ivingston  Clianler,  Mrs.  Harriet  Blaine  Beale,  INlrs. 
Joseph  Hobson,  Mrs.  ^^'illiam  Sheffield  Cowles.  Mrs.  Joseph  R.  Hawley, 
Mrs.  Amos  G.  Draper,  I\Irs.  Jolin   S.  T.  Hull,  ]\Iiss  Georgia  Xevins. 

The  Navv  Nurse  Coijjs  soon  followed.  It  was  orgaTiized  definitely  in 
1901;  the  ^irst  effort  to  pass  a  bill  in  Congress  was  made  in  190.3:  final 
passage  of  the  Bill  came  in  1908.  Navv  Appropriation  Act  of  May  13, 
1008,  Vol.  35,  U.  S.  Statutes  at  Large,  j).  129.  Dr.  McGee  helped  in 
framing  the  Navy  Nurse  Corjis  Bill  also  and  tlrougli  her  efforts  various 
appro])iiat ion  items  bent'dtiiig  bofh  services  were  secured.  In  view  f)f 
the  later  bestowal  of  "Hank"  mi  Army  nurses,  it  is  inleresting  to  know 
that  Dr.  ]\lcGce  opened  tlie  snliject  of  rank  with  the  Surgeon  General  at 
the  time  of  drafting  "Section  19."  J^ut  tlie  Army  attitude  then  was 
immovably  ojijiosed  to  any  such   innovation. 


REORGANIZATION  AND  AFFILIATION  71 

The  first  few  years  after  the  war  were  full  of  reorganization 
plans,  both  in  the  American  lied  Cross  and  in  nursing  societies. 
The  lessons  of  the  war  were  not  forgotten  and  women  in  New 
York  and  elsewhere,  who  had  been  at  the  head  of  relief  and 
nursing  work,  held  to  the  Red  Cross,  hoping  to  continue  the 
efficient  system  they  had  done  so  much  to  develop.  In  that 
period  also,  the  two  nursing  societies,  the  Superintendents' 
Society  and  the  Associated  Alumnae,  had  joined  in  a  free 
affiliation  for  international  purposes,  under  the  name  The 
American  Federation  of  Nurses,  each  one  retaining  its  corpor- 
ate identity. 

At  a  meeting  of  the  Superintendents'  Society  (October, 
1903),  a  resolution  had  been  adopted  giving  its  councillors 
power  to  act  for  the  society  in  any  public  question  that  might 
arise  during  the  year.  This  action  had  been  specifically  taken 
with  a  view  to  future  union  with  the  Red  Cross,  for  which  they 
cherished  a  desire.  The  Associated  Alumnte  were  equally  alive 
to  this  possibility,  one  of  the  great  questions  of  that  day,  and  a 
concerted  effort  to  open  np  a  way  of  affiliation  with  the  Red 
Cross  was  made  in  the  winter  of  190-i  by  executive  officers  of 
the  two  societies.  The  American  Journal  of  Nursing  said  in 
April,  1904: 

On  February  23,  a  number  of  well-known  women  in  the 
nursing  profession  came  together  in  New  York  and  quite 
informally  a  group  of  New  York  women  met  with  them 
in  the  e\ening  to  discussion  questions  of  importance  to  nurses. 

The  out-of-town  members  present  were  ^lary  M.  Riddle, 
president  of  the  Associated  Alumna\;  M.  Adelaide  Nutting, 
president  of  the  American  Federation  of  Nurses;  Isa- 
bel ^Iclsaac,  president  of  the  American  Journal  of  Nurs- 
ing Company;  Sophia  F.  Palmer,  editor  of  the  American 
Journal  of  NuKsin>g.  and  tlie  five  Chicago  members  of  the 
class  in  Ilosjiital  Economics  at  Feachers  College. 

Of  tlie  well-know]!  New  York  women  there  were  present 
]\riss  :\raxwell,  :\riss  Delano,  :\riss  Wibon  of  St.  Lid<e's; 
]\Iiss  Sanborn  of  St.  A'iiiccut's ;  ^liss  Fiiidell,  of  the  ^letro- 
politan;  ^Irs.  Dean,  of  ^It.  Sinai;  ^liss  (iihnour.  of  the  Xew 
York  C\\\  school:  Miss  ^biry  \\.  Thornton,  secretary  of  the 
Associated  Alumna\  and  others. 

The  recent  detFiration  of  war  between  Russia  and  Japan 
l)rought  11])  the  question  of  the  })osition  Anieriiaii  nurses 
should  take  in  lime  of  national  or  international  calamity  and 
it  was  agreed   that  some  action  should  be  taken  that  would 


72     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

place  American  nurses  always  in  an  attitude  of  readiness 
when  their  services  were  needed,  either  at  home  or  abroad. 
In  a  discussion  the  following  points  were  brought  out : 

1.  American  nurses,  to  be  at  all  times  in  a  position  to 
render  aid  to  suffering  humanity,  regardless  of  nationality 
or  creed,  should  be  affiliated  in  some  way  with  the  American 
National  Eed  Cross. 

2.  Such  affiliation  should  be  consummated  through  some 
one  of  the  existing  nursing  organizations. 

An  informal  committee  was  appointed  to  ascertain  whether 
the  American  National  Red  Cross  had  so  far  contemplated 
its  reorganization  that  it  could  consider  a  proposition  for 
such  affiliation  if  magie  through  the  proper  official  channel. 

The  editorial  added: 

The  Society  [Eed  Cross]  is  now  in  a  condition  of  re- 
organization and  this  reconstruction  period  would  seem  to 
be  a  very  proper  time  for  American  nurses  to  endeavor  to 
obtain  some  form  of  affiliation  which  would  identify  them 
with  the  Ked  Cross. 

At  this  point  Miss  Delano  reappears  in  our  history  for  the 
first  time  since  the  yellow  fever  episode.  She  had  not  entered 
the  war  service,  but  had  remained  at  her  institutional  work. 
In  1902-1904  she  was  at  the  head  of  the  Bellevue  school. 
There  she  was  in  close  association  with  Mrs.  Whitelaw  Reid — 
w^hose  family  had  long  been  identified  with  large  gifts  to  Belle- 
vue and  who  was  one  of  the  Board  of  Managers — with  Mrs.  W. 
K.  Draper  and  others  who  had  been  members  of  the  Red  Cross 
Auxiliary  Xo.  3,  Whilst  the  war  activities  were  going  on  Miss 
Delano  had  joined  the  New  York  State  Red  Cross  Branch  and 
had  become  deeply  interested  in  bringing  a  large  enrollment  of 
nurses  into  it.  So  keen  was  this  interest,  even  when  the  war 
was  over  and  reconstruction  not  yet  begun,  that  one  of  her  assist- 
ants in  the  school,  Mary  A.  Clarke,  wrote  later: 

During  that  period  we  often  discussed  the  work  of  the 
American  Eed  Cross  nurses,  and  even  then  it  seemed  to  me 
tliat  of  all  the  nurses  in  the  United  States  Miss  Delano  was 
the  one  woman  capable  of  taking  hold  of  the  nursing  service 
and  promoting  it  for  greater  development. 

From  that  time  on  Tiliss  Delano's  devotion  to  the  Red  Cross 
gi'adually  becanu;  paramount  with  her. 


REORGANIZATION  AND  AFFILIATION  73 

The  next  advance  toward  affiliation  was  taken  by  the  national 
association  in  1904.  At  the  Associated  Ahimnas  convention  of 
that  year  the  president,  Mary  M.  liiddle,  a  Pennsylvania 
woman,  trained  at  the  Boston  City  Hospital,  who  had  held 
execntive  positions  there  and  in  other  Massachusetts  hospitals 
and  who  had  been  for  years  a  strong  figure  in  nursing  affairs 
and  in  lied  Cross  organization  in  that  state,  said,  in  part: 

We  have  in  this  country  an  organization  known  as  the 
National  Red  Cross,  with  whose  name  at  least  we  are  familiar, 
but  whose  plans  for  work  we  do  not  always  comprehend. 
Our  idea  would  be  to  ally  ourselves  with  this  national  body 
for  practical  purposes. 

So  strong  was  the  conviction  that  nurses  should  be  awake 
to  their  opportunities  and  responsibilities  in  this  direction 
that  an  informal  committee  visited  last  winter  in  Washing- 
ton members  of  the  ]?ed  Cross  Association  in  high  official 
position  and  placed  the  matter  before  them.  The  suggestions 
of  the  committee  were  welcome  and  it  was  advised  to  make 
preparations  for  the  work,  with  the  promise  that  an  oppor- 
tunity would  be  given  the  nurses  for  rendering  their  service 
whenever  the  demand  for  such  service  should  arise.  .  .  . 

The  appeal  is  made  to  you  to  consider  the  advisability  of 
getting  into  form  for  such  work.  It  is  made  to  you  because 
you  are  the  rank  and  file  of  the  nursing  profession  in  this 
country  and  without  you  nothing  can  he  done,  upon  you 
must  the  dependence  for  service  be  placed.- 

Discussion  followed  and  then  action: 

The  President:  I  would  like  to  ask  if  it  is  your  pleasure 
to  refer  any  question  of  alliance  with  the  Red  Cross  Society 
to  the  Executive  Committee  and  Board  of  J)irectors? 

The  Secretary :  I  would  like  to  move  that  since  i\Iiss  Riddle 
has  already  conferred  with  ladies  on  the  Board  of  Directors 
of  the  Red  Cross  Society,  she  be  empowered  to  associate  with 
her  two,  three  or  four  people  whom  she  knows  to  be  interested 
in  the  matter  and  ])rocee(l  in  such  manner  as  the  committee 
thus  formed  may  decide. 

Seconded  and  carried. 

The  committee  formed  comprised  Miss  Riddle,  chairman. 
Miss  ^Maxwell  and  Miss  Damer.- 

Thc  Superintendents'  Society  then  appointed  a  similar  com- 
mittee with  ^liss  Cutting  as  chairman,  to  meet  and  confer  witii 
'Proceedings  Annual  Convention  of  the  Associated  Alumnir,  l!t04. 


74     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Riddle  and  her  associates  and  together  they  approached 
representative  women  of  the  Red  Cross  in  New  York  and 
Washington  with  their  suggestions.  While  these  steps  were 
being  taken  the  reorganization  of  the  Red  Cross  by  Act  of  Con- 
gress had  been  completed. 

The  American  Journal  of  Nursing  said  (March,  1905)  : 

The  plan  of  the  reorganization  of  the  Xational  Red  Cross 
Society  is  of  special  interest  to  nurses  in  view  of  the  fact 
that  a  committee  was  appointed  at  the  last  meeting  of  the 
Associated  Alumnae  to  arrange,  if  possible,  for  some  form 
of  affiliation  with  the  Eed  Cross,  so  that  the  great  nursing 
body  of  the  country  might  have  a  recognized  place  in  the 
Eed  Cross  work.  At  the  first  annual  meeting,  held  under 
the  new  charter,  William  H.  Taft,  Secretary  of  War,  was 
elected  president.  The  Executive  Committee  includes 
Surgeon  General  Wyman  and  Miss  Mabel  T.  Boardman. 

It  is  planned  to  have  a  committee  of  twelve  in  each  State 
to  work  for  the  upbuilding  of  the  Eed  Cross  and  make  it 
more  national  in  character  and  it  would  seem  a  very  natural 
conclusion  to  reach  that  nurses,  who  will  be  depended  upon 
to  do  the  hard,  practical  work  in  caring  for  the  sick  and 
wounded  in  time  of  national  calamity,  should  .  .  .  have 
representation  on  these  committees. 

In  Miss  Boardman  the  nnrses  were  to  come  into  close  work- 
ing relations  with  a  strong  and  judicious  friend,  a  woman  whoso 
abundant  common  sense  and  keen  perception  were  of  the  great- 
est support  and  value  in  building  up  a  Red  Cross  Nursing 
Service. 

Mabel  Thorp  Boardman  was  bom  in  Cleveland,  Ohio.  Her 
family  later  moved  to  Washington  and  made  it  a  permanent 
home.  In  1900  when  the  American  Red  Cross  was  incorporated 
by  Act  of  Cong^i-ess,  several  persons  who  had  worked  in  the  Red 
Cross  during  the  Spanish-American  War  asked  Frederick  H. 
Gillett,  who  was  in  charge  of  the  bill,  to  insert  Miss  Boardman's 
name  as  one  of  the  incorporators.  She  was  active  in  the  reor- 
ganization in  1905.  In  those  early  days  there  was  but  one  paid 
employee, — the  secretary,  and  ^liss  Boardman  freely  devoted 
her  time  and  resources  to  the  work  at  home  and  abroad.  She 
traveled  over  tliis  country  organizing  Red  Cross  Chapters  and 
went  through  Europe  and  to  Japan  studying  Red  Cross  organ- 
ization.   In  1907  she  was  a  delegate  to  the  Eighth  International 


REORGANIZATION  AND  AFFILIATION  75 

Conference  in  London  and  in  1912  to  the  Ninth  held  in  Wash- 
ington. 

At  a  very  early  moment  Miss  Boardman  realized  that  a  nurs- 
ing service  should  be  one  of  the  most  important  departments  of 
the  lied  Cross.  She  made  it  a  point  to  become  acquainted  with 
heads  of  training  schools  and  assure  them  of  her  conviction  that 
nurses  themselves  must  take  charge  of  the  nursing  department 
as  they  best  understood  nursing  problems,  duties  and  qualifica- 
tions. With  this  object  she  made  a  visit  to  the  Johns  Hopkins 
Hospital  and  met  ^fiss  Nutting  and  Dr.  Hurd.  In  April,  1906, 
she  spoke  before  the  American  Society  of  Superintendents  of 
Training  Schools  on  "The  Red  Cross  Nurse"  and  in  October, 
1907,  wrote  in  the  Bed  Cross  Bulletin: 

There  is  no  doubt  that  this  important  department  of  the 
Eed  Cross  work  will  greatly  develop  as  the  nurses  themselves 
take  the  matter  in  hand  and  assist  in  this  development. 

After  its  reincorporation  by  Congress,  the  American  Red 
Cross  issued  the  following  circular.  It  was  reprinted  in  the 
American  Journal  of  Nursing  in  July,  1905.  In  this  circular 
the  Red  Cross  Central  Committee  outlined  its  own  plan  of  or- 
ganization and  ideas  as  to  the  recruiting  of  nurses  as  follows : 

Am  AND  rntrosE  of  A:mi:ricax  Natioxal  Red  Cross 

The  International  Conference  which  met  at  Geneva, 
Switzerland,  August  22,  18(54,  agreed  upon  a  treaty  for  the 
purpose  of  mitigating  the  evils  inseparable  from  war.  This 
treaty  has  been  ratified  by  forty-four  nations,  including  the 
United  States.  The  conference  recommended  "that  there 
shall  exist  in  every  country  a  committee  whose  mission  shall 
consist  in  cooperating  in  times  of  war  with  the  hospital 
service  of  the  armies  ])y  all  means  in  its  power."  It  also 
reconnnended  the  adoption  and  use  of  a  distinctive  flag  and 
arm  badge.  .  .  . 

The  charter  granted  by  Congress  in  January.  1905,  to  the 
American  National  l\ed  Cross  declared  the  purpose  of  the 
corj)oration  to  be:  ''To  furnish  volunteer  aid  to  the  sick  and 
wounded  of  armies  in  time  of  war,  in  accordance  witii  the 
s])irit  and  conditions  of  the   (Jeneva   Convention.   .  .  ." 

"To  continue  and  carry  on  a  system  of  national  and  inter- 
national relief  in  time  of  ])eace,  and  ;q)])ly  tlie  same  in 
miti.^atin^-  tlie  sulTerings  caused  by  ])estileiice,  famine,  fire, 
floods  and  other  ureal    naiional  calamities." 


76     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Congress  considered  the  importance  of  the  work  so  great 
that  the  charter  granted  in  1905  provided  for  Governmental 
supervision. 

The  charter  conferred  on  the  Board  of  Incorporators  and 
the  Central  Committee  the  power  necessary  to  carry  into 
effect  the  above  provisions. 

In  pursuance  of  this  authority  the  Central  Committee  pro- 
poses to  organize  in  every  State  and  Territory  of  the  United 
States,  branch  societies,  to  enable  every  person  who  desires 
to  do  so  to  become  a  member  of  the  society  and  to  awaken  in 
this  country  the  same  interest  in  the  objects  of  the  organ- 
ization that  is  so  markedly  manifested  in  every  other  nation 
having  a  National  Eed  Cross  Society. 

The  necessity  of  being  prepared  for  emergencies  has  been 
too  often  demonstrated  to  require  argument.  The  object  of 
the  Central  Committee  is  to  have  in  each  State  and  Territory 
a  branch  society  that  will  be  ready  to  act  at  once  in  time  of 
war  or  disaster,  and  so  strong  in  its  personnel  that  it  will 
command  universal  confidence. 

Each  branch  will  act  as  a  unit  in  the  organization  and  take 
charge  in  case  of  any  great  calamity  in  its  State.  Its  Execu- 
tive Committee  or  a  special  committee  will  enroll  doctors  and 
nurses  for  Red  Cross  service  in  time  of  war  or  great  disaster 
in  the  State  or  its  immediate  vicinity.  Eeports  as  to  the 
number  of  doctors  and  nurses  enrolled  by  each  branch  will 
be  made  annually  through  the  Central  Committee  to  the 
Army  Medical  Department.  ... 

The  secretary  of  each  branch  will  keep  informed  as  to  the 
number,  names  and  addresses  of  the  doctors  and  nurses  en- 
rolled for  active  service.  This  service  may  be  given  either 
without  compensation  or  for  the  same  salaries  as  those  paid 
by  the  War  Department,— namely,  one  hundred  and  fifty 
dollars  for  medical  officers  and  for  nurses,  forty  dollars  a 
month  for  service  in  the  United  States  and  fifty  dollars  a 
month  for  service  outside  of  the  United  States.  The  secre- 
tary will  also  keep  informed  as  to  where  hospital  and  relief 
supplies  can  be  obtained  at  shortest  notice.^ 

At  the  time  the  circular  was  issued,  plans  for  organization  by 
states  were  already  well  under  way.  The  District  of  Columbia 
had  the  first  branch.  New  York  perhaps  made  the  best  showing 
of  the  States,  althongli  (California  was  also  strong.  Miss 
Delano  was  Secretary  of  Enrollment  for  New  York  State  and 
Miss  Palmer,  of  Eoeliester,  editor  of  the  American  Journal  of 

'In  tlie  Red  Cross  Archives. 


REORGANIZATION  AND  AFFILIATION  77 

Nursing,  reached  nurses  at  large ;  Miss  Maxwell,  eminent  in  the 
hospital  field,  and  Miss  Wald,  head  of  the  IvTurses  (now  Henry 
Street)  Settlement,  who  led  in  social  movements  and  altruistic 
work  growing  out  of  the  visiting  nurse  service,  all  bent  their 
best  energies  to  stimulate  interest,  membership  and  enrollments. 
Mrs.  W.  K.  Draper  received  the  applications  for  ISTew  York 
membership  and  Miss  Delano  sent  out  an  urgent  appeal  for 
every  nurse  in  the  State  to  join  and  enroll.  Two  other  nurses, 
Beatrice  Von  Homrigh  Stevenson  and  ]\Iary  A.  Gladwin,  both 
of  whom  we  met  first  on  the  Lampasas  expedition,  were  espe- 
cially untiring  in  their  efforts  to  gain  new  members. 

By  becoming  paying  members  at  a  moderate  fee,  nurses  as 
well  as  others  would  have  had  a  vote  in  the  management  of 
Red  Cross  State  societies  and  it  was  then  thought  that  in  this 
way  nurses  could  help  to  direct  the  details  of  nurse  enrollment 
and  their  service  in  war  or  other  calamity.  The  mere  enroll- 
ment for  such  service  was  a  different  thing;  it  alone  would  not 
confer  a  voice  in  management;  membership  must  also  be  held. 
But  nurses  did  not  come  forward  for  membership  or  enroll- 
ment. As  states  organized  and  fell  in  line,  state  nurses'  com- 
mittees were,  therefore,  formed  to  promote  enrollments  and 
select  women  of  the  necessary  qualifications  from  among  those 
who  applied.  It  became  evident  that  nurses  would  follow  none 
but  their  own  leaders  and  so  it  was  hoped  that  committees  of 
nurses  in  the  various  states  could  bring  the  rank  and  file  into 
the  enrollment  lists. 

The  American  Journal  of  Nurshig  lost  no  opportunity  of 
giving  publicity  to  Red  Cross  events  and  information  to  its 
readers. 

In  February,  1900,  it  explained  editorially  the  reorganiza- 
tion of  the  Tied  Cross  and  the  features  of  the  new  charter.  It 
also  stated  the  restrictions  on  the  use  of  the  brassard  and  the 
emblem,  which  had  been  indiscriminately  and  improperly  used, 
saying : 

The  arm  piece  or  "brassard,"  consisting  of  a  white  band 
with  a  Red  Cross,  may  only  be  worn  when  on  duty  under  the 
officers  of  the  Red  Cross.  Xo  nurse  has  the  right  to  wear  it 
on  any  other  occasion,  nor  has  any  other  body  the  right  to 
give  it  to  lior.  There  are  some  surgical  iirnis  and  First  Aid 
corporations  which  have  in  former  years  legally  scM-urcd  the 
use  of  the  red  cross  as  a  badge  (for  instance  Johnson  c^"  John- 
son) and  from  these  it  cannot  be  taken  awav;  but  no  one  in 


78      HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

future  can  ever  obtain  this  privilege.  The  laws  of  all  coun- 
tries rigidly  protect  the  use  of  the  Red  Cross  as  an  emblem 
reserved  to  the  national  societies  and  their  workers  on  the 
battle  field,  or  in  the  camp  or  hospital  in  time  of  disaster. 

Miss  Boardman,  too,  was  untiring  in  her  efforts  to  make  plain 
the  purposes  and  plans  of  the  Red  Cross.  In  her  travels  over 
the  country  she  spoke  before  many  gatherings  of  nurses.  She 
dwelt  upon  the  importance  of  the  nurse's  place  in  the  recon- 
structed Red  Cross,  emphasized  the  high  standards  that  would 
be  required  and  told  her  hearers  that  it  was  agreed  by  the 
Government  that,  in  case  of  war,  the  Red  Cross  nurses  would 
be  the  Army  Reserve. 

At  these  meetings  she  explained  the  two  forms  of  agreement 
then  existing,  one  for  paid,  the  other  for  volunteer  service.  The 
latter  did  not  signify  amateur  service,  but  presumed  that  fully 
trained  women  might  sometimes  be  in  a  position  to  give  their 
aid  without  compensation. 

Volunteer  Nurse 

I  hereby  agree  to  hold  myself  in  readiness  and  to  enter  the 
service  of  the  American  National  Red  Cross  when  and  where 
my  services  may  be  required  as  a  nurse,  without  compensa- 
tion except  transportation  and  subsistence. 

Paid  Xurse 

I  hereby  agree  to  hold  myself  in  readiness  and  to  enter 
the  service  of  the  American  National  Red  Cross  when  and 
where  my  services  may  be  required  as  a  nurse,  with  com- 
pensation at  the  rate  of  forty  dollars  per  month  when  on 
duty  in  the  United  States,  and  fifty  dollars  per  month  wlien 
without  the  limits  of  the  United  States,  in  addition  to  trans- 
portation and  subsistence. 

She  also  set  forth  the  rules  that  had  been  agreed  upon  for 
the  enrollment  of  paid  and  unpaid  nurses.  As  there  was,  then, 
no  nursing  committee  at  the  Washington  headquarters,  these 
rules  had  been  framed  by  hor  in  consultation  with  the  New 
York  State  and  District  of  Columbia  members. 

1.  All  nurses  enrolled  for  service  under  the  American 
National  Eed  Cross  shall  be  required  to  show  a  certificate  of 
registration    when    enrolled    in    states    or    territories    where 


REORGANIZATION  AND  AFFILIATION  79 

registration  is  required  by  law.  Nurses  enrolled  in  states  or 
territories  wliere  re  <:^i  strati  on  is  not  required  by  law  shall 
show  a  certificate  or  diploma  of  graduation  from  a  recognized 
training  school  for  nurses  requiring  a  course  of  not  less  than 
two  years. 

2.  No  nurse  under  twenty-five  years  of  age  shall  be  en- 
rolled for  active  service. 

3.  All  applicants  shall  be  required  to  give  a  physician's 
certificate  of  sound  health  and  unimpaired  faculties,  which 
certificate  shall  be  renewed  every  two  years. 

4.  The  moral  character,  professional  standing  and  suita- 
bility of  applicants  for  enrollment  as  nurses  shall  be  de- 
termined in  such  manner  as  the  branch  society  may  prescribe.* 

At  that  time  New  York  State  had  one  of  the  first  and  best 
nurse  registration  acts  and  the  Red  Cross  State  Committee  had 
laid  down  these  additional  stipulations : 

1.  All  nurses  enrolled  in  the  State  of  New  York  for  Eed 
Cross  service  shall  be  required  to  show  a  certificate  of  regis- 
tration with  the  Regents  of  the  University  of  the  State  of 
New  York. 

2.  All  applications  must  have  three  signatures,  vouching 
for  their  moral  character,  professional  standing  and  suita- 
bility to  this  special  work — two  from  nurses  of  good  stand- 
ing and  the  third  from  the  president  of  the  subdivision. 

3.  .  .  . 

4.  All  applicants  must  appear  before  a  member  of  the 
Nurses'  Committee  for  examination,  and  must  present  to 
the  committee  with  their  other  papers,  the  endorsement  of 
their  applications  by  that  member  of  the  committee. 

5.  .  .  . 

The  District  of  Columbia  Branch  was  the  first  to  arrange 
special  lectures  designed  to  attract  nurses  to  the  Red  Cross 
work  and  also  to  enlarge  their  information.  The  Red  Cross 
Bulletin,  April,  1907,  has  the  following  record  of  this  effort: 

The  District  of  Columbia  Branch  is  preparing  to  give  to 
its  enrolled  nurses  a  special  course  of  lectures  with  practical 
demonstration  of  field  hospital  work  under  the  auspices  of 
the  ]\redical  Department  of  the  Army.  These  lectures  will 
be  given  at  the  Washington  Barracks. 

*  Article  bv  Miss  Boardman,  American  Journal  of  Xursing,  August, 
1900,  Vol.  Vi,  p.  810. 


80     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  syllabus  of  the  lectures  follows: 

I.  General  outline  of  the  organization  of  the  Army  in  time 
of  war  and  of  its  medical  and  sanitary  service.  II.  The  regi- 
mental hospital.  Tlie  ambulance  section.  The  field  hospi- 
tal. The  base  hospital.  Other  hospitals  and  stations.  III. 
Medical  and  sanitary  service  of  camps  and  on  the  march. 
IV.  Service  m  battle  at  the  front.  V.  Service  in  battle  at 
the  rear. 

One  afternoon  will  be  devoted  to  the  practical  demonstra- 
tion of  the  field  hospital.  This  will  be  done  at  the  conclusion 
of  the  course  as  detailed  above.  An  opportunity  will  then 
be  given  to  examine  the  equipment  and  working  plan  of  the 
organization. 

One  of  the  subjects  brought  forward  and  exciting  warm  dis- 
cussion in  the  early  formative  period,  before  the  final  affiliation 
of  the  Red  Cross  with  the  nurses'  association  had  taken  place, 
w^as  that  of  the  desirability  of  giving  elementary  instruction  in 
nursing  to  women  of  the  home  under  the  Red  Cross  auspices. 
The  District  of  Columbia  Chapter  had  pioneered  in  holding 
classes  of  this  kind  and  Beatrice  Stevenson,  attracted  by  their 
example,  initiated  similar  work  in  Brooklyn  (1908)  in  a  set  of 
talks  on  Hygiene,  Sanitation  and  the  Emergency  Care  of  the 
Injured. 

This  new  departure  elicited,  at  first,  considerable  opposition 
among  nurses,  who  feared  that  the  American  Red  Cross  might 
perhaps  follow  the  example  of  European  societies  in  promoting 
a  superficially  trained  volunteer  nurse  corps,  which  would  in 
the  event  of  war  or  other  disaster,  cause  confusion  and  diflficulty. 
A  meeting  of  the  New  York  County  Nurses'  Association  was 
held  in  the  Bellevue  Nurses'  Club,  in  April,  1908,  where  the 
allied  questions  of  nurses'  enrollment  in  the  Red  Cross  and  the 
evolution  of  teaching  under  its  banner  were  warmly  discussed. 
It  now  seems  obvious  that  the  very  concern  felt  over  such  pos- 
sible d(!velopment,  brought  home  to  nurses  a  sense  of  their  own 
duty  to  the  Red  Cross.  The  two  questions  were  introduced 
together  by  IMiss  Pindell,  who  stated  that  the  Alumnse  of  the 
New  York  City  Training  School  for  Nurses  had  sent  a  com- 
munication to  the  Nurses'  Committee  of  the  New  York  State 
Red  Cross  branch,  asking  for  recognition  as  an  association 
desirous  of  affiliation  with  the  Red  Cross  Nurse  Corps.  Miss 
Pindell  read  the  answer  received,  also  the  rules  of  the  com- 
mittee in  regard  to  tlie  enrollment  of  nurses.     The  syllabus  of 


REORGANIZATION  AND  AFFILIATION  81 

the  course  of  lectures  on  Home  Care  which  had  been  given  in 
Washington  under  the  auspices  of  the  Red  Cross,  was  also  read 
and  Miss  Darner  was  asked  to  open  the  discussion.  A  Bellevue 
woman  (1885)  and  a  Canadian,  she  had  long  held  responsible 
positions  in  nursing  associations.  She  had  been  one  of  the  chief 
builders  of  the  Associated  Alumna?  and  State  nurses'  societies. 
She  now  said,  with  the  strong  common  sense  which  was  her 
leading  characteristic,  that  she  felt  that  the  nursing  profession 
had  not  been  doing  its  duty  by  the  Red  Cross,  for  as  the  latter 
had  shown  its  readiness  to  conform  to  the  imrses'  standards, 
the  imrses  sliould  either  have  enrolled  in  force  or  stated  why 
they  were  not  willing  to  do  so.  If  they  took  no  action  in  the 
matter  they  must  expect  that  the  Red  Cross  would  take  other 
steps  to  provide  nurses  for  its  work. 

Hiss  Gladwin  and  Mrs.  Stevenson,  who  knew  that  the  pur- 
poses and  plans  of  the  Red  Cross  were  not  directed  toward  the 
creation  of  a  short  term  luirsing  corps,  spoke  in  defense  of  the 
Home  ]!^ursing  teaching  and  what  they  said  has  been  amply 
justified  by  time  and  by  the  ultimate  cooperation  of  nurses  as 
a  body  in  guiding  the  direction  of  classes  for  women  of  the 
home. 

Mrs.  Stevenson  spoke  of  the  new  policy  in  the  Red  Cross,  of 
guarding  health,  and  mentioned  the  international  resolution  of 
London  (1907)  to  the  effect  that  Red  Cross  societies  might  take 
a  share  in  the  warfare  against  tuberculosis.^  She  quoted  Major 
Lynch's  address  at  the  annual  meeting  (1907)  of  the  New 
York  State  Red  Cross  Branch,  in  which  he  had  said  that,  in 
order  to  get  members  and  to  keep  up  their  interest  in  the  Red 
Cross,  opportunities  should  be  seized  to  show  individuals  that 
they  had  a  part  to  play  in  Red  Cross  work  and  that  universal 
instruction  of  people  in  the  laws  governing  sanitation  would 
seem  to  be  a  peculiarly  appropriate  field  of  work  for  nurses. 

Miss  Gladwin  spoke  to  the  same  effect.^  An  article  written 
later  by  Mrs.  Stevenson  said  in  part: 

It  has  been  said  tliat  social  efficiency  depends  upon  a 
sense  of  social  responsibility.  ...  It  was  this  spirit  of  social 
responsibility  which  prompted  the  Red  Cross  to  undertake 
a  campaign  of  health  education  with  reference  to  the  pre- 

"  The  American  Red  Cross  opened  its  first  Day  Camps  for  Tuberculosis 
in  June,  IflOS.  Many  others  followed  and  brought  nurses  into  contact 
with  the  Red  Cross. 

'See  American  Journal  of  Xursiny,  May,  1908,  p.  603. 


82     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

vention  of  disease  and  accidents,  and  the  highest  degree  of 
social  efficiency  of  both  societies,  the  Nurses'  Associated 
Alumnae  and  the  Red  Cross,  can  best  be  reached  by  the  affilia- 
tion of  the  nurses  with  the  Eed  Cross  and  the  hearty  co- 
operation of  both  in  the  furtherance  of  this  public  health 
work. 

The  registered  nurses  have  been  asked  to  cooperate  with 
the  Eed  Cross  in  this  work  by  delivering  these  addresses. 
Two  reasonable  objections  have  been  offered,  one,  that  the 
majority  of  nurses  know  nothing  about  teaching  and  are  not 
accustomed  to  speaking  in  public;  the  other,  that  as  time 
means  money  to  the  majority  of  nurses,  it  will  be  impossible 
to  do  any  effective  work  unless  the  Red  Cross  can  have  salaried 
teachers.  It  is  probable  that  for  some  of  this  work  the  Red 
Cross  will  arrange  a  definite  course  of  instruction  with  salaried 
teachers,  but  in  a  movement  which  it  is  hoped  will  become 
as  wide-spread  and  far  reaching  as  this,  some  of  the  pioneer 
work  must  be  voluntary.'^ 

After  the  first  doubts  of  the  nurses  were  allayed,  it  is  certain 
that  to  most  of  them  the  prospect  of  peace  activities  under  the 
Red  Cross  was  more  attractive  than  war  work.  Those  especially 
who  were  absorbed  in  teaching  and  training  for  lives  of  con- 
structive usefulness  became  greatly  interested  in  the  class-work 
plans.  For  some  years  this  interest  ran  parallel  with  "affilia- 
tion" and  will  be  shown  briefly  in  that  way  during  the  early 
stages  of  growth,  while  the  details  will  be  presented  fully  in  the 
section  on  class  work  and  teaching. 

The  calls  made  upon  the  reorganized  Eed  Cross  in  its  early 
years,  by  the  calamities  of  the  Japanese  famine  and  the  San 
Francisco  earthquake  and  fire,  gave  the  nation  striking  lessons 
which  it  was  not  slow  to  learn,  but  the  nursing  reserve  was  then 
not  well  enough  organized  to  make  a  record  and  individual 
nurses  came  forward  as  volunteers  in  San  Francisco  in  response 
to  telegrams  from  headquarters.  The  American  Journal  of 
Nursing  pressed  home  the  lesson  by  saying : 

We  urge  upon  all  nurses  enrollment  in  the  Red  Cross 
Society,  as  working  members  if  possible,  as  contributing 
members  without  fail.  This  is  one  of  the  obligations  of 
citizenship  or  residence  in  this  prosperous  country.  .  .  . 
Will  the  nurses  of  this  country  learn  a  lesson  from  this 
greatest  national  calamity? 

'  See  American  Journal  of  Nursing,  June,  1908,  p.  701. 


REORGANIZATION  AND  AFFILIATION  83 

Impressed  by  these  events,  the  Red  Cross  and  its  nurse  mem- 
bers redoubled  their  eiforts  to  build  up  enrollment  and  member- 
ship, but  weak  spots  presently  appeared  in  the  professional 
requirements  of  state  units.  The  standard  of  the  Regents' 
examination  set  by  Xew  York  was  not  acceptable  to  others. 
Pennsylvania,  for  instance,  desired  to  make  exceptions,  as  in 
the  following  clause ; 

Xurses  wlio  have  graduated  in  less  than  a  two  years' 
course  must  have  served  at  least  three  years  at  nursing  after 
graduation  and  be  recommended  by  two  doctors  as  to  efficiency 
as  nurses. 

To  this  ambiguous  proposal  IMiss  Boardman  replied  with 
great  clearness  and  decision.  All  questions  of  this  kind  then 
came  to  her  for  final  answers  and  it  is  fortunate  for  the  Red 
Cross  ISTursing  Service  that  her  administration  was  so  able  and 
w'ise.     She  wrote  (July,  1908)  : 

Tlie  rule  that  all  of  the  American  Eed  Cross  nurses  must 
be  graduates  of  recognized  training  schools  with  at  least  two 
years'  training  in  the  course  is  of  first  importance  and  a  rule 
that  cannot  be  omitted.  The  Army  makes  this  one  of  its 
regulations  and  we  cannot  be  less  particular,  not  only  on  this 
account  but  for  many  other  reasons.     At  the  time  of  the  late 

war,  the  state  branch  of  the  Red  Cross  sent  out  a 

number  of  nurses  to  the  Philippines  whose  characters  were 
of  such  a  nature  as  to  force  the  United  States  to  require  their 
recall.  .  .  .  I^ter  when  ]\Irs.  Whitelaw  Peid  had  charge  of 
such  matters  for  the  Xew  York  Ped  Cross  the  nurses  were 
selected  for  their  character  and  ability  and  as  a  result  most 
excellent  women  went.  We  can  run  no  risk  of  repeating 
the  .  .  .  experience  by  taking  in  as  Ped  Cross  nurses  women 
whose  character,  training  and  ability  have  been  guaranteed 
by  no  one.  1  would  rather  have  no  nurses  at  all  than  run 
any  such  risk.  .  .  .  Quality  must  come  first,  quantity  sec- 
ond. .  .  .  Certain  regulations  must  be  observed;  if  they  are 
not  willing  to  observe  them  in  Philadelphia  we  will  get  our 
nurses  from  elsewliere.  According  to  those  rules  any  nurse 
who  had  received  one  of  those  six  weeks'  training  courses  and 
could  get  two  physicians  to  testify  to  her  efficiency,  after  she 
had  been  practicing  for  three  years  could  become  a  Ped  Cross 
luirse.  As  a  result  we  would  promptly  lose  our  best  nurses 
and  supply  ourselves  with  a  second  rate  and  poor  lot  of 
women.     Xot  only   is  the  two  years  of  study  and  training 


84      HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

necessary  to  make  a  good  nurse,  but  the  discipline  that  these 
schools  provide  is  of  great  value.  We  pay  far  too  little  at- 
tention to  this. 

To  the  officers  of  the  Pennsylvania  Branch,  all  of  whom  were 
men,  who  wrote  asking: 

Who  appoints  the  Committee  on  Nurses,  and  could  the 
committee  consist  of  the  president  and  secretary  of  any 
State  branch? 

Miss  Boardman  replied : 

A  Committee  on  Enrollment  might  be  appointed  by  the 
chairman  of  the  Executive  Committee  or  the  president  of  a 
Branch.  .  .  .  There  is  no  reason  why  the  president  and 
secretary  of  a  Branch  should  not  be  members  of  the  com- 
mittee for  the  enrollment  of  nurses.  It  would  seem  advisable, 
however,  to  have  as  a  third  member  of  such  committee  the 
superintendent  of  some  training  school  of  unquestionable 
standing. 

The  above  material  selected  from  among  other  examples  illus- 
trates the  firm,  intelligent  support  given  by  Miss  Boardman  to 
the  ideals  of  good  nursing  and  shows  her  part  in  maintaining 
standards  in  the  Red  Cross  jSTursing  Sei-vice.  Such  examples 
recur  from  time  to  time,  but  this  one  will  suffice  to  make  the 
point. 

An  excellent  plan  now  devised  for  the  ISTursing  Service  of  the 
Red  Cross  State  Branches  was  one  whereby  the  superintendents 
of  training  schools  might  be  secured,  if  necessary,  to  take  com- 
mand in  time  of  need,  such  as  war.  The  American  Journal  of 
Nursing,  December,  1906,  said  of  this: 

A  meeting  of  the  New  York  Committee  for  the  enrollment 
of  nurses  for  Bed  Cross  service  was  held  at  the  house  of 
Mrs.  William  K.  Draper,  on  October  19,  1905.  It  was  de- 
cided to  enroll  two  classes  of  nurses  for  Bed  Cross  service; 
the  regular  private  nurses  for  field  work  and  hospital  nurses 
for  administrative  work,  the  conditions  of  salary,  health 
certificates,  etc.,  l)eing  identical  for  the  two.  This  will  make 
it  possible  for  many  of  the  older  women  holding  positions 
at  the  head  of  hospitals  or  training  schools,  to  enroll  for  Ked 
Cross  duty  and  will  insnrc  to  the  Red  Cross  the  services  of 
trained  executive  heads  if,  in  emergencies,  temporary  hos- 
pitals have  to  be  established.  By  this  provision  also,  there 
would  be  no  age  limit,  as  many  of  our  most  valuable  workers, 


REORGANIZATION  AND  AFFILIATION  85 

who  would  not  feel  physically  able  to  give  field  service  in 
emergencies,  will  enroll  with  the  prospect  of  being  able  to 
serve  the  country  as  supervising  nurses. 

The  New  York  Ked  Cross  committee  decided  in  1907  to 
enroll  dietitians  for  hospital  service  and  Miss  Corbett,  dietitian 
of  the  Department  of  Charities  in  New  York  City,  was  placed 
on  the  nurses'  committee  to  draw  up  proper  rules  for  such 
enrollments. 

In  1907  the  Executive  Committee  of  the  American  National 
Red  Cross  issued  resolutions  explaining  the  protection  of  the 
Emblem  by  international  treaty  and  requesting  that  all  hospi- 
tals and  commercial  firms  give  up  its  hitherto  widely  exploited 
use.     The  latter  resolution  follows : 

Be  it  Resolved :  That  the  Executive  Committee  of  the 
American  National  J^ed  Cross  request  that  all  hospitals, 
health  departments  and  like  institutions  kindly  desist  from 
the  use  of  the  l^ed  Cross  created  for  the  special  purpose 
mentioned  above,  and  suggests  that  for  it  should  be  sub- 
stituted some  other  insignia,  such  as  a  green  St.  Andrew's 
cross  on  a  white  ground,  to  be  named  "Hospital  Cross"  and 
used  to  designate  all  hospitals  (save  such  as  are  under  the 
Medical  Department  of  the  Army  and  Navy  and  the  author- 
ized volunteer  aid  society  of  the  Government),  all  health 
departments  and  like  institutions,  and  further, 

Be  it  Kesolved :  That  the  Executive  Committee  of  the 
American  Xational  Eed  Cross  likewise  request  that  all  in- 
dividuals or  business  firms  and  corporations  who  employ  the 
Geneva  l?ed  Cross  for  business  purposes,  kindly  desist  from 
such  use,  gradually  withdrawing  its  employment  and  substi- 
tuting some  other  distinguishing  mark.^ 

This  request  was  generally  heeded ;  thus  Robert  W.  Hebberd, 
then  Commissioner  of  Public  Charities  in  New  York  City, 
substituted  for  the  Red  Cross  on  the  sleeve  of  the  white  uni- 
forms in  the  city  hospitals,  the  staff  and  serpent  of  Aesculapius. 

In  that  year  (1907)  occurred  the  first  instance  of  a  County 
Nurses'  Society  joining  a  Red  (^ross  State  Branch  as  a  body,  in 
'the  affiliation  of  the  San  Francisco  County  Nurses  Association 
with  the  California  State  lied  Cross.  Another  and  different 
early  grouping  was  shown  in  the  affiliation  of  the  District  Nurs- 
ing Association  of  Troy,  New  York,  with  the  Red  Cross. 

In  the  autumn  of  1907,  the  American  Journal  of  Nursing 

^Miiuitos  of  C(>iitral   Kxiriitivt>  C'oiiiinittoc,  Vol.   1,  i).   102. 


86     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

established  a  Red  Cross  Nursing  Department,  for  the  purpose 
of  spreading  knowledge  more  widely  among  nurses  and  stimu- 
lating their  interest  by  giving  reports  from  all  sections  of  the 
country.  It  was  at  first  edited  by  Miss  DeWitt,  editorial 
assistant  in  the  Journal  office.  With  this  department  a  system- 
atic and  complete  history  of  Red  Cross  nursing  growth  and 
activity  appeared  regularly  month  by  month.  In  that  year 
also,  the  International  Red  Cross  had  resolved  to  take  a  part  in 
the  crusade  against  tuberculosis  and  it  was  realized  that  this 
would  need  the  services  of  many  more  nurses.  But  with  all 
these  efforts,  it  became  clear  that  nurses  were  not  closely  enough 
approached  and  that  they  were  hanging  back.  Between  the 
Red  Cross  Central  Committee  at  Washington,  the  State  so- 
cieties with  the  nursing  committees  and  the  individual  nurse, 
there  was  too  lengthy  a  line  of  communication.  Perhaps  lead- 
ing nurses  felt  this  even  more  definitely  than  did  the  Central 
Committee  of  the  Red  Cross.  They  were  aware  that  the  nurs- 
ing service  was  too  loosely  knit  together  to  hold  well  in  a  dire 
emergency.  They  then  made  the  suggestion  that  instead  of 
State  nursing  committees  within  Red  Cross  State  societies, 
the  State  Associations  of  Nurses,  by  that  time  strongly  devel- 
oped throughout  the  country,  should  themselves  be  the  bodies 
responsible  for  enrollment  and  should  cooperate  in  this  work 
wdth  State  Red  Cross  societies.  Several  states  had  actually 
brought  such  an  arrangement  into  being.  !Miss  Damcr,  presi- 
dent of  the  Associated  Alumnre,  pointed  this  out  in  her  address 
at  the  Tenth  Annual  Convention  in  1907.     She  said: 

Another  matter  in  which  we  have  made  the  discovery  of 
the  need  of  eooporation  is  the  Eed  Cross  work.  .  .  .  The 
Red  Cross  calls  upon  us  nurses  in  its  work  in  many  ways.  .  .  . 
It  has  been  suggested  tliat  we  ask  the  state  (nursing)  associa- 
tions to  cooperate  in  this  matter,  to  form  auxiliary  societies 
among  their  members  or  have  committees  appointed  who  will 
enroll  nurses  for  the  Eed  Cross  work.  Ohio  is  very  well 
organized  in  that  respect,  and  California  has  recently  started 
an  auxiliary. 

In  1008  came  the  first  severe  test  of  the  efficiency  of  the 
Red  Cross  Nursing  Reserve,  ^vith  the  calls  for  help  from  inun- 
dated sections  of  Mississippi,  following  the  tornado  and  floods 
that  occurred  in  April  of  that  year.  By  dint  of  great  effort, 
the  need  was  met,  but  the  machinery  creaked,  as  explained  with 
candor  by  the  American  JuiirnaJ  of  Xiu\^in(j  (June,  U»08). 


REORGANIZATION  AND  AFFILIATION  Si 

After  reciting  the  incidents  of  mustering  the  required  nurs- 
ing reserves,  it  said  editorially: 

Judging  from  these  facts,  one  receives  the  impression  of 
prompt  and  efficient  service,  but  knowing  the  inner  side  of 
the  story,  the  nursing  profession  is  given  some  cause  for 
serious  reflection.  .  .  . 

The  question  before  us  is  how  to  bring  all  of  our  forces  so 
into  cooperation  with  the  Red  Cross  that  prompt  and  efficient 
service  may  always  be  at  the  command  of  that  society  with- 
out unnecessary  delays. 

All  other  considerations  in  connection  with  the  Red  Cross 
are  secondary  to  this  one  of  efficient  enrollment.  Jt  should 
be  taken  up  by  every  local  organization  and  carried  into  our 
state  and  national  conventions  until  the  problem  has  been 
satisfactorily  threshed  out.  Otherwise  the  Red  Cross  will 
be  forced  to  train  its  own  workers. 

So  far  all  the  steps  taken  toward  providing  a  Red  Cross 
Nursing  Reserve  had  proved  to  be  but  tentative  and  oppor- 
tunistic and  did  not  satisfy  the  nurses  themselves. 

The  genuine  affiliation  of  organized  nursing  bodies  with  the 
Red  Cross  which  finally  took  shape,  began  with  the  work  of 
Isabel  Hampton  Robb  in  1908-1909,  though  her  plan  did  not 
then  carry  in  its  original  form.  The  story  is  fully  told  in  Mrs. 
Robb's  words  at  the  second  convention  of  the  Federation  of 
Nurses.  This  body,  it  is  to  be  remembered,  was  composed  of 
the  two  societies,  the  Superintendents  and  the  Associated 
Alumna}  in  joint  meetings. 

At  the  Superintendent's  Convention  in  April,  1908,  Miss 
Nutting,  its  president,  had  asked  ]\[rs.  Robb  to  serve  as  chair- 
man of  a  Red  Cross  Committee  and  to  enable  such  a  committee 
to  confer  with  the  Central  Committee  of  the  Red  Cross  for  the 
purpose  of  finding  out  whether  any  arrangements  could  be 
made  whereby  a  settled  Red  Cross  Nursing  Service  might  be 
established.  The  following  women  were  selected  to  serve  with 
Mrs.  Robb:  Miss  Damer  (representing  the  Alumnte),  ^liss 
Nutting  (the  Federation),  ]\Iiss  Nevins  (the  Superintendents' 
Society)  and  Miss  Maxwell,  who  had  had  great  experience  in 
the  Red  Cross  work  of  the  Spanish-American  War,  as  member 
at  large. 

On  June  13,  1908,  ^Mrs.  Robb  wrote  to  Miss  Boardman  tell- 
ing her  of  the  nurs(>s'  wishes  and  of  tlic  existence  of  the  com- 
mittee.    Miss  Eoardman  replied  on  July  20,  1908,  saying: 


88     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  was  very  glad  to  receive  your  letter  and  am  delighted.  .  .  . 
This  spring  there  were  created  three  Red  Cross  Departments 
on,  first,  War;  second,  Emergency,  and  third,  International 
Relief.  A  Board  is  at  the  head  of  each  Department.  General 
O'Reilly,  Surgeon  General  of  the  Army  and  a  member  of 
our  Central  Committee,  is  the  chairman  of  the  first  Board 
and  I  am  chairman  of  the  second.  At  the  time  of  our  annual 
meeting  in  December,  the  8th  and  9th,  there  will  be  meetings 
of  these  two  Boards  and  there  will  also  be  a  meeting  of  the 
Emergency  Board  in  Washington  the  first  part  of  October 
and  probably  also  a  meeting  of  the  War  Board  about  the 
same  time. 

If  you  are  near  Washington  at  that  time  and  could  meet 
these  Boards  it  would  be  very  useful  as  they  are  the  Boards 
which  will  have  active  charge  of  those  relief  measures  in 
which  we  would  probably  need  the  nurses'  assistance. 

Mrs.  Robb  and  Miss  Maxwell  v(7ent  to  Washington  in  October 
and  had  an  informal  conference  with  Miss  Boardman  and  Mr. 
Bicknell.  They  returned  to  New  York  and  met  the  other  com- 
mittee members,  no  definite  conclusion  being  arrived  at.  Mrs. 
Robb  next  summed  up  the  substance  of  their  conference  with 
the  Red  Cross  officials  in  the  following  letter  to  Miss  Board- 
man: 

Cleveland,  October  15,  1908. 
My  dear  Miss  Boardman : 

I  beg  to  submit  to  you  in  writing  the  substance  of  the 
conversation  Miss  ]\Iaxwell  and  myself  had  with  you  on 
October  4,  to  the  effect  that  the  Federation  of  Xurses,  which 
.  .  .  numbers  about  15,000  members,  appointed  a  special 
committee  to  confer  with  the  Central  Committee  of  the  Red 
Cross  to  find  out  if  it  might  l)e  possible  to  make  suital)lc 
arrangements  whereby  all  nursing  and  allied  work  required 
by  the  Red  Cross  Society  might  be  done  through  the  Federa- 
tion of  Nurses  under  proper  organization.  Unless  some  such 
organization  is  effected  the  majority  of  nurses  feel  that  the 
most  efficient  nursing  work  cannot  be  attained,  nor  the  proper 
selection  of  nurses  made,  and  that  in  consequence  all  mem- 
bers of  the  profession  are  subject  to  unnecessary  adverse 
criticism.  The  nurses  also  feel  that  suitable  recognition 
should  be  accorded  them  as  a  body  of  professional  women  and 
the  integrity  of  their  work  should  be  maintained.  To  those 
of  us  wlio  have  given  the  matter  careful  thought,  it  would 
seem  tliat  a  satisfactory  agreement  to  both  the  Red  Cross 
and   the    Federation    of   Nurses   miirht   be   reached    through 


REORGANIZATION  AND  AFFILIATION  89 

affiliation,  whereby  a  nursing  department  carefully  planned 
in  every  detail  miglit  be  organized  that  would  cover  all 
branches  of  Red  Cross  nursing,  including  that  of  the  Army 
and  Xavy.  This  would  not  necessarily  mean  that  women  for 
appointment  to  any  branch  of  the  Hed  Cross  nursing  work 
must  be  a  member  of  some  nursing  organization,  but  that  she 
should  have  the  qualifications  now  considered  essential  for  a 
nurse  in  good  and  regular  standing.  If  the  Central  Com- 
mittee of  the  Ked  Cross  is  willing  to  consider  this  affiliation 
proposition,  then  it  will  be  necessary  to  hold  a  conference 
to  decide  upon  what  grounds  such  an  affiliation  can  be  best 
worked  out. 

Very  truly  yours, 

(signed)  Isabel  Hampton  Eobb. 

To  this  Miss  Boardman  replied : 

My  dear  Mrs.  Robb : 

Your  letter  of  the  loth  has  been  forwarded.  ...  I  feel 
confident  that  a  plan  satisfactory  to  all  can  be  worked  out. 
I  shall  be  at  my  otlice  in  Washington  on  Thursday  and  then 
will  go  into  the  matter  at  length.  I  want  you  on  the  War 
Relief  Board  and  as  a  meeting  of  the  Board  will  be  held  soon 
after  my  return  to  Washington,  your  appointment  will  then 
be  arranged  for.  The  Red  Cross  president,  Mr.  Taft,  makes 
this  appointment. 

Yours  sincerely, 

(signed)   ^Iabel  T.  Boardman. 

A  week  later  Miss  Boardman  wrote  again  to  Mrs.  Robb: 

There  has  not  yet  been  a  meeting  of  the  War  Relief  Board, 
but  I  think  one  will  be  held  next  week  at  whicli  time  your 
letter  will  be  ])resented  to  tlie  Board  and  at  the  same  time 
your  ai)poiiitment  as  a  member  of  that  Board  to  represent 
the  Trained  Nurse  part  of  the  Red  Cross  and  as  a  represen- 
tative of  the  Federation  of  Nurses,  will  be  made.  I  feel 
sure  that  this  pro])osed  affiliation  with  the  Federation  of 
Nurses  can  be  brought  about  in  a  way  satisfactory  to  all. 

Please  let  mo  know  when  you  ex])ect  to  1)€  east  so  that  a 
meeting  of  this  Board  can  be  held  during  that  time.  A 
meeting  of  this  I^oard  will  also  be  held  about  the  time  of  the 
regular  annual  Red  Cross  meeting,  December  8.  At  the 
meeting  next  week  or  thereabouts,  1  will  read  your  letter  to 
me  of  Oetol)er  15. 

Tn  order  that  ^Mrs.  Rohb  might  obtain  a  seat  on  the  War 
Relief  Board,    ]\riss  Boardman   generously   resigiu'd  her  own, 


90     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

thus  creating  a  vacancy  which  Mrs.  Robb  was  appointed  to  fill, 
January,  1909. 

Having  conferred  with  her  committee,  Mrs.  Robb  attended 
the  War  Relief  Board  meeting  in  Washington  (March  25)  and 
there  submitted  the  plan  of  affiliation  as  agreed  on  by  her  com 
mittee.  The  plan  was,  with  but  a  few  modifications,  the  same 
as  one  drawn  up  by  Mrs.  Robb  herself,  earlier  in  the  winter, 
which  had  been  informally  discussed  at  Red  Cross  Headquarters 
and  which  is  now  in  the  Red  Cross  archives.  This  historical 
detail  explains  dual  allusions  in  Red  Cross  official  material  to 
''Mrs.  Robb's  Plan"  and  ''Mrs.  Robb's  Committee's  Plan." 
Both  were  essentially  the  fruit  of  Mrs.  Robb's  ideas.  The  plan 
presented  follows : 

To  the  Eed  Cross  Board  of  Control  of  War  Relief:— 

The  committee  appointed  by  the  Federation  of  Xurses  to 
devise  a  plan  whereby  the  Red  Cross  might  enter  into  affilia- 
tion with  the  Federation  of  Xurses  for  nursing  purposes,  begs 
to  suggest  the  following  plan  for  your  consideration. 

Whereas  it  has  been  proven  that  volunteer  service  by  the 
individual  nurse  is  not  a  success  owing  to  the  fact  that  it  is 
impossible  to  count  upon  her  services  in  emergency : — 

It  would  seem  advisable  to  form  a  regular  nursing  depart- 
ment of  the  Eed  Cross.  That  a  permanent  Chief  Xurse  hav- 
ing the  requisite  training,  experience  and  organization  ability 
be  appointed  to  the  head  of  this  department.  That  the  de- 
partment be  subdivided  into  four  large  sections,  that  of  the 
Xorth,  South,  East  and  West,  and  that  a  permanent  Head 
Nurse  be  placed  over  each  of  these.  That  the  Federation  of 
Nurses  be  asked  to  affiliate  with  the  Red  Cross  for  the  pur- 
pose of  supplying  the  main  nursing  force.  This  force  to  be 
composed  of  its  members  specially  selected,  and  in  considera- 
tion of  this,  the  Federation  would  request  the  following 
privileges : 

That  its  nursing  force  be  drawn  upon  first  for  active 
service;  that  this  nursing  force  have  the  privilege  of  wear- 
ing the  Red  Cross  brassard  on  nursing  service  of  any  kind ; 
that  an  executive  committee  from  among  its  members  shall 
be  appointed  by  the  Federation  Council  to  act  with  the  War 
Relief  Board  of  Control :  that  the  Federation  be  represented 
at  the  Red  Cross  annual  meeting  by  one  or  more  delegates 
selected  from  the  Federation. 

The  source  of  siip])ly  shall  be  drawn  from  the  ranks  of  the 
Federation,  from  other  qualified  nurses  not  members  of  the 
P^deration,    from    Si.-terhoods    and    from    so-called    "experi- 


REORGANIZATION  AND  AFFILIATION  91 

enced  nurses."  It  is  further  suggested  that  in  order  to  insure 
a  ready  supply  of  nurses  the  Federation  of  Nurses  be  asked 
to  form  a  central  directory  in  all  the  large  cities  of  the 
Union  and  the  head  nurse  in  charge  of  these  directories  be 
put  on  the  permanent  staff  of  the  Red  Cross  Xursing  Depart- 
ment subject  in  emergencies  to  orders  from  the  national  head 
nurse. 
Duties  of  the  Chief  Nurse: 

To  organize  the  nursing  force  in  detail  in  cooperation  with 
the  Executive  Committee  and  Board  of  Control  and  the  sec- 
tional head  nurses.  To  keep  corrected  lists  of  all  nurses  on 
the  sectional  registers.  To  visit  and  inspect  the  various 
sections  from  time  to  time.  To  arrange  for  special  courses 
in  emergency  training  throughout  the  country.  To  arrange 
for  Home  Nursing  courses  in  the  various  sections.  To  talk 
upon  Red  Cross  nursing  matters  -wherever  and  whenever 
desirable.  To  study  Red  Cross  nursing  organizations  of 
other  countries  with  a  view  of  improving  that  in  America. 
The  Xursing  l)e})artment  of  the  Bulletin  to  be  edited  by  her. 
Duties  of  the  Sectional  Head  Nurse: 

To  make  lists  with  records  of  all  trained  nurses  in  their 
sections : 

1.  Number  of  Federated  Nurses. 

2.  Number  of  Graduated  Nurses  not  in  the  Federation. 

3.  Number  of  Sisterhoods — available. 

4.  Number  of  experienced  nurses — available. 

5.  Lists  of  nurses  on  directories. 

6.  Lists  of  all  available  nurses. 

7.  Represent  Red  Cross  work  by  at  least  one  lecture  be- 
fore students  in  training  schools.  To  arrange  for  and  over- 
see courses  on  emergency  and  first  aid  nursing.  Also  to  give 
courses  on  homo  nursing.  To  cooperate  with  other  Red 
Cross  work  where  possible. 

(signed)   Isabel   IIamptox   Robb,   Chairman. 
Annie  1)a:\ier, 
M.  Adel-vide  Nutting, 
Georgia  Nevins, 
Anna  Maxwell. 

Thoro  woro  present  besides  ^Uss  Boardman,  Surgeon  General 
Tonicy,  Dr.  Wise  of  the  Navy,  and  ^lajor  Davis.  Exception 
was  taken  (quite  properly)  to  the  point  concerning  the  use  of 
the  brassard  (a  matter  wliich  could  have  been  easily  arranged) 
and  to  the  expense  the  schenu^  would  entail.  The  nKMubers 
present  seemed,  reasonably  enough  in  so  c^arly  a  stage  of  the 
organization,  unready  to  accept  so  considerable  a  plan,  as  tliero 


92     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

would  not  always  be  a  need  for  a  great  many  nurses.  Mrs. 
Robb  suggested,  in  answer  to  this,  that  they  might  be  used  in 
nursing  people  of  moderate  means,  but  that,  it  was  thought,  was 
outside  the  Red  Cross  province. 

The  meeting  then  adjourned.  The  plan  was  talked  over 
further  by  the  Red  Cross  officers,  who  thought  it  elaborate  and 
complicated,  and  a  little  later  they  sent  the  following  statement 
in  regard  to  it : 

At  a  meeting  of  the  War  Belief  Board  held  March  25  at 
the  National  Headquarters  in  the  War  Department  the  sug- 
gested outline  of  plan  for  the  affiliation  of  the  Federation  of 
Nurses  with  the  Eed  Cross,  prepared  by  Mrs.  Bobb  at  the 
request  of  the  Board  and  after  consultation  with  the  Federa- 
tion of  Nurses'  committee  on  Eed  Cross  nursing,  of  which 
Mrs.  Eobb  is  chairman,  was  presented  by  Mrs.  Eobb  and 
informally  discussed.  ,  The  Board  considered  the  plan  care- 
fully studied  out  and  containing  valuable  suggestions,  but 
that  as  the  carrying  out  of  such  a  plan  would  involve  a  large 
expenditure  of  money  from  the  Administration  Fund  of  the 
Society,  the  Board  felt  that  it  would  be  impossible  under 
present  conditions  for  it  to  undertake  any  such  elaborate 
plans.  Mrs.  Eobb  thought  that  it  would  involve  an  annual 
expenditure  of  from  nine  to  ten  thousand  dollars  to  carry 
out  the  proposed  plan. 

As  experience  has  shown  that  for  both  war  and  emergency 
relief,  the  services  of  a  nimiber  of  nurses  have  very  seldom 
been  required  for  strictly  Eed  Cross  work,  the  Board  ques- 
tioned as  to  whether  at  any  time  it  would  be  justified  in  such 
a  large  annual  expenditure  for  the  proposed  plan  unless  some 
continuous  beneficial  use  within  the  Eed  Cross  sphere  of 
work  could  be  made  of  this  affiliation. 

The  Board  hoped  that  for  the  present  a  plan  for  some 
limited  affiliation  may  be  brought  about  that  will  involve 
little  or  no  expense  to  the  Eed  Cross.  It  is  desirous  of  ob- 
taining the  interest,  su})]H)rt  and  assistance  of  the  Federation 
of  Nurses  in  Eed  Cross  work  so  that  the  trained  nurses  of  our 
country  may  l)e  able  to  take  their  part  in  the  patriotic  and 
humane  service  of  the  Society  in  time  of  war  or  disaster. 

The  Board  desired  to  e.\i)ress  its  thanks  to  3Irs.  Eobb  and 
the  other  members  of  \ho  Federation  of  Nurses'  cominittee 
on  Eed  Cross  nursintr  for  the  care  aiid  thought  given  the 
proposed  plan  and  regret  that  the  financial  question  makes  its 
adoption  under   existing  circumstances   impossible. 

Chairman,  lied  Cross  \\'ar  Eelief  Board. ^ 
"Minutes,  Meeting  War  Relief  Board.  Marcli  25,  1909. 


REORGANIZATION  AND  AFFILIATION  93 

Thus  the  first  negotiations  failed,  but,  in  the  light  of  later 
history,  it  is  interesting  to  pause  a  moment  and  consider  how 
the  Red  Cross  Nursing  Service  has  actually  developed,  along 
the  lines  of  the  plan  presented  by  Mrs.  Robb.  The  Department 
of  ]^ursing  was  evolved  for  war  purposes  almost  exactly  as  she 
recommended  and  gave  striking  testimony  to  Mrs.  Robb's  vision 
and  foresight. 

The  decentralization  of  the  service,  as  suggested  by  her 
under  four  sections,  was  rapidly  effected  after  the  declaration 
of  war  (1017)  but  instead  of  four  it  was  necessary  to  create 
fourteen  divisions,  in  each  of  which  a  full  time,  paid  nursing 
director  with  a  staff  has  been  required. -^^  The  Executive 
Committee  of  her  plan  exists  as  the  present  National  Committee 
on  Red  Cross  Nursing  Service. 

The  provision  to  include  Sisterhoods  was  carefully  con- 
sidered (1914)  and  found  of  much  practical  value.  For  ex- 
ample, the  nursing  personnel  of  Base  Hospital  No.  102,  from 
Xcw  Orleans,  was  directed  by  Sister  Chrysostom  Moynahan 
and  included  ten  other  Sisters.  Practical  nurses  were  utilized, 
especially  during  the  influenza  epidemic  in  1919-1920,  when 
many  hundreds  of  women  were  needed. 

The  suggested  directories  as  centers  for  enrollment  were  not 
utilized  to  any  extent  but,  instead,  local  committees  of  nurses 
attached  to  state  associations  were  organized  and  they  collected 
credentials,  passed  upon  the  professional  qualifications  of  appli- 
cants and  finally  forwarded  all  papers  to  National  Headquarters 
where  they  were  filed.  The  duties  of  the  chief  nurse  as  indi- 
cated by  jMrs.  Robb  are  almost  identical  with  those  of  the 
Director  of  the  Department  of  Nursing.  Time  has  shown  that 
her  general  plan,  while  a  little  startling  when  first  submitted  to 
tli(^  War  Relief  Board,  and  pro])ably  as  a  b(>ginning  too  (elabo- 
rate, was  gradually  accepted  and  that  a  still  furtlua*  elaboration, 
on  an  even  more  generous  basis,  soon  became  necessary.  It  was 
fortunate  that  this  was  so,  for  upon  the  declaration  of  war  in 
April,  1917,  tlu^re  were  7000  nurses  enrolled  under  the  Red 
Cross  and  so  well  organized  were  its  state  and  local  connnitte(>s 
that  this  enrollment  was  easily  increased  with  arcat  rapidity. 
Airs.  Rohl)  (lid  not  embody  in  her  j)lan  lun*  conviction  that  the 
IumI  Cross  nurs(es  slionld  form  the  Army  reserve  but  her  mind 
was  cle;\r  on  this  jioint.  Finally  her  ho})e  of  se(Mng  Home 
Xursiiig  classes  developed  on  a  national  scale  has  been  fullillcd, 

^"  This  number   (inder   peace   cnnditions  was  reduced   to  tMglit. 


94     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

beyond,  perhaps,  even  what  she  foresaw  as  possible,  as  we  shall 
learn  in  another  chapter. 

The  Central  Committee  of  the  Red  Cross,  disappointed  in 
their  first  attempt,  took  counsel  among  themselves  and  planned 
another  way  of  solving  the  nursing  question. 

In  May,  1909,  the  War  Relief  Board  proposed  placing  the 
Red  Cross  Nursing  Department  under  a  special  subcommittee 
and  sent  to  Mrs.  Robb  the  following  resolution  passed  by  them 
on  May  7  to  that  effect : 

Resolved,  That  the  subcommittee  on  .Eed  Gross  Nursing 
Service  sliall  consist  of  a  chairman  and  fourteen  other  mem- 
bers, five  to  constitute  a  quorum.  The  chairman  and  five 
members  to  be  members  of  the  War  Belief  Board,  to  be  ap- 
pointed by  the  chairman  of  the  Board ;  six  members  to  be 
appointed  by  the  chairman  of  the  Board  from  a  list  of 
trained  nurses  submitted  by  the  Nurses'  Federation,  and  three 
persons  to  be  appointed  by  the  chairman  on  recommendation 
of  the  Board. 

The  chairman  and  two  other  members  of  the  committee 
to  be  selected  from  trained  nurses,  members  of  the  "War  Eelief 
Board.  Of  the  three  other  members  one  should  be  a  surgeon 
of  the  Army,  one  a  surgeon  of  the  Navy,  and  the  third  some 
other  member  of  the  War  Relief  Board.  This  will  give  a 
membership  of  nine  trained  nurses  on  a  committee  of  fifteen.^^ 

The  resolution  was  read  by  Mrs.  Robb  as  a  part  of  her 
report  at  the  annual  convention  in  Minneapolis  (1909)  and 
discussed.  Mrs.  Robb  was  keenly  disappointed  in  that  the 
work  and  thought  she  and  her  committee  had  put  upon  their 
plan  seemed  to  have  been  lost,  and  she  feared  that  the  hope  of 
satisfactory  affiliation  had  faded.  But  her  intense  idealism  and 
love  of  perfection  perhaps  led  her  to  forget  how  new  and  un- 
tried, as  yet,  was  the  American  Red  Cross  organization.  It  is 
easy  to  see,  now,  how  formidable  and  binding  tlie  plan  must 
have  seemed  to  the  Red  Cross  executives.  Other  nurses  realized 
this  at  the  time  and  believed  that  it  would  be  better  to  begin  in 
a  smaller  way  and  to  build  up  little  by  little.  The  suggested 
committee  of  fifteen  seemed  to  them  a  sensible  compromise 
and  ^liss  Palmer  arose  as  the  spokesman  of  this  group.  She 
spoke  of  being  an  officer  in  the  Rochester  branch,  reviewed  the 
general  conditions  of  Red  Cross  state  work  and  offered  thia 
motion : 

"^linutcs,  War  Relief  Board,  May  7,   1900.. 


REORGANIZATION  AND  AFFILIATION  95 

Resolved,  That  the  American  Federation  of  Nurses 
afiiliate  in  a  body  with  the  National  Ked  Cross  Society  and 
that  nurses  be  nominated  by  this  association  to  serve  with 
the  National  Red  Cross  Committee  as  outlined  by  the 
National  War  Eelief  Board. 

Miss  Delano  had  gone  to  the  Minneapolis  meeting  with  a 
hope  of  securing  the  assent  of  the  Federation  to  the  proposal 
made  by  the  Red  Cross.    Miss  Palmer  wrote  later: 

I  know  from  my  close  association  with  Miss  Delano  in 
those  early  days  .  .  .  that  she  had  very  definite  plans  for  the 
development  of  the  service.  .  .  .  Although  I  submitted  the 
resolution  for  affiliation  it  was  really  Miss  Delano's  resolu- 
tion, as  she  had  it  written  out  in  ink  before  the  meeting 
and,  sitting  next  to  nie,  asked  me  to  present  it.^- 

Tliere  was  an  animated  discussion  and  the  resolution  was 
adopted,  but  with  an  amendment  to  make  the  Associated  Alumna) 
the  affiliating  body,  as  all  the  superintendents  belonged  individ- 
ually to  it.  After  the  annual  meeting  of  the  Red  Cross  in 
December,  1909,  the  War  Relief  Board  named  the  following 
National  Committee  on  Red  Cross  Nursing  Service,  and  Miss 
Delano  was  made  chairman  :^^ 

From  War  Relief  Board 

Mrs.  Whitelaw  Reid,  Now  York  City;  ^Irs.  Isabel  Hamp- 
ton Robb,  Cleveland,  Ohio;  ]\Iiss  Jane  A.  Delano,  Office  of 
the  Surgeon  General,  War  Department,  Washington,  D,  C; 
IMiss  Georgia  Nevins,  Washington,  D.  C. ;  Major  Charles 
Lynch,  T".  S.  Army,  Washington,  D.  C;  Surgeon  W.  L.  Bell, 
U.  S.  Navy,  Washington,  D.  C. 

From  Emergency  Relief  Board 

^riss  ^ra])el  T.  Boardinan,  War  Department,  Washington, 
D.  C;  Mrs.  William  K.  Draper,  New  York  City. 

Nurses'   Associated   Alumx.e 

^liss  Sopliia  F.  Palmer.  Rochester,  New  York  ;  ^liss  Emma 
]\r.  Xicliols,  l-)Ost()n  City  Hospital,  Boston.  ^Tass. ;  ^liss  Linna 
G.  Iiicliardson.  Portland,  Oregon;  Miss  Anna  C.  Maxwell. 
Presbyterian  Hospital,  New  York  City:  Mrs.  F.  Tic-e.  Chi- 
cago, ill.;  Miss  ^iargaret  A.  Pepoon.  San  Diego,  California: 
^Irs.   Harriet  Camp    Lounsbury,   Charleston.  West  Virginia. 

"Letter   in   Red   Cross   tiles. 

"-Minutes,  War   Relief   Board.   December  20.   1900. 


96     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  American  Journal  of  Nursing  said  editorially: 

By  the  appointment  of  this  committee,  with  the  majority 
of  its  members  nurses,  the  responsibility  of  the  nursing  de- 
partment of  the  American  National  Eed  Cross  is  placed  upon 
the  shoulders  of  the  members  of  the  Associated  Alumnae.  .  .  . 

So  far,  the  nurses  of  the  country  have  not  responded  to  the 
call  for  enrollment  in  the  Eed  Cross  as  they  should,  the 
reason  frequently  given  being  that  such  a  department  under 
the  direction  of  laymen  could  not  be  conducted  on  a  practical 
working  basis.  This  excuse  can  no  longer  be  advanced, — 
the  work  of  organizing  a  Eed  Cross  nursing  service  is  now  in 
the  hands  of  nurses.  With  the  concentrated  strength  of  all 
our  national  and  local  nursing  societies  it  can  be  made  a 
practical  working  force.  .  .  . 

The  action  of  the  Associated  Alumnae  brings  the  nurses 
of  this  country  into  distinct  relationship  with  the  War  Eelief 
Board  and  gives  to  them  a  very  influential  place  in  the  ad- 
ministration of  the  strictly  nursing  side  of  the  work  of  the 
National  Eed  Cross.  It  is  an  opportunity  which  has  never 
been  ours  and  one  which  must  receive  the  most  intelligent 
cooperation  from  all  the  affiliated  societies  in  order  to  prove 
our  worthiness  of  the  confidence  which  has  been  shown  us. 

After  the  meeting  at  ^Minneapolis,  Miss  Delano  had  gone 
abroad  for  a  short  trip  but  was  suddenly  recalled  by  receiving 
the  appointment  to  the  post  of  Superintendent  of  the  Army 
Nurse  Corps,  as  indicated  in  the  list  given  above.  Her  selec- 
tion for  this  responsible  work  had  been  made  on  Miss  Board- 
man's  recommendation.  The  Surgeon  General  had  gone  through 
Colonel  Lynch  to  Miss  Boardman  for  advice  and  she  knowing 
that  ]\[iss  Delano  was  then  free  (her  mother  having  some  time 
before  passed  away)  and  feeling  confident  of  her  ability,  had 
counseled  them  to  secure  her  if  possible.  Miss  Boardman 
believed  this  appointment  would  unify  the  Red  Cross  and  the 
Army  Xursing  work  and  ]\Iiss  Delano  shared  this  feeling,  for 
she  once  said  to  Miss  Boardman,  "one  of  my  reasons  for  taking 
this  (the  Army  Nurse  Corps)  is  my  interest  in  Red  Cross 
nursing  and  I  believe  the  Army  Nurse  Corps  and  the  Red  Cross 
Nursing  Service  should  work  in  harmony." 

The  Red  (.'ross  Bulletin  of  October,  1919,  said  of  Miss  De- 
lano's appointment: 

By  this  arrangement  the  wliole  system  of  the  Ecgular 
Army  Nursing  Corps  and  the  Eed  Cross  Nursing  Corps  will 
be  placed  under  one  head,  so  that  in  case  of  war  the  plans 


REORGANIZATION  AND  AFFILIATION  97 

for  Red  Cross  nursing  assistance  will  fall  into  complete  ac- 
cord with  the  demands  of  the  Army  Medical  Service.  Miss 
Delano  will,  therefore,  be  not  only  fully  advised  as  to  the 
regular  nursing  strength  of  the  Army  Corps,  but  will  know 
exactly  the  status  of  the  volunteer  aid  of  the  lied  Cross 
Nursing  Corps. 

On  a  later  occasion,  when  narrating  the  steps  by  which  Miss 
Delano  went  on  to  her  long  volunteer  service  in  the  Red  Cross, 
Miss  Boardman  recalled  the  incidents  of  that  time.     She  wrote : 

...  At  the  time  of  Miss  Delano's  appointment  to  the  Army 
Nurse  Corps  she  was  asked  by  the  Eed  Cross  to  accept  the 
chairmanship  of  its  nursing  committee.  In  consenting 
to  do  so  Miss  Delano  said  that  one  of  the  motives  which  in- 
fluenced her  in  taking  the  Army  position  was  the  opportunity 
it  would  give  to  bring  about  a  close  relationship  between  the 
Army  Nurse  Corps  and  the  Red  Cross  Nursing  Service.  .  .  . 
At  that  time  there  were  not  more  than  twenty  nurses  report- 
ing regularly  as  members  of  the  Army  Nursing  Reserve  and 
Miss  Delano  concluded  that  the  best  way  to  secure  an  ade- 
quate number  of  reserve  nurses  was  to  do  away  with  this 
branch  of  the  Army  Nurse  Corps  and  to  have  the  Red  Cross 
authorized  to  ])rovide  this  service.  The  Surgeon  General 
agreed  to  her  suggestion.  .  .  .  Devoting  herself  to  the  serious 
duty  of  reorganizing  and  improving  the  Army  Nurse  Corps 
Miss  Delano  quietly  and  carefully  studied  it.  .  .  .  The  pay 
of  the  Army  nurse  was  so  low  that  it  was  impossible  to  obtain 
graduates  of  the  best  training  schools  and  to  correct  this  Miss 
Delano  urged  the  increase  of  the  pay  in  an  Army  appropria- 
tion bill.  The  Surgeon  General's  ofHce  approved  her  sugges- 
tion and  included  in  it  an  increase  in  the  pay  of  tlie  superin- 
tendent of  tile  Army  Nurse  Corps,  which  was  also  inadequate. 
\\']ien  tin's  amendment  was  submitted  to  ]\Tiss  Delano  she 
promptly  struck  it  out  so  that  she  should  be  untrammeled 
by  any  apparent  self-interest  in  her  efforts  for  the  benefit 
of  the  nurses. 

After  two  years  as  sup(>rintcndont  of  the  Army  Nurse 
Cor])s  Miss  Delano  came  to  me  one  day  and  said:  "1  believe 
now  tlu>  time  has  come  when  1  can  give  up  my  position  in 
the  Surgeon  (icnerars  otlice.  A  very  ca])able  nurse.  Miss 
jMcIsaac,  will  be  appointed  to  succeed  me.  T  have  a  little 
means  of  my  own  and  I  would  rather  live  on  a  crust  and 
serve  the  Red  Cross  than  do  anything  else  in  the  world.  I 
will  gladly  give  my  services  to  the  IJed  Cross  if  it  d»\-;ires 
them,  to  organize  and  develop  its  Nursing  Department.'"' 


98     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

It  was  a  very  wonderful  gift  .  .  .  there  never  was  a  gift 
given  in  a  nobler  spirit.  .  .  .^* 

The  official  correspondence  touching  Miss  Delano's  resigna- 
tion as  head  of  the  Army  i^urse  Corps  follows : 

War  Department 

Office  of  the  Surgeon  General 

Washington 

March  11,  1912. 
To  the  Surgeon  General, 

United  States  Army, 
Sir: 

In  accepting  the  position  of  superintendent  of  the  Army 
Nurse  Corps  I  did  so  in  the  hope  of  developing  in  connection 
with  the  American  Eed  Cross  an  adequate  nursing  personnel 
which  would  in  the  event  of  war  be  available  as  a  reserve  for 
the  Army  Nurse  Corps. 

The  organization  of  this  nursing  service  is  progressing 
most  satisfactorily,  but  in  addition  to  my  duties  as  super- 
intendent of  the  Army  Nurse  Corps  the  work  has  grown  be- 
yond my  capacity.  Believing  that  the  maintenance  of  this 
Eed  Cross  reserve  is  as  necessary  to  the  Army  as  the  Nurse 
Corps  and  that  Eed  Cross  work  should  be  as  far  as  possible 
volunteer  service,  I  have  the  honor  to  submit  my  resignation 
as  superintendent  of  the  Army  Nurse  Corps,  to  take  effect 
April  1,  1912. 

My  only  object  in  resigning  is  that  I  may  have  the  time 
to  devote  to  the  development  and  maintenance  of  an  efficient 
reserve  of  Eed  Cross  nurses  for  the  service  of  the  Army. 
Very  respectfully, 

(signed)   Jaxe  A.  Delano, 
Superintendent,  Army  Nurse  Corps. 
1st  Indorsement,  War  Department,  Office  of  the  Surgeon 

General, 
]\rarch  11,  1912. 

Eespectfully  forwarded  to  the  Adjutant  General  of  the 
Army,  recommending  that  Miss  Delano's  resignation  ])o  ac- 
cepted to  take  effect  April  1.  I  view  with  great  regret  Miss 
Delano's  separation  from  the  Medical  Department  of  the 
Army.  She  aecepted  the  position  of  superintendent  of  the 
Nurse  Corps  in  August,  1909,  with  the  understanding  tbat 
she  wouhl  remain  in  office  for  only  sufficient  length  of  time 
to  put  the  Xurse  Corps  on  a  thoroughly  satisfactory  basis. 
This  she  has  done  in  an  admirable  manner. 

^*  Red  Cross  BuUetin,  May  12,  1919. 


REORGANIZATION  AND  AFFILIATION  99 

When  she  came  to  this  office  there  were  only  80  nurses  on 
duty  in  the  Army  Xurse  Corps  and  there  was  no  eligihle 
list  from  whicli  appointments  could  be  made.  In  addition 
to  this  admirable  work  Miss  Delano  has  had  charge  of  the 
enrollment  of  l^ed  Cross  nurses  and  has  now  on  her  list 
nearly  ;5,000  well  selected  nurses  that  will  be  available  for 
service  in  the  oMedical  Department  in  case  of  emergency. 

In  view  of  the  success  which  has  attended  ]\Iiss  Delano's 
work  as  superintendent  of  the  Army  Xurse  Corps  in  j)re- 
paring  that  organization  to  meet  fully  its  obligations  in  the 
event  of  war,  it  is  recommended  tliat  the  Secretary  of  War 
in  accepting  her  resignation  place  on  record  his  appreciation 
of  her  services. 

(signed)  Geo.  H.  Tokxey,  Surgeon  General,  U.  S,  Army 
Approved : 

By  order  of  the  Secretary  of  War, 

(signed)  Leonaud  Wood, 

Major  General 

Chief  of  Staff. 

Affiliation  was  now  firmly  rooted,  but  before  following  it 
further  a  brief  final  glance  should  be  taken  at  the  evolution  of 
the  Army  Nurse  Corps  as  part  of  Miss  Delano's  work.  Mrs. 
Kinney  had  effected  improvements  in  the  Army  Nurse  Corps, 
thougli  in  her  time  the  War  Department  had  cut  down  very 
materially  on  all  expenses.  She  had  gained  saloon  mess  for  the 
nurses  at  sea  and  helped  greatly  in  improving  from  the  profes- 
sional and  social  standpoint  the  position  they  had. 

She  did,  probably,  as  much  as  anyone  could  have  done  in  those 
early  months,  but  there  was  still  progress  to  be  made  when  ^liss 
Delano  took  charge.  The  Surgeon  General  had  planned  a  Nurse 
Tveserve  which  he  call(>d  the  "Eligible  Volunteer  Corps,"  ^^  but 
in  this  he  had  not  been  successful.  Early  in  1!)04,  the  Surgeon 
General  had  issued  the  following  regulations,  which  the  Journal 
of  Nursing  published. 

EEKiiiiLE  List  of  Volfxteek  Xukses 

The  Surgeon  General  has  deemed  it  advisable  to  open  in 
his  otlice  wliat  shall  be  known  as  the  Eligible  List  of  Volun- 
teer Nurses.  The  names  of  acceptal)le  graduate  nurses  who 
are  willing  to  serve  in  time  of  war  or  luitional  emergency 
will  constitute  this  list  and  the  requirements  for  enrolhneiit 
shall  be  as  follows:  Applicants  must  have  graduated  from  a 
training-school  for  nurses  which  gives  a  thorough  professional 
^''  A))ivriva)i  Joiunial  of  'Sursing,  Marcli,   1904. 


100   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

education,  both  practical  and  theoretical,  and  which  requires 
at  least  a  two-years'  residence  in  an  acceptable  general  hos- 
pital of  not  less  than  fifty  beds.  Graduates  from  special  hos- 
pitals and  from  insane  asylums  and  private  sanatoria  will 
not  be  considered  unless  their  training  has  been  supplemented 
by  not  less  than  six  months  in  a  large  general  hospital. 

Application  for  enrollment  must  be  made  to  the  Surgeon 
General  and  before  being  accepted  the  applicant  must  submit 
to  the  following:  (1)  A  statement  of  her  physical  condition 
filled  out  in  her  own  handwriting  and  sworn  to  by  a  notary 
public.  (2)  A  certificate  of  her  health  from  at  least  one 
reputable  physician  personally  acquainted  with  the  applicant. 

(3)  The  name  of  her   school   and  date  of  her  graduation. 

(4)  A  certificate  concerning  the  moral,  physical  and  pro- 
fessional qualifications  of  the  applicant  as  shown  by  the  records 
of  the  hospital  must  be  furnished  by  the  superintendent  of 
the  training  school  from  which  the  applicant  graduated.  If 
she  was  trained  under  a  former  superintendent  of  nurses, 
her  endorsement  is  also  desirable.  Blanks  for  these  pur- 
poses will  be  furnished  by  the  Surgeon  General. 

Approved  candidates  will  be  placed  on  the  eligible  list  for 
appointment  in  event  of  war  or  national  calamity. 

Each  nurse  must  agree  to  enter  active  service  as  she  may 
be  needed  in  time  of  war  or  national  calamity.  On  the  first 
of  January  and  the  first  of  July  of  every  year  she  shall  report 
to  the  Surgeon  General,  giving  her  address  and  enclosing  a 
certificate  from  some  reputable  physician  showing  the  con- 
dition of  her  health  at  that  time. 

When  called  into  active  service  these  nurses  will  be  sub- 
ject to  all  established  rules  and  regulations  and  will  re- 
ceive the  pay  and  allowances  of  nurses  of  tlie  Army  Xurse 
Corps  as  set  forth  in  General  Orders  Xo.  54,  War  Depart- 
ment, November  IG,  1903. 

!Nnrses  did  not  enroll,  however,  in  large  numbers  in  the 
Volunteer  Corps.  In  the  September,  1905,  issue  of  the  Joimuil, 
Miss  Palmer,  the  editor,  wrote: 

Another  year  is  drawing  to  a  close  and  at  the  beginning  of 
August  tlie  "Eligible  List  of  Volunteer  Xurses"  stands,  since 
the  first  appeal  in  March.  li)()4:  number  of  applicants  for 
blanks.  174.  Of  these  there  have  been  returned  42  :  not  recom- 
mended by  her  superintendent,  1  ;  total  number  on  the  list, 
41.  Of  these  the  number  who  liave  been  or  who  are  at  present 
in  the  Army  are  l<s.  thus  leaving  the  number  of  outside 
graduates  on  the  list  as  twenty-three.  If  this  means  any- 
thing, it  means  tliat  only  fortij-one  nurses  out  of  over  thirty 


REORGANIZATION  AND  AFFILIATION  101 

thousand  desire  to  serve  their  country  in  its  time  of  need. 
But  we  know  that  if  an  emergency  arose  the  nurses  would 
rise  to  meet  it  and  we  would  have  a  repetition  of  the  con- 
fusion and  dissatisfaction  which  we  were  so  ready  to  criticize 
and  rehuke  seven  years  ago  simply  because  we  are  more 
selfish  than  patriotic.  .  .  . 

Our  faults  are  not  the  faults  of  nurses  alone,  for  we  only 
reflect  the  signs  of  the  times  and  our  own  people,  who  love 
the  glare  of  notoriety  and  excitement  and  are  fickle  and  in- 
constant until  misfortune  and  disaster  overtake,  when  their 
inborn  courage  and  faithfulness  come  to  the  front  and  save 
the  day.  Meanwhile  we  cry  aloud,  "How  long,  0  Lord,  how 
long?''  with  this  record  of  our  indifference  standing  as  a 
public  rebuke  upon  us? 

Through  ^[iss  Delano's  influence,  the  Red  Cross  Nursing 
Corps  became  the  Army  Xurse  Reserve  and  the  Eligible  List 
of  Volunteer  Xurses  was  finally  discontinued.  Miss  Delano 
secured  for  the  Army  Xurse  Corps  additional  pay ;  cumulative 
leave ;  laundry  of  uniforms ;  first-class  transportation  for  all 
nurses  and  improved  quarters  and  in  all  of  this  the  cooperation 
of  the  Red  Cross  had  been  most  effective. 

]\Iiss  Boardman  has  said  that  ^Fiss  Delano's  influence  with 
officials  of  the  Army  was  most  marked.  She  gained  their  con- 
fidence by  her  sober,  solid  judgTnent  and  by  her  willingness  to 
consider  opposing  viewpoints.  She  was  usually  able  to  get  her 
recommendations  through. 

Her  successor  in  the  Army  I^ursc  Corps,  Isabel  Mclsaac,  was 
one  of  the  most  widely  known  and  beloved  nurses  in  the  country. 
A  graduate  under  ]sabel  Hampton  Robb,  of  the  Illinois  Train- 
ing School,  she  had  risen  through  (n'ory  position  there  to  the 
superintendency ;  had  been  prominent  in  all  nursing  associa- 
tions, had  met  thousands  of  nurses  intimately  as  inter-state 
secretary  and  had  written  popular  textbc^oks.  Very  attractive 
in  appearance,  with  a  personality  expressing  great  sincerity,  her 
Scotch  ancestry  was  always  evident  in  a  certain  dry  and  un- 
failing humor.  Her  views  were  bnxid  and  tolerant  and  her 
common  sense  amounted  to  a  kind  of  genius.  ]\liss  Alclsaac 
threw  all  her  gifts  into  the  Army  work  and  also  her  life,  for 
she  died  "in  harn(>ss"  at  the  Walter  Reed  Hospital,  Washing- 
ton, D.  C,  on  September  21,  lUlt. 

A  general  r(M)rgani/ation  plan  was  now  issued  from  Wa?h- 
inaton  as  outlined  in  the  followinu'  sunnnarv.     It  Joc^s  not  seem 


102   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  have  applied  directly  to  nursing  enrollment,  but  instituted 
the  ^'Chapter"  which  from  now  on  becomes  a  familiar  word. 

The  Central  Committee  at  Washington  has  found  it  neces- 
sary to  make  certain  changes  in  the  form  of  the  state 
branches  and  in  a  letter  to  these  branches,  under  date  of 
Xovember  1,  1909,  the  reasons  are  clearly  set  forth.  Briefly 
stated,  these  are  distances  which  prevent  representation  from 
all  parts  of  a  state,  with  a  tendency  to  concentrate  officers 
and  members  at  some  central  point,  absence  of  state  officers, 
jealousies,  .  .  .  conditions  detrimental  to  the  best  interests  of 
the  lied  Cross.  Moreover,  experience  has  taught  that  in 
case  of  disaster  within  the  state  the  governor  is  the  one  who 
makes  the  appeal  for  assistance  to  the  rest  of  the  state,  or 
to  the  President  of  the  United  States  if  national  help  is 
needed.  Therefore,  that  the  national  headquarters  with  its 
active  working  force  may  be  in  immediate  and  close  touch 
with  all  its  branches  when  relief  is  needed,  new  regulations 
have  been  adopted  by  which  local  branches,  hereafter  to  be 
called  "Chapters,"  will  be  in  direct  communication  with 
headquarters  at  Washington,  retaining  fifty  cents  on  the  an- 
nual dues,  instead  of  twenty-five,  for  local  use,  and  each 
Chapter  may  have  tlie  privilege  of  sending  one  delegate  to  the 
annual  meeting  at  Washington.  The  state  boards  will  as- 
semble only  in  case  of  war  or  serious  disasters. 

The  charter,  by-laws  and  regulations  for  state  boards  and 
Chapters  have  been  issued  under  date  of  January  1.  1910, 
copies  of  which  may  be  obtained  from  Major  General  George 
W.  Davis,  chairman  Central  Committee,  American  National 
Eed  Cross,  Washington,  D.  C.^*' 

At  the  first  meeting  of  the  Xational  Committee  on  Red  Cross 
Xursing  Service,  held  on  January  20,  1910,  at  the  home  of 
Mrs.  AV.  K.  Draper,  Xew  York,  ]\liss  Delano's  appointment 
was  ratified  and  slie  was  asked  to  take  the  chair.  Miss  Georgia 
Xcvins,  head  of  the  Garfield  Hospital,  was  appointed  secretary 
but  as  she  was  not  present  ]\Irs.  Draper  was  asked  to  act  as 
secretary  ])ro  torn.  ^liss  Delano  tlien  submitted  the  list  of 
suggestions  drawn  up  by  her  committee  and  herself: 

Outline  of  Plan  for  the  Enrollment  of  Xurses  Adopted  by 
the  Xational  Coniniittoe  on  Ped  Cross  Xursing  Service. 

Duties  of  Xational  Connuittee: 

To  or,L!'an-ize  tlie  iiui'.-ing  service  of  the  Pcd  Cross. 

'"Chartei-.  By-Laws,  juul  Itc^nilat inns  for  State  Boards  and  Chapters, 
American    iied    Cross.   Januarv    1.    1!)10. 


REORGANIZATION  AND  AFFILIATION  103 

To  make  uniform  rules  for  the  enrollment  of  nurses 
throughout  the  country. 

To  arrange  for  the  estahlishment  of  state  and  local  com- 
mittees on  lied  Cross  Nursing  Service,  and  to  specify  the 
duties  of  all  such  committees. 

To  appoint  annually  state  committees  on  Red  Cross  Nurs- 
ing Service  of  not  less  than  five  or  more  than  ten  nurses 
who  are  members  of  organizations  affiliated  with  the  Nurses' 
Associated  Alumna3  of  the  United  States,  but  where  a  state 
nurses'  association  exists  which  is  affiliated  with  the  Nurses' 
Associated  Alumna',  appointments  must  be  made  from  names 
submitted  by  the  executive  committee  of  such  nurses'  associa- 
tions. 

To  issue  to  local  committees  on  Eed  Cross  Nursing  Service 
the  necessary  blank  forms  for  application  of  nurses  for  en- 
rolhnent. 

To  receive  and  file  in  the  central  office  of  the  Red  Cross  in 
Washington  the  application  blanks  and  required  credentials  of 
all  nurses  who  have  been  accepted  by  local  committees  for 
enrollment  as  Red  Cross  nurses,  and  to  issue  cards  of  ap- 
pointment and  Red  Cross  badges  to  all  such  accepted  appli- 
cants. 

To  appoint,  as  headquarters,  registries  for  nurses  or  other 
offices  recommended  by  local  committees  as  suitable  places  for 
filing  lists  of  enrolled  nurses. 

To  keep  in  the  National  office  of  the  Red  Cross  in  Wash- 
ington card  catalogues  of  all  state  and  local  committees  and 
of  all  lieadquarters  for  enrolled  nurses  with  the  approximate 
number  of  nurses  available  at  each. 

To  ascertain  and  keep  on  file  the  various  sources  of  volun- 
teer service  available,  including  Sisterhoods  and  members  of 
other  orders. 

To  arrange  for  courses  in  home  nursing,  hygiene,  and  first 
aid  under  the  direction  of  the  Red  Cross,  utilizing  as  far  as 
possible  for  this  instruction  enrolled  Red  Cross  nurses. 

To  arrange  for  lectures  on  the  relation  of  nurses  to  the 
Red  Cross,  and  to  encourage  the  presentation  of  the  subject 
to  graduating  chisses  of  nurses  throughout  the  country. 

To  study  tlie  nursing  service  of  tlie  Red  Cross  in  other 
countries,  with  the  object  of  improving  that  in  America. 

In  cooperation  with  the  medical  departments  of  the  army 
and  navy,  to  provide  instruction  for  enrolled  nurses  in  the 
special  duties  which  would  be  required  of  them  in  time  of 
war. 

All  matters  relating  to  tlie  services  of  nurses  under  tlie 
Re(l   Cross  will  be  referred  to  the  cliairnian  or  secretarv  of 


104   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  National  Committee  of  Nursing  Service,  and  in  coopera- 
tion with  such  other  members  of  the  committee  as  may  be 
necessary  they  will  be  responsible  for  all  assignments  of 
nurses  to  duty,  and  when  two  or  more  nurses  are  sent  out  to- 
gether one  shall  be  placed  in  charge  or  authorized  to  act  as 
head  nurse. 

The  National  Committee  on  Eed  Cross  Nursing  Service 
shall  hold  regular  semi-annual  meetings,  one  in  Washing- 
ton at  the  time  of  the  annual  meeting  of  the  Red  Cross,  and 
the  second  at  the  time  and  place  of  the  annual  meeting  of 
the  Nurses'  Associated  Alumnae. 

Special  meetings  may  be  held  at  any  time  at  the  call  of 
the  chairman. 

Full  reports  shall  be  presented  at  the  semi-annual  meet- 
ings." 

Jane  A.  Delano. 

The  form  of  application,  as  prepared  by  Miss  Delano's  com- 
mittee was  submitted  and  with  one  or  two  slight  changes  was 
approved,  as  follows : 

1.  Name  of  applicant   

2.  Address    

3.  Date  of  birth Place  of  birth 

4.  Are  you  married,  single  or  a  widow? 

5.  Are  you  a  citizen  of  the  United  States  ? 

6.  Have  you  any  physical  defects? 

7.  Education     and     occupation     before     entering    training 
school  

8.  From  what  training  school  did  you  graduate? 

9.  Is    it    connected    with    a    general,    special    or    private 
hospital  ?   

10.  How  many  beds  in  hospital  at  time  of  graduation? 

11.  Date  of  graduation Length  of  course 

12.  Name  and  address  of  superintendent  under  wliom  you 
were  trained   

13.  Of  what  nursing  organization  are  you  a  member? 

14.  Give  name  and  address  of  secretary 

15.  Are  you  a  registered  nurse? In  what  State? 

Date  of  registration 

IG.  How  have  you  been  employed  since  graduation? 

Give  information  for  each  year 

17.  Give  name  and  permanent  address  of  nearest  relative. . . . 

Signature 

Date 

"American  Journal  of  Nursing,  February,  1910,  p.  303. 


Indoor  unifnnn,  fr^-ay  dress,  hrassard  and  cap.  of  an  American  Wetl 
Cross  Nurse.  The  dress  luiitdrni  of  the  Nursing  Service  consists  of  a  wliite 
dress  of  this  tyjie.  while  slices  and  stockings,  the  lirassard.  tiie  cap  and  tlie 
cape,  hut   no  apron. 


REORGANIZATION  AND  AFFILIATION  105 

The  chairman  then  presented  suggestions  to  be  filed  as  ref- 
erence for  the  applicants — this  blank  to  be  entitled  "Creden- 
tials from  Training  Schools."  After  a  short  discussion  of  the 
above  title,  and  one  or  two  slight  changes  in  the  text,  the  blank 
was  accepted  as  follows: 

1.  Name  of  applicant 

2.  Name   of   training   school Address 

3.  Date  of  graduation 

4.  Length  of  course 

5.  Number   of   beds   in   hospital    during   applicant's   train- 
ing ••••  •  : 

6.  Character  of  hospital : 

General Special Private 

7.  Are  pupils  sent  out  for  private  duty  ? 

8.  What,  if  any,  position  of  responsibility  did  applicant  hold 

during  her  training 

9.  Was  her  record  satisfactory  in  regard  to  the  following: 

Work  ?   

Health? 

Conduct  ? 

10.  Was  she  employed  in  your  hospital  after  graduation  ? 

11.  What  has  been  her  standing  as  a  nurse  and  woman  since 
graduation  ?    

12.  Arc    you    willing    to    recommend    her    for    Ked    Cross 

Service? 

Superintendent  of  Training  School 


Hospital    

Graduate  of    

Name  and  address  of  superintendent  under  whom  the  appli- 
cant was  trained : 

Remarks    

Date 

It  was  moved  by  Miss  Palmer  and  seconded  by  Mrs.  Robb 
that  the  form  of  application  and  credentials  from  training 
schools  bo  adopted.  These  were  as  nearly  uniform  as  possibh' 
with  tliose  used  by  the  (Government,  so  that  in  time  of  war  they 
can  be  made  immediately  useful  in  the  Surgeon  (leneral's  otlice. 

The  rules  governinc;  the  enrollment  of  nurses  for  service  under 
the  American  Ived  Cross  were  adopted,  as  follows: 

1.  All  nurses  enrolled  for  service  under  the  American 
National  I\ed  Cross  must  have  graduated  from  a  school  for 
nurses  which  gives  a  thoi'ough  professional   edutation,  both 


106   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

theoretical  and  practical,  and  which  requires  a  residence  of 
at  least  two  years  in  an  acceptable  hospital.  In  states  and 
territories  where  registration  of  nurses  is  required  by  law, 
graduates  of  schools  not  acceptable  to  Boards  of  Registration 
will  not  be  considered  eligible  for  enrollment  as  Red  Cross 
nurses. 

2.  All  applicants  for  enrollment  must  be  endorsed  either 
by  superintendents  by  whom  they  were  trained,  or  by  a  nurs- 
ing organization  which  is  a  member  of,  or  affiliated  with,  the 
Nurses  Associated  Alumna  of  the  United  States;  or  must 
submit  such  other  evidence  of  moral,  professional  and  mental 
qualifications  as  may  be  required. 

3.  All  enrolled  nurses  shall  receive  a  physical  examina- 
tion before  being  assigned  to  service,  if  required, — such  ex- 
amination to  be  made  at  most  convenient  point  by  a  physician 
authorized  by  the  Ked  Cross. 

4.  Xo  nurse  under  twenty-five  years  of  age  shall  be  en- 
rolled for  active  service. 

5.  All  nurses  called  on  for  service  in  time  of  war  will  be 
required  to  take  the  oath  of  allegiance. 

Mrs.  Robb  moved  that  this  committee  recommend  that  the 
Red  Cross  Nursing  Corps  enroll  for  paid  service.  This  motion 
was  seconded  by  Miss  Nichols,  and  after  a  short  discussion  was 
carried. 

The  plan  for  carrying  on  the  work  of  enrollment  was  then 
discussed  by  the  committee  and  the  following  motion  made  by 
Miss  Cooke  and  seconded  by  Miss  Palmer  was  unanimously 
adopted : 

That  the  Central  Committee  on  Eed  Cross  Nursing 
Service  should  ask  each  State  Xurses'  Association  to  instruct 
their  executive  committee  to  appoint  a  Eed  Cross  committee, 
of  not  less  than  five  members,  to  organize  local  committees 
throughout  the  State  for  the  purpose  of  enrolling  nurses. 
The  local  committees  to  be  seven  in  number — five  nurses 
and  two  lay  members,  representing  the  local  Eed  Cross ;  these 
committees  to  have  charge  of  enrollment.  The  application 
blanks  and  credentials  of  the  nurses,  as  accepted  by  this  com- 
mittee, to  be  sent  to  Washington  for  filing;  and  a  card  cata- 
logue, giving  the  name,  address,  telephone  number,  school 
of  graduation  and  date  of  graduation  to  be  kept  by  the  local 
committee  for  reference — the  local  committee  also  having  the 
responsibility  with  the  approval  of  the  State  Nurses  Eed 
Cross  Committee,  for  arranging  with  some  registry,  training 
school  or  office  to  take  charge  of  these  cards,  and  be  respon- 


REORGANIZATION  AND  AFFILIATION  107 

sible  for  the  immediate  notification  of  these  nurses  in  case  of 
an  emergency  call. 

AMERICAN  NATIONAL  RED  CROSS 

Branch^^ 

19 

On  recommendation  of  the  Committee  on  Nurses  of  the 

Branch  of  the  American  National  Red  Cross 

your  offer  of  service  is  hereby  accepted  for  assignment  to  duty 
when  and  where  your  services  may  be  required. 

When  assigned  to  duty  your  compensation  will  be  at  the 
rate  of  forty  dollars  per  month  when  on  duty  in  the  United 
States  and  fifty  dollars  per  month  when  without  the  limits 
of  the  LTnited  States,  in  addition  to  transportation  and  sub- 
sistence. 

This  acceptance  to  hold  until  your  services  are  no  longer 
required,  or  until  your  resignation  is  accepted. 
Very  respectfully, 


President Branch/^ 

American  National  Rod  Cross. 
To 


The  correspondence  between  !Miss  Delano  and  her  co-workers 
at  that  time  teems  with  suggestions  and  counter-suggestions. 
The  letters  are  full  of  interest  and  many  tempt  one  to  in- 
clude them,  but  their  length  precludes  all  but  brief  illustrative 
examples. 

Mrs.  Helen  F.  Draper  to  ]\Iiss  Delano : 

I  agree  with  you  that  as  a  general  thing  it  is  wiser  to 
limit  the  number  of  persons  to  serve  on  a  committee.  In  this 
particular  instance,  however,  where  we  are  not  starting  out 
on  a  new  basis,  but  reorganizing  a  former  plan.  I  think  that 
local  conditions  have  to  lie  taken  into  consideration.  It  would 
seem  to  me  wiser,  as  in  Brooklyn  and  New  York,  to  continue 
the  former  committees  as  far  as  ])ossil)le.  1  tlierefore  think 
that  your  suggestion  in  regard  to  State  Committoes  is  good — ■ 
"Tt  shall  be  the  duty  of  the  National  Committee  to  a]iiioint 
State  Connnittees  of  at  least  five  nurses  who  are  members  of 
organizations  affiliated  witli  tlie  Nurses'  Associated  Aluinna\ 
but  where  a  State  Xursos'  Association  exists  tliese  a]ipoint- 
"  Minutes,  Xat.  Com.  on  Red  Cross  Xursing  Service.  .Taniuuv  ill.   ]'M0. 


108    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ments  must  be  made  from  names  submitted  by  the  executive 
committee  of  such  State  Nurses'  Association.'*  I,  also,  agree 
to  the  suggestion  in  regard  to  the  appointment  of  local  Bed 
Cross  committee  by  the  State  Committee  on  Nursing  Service. 
In  regard  to  the  annual  appointment  of  committees,  I 
think  if  this  is  done,  it  should  be  done  only  with  the  idea  that 
two  members  only  should  come  up  each  year.  I  would  per- 
sonally prefer  a  permanent — but  if  the  majority  of  the  Cen- 
tral Committee  on  Ked  Cross  Nursing  Service  feel  that  a 
varying  committee  is  wiser,  I  would  be  willing  to  vote  for  one 
where  two  members  were  changed  each  year. 

The  manifold  details  of  bringing  affiliation  plans  into  shape 
and  of  uniting  on  some  definite  lines  of  activity  for  peace 
times  are  suggested  in  the  following  letter  from  Miss  Delano 
which  touches  on  all  the  problems  then  pressing  for  solution. 
Of  these  one  of  the  most  significant  was  that  already  mentioned 
as  having  arisen  in  1908,  of  carrying  instruction  into  the  homes 
of  the  people. 

March  15,  1910. 
My  dear  ^Mrs.  Draper : — 

At  last  we  have  the  first  installment  of  the  Red  Cross  matter 
ready,  and  it  seems  to  me  that  it  would  be  possible  to  begin 
on  the  formation  of  the  State  Committees  while  we  are  at 
work  on  the  other  data.  In  the  meantime  the  State  Com- 
mittees can  be  plaiming  out  their  work  and  locating  the 
branches.  After  talking  the  matter  over  a  number  of  times 
we  decided  that  it  would  be  better  to  publish  all  the  data  in 
a  little  book  about  tlie  size  of  the  Constitution  of  the  Red 
Cross  so  that  every  one  interested  will  know  all  of  the  steps 
from  the  duties  of  the  National  Committee  down  to  the  actual 
enrollment  of  nurses.  Miss  Boardman  thought  that  it  would 
be  well  to  have  a  little  outline  of  the  Red  Cross  at  the  be- 
ginning and  the  circumstances  leading  up  to  the  affiliation 
of  the  Nurses'  Associated  Alumna",  which  accounts  for  the 
little  "foreword"  1  am  sending  you.  Some  changes  may  be 
necessary  in  the  "duties  of  the  National  Committee,"  and  we 
hope  you  will  criti(iz(;  and  suggest  any  changes  you  think 
necessary.  After  nnuh  discussion  and  many  letters  it  seemed 
wise  to  leave  the  size  of  tlie  State  Committee  with  the  various 
States.  Do  you  approve  of  the  paragraphs  relating  to  "sources 
of  volunteer  service,"  "the  courses  in  home  nursing," 
"hygiene,"  "first-aid"  (tliese  were  among  Mrs.  Rol)b's  sug- 
gestions) and  provision  for  lectures  on  Red  Cross  subjects? 
]\Iiss  Boardman  wisbed  to  leave  the  matter  of  assignment  of 


REORGANIZATION  AND  AFFILIATION  109 

nurses  to  active  duty  to  the  National  Committee,  and  the 
paragraph  referring  to  this  was  added  at  her  request.  .  .  . 
In  talking  with  Miss  Boardman  and  Miss  Nevins  in  regard 
to  the  appointment  of  the  committees  it  was  suggested  that 
it  would  be  almost  impossible  to  keep  track  of  the  members 
going  out  at  varying  periods  where  there  are  so  many  com- 
mittees to  consider.  The  idea  of  the  annual  appointment  was 
that,  as  a  matter  of  course,  all  members  of  the  Committee 
should  be  reapi)ointed,  unless  for  some  reason  it  seemed  best 
to  make  a  change.  If  we  make  any  provision  for  reappoint- 
ment with  so  many  permanent  committees  all  over  the  coun- 
try, there  seems  more  or  less  danger  of  having  a  certain 
number  of  inactive  people  on  the  committees  with  difficulty 
in  regard  to  placing  them.  This  would  make  it  possible  to 
reappoint  all  of  tlie  committee,  if  desirable,  or  to  make 
changes  without  hurting  anyone's  feelings. 

To  the  reference  in  this  letter  to  the  home  nursing  plan  Mrs. 
Draper  replied  with  suspended  judgment,  as  she  thought  it  was 
too  soon  to  branch  out  in  new  directions.  What  the  subsequent 
developments  of  this  department  were  will  be  dealt  with  in  a 
special  section. 

In  April,  1910,  Isabel  Hampton  Robb  was  suddenly  removed 
by  death  from  the  manifold  activities  in  which  she  took  so  eager, 
intense  and  inspiring  a  part.  In  the  Amencan  Journal  of 
Nursing  of  May,  we  read : 

The  shock  of  her  death  is  so  great  that  it  seems  impossible 
yet  to  collect  one's  thought  sufficiently  to  look  back  over  her 
long  service  to  the  nursing  profession — she  was  still  in  close 
touch  with  all  its  activities.  One  cannot  tliink  of  a  move- 
ment of  importance  of  which  she  was  not  one  of  the  moving 
spirits,  organizer,  supporter;  the  Superintendent's  Society, 
of  which  she  was  president  only  last  year ;  the  Associated 
Alumna\  of  which  she  was  president  for  the  first  five  years 
and  at  whose  meetings  she  was  almost  always  present;  the 
Journul  the  course  at  Teachers  College,  of  which  she  was 
one  of  tht'  lecturers:  the  International  Association  to  which 
she  was  a  delegate  last  summer ;  the  Ked  Cross,  of  whose 
Central  Connnittee  she  was  a  member.  All  of  these  will  miss 
her  sadly. 

The  ^finutos  of  the  C\Mitral  Comniittoe  said  of  her: 

We  record  with  much  sorrow  the  tragic  death  of  ^Irs. 
Tsat)el  Hampton  I'oljb,  a  most  valuable  member  of  the  War 
IJelief  Koarci  and  of  the  sub-committee  on  l\eil  Cross  Xursing 


110   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Service,  a  woman  of  large  insight,  warm  sympathies  and 
broad  experience,  to  whom  we  are  indebted  more  than  to  any 
other  person  for  the  development  and  perfection  of  nursing 
organizations  which  has  made  the  work  of  this  committee 
possible. 

By  early  summer  Miss  Delano  presented  the  following  en- 
couraging report  on  affiliation  and  enrollment : 

American  Eed  Cross  Xotes 

The  Xational  Committee  on  Eed  Cross  Xursing  Service 
announces  with  pleasure  the  completion  of  the  plan  for  the 
enrollment  of  Ked  Cross  nurses.  The  first  step  necessary 
is  the  formation  of  State  Committees  on  Eed  Cross  Xursing 
Service  in  accordance  with  the  following  provisions. 

"The  Xational  Committee  shall  appoint  State  Committees 
on  Eed  Cross  Xursing  Service  of  not  less  than  five  nor  more 
than  ten  nurses  who  are  members  of  organizations  affiliated 
with  the  Xurses'  Associated  Alumnae  of  the  United  States, 
but  where  a  state  nurses'  association  exists  which  is  affiliated 
with  the  Xurses'  Associated  Alumnae  appointments  must  be 
made  from  names  submitted  by  the  executive  committees 
of  such  state  nurses'  associations.  Unless  changes  in  personnel 
become  necessary,  it  is  desirable  that  a  majority  of  the  mem- 
bers of  State  Committees  be  reappointed  annually." 

The  following  State  Committees  on  Eed  Cross  nursing 
service  have  already  been  appointed. 

West  Virginia:  ]Mrs.  H.  C.  Lounsbury,  Charleston;  Mrs. 
Mary  G.  Carpenter,  Wheeling;  Miss  Vernon,  Fairmont;  M. 
Virginia  McCune,  Martinsburg;  Mrs.  M.  Lingenfelter, 
Hinton. 

Illinois:  Adda  Eldredge,  chairman,  Chicago:  Mary  C. 
Wheeler,  Quincy;  Adelaide  ]\I.  Walsh,  Chicago;  Ellen  Par- 
sons, Chicago ;  Mrs.  Tice,  Chicago ;  Helena  M.  McMillan, 
Chicago;  Benna  M.  Henderson,  Chicago. 

Xew  York:  Elizabeth  Dewey,  chairman,  Brooklyn; 
Beatrice  V.  Stevenson,  Brooklyn;  ^Mrs.  C.  V.  Twiss,  Xew 
York  City;  Elsie  Patterson,  Xew  York  City;  Anna  Charlton, 
Xew  York  City;  Mrs.  Ernest  G.  H.  Schenck,  Xew  York 
City;  ^Irs.  Harvey  D.  Burrill,  Syracuse;  Sophia  F.  Palmer, 
Eochester ;  ^larie  T.  Plielan,  Eochester;  Eye  Morley,  Buffalo. 

To  facilitate  the  formation  of  these  committees  the  follow- 
ing states  have  been  assigned  to  members  of  the  Xational 
Committee  and  state  secretaries  are  earnestly  urged  to  com- 
municate with  their  organizing  member  of  the  Xational  Com- 
mittee for  information  and  advice. 


REORGANIZATION  AND  AFFILIATION  111 

Emma  M.  Nichols,  Boston,  Mass.,  Maine,  New  Hampshire, 
Vermont,  Massachusetts,  lihode  Island,  Connecticut. 

Anna  C.  Maxwell,  New  York  City,  New  York  and  New 
Jersey. 

Georgia  l\r.  Nevins,  Washington,  D.  C,  District  of  Colum- 
bia and  Maryland. 

Mrs.  H.  C.  Lounsbury,  Charleston,  W.  Virginia,  West  Vir- 
ginia, North  Carolina,  South  Carolina,  Georgia,  Kentucky 
and  Tennessee. 

Mrs.  Frederick  Tice,  Chicago,  Illinois,  Michigan,  Iowa, 
Minnesota,   jMissouri,  Arkansas,  Louisiana. 

Linna  G.  Eichardson,  Portland,  Oregon,  Washington,  Ore- 
gon, Idaho,  Montana,  Wyoming. 

IVfargaret  A.  Pepoon,  San  Diego,  Calif.,  California,  Nevada, 
Utah,  Arizona. 

States  unassigned  will  communicate  directly  with  the 
Chairman  of  the  National  Committee  on  Nursing  Service, 
State,  War  and  Navy  Building,  Washington,  D.  C. 

(signed)   Jaxe  A.  Delano, 
Chairman  National  Committee 
on  Nursing  Service.^" 

States  which  were  not  yet  organized  were  summed  up  thus 
by  Miss  Delano : 

To  myself,  as  chairman  of  the  Committee,  came  the 
mother's  share,  all  those  states  which  did  not  seem  to  fit 
in  any  locality,  many  of  them  without  state  organizations.  I 
am  sorry  that  I  am  not  able  to  show  a  better  report  of  my 
own  work. 

Pennsylvania  has  begun  its  organization.  Delaware  has 
not  been  communicated  with.  Mrs,  Lounsbury  is  going  to 
consult  with  Mrginia  to  bring  about  an  organization,  while  the 
delegates  are  here.  Florida  has  no  state  organization.  Texas 
is  at  work  and  I  hope  will  very  soon  be  organized.  North 
Dakota  and  South  Dakota  have  no  state  organizations. 
Nebraska  has,  and  has  a  delegation  here,  and  we  hope  to  have 
something  done  before  it  goes  back. 

Kansas  has  no  state  organization.  Colorado  has.  New 
]\rexico  has  none.  Alabama  has  none.  Mississippi  has  none. 
Ohio  is  organized  with  ^Fiss  Johnson,  who  is  in  charge  of  the 
district  nurses  in  Cleveland,  as  chairman.  Indiana  is  or- 
ganized with  ]\riss  Elizal)eth  Johnson  of  Indianajiolis,  chair- 
man. Wisconsin,  one  of  the  two  states  admitted  this  session, 
is  organized.     With  true  western  spirit  they  had  their  coni- 

*"  Afncricnn  ■JournnJ  of  Xiirsiti'j,  May.  IHIO,  p.  .399. 


112   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

mittee  all  appointed  in  case  they  were  accepted,  so  there 
was  very  little  trouble,  and  Miss  Matthews  is  chairman. 

I  think  you  will  agree  with  me  that  this  is  a  good  showing 
for  a  very  few  weeks'  service. 

Within  a  couple  of  months  the  results  of  the  labors  of  the 
National  Committee  members  to  whom  had  been  entrusted  the 
sections  of  the  country  above  named,  were  recorded  in  Miss 
Delano's  notes,  together  with  an  outline  of  her  own  coast-to- 
coast  tour  of  speech-making  before  audiences  of  nurses.  She 
wrote : 

The  response  from  various  sections  of  the  country  has 
been  most  gratifying  and  already  the  following  State  Com- 
mittees have  been  appointed  and  are  at  work  organizing  Local 
Committees :  Massachusetts,  chairman,  Mary  M.  Eiddle ;  Xew 
York,  chairman,  Elizabeth  Dewey:  District  of  Columbia, 
chairman,  Anna  J.  Greenlees;  Maryland,  chairman,  Mary  C. 
Parkard;  West  Virginia,  chairman,  Mrs.  H.  Camp  Louns- 
bury;  Georgia,  chairman,  Mrs.  A.  C.  Hartridge;  Tennessee, 
chairman,  Lena  A.  Warner;  Illinois,  chairman,  Adda  Eld- 
redge;  Michigan,  chairman,  Mrs.  L.  E.  Gretter;  Iowa,  chair- 
man, Helen  Balcom;  Louisiana,  chairman,  Emma  L.  Wall; 
California,  chairman,  Moselle  Eichie ;  Oregon,  chairman, 
Jennie  V.  Doyle;  Oliio,  chairman,  Matilda  L.  Johnson;  In- 
diana, chairman,  Elizabeth  Johnson;  Wisconsin,  chairman, 
Stella  S.  Mathews.  .  .  . 

The  following  letters  show  how  the  work  of  tying  up  State 
societies  of  nurses  with  the  Ked  Cross  was  completed : 

December  2,  1910. 
General  George  IT.  Torney,  Chairman, 
of  the  War  Eelief  Board  of  the 
American  Eed  Cross. 
Sir  :— 

In  accordance  with  the  provision  of  the  By-Laws  of  the 
American  Kcd  Cross,  Article  15,  paragraph  f,  page  21,  which 
reads  as  follows:  "Societies  of  Nurses.  The  Central  Commit- 
tee sliall  have  authority  to  establish  a  class  of  membership  into 
which  may  be  invited  permanent  State  or  Territorial  so- 
cieties of  nurses.  When  accepted  into  membership  by  the 
Central  Committee  any  such  society  shall  be  entitled  to  dele- 
gate representation  in  the  annual  meeting  of  the  American 
Ked  Cross  under  terms  and  regulation  prescribed  by  the 
Central  Connnittcc/' — I  would  request,  as  cliairman  of  the 
Connnittee  on  Eed  Cross  Nursing  Service,  that  membership 


REORGANIZATION  AND  AFFILIATION  113 

be  allowed  all  State  Nurses'  Associations  organized  for  the 
enrollment  of  Red  Cross  nurses. 

If  this  suggestion  meets  with  the  approval  of  the  Central 
Committee  of  the  American  Eed  Cross,  the  following  State 
Nurses'  Associations  would  be  eligible  for  membership : 
California;  District  of  Columbia;  Georgia;  Illinois;  Indiana; 
Iowa;  Louisiana;  Maryland;  Massachusetts;  ]\[ichigan;  Ne- 
braska; New  Jersey;  New  York;  North  Carolina;  Ohio; 
Oregon;  Pennsylvania;  Tennessee;  West  Virginia;  and  Wis- 
consin. 

Very  respectfully, 

(Jane  A.  Delano) 
Chairman,  National  Committee  on 
lied  Cross  Nursing  Service. 

December  5,  1910. 
To  Miss  Delano: 

.  .  .  Tliat  the  plan  in  general,  as  outlined  in  report  sub- 
mitted by  tbe  Chairman  of  the  Subcommittee  on  lied  Cross 
Nursing  Service,  is  apj)roved  and  the  Chairman  is  requested 
to  transmit  the  same  to  the  Central  Committee  for  its  con- 
sideration and  action. 

(signed) 

TORNEY. 

An  example  of  the  letters  sent  throughout  the  country  is  this 
one  of  Mrs.  Louusbury. 

TiiK  American  National  Ekd  Cross 
Washington,  D.  C. 

National  Headquarters, 
lioom  311,  State,  War  aiid  Navy  Building 

Miss  

I'resident  State  Nurses  Association. 
Dear  M 

Tbe  National  Eed  Cross  Nursing  Service  has  l)een  tlior- 
ougbly  reorganized,  and  is  now  ready  to  receive  the  names 
of  nurses  wlio  wisli  to  be  enrolled  for  service.  The  plan  of 
tbe  National  C^onimittee  is  to  enlist  the  active  sympathy  and 
cooperation  of  the  jiresidents  of  the  State  Nurses'  Associa- 
tions and  tlirough  tiiem  to  reach  tbe  individual  nurses. 

You  are  conlially  invited  to  assist  in  this  great  work,  and 

to  act  as  the  distributing  center  for .     1  enclose  a 

booklet  containing  tbe  rules  and  regulations  for  tbe  Ameri- 
can lied  Cross  Nursing  Service,  and  sample  copies  of  tbe 
application  for  enrollment,  tbe  card  for  tiling  in  Washington 


114   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  the  card  for  the  endorsement  of  applicants  by  State  or 
Alumnae  Society. 

Will  you  kindly  let  me  know  if  you  will  assist  us  in  this 
great  work,  which  seeks  to  place  in  the  hands  of  the  Red 
Cross  in  Washington  the  names  and  addresses  of  graduate 
registered  nurses,  who  can  be  called  upon  in  time  of  war  or 
national  calamity. 

Will  you  send  me  the  names  of  four  responsible  nurses  of 

who  will  assist  you,  acting  as  a  State  Committee? 

An  early  reply  will  be  much  appreciated. 
Sincerely  yours, 
(signed)  Harriet  Camp  Lounsbury,  E.  N. 
Mrs.  George  Lounsbury. 

We  must  pass  over  ]\riss  Delano's  trips  to  the  West  in  the  sum- 
mer of  1910,  primarily  to  inspect  the  Army  J^urse  Corps.  It  is 
more  relevant  to  give,  here,  some  glimpse  of  how  the  Red 
Cross  enrollment  went  on,  as  recorded  by  Mary  A.  Clarke  in 
her  personal  recollections  of  Miss  Delano : 

On  her  return  to  Washington  about  December  1,  1910,  she 
asked  me  to  come  to  assist  her  in  the  work  of  enrollment.  .  .  . 
Miss  Delano  was  just  getting  settled  in  a  cozy  home.  .  .  . 
She  was  essentially  domestic  in  her  tastes.  .  .  .  The  Ameri- 
can Eed  Cross  offices  were  then  in  the  State,  War  and  Navy 
Building,  but  ]\Iiss  Delano,  expecting  to  do  her  Eed  Cross 
work  before  and  after  her  day  at  the  War  Department,  made 
her  office  in  her  home. 

Her  largest  room  was  fitted  up  for  Eed  Cross  work.  .  .  . 
Applications  and  letters  were  gone  over  daily.  A  vast  num- 
ber of  typewritten  letters  of  instructions  and  large  packets  of 
circulars  were  sent  east  and  west,  north  and  south.  .  .  .  Every 
application  was  carefully  gone  over,  first  by  me  and  then  by 
Miss  Delano.  .  .  . 

When  the  nursing  service  was  reorganized  it  was  found  that 
about  950  nurses  liad  l)ecn  enrolled  under  the  old  dispensa- 
tion. Through  tlie  Journal  ]\Iiss  Delano  sought  to  locate 
them  all,  list  names  and  addresses,  number  of  their  badges, 
date  of  enrollment  and  ascertain  how  many  were  still  available 
for  service.  .  .  , 

Steadily  as  time  went  on,  qualifications  for  enrollment  be- 
come more  stringent.  Training  schools  everywliere  were 
anxious  to  come  up  to  the  requirements,  some  insisting  upon 
more  extensive  preliminary  education  on  the  part  of  their 
applicants,  others  lengthening  tbeir  course  of  instruction,  and 
some  superintendents  adding  beds  to  the  liospital's  former 
cai)a(ity  in  order  to  meet  the  fifty-bed  requirement.  .  .  . 


REORGANIZATION  AND  AFFILIATION  115 

It  was  soon  evident  that  the  more  the  enrollment  of  nurses 
was  restricted  the  more  eager  nurses  were  to  join.  By  July, 
1911,  applications  were  coming  in  at  the  rate  of  200  a 
month.  .  .  . 

Miss  Delano  was  single  minded  in  her  determination  to  en- 
roll only  those  women  who,  in  addition  to  professional  effi- 
ciency were  well  recommended  personally  both  by  the  hospital 
superintendent  and  the  president  of  the  alumnae  associa- 
tion. ,  .  .  She  was  tenacious  of  her  point  as  to  the  personality 
of  the  nurse  because  she  felt  that  the  women  chosen  for  Eed 
Cross  nursing  must  be  of  such  uprightness  of  character, 
purity  of  life  and  good  judgment,  that  they  could  be  relied 
on  to  do  the  discreet  and  right  thing  wherever  placed. ^^ 

The  home-loving  phases  of  Miss  Delano's  many-sided  per- 
sonality, to  which  ]\Iiss  Clarke  made  reference,  were  further 
described  by  a  close  friend  who  later  made  her  home  with  Miss 
Delano : 

I  grew  to  love  her  dearly,  not  only  for  her  goodness  to  me 
but  because  of  her  personal  charm,  her  interest  in  all  that  per- 
tains to  home  life,  her  love  of  animals  and  flowers,  her  almost 
child-like  enjoyment  of  the  simplest  pleasures.  A  strong  sense 
of  humor  carried  her  through  many  trying  situations  and 
she  loved  both  to  hear  and  to  tell  a  good  story.  She  was 
rarely  idle,  rest  to  her  meaning  only  change  of  occupation. 
She  worked  deftly  and  swiftly,  making  every  moment  count, 
and  she  played,  when  not  overburdened  as  in  the  last  year, 
with  the  same  thoroughness.  An  excellent  housekeeper  in 
methods  familiar  to  Xew  England,  she  was  interested  in  the 
smallest  details  of  lior  household.  .  .  .  Tt  was  a  pleasure  to 
watch  the  motion  of  her  hands,  they  were  so  capable  and 
eflicient.  She  was  very  orderly  as  to  her  belongings,  but  at 
the  same  time  deliglitfully  inconsistent,  for  she  would  allow 
her  pet  dog  to  take  liberties  which  to  most  people  would  liave 
been  annoying.  lie  adored  her  and  from  the  moment  her 
car  turned  into  our  street  he  was  at  the  door  with  a  rapturous 
greeting. 

She  ])rofessed  to  have  forgotten  how  to  nurse,  yet  I  shall 
never  forget  an  illness  when  sbe  carried  nie  l)odily  to  her 
home,  put  me  to  ])ed  and  cared  for  me  licrself  with  wonderful 
tenderiiess,  skill  and  resourcefulness.  .  .   .-- 

In  January  1011  ]\Iiss  Delano  l)(\uan  writing  the  Rod  Cross 
DepartnuMit  of  the  A})icriani  Journal  of  Xursi)};/,  a  rcspoiisi- 

"  ^^pTll()^all(luIn  in  Kcd  Cros^  Archives. 

"  (,}.   M.  Ncvins,  Am(  riaui  Journal  of  Sursing,  \'ol.   19.  p.  (iUn. 


116    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

bility  which  she  carried  until  her  death.     In  her  first  notes  she 
wrote : 

At  a  meeting  of  the  Central  Committee  of  the  American 
Red  Cross  held  on  jMonday,  December  5,  1910,  the  following 
resolution  was  adopted: 

That  each  State  or  Territorial  nurses'  association  organized 
for  the  enrollment  of  Red  Cross  nurses  be  admitted  to  mem- 
bership in  the  American  Red  Cross  with  the  right  to  send  a 
delegate  to  the  annual  meeting.  .  .  . 

[The  names  of  the  states  admitted  to  membership  followed; 
they  have  already  been  given.] 

We  will  confine  this  report  more  especially  to  the  activities 
of  the  Committee  on  Red  Cross  Nursing  Service.  The  im- 
portance with  which  this  work  is  considered  is  shown  by  the 
official  report  of  Surgeon  General  George  H.  Torney,  chair- 
man of  the  War  Relief  Board,  Avhich  was  read  at  the  annual 
meeting  and  from  which  we  quote  the  following: 

"Probal)ly  the  most  important  accomplishment  of  the  War 
Relief  Board  during  the  year  has  been  the  organization  of 
two  departments,  the  First  Aid  Department  and  tlie  Nursing 
Department.  It  was  realized  that  the  importance  of  these 
two  classes  of  work  had  become  so  great  and  demanded  such 
close  supervision  that  it  was  essential  that  two  departments 
be  created.  The  wisdom  of  this  decision  has  been  proved 
by  the  outcome.  The  work  of  the  First  Aid  Department  and 
of  the  Nursing  Department  will  be  described  by  their  re- 
spective chairmen.  I  feel,  however,  that  I  can  allude  to 
the  importance  of  the  work  of  these  departments  with  more 
grace  than  can  these  chairmen."  .  .  . 

Since  some  of  our  nurses  can  be  relied  upon  only  for  or- 
ganization work,  and  realizing  the  importance  of  this,  either 
in  time  of  peace  or  in  tlie  event  of  war,  it  was  resolved  "that 
all  nurses,  members  of  Red  Cross  Committees,  be  asked  to 
enroll  even  though  unable  to  respond  to  a  call  for  active 
service. 

The  first  suggestion  of  Knral  Xursing  was  made  in  1010  at  the 
annual  meeting: 

A  letter  from  ^liss  Wald  to  ]\Tr.  Schiff  was  then  read  by 
the  chairman.  ^liss  Wald  set  forth  the  needs  of  the  rural 
communities  for  nursing  and  wished  to  know  if  the  Red 
Cross  might  not  consider  taking  up  such  a  work.  While  the 
fact  was  recognized  by  the  (V)mmittee  that  effort  should  be 
made  to  keep  uj)  the  interest  of  enrolled  nurses,  it  was  thought 
that  preparation   for  war,  and  emergency  work  in  the  form 


f/^'^^l 


Tn>i_aiiia    (actual  ^izc) 

].  I'ailiri"  ^^■()^ll  li\'  an  Ainciicaii  lied  ('r(i>s  iiiii'so.  2.  PjadiiO  W(ini  liy  an 
Aiiu'iicau  Itt'd  ('r(i~s  llimi.'  Drifust'  iiui-sc.  :!.  I'didanl  ( imw  (ili-iolcti' ) 
ti'i-iiicil y  worn  li\  an  Ahu'i-icaii  KimI  ('r(i>s  'I'dwii  and  ('oiiniry  iinr-t-,  4. 
liaduf  worn  li\  an  AimTicaii  IN-d  (i-o-s  dietitian.  •").  ln~i,L:nia  ndlar 
df\  ice  I  wniii  duriiiL'  the  l-".iir()|i('an  War  liy  incndiiTs  nl'  tlic  l'.  S.  Aimy 
Nnrsc  ('(ir]i>.  (i.  I'ii'~imi1  insiunia  (ctillai  device  i  worn  liy  nienilur-  nt  ilie 
r  S.  Arni\  Xiir-e  (dip-  7.  In-iiinia  icidlar  dc\'ice  i  wnrn  hy  incndiers; 
lit  the  r.  S.  \av\  \iir-e  Cui-ii-.  S.  (dii)-.  de\  ice  of  tlie  ('.  S.  I'liidic  !lc;ilth 
Sei\  ice.  worn  liy  niemliei's  of  tlie  Xui'sinu  Sei'\dce,  V.  S.  Tublic  Health 
Scr\  iiH>. 


REORGANIZATION  AND  AFFILIATION  117 

of  le(  ures  from  army  officers,  if  possible,  and  later  perhaps, 
the  formation  of  home  nursing  classes,  were  preferable  to 
any  o.her  nursing  work  by  the  Ked  Cross  at  present. 

Mrs.  Draper  strongly  urged  that  the  Ked  Cross  direct  its 
attention  for  some  time  to  come  to  the  subject  of  thorough 
organization.  Mrs.  Tice  moved  that  a  committee  including 
Mrs.  Draper,  Mv.  and  ^Irs.  Glenn,  and  ^liss  Alaxwell  be  ap- 
pointed to  confer  with  Miss  Wald.     This  was  carried. 

Mrs.  Draper  then  brought  up  the  question  of  assistance 
to  the  chairman  of  the  Ked  Cross  Nursing  Service.  The  small 
office  of  the  superintendent  of  the  Army  Kurse  Corps  was 
wholly  inadequate  and  she  was  no  longer  able  to  do  the  con- 
stantly increasing  work  of  this  committee  unaided.  Major 
Lynch  moved  that  the  Red  Cross  be  asked  to  appropriate  a 
sum  not  exceeding  $1200  annually  for  salary  of  a  clerk  and 
room  rent.    It  was  carried. 

A  paper  was  read  at  the  same  meeting  on  the  "Coordination 
of  Social  Agencies,"  by  Annie  Laws,  secretary  of  the  Cincin- 
nati Chapter.  IMiss  Laws,  as  Miss  Wald  had  done,  brought 
larger  social  problems  forward.  She  said  among  other  sug- 
gestive things: 

The  question  has  arisen  in  the  minds  of  many  as  to  whether 
the  great  American  Ked  Cross,  pledged  to  help  humanity 
in  so  many  directions,  might  not  extend  its  fostering  care, 
through  the  visiting  Red  Cross  nurses,  to  others  needing  help 
quite  as  badly  as  tuberculosis  patients,  in  some  cases  more. 
Also,  whetlicr  the  fact  that  the  Red  Cross  with  its  insignia 
being  so  al)solutely  identified  at  Cliristmas-time  with  a  more 
limited  organization,  and  yet  !)eing  ])rought  so  prominently 
forward,  does  not  tend  to  confuse  the  minds  of  many  ])eo])le 
and  obscure  the  larger  significance  of  the  Red  Cross,  and 
make  it  apjH'ar  as  an  adjunct  rather  than  as  the  great  inter- 
national and  national  emblem.   .  .  .-'^ 

This  paper  and  ]\Iiss  Wald's  letter  contain  tlie  initial  sugges- 
ti(uis  of  important  sul)se(pu'nt  work  of  tho  lied  (^ross  for  public 
health  which  will  form  the  subject  of  later  cluipters. 

The  year  1!>11  saw  the  first  movement  of  the  I'nited  States 
troops  since  the  lied  Cross  Nursing  Service  had  conu'  into 
existence  and  ]Miss  Delano  said  in  her  Journal  notes: 

All  Red  Cross  nurses  will  be  interested  in  tlu^  mobiliza- 
tion of  •20. 0(10   I'nited  States  troops  on  tlie  Mexiean   frontier, 

"  TIcpnrt  ef  tlic  Annual  ^fect  inir  <>f  tlie  Ked  Cress  Xursini.'-  Service  C'oni- 
niittee.   Deccniher   7.    I'.UO. 


118   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  over  2000  marines  in  the  Gulf  of  Mexico,  for  never  before 
in  the  history  of  the  country  has  such  a  large  body  of  soldiers 
been  brought  together  in  time  of  peace.  .  .  .  Should  a  sud- 
den need  for  nurses  arise,  there  stand  ready  to  cooperate  with 
the  National  Committee  on  Eed  Cross  Nursing  Service,  141 
nurses  on  2-1  State  Red  Cross  committees,  and  233  more  on 
local  committees.  These  committees,  with  nearly  1300  en- 
rolled nurses,  are  a  guarantee  to  the  nation  that  neither  the 
stress  of  calamity  nor  the  turmoil  of  war  will  ever  again 
find  us  wholly  imprepared. 

The  National  Committee  on  Red  Cross  Nursing  Service 
has  in  contemplation  a  plan  for  providing  instructive  lec- 
tures to  be  given  by  medical  officers  of  the  army  to  assemblages 
-of  nurses  in  different  parts  of  the  country.  Two  of  these 
have  already  been  given  by  Colonel  L.  M.  Maus,  Chief  Surgeon 
,of  the  Department  of  the  Lakes ;  one  in  Illinois,  the  other  in 
Wisconsin,  at  the  meeting  of  their  respective  State  associa- 
tions.^* 

A  letter  to  Mrs.  Reid  from  Miss  Delano  at  this  time  gives  a 
pejSQjtall  .touch  to  the  activities  of  each : 

Hay  I  thank  you  for  your  most  generous  contributions 
toward  the  work  of  the  National  Committee  on  Red  Cross 
Nursing  Service  and  tell  you  something  of  what  has  been  ac- 
complished during  the  past  year : —  ,  .  . 

We  have  a  special  Red  Cross  Department  in  the  Journal 
of  Nursing,  and  the  interest  shown  by  nurses  all  over  the 
country  is  most  gratifying.  We  send  to  each  nurse  enrolled 
the  usual  badge  and  an  appointment  card  like  the  enclosed, 
which  is  really  a  card  of  identification  in  case  the  badge  is 
lost.  I  am  sending  by  separate  mail  copies  of  our  various 
blanks,  which  may  be  of  some  interest. 

I  have  been  hoping  all  winter  that  we  could  arrange  for  a 
reception  for  enrolled  Red  Cross  nurses  in  Boston  at  the  time 
of  the  meetings  of  the  Associated  Alumnje  in  June,  and 
Just  when  I  was  wondering  how  it  could  be  managed  your 
contribution  came  through  ]\lrs.  Draper.  Nothing,  I  am 
sure,  would  more  stimulate  interest  in  our  Red  Cross  work 
than  bringing  the  enrolled  nurses  together.  I  have  talked 
this  over  with  ^Irs.  Draper  and  ^Miss  Boardman  and  they 
both  feel  sure  tliat  you  would  approve  of  our  using  a  por- 
tion of  this  last  contril)ution  for  the  expenses  incurred  in 
giving  this  reception.  We  will  send  an  invitation  to  each  en- 
rolled  Red  Cross  nurse  in  tlie  Ignited  States   (we  have  now 

^  AmrricfDi  Journal  of  \ursing,  Ay.vU.  1011,  p.  ."iHT. 


REORGANIZATION  AND  AFFILIATION  119 

nearly  IfiOO),  and  hope  that  many  of  the  Alumnae  Associa- 
tions may  send  them  as  delegates  to  the  Boston  meetings. 
Mrs.  Draper,  ^liss  Boardman,  Major  Lynch  of  the  Army  and 
Dr.  Elliott  of  the  Navy  have  all  promised  to  assist  in  re- 
ceiving, and  !Major  Lynch  has  suggested  that  we  invite  all 
the  physicians  in  Boston  who  are  on  the  Army  Medical  Ee- 
serve  list. 

It  was,  suggested  at  the  meeting  of  the  Associated  Alumnae 
last  year  that  it  would  be  a  great  advantage  to  have  a  well- 
known  nurse  attend  the  various  meetings  of  State  Societies, 
Alumnae  Associations,  etc.,  and  speak  to  the  nurses  in  regard 
to  the  purposes  of  our  larger  organization,  the  educational 
value  of  the  Journal  of  Nursing,  and  the  responsibility  of 
individual  nurses  toward  tlie  Red  Cross.  We  selected  Miss 
Isabel  Mclsaac,  for  many  years  superintendent  of  the  Illinois 
Training  School  for  Nurses,  for  this  work.  She  was  em- 
ployed for  six  months,  receiving  $100.00  a  month,  and  made 
a  complete  tour  of  the  various  states.  All  of  her  traveling 
expenses  Avere  met  by  the  nurses  themselves,  leaving  only  her 
salary  of  $(500  to  be  shared  by  the  American  Journal  of  Nurs- 
ing,  the  Red  Cross  and  the  Associated  Alumnae.  Your  con- 
tribution of  last  year  made  it  possible  for  the  Red  Cross  to 
do  its  part,  and  I  feel  sure  that  we  have  been  more  than 
repaid  by  the  interest  aroused  in  all  sections  of  the  country. 

This  is  a  hopelessly  long  letter,  but  I  am  sure  you  will  for- 
give me,  for  I  feel  that  I  must  tell  you  again  how  thankful 
we  are  for  your  interest  and  help.  To  have  your  name  on 
the  Committees  means  much,  and  I  really  want  you  to  know 
just  what  progress  we  are  making. 
Believe  me, 

Yours  sincerely, 

(signed)  Jaxe  A.  Delano. 

Tho  June  !Nrocting  of  the  Associated  Alumnae  in  Boston, 
1911,  was  made  a  special  Ked  Cross  nursing  event.  A  Red 
Cross  reception  was  hold  at  the  Hotel  Brunswick,  and  letters 
of  greeting  and  congratulation  were  read.     Dr.  Torncv  wrote : 

War  Department, 
Office  of  tho  Surireon  General. 
Washington,  D.  C.'.  May  25,  1911. 
Dear  ^liss  Delano : 

It  is  witli  great  gratifieaticHi  that  I  learn  that  nearly  2000 
nurses  liave  enrolled  in  the  Hed  Cross  Nursing  Service.  The 
!^^e(li(■al  l)(>])artTueiit  always  looks  upon  these  nurses  as  its 
reserve  in  tiini^  of  war.  and  tliis  large  enrollment  is  the  most 
eneoura2fin<i  in  formation  I  have  received  in  a  lonir  time  with 


120   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

reference  to  our  efforts  to  prepare  the  Department  for  its 
work  in  time  of  emergency. 

I  hope  you  will  take  occasion  at  your  Boston  meeting  to 
express  my  appreciation  of  the  patriotism  shown  by  the  State 
and  Local  Committees  and  the  nurses  throughout  the  country 
in  respondng  to  the  call  to  join  the  Eed  Cross  Nursing 
Service. 

With  a  large  enrollment  of  Eed  Cross  nurses,  the  diffi- 
culties that  have  been  experienced  by  the  Medical  Depart- 
ment in  obtaining  a  suitable  nursing  service  will  be  im- 
possible in  the  future. 

Miss  Delano  wrote,  after  this  meeting: 

Nothing  has  so  stimulated  interest  in  the  Eed  Cross  as 
the  bringing  together  of  Eed  Cross  nurses  from  different  sec- 
tions of  the  country  during  the  meetings  of  the  American 
Nurses  Association. 

In  August,  1911,  the  President  issued  a  proclamation  relat- 
ing to  the  Red  Cross  service.     Its  text  follows : 

By  the  President  of  the  United  States. 
A  Proclamation. 

WHEEEAS,  the  American  National  Eed  Cross  having  been 
incorporated  by  an  act  of  Congress,  January  5,  1905,  "To 
furnish  volunteer  aid  to  the  sick  and  wounded  of  armies  in 
time  of  war,  in  accordance  with  the  spirit  and  conditions  of 
.    .    .   the  Treaty  of  Geneva  of  August  22,  1804,"  and 

WHEEEAS,  it  is  desirable  definitely  to  state  the  relations 
that  shall  exist  between  the  American  National  Eed  Cross 
and  the  Military  departments  of  the  government  in  event  of 
war: 

NOW,  THEEEFOEE,  I,  WILIJAM  H.  TAFT,  Presi- 
dent of  the  United  States,  by  virtue  of  the  authority  in  me 
vested,  do  liereby  declare  and  proclaim — 

1.  That  the  American  National  f'ed  Cross  is  the  only  vol- 
unteer society  now  authorized  by  this  government  to  render 
aid  to  its  land  and  naval  forces  in  time  of  war. 

2.  That  any  other  society  desiring  to  render  similar  as- 
sistance can  do  so  only  through  the  American  National  Eed 
Cross. 

3.  That  to  comply  with  the  requirements  of  Article  10  of 
the  fntornational  Eed  Cross  Convention  of  190(5  (revision 
of  the  Treaty  of  (ienova),  tliat  part  of  the  American  National 
Eed  Cross  rendering  aid  to  the  land  and  naval  forces  will 
constitute  a  part  of  the  sanitary  services  thereof. 


REORGANIZATION  AND  AFFILIATION  121 

4.  That  if  it  should  be  desirable  in  time  of  war,  or  when  war 
is  imminent,  for  the  War  Department  or  the  Xavy  Depart- 
ment to  make  use  of  the  services  of  the  xVmerican  National 
Ked  Cross,  the  Secretary  of  such  Department  is  authorized 
to  communicate  with  the  President  of  the  Society,  specifying 
the  character  of  the  services  required,  and  designating  the 
place  or  places  where  the  personnel  and  material  will  be  as- 
sembled. 

5.  That  when  any  member  of  the  American  National  Red 
Cross  reports  for  duty  with  the  land  or  naval  forces  of  the 
United  States,  pursuant  to  a  proper  call,  he  will  thereafter 
be  subject  to  military  laws  and  regulations  as  provided  in 
Article  10,  of  the  International  Ked  Cross  Convention  of 
190(),  and  will  be  provided  with  the  necessary  brassard  and 
certificate  of  identity. 

6.  That  excejjt  in  cases  of  great  emergency  the  personnel 
of  the  American  National  Ked  Cross  will  not  l)e  assigned  to 
duty  at  the  front.  l)ut  will  be  confined  to  hospitals  in  the  home 
country,  at  the  base  of  operations,  on  hospital  ships  and  along 
lines  of  commviiiication  of  the  military  and  naval  forces  of 
the  United  States. 

IN  WITNESS  WIIEKEOF  I  have  hereunto  set  my  hand 
and  caused  the  seal  of  the  United  States  to  be  affi.xed. 

Done  at  the  City  of  Washington,  this  twenty-second  day  of 
August,  A.  D.  one  thousand  nine  hundred  and  eleven,  and 
of  the  Independence  of  the  Ignited  States  of  America,  the 
one  hundred    (Seal)   and  thirtv-sixth. 

W^r.  H.  Taft.-'' 

Miss  Delano's  notes  in  October  return  to  the  educational 
outlook : 

It  is  with  much  gratification  that  we  announce  the  forma- 
tion of  Wed  Cross  (V)mmittees  in  nil  states  having  a  State 
Nurses'  Association  with  the  exception  of  Idaho,  Oklahoma. 
South  Carolina  and  Wyoming.  It  is  hoiked  tliat  before  the 
next  month's  issue  of  tlie  Journal  we  may  wclconu'  these 
states  to  our  National  Branch  of  this  world-wide  work  for 
humanity.   .  .  . 

This  makes  in  all  .'U  State  Committees,  wliile  our  Local 
Committees,  with  the  a(blition  of  such  State  Committees  as 
are  acting  as  Local  Committees,  number  T").  .   .   . 

It  was  decided  that  only  those  nui'scs  should  l)e  eligible  for 
enrollment  who  ar(>  graduat(>s  of  training  schools  c<)nnected 
with  general  hospitals  of  at  least  lifty  beds,  unless  the  appli- 
cant has  had  subsequent  hosj)ital  experience  or  ])ost-grailuate 

"War   Department.  Ceiicral  Orders   No.   170.    Dctcmlicr  -27.   lull. 


122   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

work.  Graduates  of  training  schools  connected  with  hospitals 
for  the  insane  must  have  had  at  least  six  months  training  in 
a  general  hospital.  ... 

A  special  committee  was  provided  for,  to  outline  a  course 
of  lectures  for  enrolled  Eed  Cross  Xurses.  Mary  E.  Gladwin, 
superintendent  of  the  City  Hospital,  Cleveland,  Ohio,  was 
made  chairman  of  this  committee,  with  the  privilege  of 
selecting  her  associates.  .  .  . 

Lectures  for  Eed  Cross  Xurses 
Object  of  Lectures 

1.  To  keep  alive  the  interest  which  already  exists,  and  to 
bring  to  the  attention  of  the  young  graduate  the  desirability 
and  importance  of  being  identified  with  the  Eed  Cross  Nurs- 
ing Service. 

2.  To  be  a  means  of  education  and  preparation  for  future 
work,  either  in  time  of  peace  or  war, 

3.  To  give  enrolled  nurses  more  knowledge  of  the  history, 
aims  and  achievements  of  the  Eed  Cross,  a  better  under- 
standing of  relief  problems  in  general,  and  of  the  modern 
humanitarian  movements  which  so  closely  concern  nurses. 

4.  To  furnish  a  pleasant  and  useful  pretext  for  bringing 
enrolled  nurses  together  in  localities  where  it  is  seldom  pos- 
sible to  provide  military  or  Eed  Cross  speakers.  To  give  to 
nurses  in  such  places  a  community  of  interests  which  shall 
make  them  more  valuable  to  the  Eed  Cross. 

5.  To  have  these  papers  printed,  but  not  published  until 
after  they  have  been  well  distributed  and  used.  To  furnish 
them  to  Local  and  St-ate  committees,  part  of  whose  duties 
it  shall  be  to  see  that  they  are  regularly  and  properly  used. 

Suggested  Outline 

I.  History  of  Eelief  and  the  Eed  Cross. 

(a)  Before  the  Crimea. 

(b)  Florence  Xightingalc. 

(c)  Solferino  and  Henri  Dunant. 

(d)  ]\lodern  Eed  Cross. 
II.   San  P>anciseo  Disaster. 

(a)  The  Disaster. 

(b)  Immediate  Eelief. 

((•)   Eeliabilitation  and  Eeconstruetion. 
III.  The  Italian   l-]art]iquake. 

(a)  The  Disaster. 

(b)  Eelief  Work — Eoad  flaking,  Shoemaking, 
etc. 


REORGANIZATION  AND  AFFILIATION  123 

IV.  Chinese  Famine. 

(a)  Description  of  Country  and  Cause  of 
Famine. 

(b)  Famine  Camps — Material  Used  for  Food. 

(c)  Newspaper  Criticism,  i.e.,  Futility  of  Fre- 
quent Kelief  Unless  Steps  Are  Taken  To- 
wards Prevention. 

V.  Spanish- American  War. 
VI.  :Military  Hospitals. 
VJI.  The  l?ed  Cross  in  Other  Countries. 
VIII.  Notable  Medical  Achievements  of  U.  S.  A. 
IX.  Forest  Fires,  ^line  Disasters. 
X.  Eelief  Work  for  Celebrations  and  Parades.^" 

The  full  committee  on  the  lecture  course  were :  ]\Iary  E. 
Gladwin,  ^Nfabel  T.  Boardman,  Major  Lynch,  Ernest  P.  Bick- 
ncll  and  ^liss  Delano,  ex-othcio. 

Important  details  of  perfected  organization  were  referred  to 
by  Miss  Delano  in  her  report  of  1912 : 

At  the  last  meeting  of  the  National  Committee,  held  in 
Washington,  December  4,  1911,  it  was  decided  that  every 
nurse  enrolled  for  service  under  the  Red  Cross  must  be  a 
menil)er  of  an  organization  affiliated  with  the  American 
Nurses'  Association. 

Believing  tliat  in  order  to  do  effective  work,  there  must  be 
coordination  of  the  various  Ked  Cross  activities,  it  was  sug- 
gested by  the  National  Committee  that  there  should  be  ap- 
pointed on  the  Red  Cross  relief  committee  of  each  institutional 
nieml)er  an  enrolled  Ped  Cross  nurse  to  represent  the  nursing 
service. 

In  the  notes  of  April,  1912,  there  comes  the  anticipation  of 
the  beautiful  building  in  which  the  Eed  Cross  is  now  housed: 

^Mention  was  made  in  the  November  Journal  of  the  proposal 
to  erect  in  the  city  of  Washington  a  national  monument  to 
tlic  memory  of  tlie  brave  women  of  the  Civil  War.  At  tliat 
time  no  suggestions  had  l)een  offered  as  to  the  form  which 
this  memorial  should  take,  but  it  seemed  a  gracious  tribute 
to  the  work  of  women  many  of  wliom  liad  served  as  nurses 
during  tbe  four  years  of  war.  It  is  now  proposed  that  the 
monument  to  be  erected  shall  take  the  form  of  a  buibling 
to  be  given  as  lieadquarters  to  the  American  Ped  Cross  in 
perpetuity,  it  s(>«'nis  most  appropriate  that  the  humanitarian 
work  of  til?  American   Ped  Cross  in  all  the  years  to  come 

'"Journal   Department,  Octoher,   IHll. 


124    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

should  be  carried  on  in  a  building  commemorating  the  zeal 
and  devotion  of  the  patriotic  women  who  inaugurated  the 
Sanitary  Commission,  raising  millions  for  relief  work  and 
who  braved  the  dangers  and  discomforts  of  fever  stricken 
camp  or  crowded  ward  to  lessen  the  suffering  of  the  sick  and 
wounded. 

Can  we  wonder  that  a  memorial  to  them  has  appealed  to 
the  public  conscience  and  finds  favor  with  all  who  shared  in 
the  sorrow  and  anxiety  of  those  years? 

In  the  summer  of  1912  the  Ninth  International  Red  Cross 
conference  was.  held  in  Washington, — the  first  outside  of 
Europe.  The  sessions  were  held  in  the  Pan-American  Build- 
ing. The  Secretary  of  State  selected  foiir  nurses  as  official 
delegates.  These  were :  Misses  Maxwell,  ISTevins,  Mclsaac  and 
Delano.  The  Red  Cross  Nursing  Service  committees  were  also 
represented,  for  there  were  present  Mrs.  Gretter  of  Michigan; 
]\Iiss  Giberson  of  Pennsylvania;  Mrs.  Tupman  of  Georgia; 
]\riss  Robinson  of  Illinois;  ]\liss  Stuff  of  Nebraska;  Miss  Rom- 
mell  of  Minnesota;  Misses  Black  and  Fletcher  of  Virginia; 
]\risses  Gladwin  and  Echols  of  Ohio ;  Miss  Wilkinson  of  Con- 
necticut and  Miss  Perry  of  North  Carolina. 

At  that  meeting  the  m(>morial  to  Miss  Nightingale  was 
agreed  upon  of  which  Miss  Delano  wrote  in  her  August  notes: 

The  Eed  Cross  societies  of  the  world  agreed  to  raise  a  fund 
to  be  known  as  the  Florence  Nightingale  Foundation.  A  spe- 
cial committee  was  appointed  to  make  recommendations  con- 
cerning tliis  fund  with  Sir  John  Furley  ol  the  St  John's 
Ambulance  Association  as  chairman.  Miss  Boardman  and 
Miss  Delano  were  asked  to  serve  on  this  committee.  It  was 
agreed  tliat  a  medal,  accompanied  by  a  certificate  on  vellum, 
to  be  called  the  Florence  Nightingale  Medal,  sliould  be  in- 
stituted and  that  six  such  medals,  to  be  increased  to  the 
number  of  twelve  in  the  event  of  a  great  war,  should  be  avail- 
able annually;  that  they  should  be  granted  only  to  trained 
nurses  who  may  liave  especially  distinguished  themselves  by 
great  ajid  exceptional  devotion  to  the  sick  and  wounded  in 
peace  or  war.  Xo  country  may  ])r()pose  more  than  one  can- 
didate for  this  medal  annually.  Tlie  final  award  is  made  by 
the  International  IJed  Cross  Committee  at  (Jeneva.  The 
awarding  of  tliese  medals  to  nurses  will  be  akin  to  the  be- 
stowal of  the  X'ictoria  (*ross  to  British  soldiers  for  "bravery 
in  action''  aiu]  will  he  the  highest  honor  which  can  be  paid 
to  any  nurse.     A  most  fitting  memorial  to  one  "who  rescued 


REORGANIZATION  AND  AFFILIATION  125 

from  obscurity  and  sliaino  a  noble  profession,"  may  this  Night- 
ingale  Medal  prove  ever  an  incentive  to  higher  and  higher 
standards  of  duty  among  us. 

At  that  time  Miss  Delano  did  not  enlarge  upon  the  discussion 
held  over  the  Florence  Nightingale  Medal,  but  later  (1918) 
she  told  something  of  her  part  in  it,  and  as  it  illustrates  very 
interestingly  her  tact  in  meeting  the  foreign  viewpoint  in  nurs- 
ing, we  include  here  her  subsequent  narrative  of  the  difficulty 
of  limiting  a  Nightingale  ]\Iedal  to  a  nurse  trained  on  the 
Nightingale  system : 

I  was  placed  on  a  committee  to  decide  as  to  the  awarding  of 
the  Nightingale  medal  for  service  in  time  of  war;  and  I 
assure  you  it  was  no  easy  task  for  me  to  convince  the  other 
members  of  the  connnittee — (I  believe  I  was  the  only  member 
representing  this  country,  but  at  any  rate  I  was  the  only  one 
that  spoke  for  nurses  alone) — first  that  it  should  be  given 
only  for  the  actual  care  of  the  sick  aiid  wounded ;  and  second, 
that  it  should  only  be  awarde<l  to  women  who  could  qualify 
as  graduate  nurses.  We  were  in  session  for  part  of  two  days 
before  I  convinced  them  that  I  was  right  that  this  medal,  the 
Florence  Nightingale  Medal,  should  be  given  to  graduate 
nurses  for  service  in  the  actual  care  of  the  sick  and  wounded. 
That  eliminated  absolutely  from  any  possibility  of  securing 
this  medal  women  who  were  engaged  in  organization  work  in 
any  of  the  countries  of  the  world.  It  eliminated  any  woman 
who  might  contribute  large  funds  to  the  organization  of  the 
nursing  service  in  the  time  of  war.  It  pinned  the  award  of 
that  nuMlal  down  absolutely  to  a  graduate  nurse.  At  that 
time  we  could  only  suggest  one  and  I  suggested  ]\Iary  E. 
Gladwin,  and  1  hope  that  eveiitually  she  will  receive  the 
Florence  Niglitingale  medal.'-" 

Miss  Delano's  etfort  in  thus  restricting  the  medal  was  heartily 
seconded  by  i\Iiss  Doardnum,  who  was  fully  in  accord  with  her 
view. 

At  the  annual  nuH'ting  of  1012  ^liss  Delano,  who  had  been 
a  mendx'r  of  tli(>  War  Ivclicf  Board  since  the  oi-ganizatiiui  of 
the  nursing  service,  was  ;i|)})()inted  also  a  member  of  the 
National  Ivelief  Doai'd.  The  tii'st  intimation  of  an  aj)proaching 
war  threat  is  given  in  the  cdnnnittce  reports  of  that  meeting. 
Miss  Delano's  notes  contain  the  following  suggestive  paragraph: 

"Proceeding's  National  League  for  Nursing  Kchieation,  1018,  page  161. 


126   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  its  annual  meeting  in  1912  the  American  Medical 
Association  authorized  the  appointment  of  a  committee  whose 
duty  it  should  be  to  confer  with  the  American  Eed  Cross  with 
a  view  to  establishing  a  comprehensive  system  of  cooperation 
between  the  Eed  Cross  and  the  physicians  of  the  United  States. 
This  cooperation  is  expected  to  be  effective  in  providing 
prompt  and  adequate  medical  and  surgical  attendance  on  the 
occurrence  of  great  disasters  and  also  to  afford  a  reserve  upon 
which  the  Red  Cross  may  draw  for  a  medical  personnel  in 
the  event  of  war.  It  is  probable  that  a  system  of  enrollment 
will  be  adopted  which  will  eventually  build  up  a  large  force 
of  Red  Cross  physicians  representing  every  section  of  the 
country.  The  committee  representing  the  American  Medical 
Association  in  this  matter  consists  of  Dr.  George  M.  Kober, 
Washington,  D.  C,  chairman  ;  Colonel  F.  A.  Winter,  of  the 
Army  Medical  Corps,  and  Surgeon  E.  M.  Blackwell  of  the 
Navy. 

The  American  Journal  of  Nursing  in  February,  1912,  made 
this  commentary  on  the  situation  indicated  in  the  sentences  just 
quoted : 

Xo  department  made  a  better  showing  of  work  done  during 
the  year  than  that  of  nursing  service  as  presented  by  Miss 
Delano.  The  medical  department  of  the  Red  Cross  is  much 
less  well  organized,  although  the  American  Medical  Associa- 
ton  has  now  taken  the  matter  in  hand  and  working  through 
a  committee  will  enroll  a  corps  of  physicians  for  Red  Cross 
service  and  to  act  as  an  army  reserve  in  time  of  war. 

In  April,  1913,  there  recurs  in  Miss  Delano's  notes  the  in- 
timation of  impending  war.     She  wrote: 

A  special  committee  has  recently  been  appointed  [of  which 
Miss  Delano  was  a  member]  to  formulate  plans  for  the  or- 
ganization of  a  Red  Cross  personnel  to  be  called  upon  for 
service,  either  in  time  of  disaster  or  with  the  military  forcas 
in  the  event  of  war.  .  .  .  It  is  proposed  as  an  experiment  to 
organize  at  various  selected  points  hospital  columns  made  up  of 
the  following:  One  director,  three  assistant  directors,  who 
shall  be  physicians,  six  chief  nurses  and  forty-five  nurses. 
It  is  intended  that  these  physicians  and  nurses  shall  be  brought 
together  for  special  instruction  in  the  duties  which  would  be 
required  of  them  when  called  upon  for  service  under  the  Red 
Cross. 

It  has  been  estimated  thai  in  the  event  of  war  with  a  first 
x^lass  power  nearly  half  a  mUIion  volunteer  troops  would  he 


REORGANIZATION  AND  AFFILIATION         127 

needed  at  once  and  four  thousand  nurses  for  the  Army  alone, 
with  an  additional  thousand  nurses  for  the  Navy,  It  is 
impossible  to  estimate  the  future  demands  but  with  our  ex- 
perienced committees  of  nurses  and  the  ever  increasing  en- 
rollment we  feel  sure  there  would  be  no  failure  on  the  part 
of  the  Nursing  Service  of  the  Ked  Cross. 

From  this  time  on  there  were  changes  preparatory  to  war 
service.  The  NTational  Committee  on  Nursing  Service  had 
some  of  these  changes.     !Miss  Delano's  notes  say: 

Owing  to  his  transfer  to  the  Philippines,  IMajor  Charles 
Lynch,  Medical  Corps,  U.  S.  A.,  has  resigned  from  this  com- 
mittee and  in  his  place  Major  R.  U.  Patterson,  Medical  Corps, 
U.  S.  A.,  has  been  appointed.  ]\Iiss  Georgia  Nevins,  who  had 
served  on  the  committee  since  its  creation  has  also  resigned 
and  ]\Irs.  Lena  S.  Higbee,  superintendent  of  the  Navy  Nurse 
Corps,  has  been  appointed  by  the  War  Relief  Board  as  her 
successor.  !Miss  Julia  C.  Stimson  and  Miss  Mary  E.  Gladwin 
have  also  been  appointed  to  fill  vacancies  on  the  committee. 
The  full  committee  is  as  follows : 

Miss  Jane  A.  Delano,  Miss  Emma  ^I.  Nichols, 

Chairman.  Miss  Alma  E.  Wrigley, 

^liss  ^label  T.  Boardman,  Mrs.  Whitelaw  Reid, 

Mrs.  William  K.  Draper,  Miss  Anna  Maxwell, 

Maj.  R.  U.  Patterson,  ]\Iiss  Isabel  McTsaac, 

Dr.  T.  W.  Richards,  Mrs,  Lenah  Higbee, 

Dr.  Wm.  H.  Welch,  i\Iiss  !Mary  E.  Gladwin, 

Mrs.  Frederick  Tice,  Miss  Julia  S.  Stimson. 

As  the  enrolled  Red  Cross  nurses  form  the  reserve  of 
the  Army,-'"  the  Surgeon  General  of  the  Army  has  detailed 
a  member  of  the  Army  Nurse  Corps,  Miss  Anna  Reeves,  to 
assist  in  the  record  work  of  the  Red  Cross  oflice.  This  will 
add  to  the  efliciency  of  the  service  and  give  the  chairman 
more  time  for  constructive  work. 

There  has  been  a  satisfactory  increase  in  the  number  of 
enrollments,  and  even  more  discrimination  and  careful  selec- 
tion of  nurses  on  the  part  of  the  T^ocal  Committees.  '\\'e  now 
have  over  4,*^00  enrolled  Red  Cross  nurses,  and  have  Local 

^^  Thoujr'i  in  praotiro  this  hiul  bcH'n  accepted  for  a  lon<r  time  the  order 
niakiiiir  tlie  Red  Cross  enrolled  mirses  the  Reserve  Cor])s  of  the  Army 
Xursin<r  Service  was  only  ])roimil<ri>ted  in  IflKi  and  reads:  ■■riie  enrolled 
nurses  of  tlie  American  Red  Cross  Xursinj:  Service  will  const  ilute  the 
Reserve  of  the  Army  Nurse  Corps,  and  in  time  of  war  or  other  emerjrency 
may,  willi  their  own  consent,  he  assiirned  to  active  duty  in  tiie  military 
estahlishment."      Maiuial    for   Mediial    Department,   l".   S.  Army.   1!)1G. 


128   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Committees  in  practically  all  of  the  large  nursing  centers 
in  the  United  States. 

The  committees  appointed  primarily  for  the  enrollment  of 
nurses  have  responded  with  enthusiasm  to  all  demands  made 
upon  them.  In  organizing  our  rural  nursing  service,  we  have 
sought  their  advice  and  assistance.  In  the  development  of 
our  classes  of  instruction  for  women  we  shall  rely  upon  them 
to  suggest  instructors  and  examiners  from  among  the  Red 
Cross  nurses.^® 

Early  in  1914  Miss  Delano  reported: 

Late  in  April  the  National  Committee  on  Red  Cross  Nurs- 
ing Service  was  instructed  by  the  War  Belief  Board  to  com- 
municate with  all  Local  Committees  asking  for  a  list  of 
nurses  available  should  it  be  necessary  to  call  on  our  Red 
Cross  personnel  for  service  in  Mexico.  The  response  was  so 
prompt  and  enthusiastic  that  we  felt  secure  in  urging  all 
nurses  not  to  begin  preparations  for  service  or  give  up  their 
present  positions  unless  definite  instructions  were  received. 
It  seemed  wise,  however,  to  have  a  small  group  of  Red  Cross 
nurses  ready,  and  a  few  Local  Committees  in  nearby  cities 
were  asked  to  prepare  eligible  lists.  These  nurses  were  then 
requested  to  present  themselves  for  physical  examination,  anti- 
typhoid treatment  and  vaccination  for  smallpox. 

On  ]\Iay  9,  a  call  came  from  the  Surgeon  General  of  the 
LTnited  States  Army  for  three  Red  Cross  nurses  to  go  to  Vera 
Cruz,  and  the  following  Washington  nurses  wore  selected  from 
among  those  on  the  available  list:  Kathrine  Donnelly,  Lulu 
T.  Floyd,  Nannie  B.  Hardy  and  Alice  B.  Harvey.  These 
nurses  reported  at  once  to  Red  Cross  Headquarters,  and  in  a 
few  hours  all  necessary  preparations  for  their  departure  had 
been  made._  They  left  Washington  on  Sunday  afternoon, 
May  10,  in  charge  of  ]\Iiss  Elizabeth  Reed,  a  member  of  the 
Army  Nurse  Corps,  who  has  been  assigned  as  cliief  nurse 
for  Vera  Cruz. 

A  circular  of  information  giving  definite  instructions  con- 
cerning uniforms  and  equipment  has  been  prepared  in  the 
hope  that  our  nurses  may  avoid  the  common  mistake  of  carry- 
ing useless  luggage  and  leaving  at  home  the  things  most 
needed.  A  special  field  uniform  of  blue-gray  had  been 
adopted,  of  such  material  and  style  as  to  launder  easily  and 
pack  in  small  space,  the  cap,  collar  and  apron  of  which  can 
be  laundered  without  starch ;  while  most  suitable  for  service 
in  a  warm  country  tlie  uniform  is  still  neat  and  attractive. ^*^ 

"Reports,  National  Committee  on  Nursing  Service,  December,  1913. 
^American  Red  Cross  Magiizine,  July,  1914. 


REORGANIZATION  AND  AFFILIATION         129 

This  note  of  July,  1914,  recapitulated  what  seemed  later  to 
have  been  a  game  of  child's  play,  faintly  foreshadowing  the 
terror  about  to  descend  on  the  world. 

In  this  section  of  this  history  no  attempt  will  be  made  to  do 
more  than  compile  in  very  brief  form  the  share  of  the  Nursing 
Service  in  those  instances  where  nursing  was  required  to  supple- 
ment the  general  work  of  relief. 

The  San  Francisco  fire,  following  the  earthquake,  brought 
out  nurses  as  volunteers.  Affiliation  had  not  taken  place,  but 
there  was  a  local  Red  Cross  society,  with  a  committee  on 
nurses.  The  chairman  of  that  committee,  Mrs.  L.  L.  Dunbar, 
wrote: 

There  was  no  further  need  of  the  Eed  Cross  Society  in 
San  Francisco  until  1906.  In  1905  when  Congress  made  the 
society  national,  an  organization  was  effected  in  San  Fran- 
cisco with  Judge  Morrow  as  president.  There  seemed  no 
hurry  and  Judge  Morrow  was  a  busy  man  and  no  committees 
were  appointed  until  April  17,  1906,  when  a  meeting  was 
called,  and  Judge  Morrow  appointed  the  committees  on 
nurses  and  physicians.  Then  the  very  next  day  came  the 
earthquake  and  fire.  I  had  been  appointed  chairman  of  the 
committee  on  nurses,  but  I  w^as  out  of  the  city  at  the  time 
and  could  not  get  back  into  it  for  a  week.  Meanwhile  our 
nurses  had  responded  to  the  need,  and  though  without  or- 
ganization had  done  much.  As  soon  as  I  was  able  to  get 
back  to  the  city  and  some  organization  could  be  effected, 
conditions  greatly  improved. ^^ 

The  call  to  send  nurses  to  the  scenes  of  the  Mississippi  floods 
(April  1908)  has  been  mentioned  as  the  first  such  demand  that 
was  made  on  the  Washington  Headquarters  after  the  interest  of 
nurses  in  the  Red  Cross  had  led  them  to  join  local  and  state 
Red  Cross  societies  in  fairly  large  nundxTs.  Eighteen  nurses 
were  sent  from  New  York,  Pennsylvania,  and  District  of 
Columbia  Branches  of  the  Red  Cross,  and  emergency  hospitals 
were  established.  The  work  centered  in  Hattiesburg,  ]\Iissis- 
sippi.  Half  an  hour  after  the  wire  came  to  Philadelphia,  ask- 
ing for  nurses,  the  nurses  wore  on  their  way.  The  character  of 
the  service  rench^rcd  is  shown  in  tlic  report  of  the  New  York 
Branch,  from  which  the  following  brief  portion  of  the  narrative 
as  told  by  the  nurse  in  charge  is  taken: 

^  Red  Cross  Magazine,  January,  1908. 


130   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  arrived  in  Hattiesburg,  May  17. 

Previous  to  the  coming  of  the  Red  Cross  nurses  the  local 
relief  committees  had  sent  to  New  Orleans  for  six  Charity 
Hospital  graduates  and  were  paying  them  at  the  rate  of  $25 
per  week  for  relief  work  in  the  two  hospitals.  Three  of  these 
nurses  were  discharged  soon  aftpr  the  arrival  of  the  first 
detachment  of  Eed  Cross  nurses,  and  the  remaining  three 
after  our  arrival.  Three  of  our  nurses  were  assigned  to  night 
duty,  two  to  day  duty,  and  I  was  to  act  with  Major  Simpson 
and  Captain  Ashford  in  coordinating  the  food,  medical  sup- 
plies and  repairs,  also  clothes,  equipment  and  the  names  of 
discharged  patients  who  were  entitled  to  transportation,  etc. 
.  .  .  My  duty  was  to  go  each  morning  to  the  hospitals,  army 
tents  and  Eed  Cross  relief  stations;  and  collect  and  inspect 
all  requisitions,  when  needful  make  suggestions  and  eliminate 
all  requisitions  not  provided  in  the  list  of  medical  and  com- 
missary supplies  provided  by  the  Relief  Expedition.  These 
requisitions  were  then  taken  by  me  to  the  official  offices  to 
be  approved  and  signed,  then  to  the  storehouse  to  be  filled 
and  delivered.  All  complaints  from  either  superintendents, 
patients  or  head  nurses  regarding  supplies,  etc.,  were  furnished 
me  in  written  signed  complaints,  to  be  adjusted  by  the  offi- 
cials in  whose  department  they  were.  As  the  buildings  were 
from  one-quarter  to  one-half  mile  apart  and  as  I  went  mostly 
on  foot,  my  first  week  was  a  pretty  busy  one,  until  I  had 
learned  to  systematize  my  work. 

May  29,  1908.  (signed)   Gexoveva  Pettit.^^ 

The  Dallas  floods  occurring  in  the  summer  of  1908  created 
conditions  that  called  for  nurses.  The  service  was  supplied 
entirely  by  the  Texas  Red  Cross  State  Nursing  Committee.  Its 
president,  Mary  Sherman  Allen,  wrote  of  the  experience  that 
she  and  her  staff  had  there : 

As  many  people  in  the  larger  camps  were  sick,  from  ex- 
posure and  the  terrible  experience  they  had  passed  through, 
some  being  days  in  tree-tops  before  rescued,  it  was  thought 
advisable  to  establish  eniergeney  hospitals  in  Camp  Hay  and 
Camp  Ferris.  We,  therefore,  issued  a  call  for  nurses  and 
nearly  all  of  our  enrolled  nurses  responded  to  the  call,  and 

"The  American  National  Red  Cross  Society,  at  its  meetin;,'  licld  last 
November,  decorated  Kli/,aV)ctli  M.  Hewitt  and  J.  Beatrice  Howman.  both 
of  the  Nurse  Corps.  United  States  Navy,  with  a  service  bar  for  volunteer 
work  done  under  the  Red  Cross  at  Hattiesburpr,  Miss.,  after  the  cyclone 
of  last  spring.  Tlie  bar  is  f)f  bronze  and  on  its  face  are  the  words, 
Hattiesburg,  1908."     Amcn'ra?!  ■Journal  of  yursing,  September,   1908. 


REORGANIZATION  AND  AFFILIATION  131 

immediately  we  established  a  large  field  emergency  hospital, 
fully  equipped  with  drugs,  sanitary  dressings,  cots  for  the 
sick  and  all  appliances  to  care  for  those  that  needed  the  at- 
tention of  the  lied  C'ross.  Doctors  Stoval,  Furgeson,  Black 
and  Davis  had  charge  of  the  medical  department ;  Miss  Mary 
Ennisson,  charge  of  the  hospital  work,  and  the  Misses  Annie 
Swinsky  and  Adrian  Palm,  trained  lied  Cross  nurses,  charge 
of  nurses'  department.  Our  Emergency  Hospital  stood  at  the 
head  of  a  broad  avenue  of  tents.  The  camp  presented  a  beauti- 
ful picture  and  the  United  States  flags  and  lied  Cross  flags 
floating  above  our  hospital  tents  could  be  seen  for  miles 
around.  Sanitary  conditions  and  perfect  order  were  main- 
tained during  the  entire  time.  Our  doctors  and  nurses  were 
kept  busy  caring  for  cases  of  fever  and  other  diseases  caused 
by  exposure. 

Our  doctors  and  nurses  cared  for  many  cases  of  destitution 
and  sickness  in  ])oth  camps,  as  well  as  in  all  parts  of  the  city 
where  needed,  and  it  has  been  the  universal  expression  that 
the  prompt,  ellicient  and  systematized  work  of  the  Eed  Cross 
did  much  in  preventing  an  epidemic  of  fever.'" 

'No  nurses  were  sent  from  America  by  our  Red  Cross  at  the 
time  of  the  earthquake  in  Sicily  (1908),  but  three  or  four 
American  nurses  wore  in  Italy  at  that  time  and  volunteered 
their  services.  It  is  interesting  to  know  that  one  of  these  was 
Alice  Fitzgerald,  a  .lohus  Hopkins  inirse,  whose  later  important 
position  as  chief  nurse  of  the  conmiission  to  France  and  still 
later  as  director  of  the  nursing  Service  of  the  League  of  Red 
Cross  Societies,  will  he  fully  told  in  another  chapter. 

When  a  building  collapsed  in  Philadelphia,  -luly,  1009,  a 
single  Red  Cross  nurse,  ^largaret  B.  Simon,  was  the  heroine  of 
this  accident,  and  for  her  work  she  was  commended  by  personal 
letters  from  the  ^^fayor  of  Philadelphia,  and  from  the  (then) 
President  Taft. 

At  the  time  of  the  dierrv  ^line  disaster,  nurses,  though 
ready,  were  not  sent  by  the  Washington  office,  as  the  Visiting 
Xurses'  Association  of  Chicago  had  enough  of  its  staff  to  till 
the  required  ser\'ic('. 

During  the  Mexican  border  disturbance's  in  PHI.  the  Cen- 
tral Office  of  th(>  Xursing  Service  at  Washington  responded 
promptly,  twice,  to  calls  for  nursing  aid,  once  for  Douglas, 
Ari/oiui,  and  next  from  l'"l  Paso,  l\>xas.  In  the  former  case  the 
exi)ected  necessity  did  not  aris(\  and  in  the  latter,  two  Ameri- 

'''^'' A  )i)rri('tni  ■loitrmil  (if  XiirsiiKj.  Oclolicr,   lOOS. 


132   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

can  Red  Cross  nurses  began  to  organize  work,  which  was  then 
taken  over  by  the  Mexican  Red  Cross. 

When  the  Austin  Dam  broke  in  1911,  the  Red  Cross  Service 
stood  ready  to  provide  nurses,  but  they  were  not  needed,  as  the 
State  of  Pennsylvania  provided  physicians  and  nurses. 

In  the  floods  of  early  summer,  1912,  Mississippi  and  Louis- 
iana being  the  chief  sufferers,  the  Red  Cross  Nursing  Service 
organized  relief  for  the  sickness  which  resulted  from  the  floods 
and  the  hot  weather.  A  staff  of  nurses  was  mustered  by  the 
Kansas  City  Local  Committee  on  Red  Cross  Nursing  Service  at 
the  request  of  the  Washington  ofiice,  to  be  sent  to  Mississippi, 
leaving  New  Orleans  nurses  to  supply  Louisiana.  Camps  were 
formed  for  the  refugees  and  the  nurses  were  stationed  in  these. 
Thirteen  nurses  were  assigned  to  duty.     Miss  Delano  wrote  :^* 

In  each  case  the  response  to  our  call  was  prompt.  Too 
much  cannot  be  said  in  praise  of  the  splendid  spirit  shown 
by  the  nurses. 

The  Omaha  cyclone  occurred  in  March,  1913.  In  the 
American  Bed  Cross  Magazine  for  July,  1913,  Miss  Delano 
wrote : 

Soon  after  the  April  number  of  the  Bed  Cross  Magazine 
went  into  print  we  were  called  upon  to  face  a  series  of  dis- 
asters such  as  this  country  had  never  before  experienced.  The 
efficiency  and  preparedness  of  tbe  Nursing  Service  of  the  Eed 
Cross  were  well  tested  and  the  nurses  were  foimd  ready  to 
meet  all  the  demands  made  upon  them. 

As  soon  as  the  news  of  the  Omaha  disaster  was  received 
in  Washington  communication  was  established,  through  the 
courtesy  of  the  Tnited  Press,  with  Aliss  Lillian  B.  Stuff,  Act- 
ing Chairman  of  the  Xehraska  Committee  on  Red  Cross 
Xursing  Service,  and  authority  was  given  her  to  call  out  Red 
Cross  nurses  and  to  organize  sucli  relief  as  lay  in  her  power. 
An  emergency  hos])ital  of  one  hundred  and  fifty  beds  was 
established  in  a  local  gN'umasium  where  they  cared  for  the 
injured   and   homeless. 

^liss  St\iff,  in  her  re])ort,  says.  "We  did  not  wait  for  calls 
to  come  to  us,  but  made  a  house  to  house  canvass  as  many 
were  huddled  together  among  neighbors  without  proper  cloth- 
ing in  which  to  n])pear  to  ask  for  aid.  Xor  did  we  confine 
our  efforts  entirely  to  nursing,  but  gave  whatever  lielp  was 
needed." 
^  AmrrircDi  Journal  of  Xursiur;,  Scptenilier,  1912. 


REORGANIZATION  AND  AFFILIATION  133 

A  hospital  of  one  hundred  fifty  beds  was  established  and 
eight  Red  Cross  nurses  were  continued  in  service  there  for 
some  weeks  after  the  disaster. 

Two  days  after  the  Omaha  cyclone,  vague  rumors  came  to 
us  over  press  wires  of  the  Dayton  horror.  Telegram  after 
telegram  was  sent  to  our  Local  Committees  on  Nursing 
Service  and  on  March  2(5  a  message  came  through  from  Cin- 
cinnati concerning  the  assignment  of  their  own  nurses  to 
duty  and  asking  that  one  hundred  additional  nurses  be  sent 
to  them  at  once  from  adjoining  cities. 

The  chairman  of  tlie  National  Committee  on  Red  Cross 
Nursing  Service  and  ten  Red  Cross  nurses  left  Washington 
with  Miss  Boardman  on  Friday,  March  28,  at  midnight  on 
a  special  relief  train  sent  out  by  the  Washington  Post.  This 
train  reached  Cincinnati  Sunday  morning  and  found  the 
most  perfect  cooperation  between  the  Local  Chapter,  nursing 
committees  and  various  relief  agencies. ^^ 

In  her  Annual  Report,  ]\liss  Delano  said : 

During  the  first  forty-eight  hours  following  the  Ohio 
flood,  which  occurred  ^larch  25,  seventy-seven  nurses  were 
assigned  to  duty  by  the  Cincinnati  Local  Connnittee,  and  in 
response  to  telegrams  sent  from  Washington  one  hundred 
and  thirty-six  nurses  from  other  cities  reached  the  flooded 
area  during  the  next  forty-eight  hours.  These  nurses  were 
sent  from  Chicago,  St.  Louis,  Detroit,  Ann  Arbor,  Cleveland, 
and  Akron,  wliile  ten  went  from  Washington  and  Baltimore 
on  the  "Post  Special"  with  the  cbairinau  of  the  National 
Committee.  Red  Cross  nurses  were  assigned  to  tlie  following 
cities  in  the  flooded  area : 

Columbus,  Dayton,  Hamilton,  ]\liddlcton.  West  Carrolton, 
Portsmouth,  ]\Iiamisburg,  Glendale,  Peru,  Shawneetown, 
Catlet^burg,  ^Maysville,  Point  Pleasant. 

The  number  of  nurses  assigned  to  dutv  at  any  one  place 
and  the  length  of  service  depended  upon  local  conditions. 

We  Avere  fortunate  in  having  an  active  I\e<]  Cross  Chapter  in 
Cincinnati  coojierating  with  the  T^ocal  Coimnittee  on  Nursing 
Service,  and  through  the  proin])t  action  of  Miss  Annie  Laws, 
secretary  of  the  Chapter,  Miss  (ireenwood.  cliairnian  of  the 
nursing  coinniittee,  and  Miss  l\eineckt\  l\e(|  Ci'oss  nurse  in 
charge  of  headquarters,  nurses  \ver(>  sent  to  the  stricken  com- 
munities before  organi/.e(l  relief  could  be  undertaken.  De- 
tailed reports  of  the  work  done  by  our  nurses  under  the 
supervision  of  Miss  Mary  \\.  (Jladwin,  chairman  of  the  Ohio 

"/i-nr/  Crnss  Ma(jn::inr,  July,   1013. 


134   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

State  Committee,  and  in  charge  of  the  nursing  relief  in 
Dayton ;  Miss  Ella  Phillips  Crandall,  of  Teachers  College, 
New  York,  responsible  for  about  fifty  nurses  doing  sanitary 
inspection  work  under  the  direction  of  Major  T.  L.  Ehoads, 
Medical  Corps,  United  States  Army;  Miss  Mary  C.  Wheeler, 
superintendent  of  Illinois  Training  School  for  Nurses,  Chi- 
cago; Miss  Emily  McLaughlin,  superintendent.  Harper  Hos- 
pital, Detroit;  Miss  Julia  C.  Stimson,  in  charge  of  social 
service  work  in  St.  Louis,  Mo.,  Miss  Jennie  L.  Tuttle,  superin- 
tendent. Visiting  Xurse  Association,  Columbus;  Miss  Mary  B. 
Wilson,  and  Miss  Abbie  Eoberts,  of  Cincinnati,  have  already 
appeared  in  the  Red  Cross  Magazine.  These  nurses  and 
many  others  were  relieved  from  responsible  positions,  and  in 
some  instances  substitutes  were  employed  in  order  that 
they  might  meet  their  obligations  as  enrolled  Eed  Cross 
nurses. 

In  describing  the  work  of  the  Red  Cross  nurses  in  Dayton,  Miss 
Glad%vin  wrote : 

They  may  be  found  serenely  picking  their  way  around 
wrecked  furniture,  sodden  mattresses,  ruins  of  porches  and 
sheds;  wearing  rubber  boots,  with  skirts  kilted  high,  wet 
nearly  to  the  waist;  sending  sick  people  to  the  hospitals,  in- 
specting plumbing,  back  yards  and  cellars ;  superintending  all 
sorts  of  work  from  feeding  the  baby  to  the  digging  of  trenches. 
Through  all  parts  of  the  flooded  city  nurses  go  on  similar 
errands,  inspecting  nearly  nine  thousand  homes  and  reporting 
conditions  found. 

Through  the  activity  of  Mrs.  H.  C.  Loun^bury,  chairman 
of  the  West  Virginia  State  Committee  on  Eed  Cross  Xursing 
Service,  most  efficient  relief  was  rendered  at  Point  Pleasant, 
West  Virginia.  Mrs.  Lounsbury  and  two  other  Eed  Cross 
nurses  "went  down  the  river  on  a  boat  loaded  with  supplies 
furnished  by  the  citizens  of  Charleston  and  the  neighboring 
towns."  They  found  little  sickness  at  Point  Pleasant,  and 
devoted  their  efforts  chiefly  to  the  distribution  of  clothing 
and  supplies  and  the  establishing  and  maintaining  of  sanitary 
conditions. •'*''' 

The  nurses  were  on  duty  for  four  weeks,  and  it  is  recorded 
that  in  Dayton  alone  they  cared  for  over  two  thousand  cases  of 
illness  or  accident.  This  was  the  severest  test  yet  given  to  the 
Ked  Cross  Xursing  Service,  and  the  way  in  which  it  was  met 

■■"' Pv('I)ort  of  tlio  Xatinna]  ('niumitto£'  on  Red  Cross  Xursing  Sorvice,  1913. 


REORGANIZATION  AND  AFFILIATION  135 

was  justifiably  regarded  as  a  triumphant  proof  that  organiza- 
tion was  now  in  perfect  running  order.^''' 

When  a  terribly  destructive  fire  in  Salem  made  thousands 
of  people  homeless  the  Boston  Local  Committee  on  Ked  Cross 
Nursing  Service  took  charge  of  nursing  relief.  Stations  were 
appointed  and  Red  Cross  nurses  assigned  to  each.  A  Mater- 
nity Hospital  with  a  Milk  and  Baby  Hygiene  Station  was 
organized  and  a  Contagious  Hospital  established.  The  work 
of  the  inirses  was  largely  preventive  and  was  well  and  thor- 
oughly done. 

The  Eastland  disaster  which  occurred  in  1915,  was  reported 
as  follows: 

On  July  24  one  of  the  large  excursion  steamers,  which  had 
been  chartered  by  the  employees  of  the  Western  Electric  Com- 
pany, overturned  just  before  the  boat  was  ready  to  leave  the 
dock.  There  were  about  twenty-five  hundred  people  on  board 
and  of  this  number  over  nine  hundred  lost  their  lives.  The 
accident  occurred  about  seven  o'clock  in  the  morning.  The 
chairman  of  the  Local  Committee  on  Red  Cross  Nursing 
Service,  Miss  Minnie  Ahrens,  heard  of  the  catastrophe  on 
the  way  to  her  odice  and  started  at  once  with  another  nurse 
for  the  scene  of  disaster.  She  telephoned  immediately  for 
additional  nurses,  not  only  to  headquarters  of  the  enrolled 
Eed  Cross  nurses,  but  to  the  registrar  of  the  Central  Di- 
rectory and  all  Public  Health  Xursing  organizations.  Nurses 
responded  quickly  and  reported  on  arrival  to  the  chairman 
of  the  Committee  for  instructions.  By  one  o'clock  at  least 
one  hundred  nurses  were  on  duty.  They  worked  in  the  pour- 
ing rain  wherever  the  rescued  were  carried,  and  many  taken 
from  the  water  before  nine  o'clock  were  resuscitated.  About 
noon  shelter  was  provided  in  the  Beed  Murdock  Wholesale 
Grocery  Building,  and  artificial  respiration,  hot  applications 
and  other  emergency  treatments  were  continued  as  long  as 
there  was  the  slightest  hope.  When  nothing  more  could  be 
done  for  the  injured,  a  morgue  was  eistablished  at  the  Second 
Kegiment  Armory  where  relatives  could  identify  their  dead. 
Five  Ked  Cross  nurses  were  assigned  to  duty  in  an  emergency 
liospital  at  the  morgue  to  give  such  care  and  comfort  as  might 
be  possil)le  to  tliose  who  were  bereaved.  This  emergency  hos- 
pital was  continued  with  relays  of  Red  Cross  nurses  until 

"See  also  articles  on  the  Dayton  Disaster  in  the  Amrricnn  .Joitmal  of 
Xurfiing.  li)l.'?.  The  Red  Cross  in  Dayton,  by  Mary  K.  (Jladwiii.  Tlie 
Work  of  the  Cincinnati  Local  Red  Cross  Xnrsinjif  Service  Coininittec,  by 
Mary  H.  Greenwood.  Report  sent  to  Miss  Delano  hy  Ella  Phillips  Cran- 
dall,'  etc. 


186   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Wednesday^  July  28,  all  serving  gratuitously.  In  closing  her 
report  Miss  Ahrens,  who  had  charge  of  the  work  and  who 
rendered  most  efficient  service,  said :  "It  is  at  such  a  time 
that  we  realize  and  appreciate  the  value  of  our  Eed  Cross 
Nursing  Service.  Without  organization  it  would  have  been 
impossible  to  have  had  such  cooperation.^® 

The  year  1917  had  a  number  of  calls  for  nurses  in  times  of 
disaster ;  six  were  called  to  ISTew  Castle  in  Indiana ;  nineteen  to 
New  Albany,  Indiana ;  four  to  Chester,  Pennsylvania ;  eight  to 
Atlanta,  Georgia ;  thirty-four  to  two  Illinois  towns ;  five  to 
Hickman,  Kentucky ;  three  to  a  Missouri  town ;  one  to  Spring- 
port,  Michigan;  five  to  East  St.  Louis;  one  to  Clay,  Kentucky. 
The  crowning  disaster  of  1917  was  the  explosion  at  Halifax, 
Nova  Scotia. 

The  terrible  calamity  resulting  from  the  explosion  of  war 
munitions  in  the  harbor  of  Halifax,  on  the  6th  of  December, 
1917,  will  long  be  remembered.  Amidst  the  many  forms  oi 
relief  and  succor  called  for  by  the  unparalleled  destructiveness 
of  the  disaster,  nursing  aid  was  needed.  From  this  country  a 
number  of  nurses  were  recruited  in  desperate  haste  by  Red 
Cress  committees  and  hospital  authorities  of  the  New  England 
states,  as  being  the  nearest  to  the  scene. 

The  Providence  Local  Committee  on  Red  Cross  Nursing 
Service  sent  fifty  nurses  in  charge  of  Grace  L.  Mclntyre,  Chief 
Nurse ;  various  hospitals  sent  physicians  and  nurses ;  the  Com- 
mittee of  National  Defense  and  the  Public  Safety  Committee 
formed  units  of  physicians  who  chose  their  own  nurses,  and 
thus  the  New  England  Division  Headquarters  of  the  Red  Cross 
was  not  called  upon  to  supply  nurses. 

Miss  Delano  was  kept  informed  of  the  movements  of  nurses 
and  on  December  17  wrote  to  Elizabeth  F.  Sherman,  of  Provi- 
dence, who  had  been  prominent  in  collecting  Miss  Mclntyre's 
staff: 

December  17,  1917. 
May  I  thank  you  for  your  very  satisfactory  report  of  the 
Halifax  activities.  It  is  our  desire  that  Bed  Cross  Com- 
mittees shall  cooperate  in  every  way  possible  in  relief  work 
of  this  kind  without  waiting  for  orders  from  Headquarters, 
as  the  important  thing  in  disaster  relief  is  to  meet  the  need 

"Annual  Report  of  tlie  Comniittoc  on  Red  Cross  Nursing  Service,  1915. 
See  also  tlie  Red  Cross,  by  Minnie  Alirens,  Ameruxi7i  Journal  of  \ursing, 
October.    191"). 


REORGANIZATION  AND  AFFILIATION 


137 


as  quickly  as  possible.  I  am  more  than  glad  that  you  were 
able  to  secure  the  nurses,  and  appreciate  greatly  your  untiring 
efforts  in  the  matter. 

In  this  brief  summary  of  special  emergency  nursing  episodes 
there  has  been  no  attempt  made  to  cover  purely  local,  isolated 
instances  where  Red  Cross  nurses  have  come  forward.  Nor  can 
the  numerous  list  be  included  of  such  preparations  for  nursing 
care  as  were  made,  for  instance,  at  the  time  of  the  Veterans' 
Reunion  at  Gettysburg,  and  similar  reunions ;  still  less  the  long 
list  of  such  occasions  as  might  be  covered  by  the  term  ''Dress 
Parade."  For  events  of  this  kind  the  report  of  a  typical  year 
will  give  sufficient  idea,  as  follows: 


Annual  Report,  1917. 

Relief  Actwities. 

The  following  relief  activities  have  been  conducted  during  the  past  year 
by  our   Local   Committees: 


Date 

Town  or  City 

Occasion  of  Service 

Red 

Cross  Nurses 
on  Duty 

January   1 

Pasadena,    Calif. 

Tournament  of  Roses 

2 

;March  4 

\A'ashington,  D.  C. 

Inauguration 

19 

March  5-10 

Cleveland,   Ohio 

Central  Armory 
Celebration 

10 

"        12 

New  Castle,  Ind. 

Cyclone  Disaster 

0 

10  from  Indiana 

"       23 

New  Albany 

Tornado  Disaster 

5   " 
4 

Cincinnati 
"  Kentucky 

April  10 

Chester,    Penna. 

Kddystone  Disaster 

4 

"       16  to 

Washington,  D.  C. 

Encampment,  Navy 

May  26 

League 

0 

May  21 

Atlanta,  Ga. 

Fire  Disaster 

S 
8   " 

Ploomington, 
HI. 

"      25 

Charleston,  111. 

Cyclone  Disaster 

4  " 

Jacksonville 

Mattoon,    111. 

Cyclone  Disaster 

()  " 

15    •' 

1    •' 

Peoria,    111. 
Chicago,  111. 
Ft.  Wayne, 
Ind. 

"      20 

Hickman.  Kentucky 

Cyclotic   Disaster 

;") 

"      10 

Brooklyn,  N.  Y. 

I'livciling  Lafayette 
Statue  by  General 
JofTre 

4 

138   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 


Date 

Town  or  City 

Occasion  of  Service 

Red  Cross  Nurses 
on  Duty 

May  30 

Bridgeport,  Conn. 

Memorial  Day  Exer- 
cises 

8 

"      31  to 

Mineral  Point,  Mo. 

Tornado  Disaster 

3 

June  30 

June  2-9 

Washington,  D.  C. 

Confederate  Reunion 

20 

"      9 

Springport,  Mich. 

Tornado  Disaster 

1 

"      17-22 

Atlanta,  Ga. 

Rotary  Convention 

4 

"      3-6 

East  St.  Louis,  111. 

Race  Riots 

5 

July  4 

Phelps,  N.  Y. 

Military  Maneuvers 

3 

"      4 

Newport,  R.  I. 

Parade 

1 

"      28  to 

Bridgeport,  Conn. 

"Lordship  Park" 

1 

Sept.  3 

August  4 

Clay,  Kentucky 

Mine  Disaster 

1 

Albany,  N.  Y. 

State  Federation  of 
Women's  Clubs 

9 

Septem- 

Grand Rapids,  Mich. 

Union  Depot  for 

2 

ber  10 

troops  passing 
through 

CHAPTER  IV 


THE  MERCY  SHIP 


The  S.  S.  "Red  Cross"  Satis — Paignton,  England — Pau, 
France — Kief,  Russia — Gleiwitz,  Germany — Kosel,  Ger- 
many— Vienjia,  Austria — Budapest,  Hungary — Belgrade, 
Serbia — Gevgeli,  Serbia — Yvetot,  France — La  Panne,  Bel- 
gium— American  National  Red  Cross  Headquarters — Close 
of  the  Early  Foreign  Relief  Program. 

A  WHITE  ship  banded  with  scarlet,  with  a  Red  Cross 
flaming  on  her  funnels,  weighed  anchor  in  the  sunlit 
waters  of  the  Hudson  River  and  with  the  bells  and 
whistles  of  ferries  and  tug-boats,  the  salute  of  liners  and  the 
throaty  roar  of  men-o'-war  to  voice  the  God-speed  of  a  nation, 
steamed  out  to  the  gray  Atlantic,  bound  on  a  rare  mission  to 
warring  Europe.     The  day  was  September  12,  1914. 

Against  the  lower  rail  of  this  good  ship,  the  Red  Cross,  was 
banked  a  line  of  women,  who  watched  Manhattan  fade  away 
and  knew  not  what  horror  of  war  might  be  theirs  before  they 
saw  that  broken  sky-line  again.  The  white  caps,  the  gray  uni- 
forms, the  line  of  scarlet  as  the  fresh  sea  wind  blew  back  the 
active  service  capes,  proclaimed  their  identity.  The  Red  Cross 
Xursing  Service,  conceived  in  the  suffering  of  the  Civil  and 
Spanish-American  wars,  brought  into  being  by  the  affiliation  of 
the  American  Nurses'  Association  and  the  American  Red  Cross, 
nurtured  and  developed  through  five  years  of  intensive  organi- 
zation by  Miss  Delano  and  the  Xational  Committee,  faced  the 
most  formidable  test  of  its  hitherto  dormant  powers.  With  its 
present  resources  untried,  its  potential  strength  unguessed,  it 
was  shouldering  its  first  burden  of  neutral  humanitarian  ser- 
vice to  the  Allied  and  Central  Powers. 

At  a  joint  meeting  of  the  International  and  War  7-felief 
Boards  held  on  August  5,  1014,  the  Am(>rican  Red  Cross  voted 
to    charter    a    ship    to    carry    trained    jxu'sonn(4    and    hospital 

139 


140    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

supplies  to  the  countries  involved  in  the  European  War.  The 
story  of  the  immediate  consequences  of  this  action  was  told  by 
Miss  Boardman  in  the  Red  Cross  Magazine  of  October,  1914: 

A  committee  consis|;ing  of  Mr.  Bernard  N.  Baker,  of 
Baltimore;  Surgeon  General  William  C.  Gorgas,  U.  S.  A.; 
Surgeon  General  William  C.  Braisted,  U.  S.  N. ;  and  Chief 
Constructor  Richard  ]\I.  Watt,  U.  S.  N.,  was  appointed  to 
secure  a  suitable  ship.  No  American  vessel  was  available, 
but  two  ships  were  most  generously  offered  free  of  charge  by 
the  Hamburg-American  Line  and  by  the  Austro-American 
Line.  The  committee  inspected  both  ships  and  finally  selected 
the  Hamburg,  of  the  former  company,  as  best  suited  to  the 
purpose. 

By  special  Act  of  Congress  [then  in  session],  the  ship  flies 
the  American  and  Red  Cross  flags,  has  a  temporary  American 
registry  and  has  changed  her  name  to  that  of  the  Red  Cross, 
sailing  from  Xew  York.  According  to  the  colors  designated 
for  such  a  ship  by  the  treaty  of  The  Hague,  she  was  painted 
white  with  a  broad  red  band. 

Major  Kobert  U.  Patterson,  Medical  Corps,  U.  S.  A.,  Chief 
of  the  Red  Cross  i\Iedical  Bureau,  soon  secured  his  corps  of 
surgeons.  Miss  Delano,  chairman  of  the  National  Committee 
on  Red  Cross  Nursing  Service,  through  the  cooperation  of 
her  Local  Committees,  selected  from  among  volunteers  from 
our  five  thousand  Red  Cross  trained  nurses,  those  best  fitted 
for  this  special  service.  [Miss  Helen  Scott  Hay  was  general 
superintendent  of  nurses  of  the  Red  Cross  Ship.] 

Admiral  Aaron  Ward,  U.  S.  N.,  retired,  who  was  in  Europe, 
accepted  by  cable  the  request  that  he  take  charge  of  the 
expedition,  joining  the  ship  in  England.  Admiral  Blue,  of 
the  Navy,  lent  his  aid  to  secure  the  rest  of  the  officers.  Cap- 
tain x\rmistead  Rust  took  command  of  the  ship  and  with  him 
are  associated  other  retired  officers.  Commander  E.  H.  De- 
lany,  U.  S.  N.,  as  chief  engineer;  Commander  J.  S.  Dodd- 
ridge, U.  S.  X.,  and  Lieutenant  Gilford  Darst,  U.  S.  N. ;  Mr. 
Richard  D.  L.  ^lolnm  is  the  paymaster.  Captain  Jarka, 
superintendent  of  this  line,  gave  invaluable  service  in  the 
coaling  and  provisioning  of  the  ship.  The  painters  hung 
along  lier  sides  and  busily  plied  their  brushes  the  moment 
the  coaling  was  over. 

The  S.  S.  Red  Cross  Avas  loaded  from  warehouses  in  Brook- 
lyn, the  use  of  which  were  donated  by  Mr.  Irving  Bush.  Colo- 
n(!l  S.  L.  1).  SlfX'um,  U.  S.  A.,  r(;tired,  was  in  command  of  the 
loading  of  liospital  and  other  supplies.      Four  hundred  thou- 


THE  MERCY  SHIP  141 

sand  pounds  of  cotton,  two  hundred  and  fifty  thousand  meters 
of  gauze,  fifteen  thousand  pounds  of  bandages,  thirty  gallons 
of  iodine,  two  thousand  cans  of  ether,  rubber  gloves,  vaseline, 
cocoa,  tobacco  and  other  comforts  and  necessities  for  the  care 
of  the  sick,  filled  the  hold  of  the  liner.  Because  of  this  cargo 
and  because  of  her  passengers,  the  Red  Cross  received  the  name 
of  the  "Mercy  Ship"  from  the  friendly  press. 

The  professional  personnel  of  this  relief  expedition  was 
made  up  of  ten  units,  each  composed  of  twelve  nurses  and  three 
surgeons.  Units  A  and  li  were  assigiied  to  Pan,  France ;  1)  and 
F  to  Paignton,  England ;  C  and  II  to  Kief,  Pussia ;  G  and  I  to 
Germany;  K  to  Austria  and  E  to  Budapest,  Hungary.  A 
Serbian  imit,  of  which  Dr.  Edward  W.  Ryan  was  director  and 
^lary  E.  Gladwin,  chief  nurse,  had  proceeded  five  days  before 
the  sailing  of  the  ]\Iercy  Ship  on  the  merchant  liner  loannina 
bound  for  the  Mediterranean  and  Nish. 

The  superintendent  of  nurses  of  the  S.  S.  Red  Cross  was 
Helen  Scott  Hay.  The  assignment  to  the  Mercy  Ship  which 
brings  her  for  the  first  time  into  this  history  was  in  keeping 
with  her  subsequently  romantic  and  brilliant  career  in  Ked 
Cross  service.  She  was  graduated  from  Northwestern  Academy 
in  1889  and  received  her  B.L.  degTce  from  Northwestern 
University  four  years  later.  Further  theoretical  phases  of  her 
broad  education  were  completed  in  1900  at  the  University  of 
Chicago.  She  had  entered  the  Illinois  Training  School  for 
Nurses  in  1893  and  following  her  graduation  became  associated 
in  executive  capacities  of  varying  types  with  the  Southwestern 
Iowa  Hospital  for  the  Insane  at  Clarinda,  Iowa,  and  w^ith 
private  sanatoria  in  Los  Angeles,  California.  She  was  super- 
intendent of  nurses  at  the  County  Institute  for  the  Insane  and 
Indigent  at  Chicago  and  later  superintendent  of  the  hospital 
and  training  school  of  the  Pasadena  Hospital,  Pasadena,  Cali- 
fornia. Private  duty  nursing  claimed  her  attention  at  inter- 
mittent periods.  An  interesting  break  in  her  professional  career 
is  marked  by  a  year  as  principal  of  the  Savannah  High  School, 
her  native  village  iu  Illinois.  She  became  superintendent  of 
nurses  of  her  alma  mater,  the  Illinois  Training  School,  in  I'.KXl 
and  remained  tlu^re  until  1912.  After  eighteen  months  spent  in 
travel,  she  undertook  the  organization  of  the  W(^st  Suburban 
Hospital  and  School  for  Nurses  at  Oak  I*ark,  Illinois,  and  re- 
mained there  six  months,  resigning  to  accept  her  first  lied  Cross 
servi('(\ 


142    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Hay's  early  war  service  was  closely  interwoven  with  a 
project  of  nursing  education  which  first  linked  the  American 
Red  Cross  with  the  development  of  foreign  nursing.  Before 
the  declaration  of  war,  Queen  Eleanora  of  Bulgaria  had  ap- 
pealed to  National  Headquarters  for  advice  and  assistance  in 
establishing  a  training  school  for  nurses  in  Sofia  in  accordance 
with  American  standards.  In  the  Red  Cross  Annual  Report 
for  1914,  Miss  Delano  stated  this  prospective  plan  of  the 
keen-visioned  Queen: 

She  wished  to  secure  an  American  superintendent  to  or- 
ganize a  training  school  and  to  send  to  America  four  Bul- 
garian young  women  of  education  and  promise  who  could 
fulfill  the  requirements  for  admission  to  one  of  our  best 
schools  for  nurses.  These  pupils  were  to  enter  the  Presby- 
terian Hospital  School  for  Nurses  in  New  York  City.  Miss 
Helen  Scott  Hay  was  selected  by  the  Red  Cross  to  establish 
the  school  in  Bulgaria.  The  Bed  Cross  assumed  the  re- 
sponsibility for  her  salary  for  three  years  and  she  was  to  have 
sailed  for  Bulgaria  [August  4,  1914].  The  declaration  of  Avar 
made  it  necessary  to  abandon  our  plans  temporarily,  ren- 
dering it  possible,  however,  for  us  to  assign  Miss  Hay  to 
duty  on  the  Bed  Cross  Ship. 

In  organizing  the  nursing  stafi's  of  the  ten  units.  Miss  Delano 
and  Miss  Hay  were  guided  in  their  assignments  by  the  princi- 
ple that  graduates  from  the  same  school  and  section  of  the 
country  would  work  advantageously  together.  An  earnest  spirit 
characterized  these  surgeons  and  nurses  bound  on  their  cru- 
sader's mission  during  that  memorable  September  of  1914.  In 
a  leading  editorial  the  Ainerican  Journal  of  Nursing  voiced  the 
sentiment  of  the  Red  Cross :  ''Our  nurses  have  been  sent  not  to 
lead  others  or  to  show  how  Red  Cross  work  should  be  done,  but 
to  supplement  the  existing  relief  work,  to  piece  in  where  there 
is  no  one  else  to  serve." 

Individualism  also  gave  way  before  the  Red  Cross  ideal  of 
neutrality.  Although  all  the  nurses  were  native-lx^rn  citizens 
of  the  United  States,  many  of  their  names  were  distinctly  con- 
tinental. After  a  first  moment  of  astonishment,  they  agreed  to 
follow  the  European  custom  and  to  be  known  only  as  "Sister 
Donna"  or  ''Sister  Charlotte,"  titles  appropriate  indeed  when 
it  is  remembered  that  the  old  Sanskrit  word  for  "sister"  meant 
"comforter." 

The  one  hundred  and  twenty-six  nurses  sailing  on  the  Mercy 


THE  MERCY  SHIP  143 

Ship  had  boen  assembled  through  the  Local  Committees  of 
Manhattan,  Boston,  Brooklyn,  Philadelphia,  Baltimore,  New 
Hampshire,  New  Jersey,  Rochester,  Biitfalo,  Detroit,  Albany, 
Chicago,  Kansas  City,  Cincinnati,  Akron,  Cleveland,  Colum- 
bus, Connecticut  and  Washington,  1).  C.  A  diary  written  dur- 
ing the  quiet  days  at  sea,  presented  a  vivid  picture  of  this 
swift  mobilization: 

On  board  the  S.  S.  Red  Cross, 
September  22,  1914. 

Almost  a  month  has  passed  since  a  telegram  came  from 
]\Iiss  Delano  saying,  "Report  Wednesday  in  New  York  for 
Red  Cross  service  in  Europe."  As  I  read  over  that  telegram, 
a  queer  feeling  come  into  my  throat.  Then  with  pencil  and 
pad  I  was  soon  busy  making  out  lists  of  necessary  articles. 
Ilurried  shopping  followed  in  the  morning.  Constant  tele- 
phone calls  from  friends  brought  varied  questions:  "Why 
are  you  going?"  "It  won't  be  any  fun !"  "How  I  envy  you  the 
opportiinity !"'  "Please  send  me  postcards  every  week,  won't 
you?"  "1  have  a  cousin  in  Germany — give  her  my  love."  "We 
have  just  finished  a  bushel  basket  of  bandages  for  the  Allies 
we  want  you  to  take  over." 

To  have  only  forty-eight  hours  in  which  to  adjust  your 
affairs  and  to  get  your  mind  into  a  realization  that  all  things 
of  your  former  life  are  to  cease  and  an  entirely  new  and 
very  real  existence  is  to  begin  is  no  easy  task.  I  can  still 
hear  my  mother's  "Yes,  you  should  go,"  though  the  look  in 
her  eyes  belied  her  words.  ]\[y  brother's  "Be  a  good  soldier, 
sis!"  is  all  mixed  up  with  "duffel  bags"  and  "war  zones"  and 
the  prescribed  number  of  flannel  night-gowns  to  be  taken. 

On  Wednesday  evening,  September  2,  nurses  began  to  arrive 
in  Xew  York  from  all  parts  of  the  country.  In  view  of  the 
fact  that  many  nurses  were  on  their  vacations,  their  mobiliza- 
tion within  two  days  after  their  "travel  orders"  were  received, 
was  remarkably  swift.  They  were  entertained  at  the  Central 
Chil)  for  Xurses,  54  East  34th  Street.  This  was  conveniently 
near  the  Xew  York  County  Chapter,  where  they  were  equipped 
with  the  regulation  uniform  upon  their  arrival.  Gray  uni- 
forms, white  aprons,  caps  with  a  small  Bed  Cross  in  front,  soft 
colhirs,  a  navy  blue  cape  lined  with  scarlet  and  with  the  Bed 
Cross  on  the  left  side,  a  dark  blue  felt  hat,  a  water-proof  duffel 
bag  of  brown  canvas  closed  with  a  bar  and  lock  and  conspicu- 
ously marked  with  a  Bed  Cross  encircled  by  the  words,  "Ani(>ri- 
can  Bed  Cross,"  were  given  each  nurse.     The  duffel  bags,  con- 


lU    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

taiiiing  three  additional  bags,  one  for  shoes,  one  for  laundry  and 
one  containing  scissors,  needles,  cotton,  buttons  and  a  piece  of 
the  uniform  material,  were  the  only  luggage  allowed,  except  a 
suit  case  or  hand  bag.  Gray  sweaters  were  also  furnished. 
Warm  storm  coats  were  later  added  to  this  equipment.  An 
^live  green  blanket,  with  a  Red  Cross  woven  in  the  center  was 
presented  to  each  member  of  the  expedition,  to  be  used  as  a 
steamer  robe  or  extra  bed  covering  in  the  hard  and  unusual 
places  of  war  where  they  soon  might  find  themselves. 

The  pleasant  hours  on  board  the  Mercy  Ship  was  busily 
taken  up  with  classes.  The  daily  routine  resembled  more  closely 
that  of  a  training  school  than  an  ocean  voyage.  The  nurses 
breakfasted  at  eight  o'clock  and  spent  the  morning  at  lectures 
given  by  the  surgeons  on  such  subjects  as  First  Aid,  languages, 
contagious  and  infectious  diseases,  anatomy,  anaesthetics,  ban- 
daging, the  metric  system,  field  surgery  and  allied  subjects.  At 
eleven-thirty,  they  exercised  in  the  gymnasium.  After  luncheon 
they  practised  nursing  technique  for  an  hour  and  a  half.  At 
four  o'clock,  they  attended  classes  in  French  and  German. 
They  dined  at  seven.  Prayers  w^ere  conducted  by  Sister  Helen 
Scott  Hay  at  eight-thirty  and  the  nurses  retired  at  ten  o'clock. 

The  grim  realities  of  war  hovered  near  the  staunch  S.  S.  Red 
Cross  as  she  plowed  her  w^ay  through  the  heavy  seas.  Letters 
and  diaries  of  the  nurses  recounted  the  eventful  days  in  the 
war  zone : 

Monday,  September  14.  About  3  A.  M.  the  searchlights 
of  the  British  cruiser,  Essex,  found  us.  After  our  flags  were 
nui  up  and  our  illuminated  Red  Cross  had  flashed  back  our 
identity,  we  were  allowed  to  proceed.  As  this  is  my  first  ocean 
trip,  my  ha})piiiess  will  not  be  complete  until  there  are  "shots 
across  the  bow"  and  I  see  a  whale. 

They  found  three  stowaways,  two  of  the  old  crew;  sighted 
four  ships,  ordinary  trading  vessels. 

Tuesday,  September  15.  Another  lesson  on  bandaging  at 
9  :30.  Passed  south  of  the  banks  of  Newfoundland  at  noon. 
The  sea  is  still  rough,  the  sun  warm,  a  strong  wind  blowing. 
Huge  waves  come  breaking  over  the  decks.  We  are  taking 
the  eastern  course  direct. 

Wednesday,  September  16.  A  beautiful,  warm,  bright 
morning.  They  found  two  more  stowaways  who  looked  as  if 
they  had  been  making  their  home  in  the  coal  boxes.  Had  a 
very  interesting  talk  on  solutions,  preparations  for  aspirat- 
ing, venous  section   and  lumbar  puncture.     It  is  dark  and 


THE  MERCY  SHIP  145 

cloudy  and  looks  very  much  like  rain.  The  Lusitania  sent 
a  wireless  at  8  P.  M.  saying  we  were  coming  to  a  storm. 
Everything  is  being  tied  fest  and  tacked  down. 

Friday,  September  18.  Such  wonderful  weather  and  the 
sick  chirping  up.  Our  class  this  morning  was  on  the  care 
of  the  wounded  in  the  field.  Then  in  the  afternoon  we  were 
shown  the  engine  room.  I  thought  my  time  had  surely  come; 
we  went  down,  down,  down.  It  was  the  cleanest  but  also  the 
oiliest  place  that  I  had  ever  seen.  There  is  one  fact  which 
penetrated  my  brain  and  remained  there :  the  stokers  are  not 
the  miserably  unhappy  mortals  one  is  likely  to  imagine.  The 
one  J  saw  was  blissfully  smoking  a  pipe  and  singing.  Then 
after  I  had  smiled  sweetly  (and  no  doubt  patronizingly), 
great  was  his  Joy  when  1  put  my  hand  on  a  rod  covered  with 
tar.    He  laughed  outright  and  so  did  I. 

Monday,  September  21.  IMajor  Patterson  received  a  wire- 
less this  morning  from  Dr.  I?yan  of  the  Serbian  unit,  stating 
they  have  had  bad  storms  for  five  days.  I  really  think  we 
are  all  feeling  the  de})ression  of  this  awful  fog.  It  is  just 
the  feeling  that  one  would  have  after  being  put  in  a  cold 
pack  and  then  forgotten  by  the  nurse. 

Tuesday,  September  22.  Another  heart-to-heart  talk  with 
our  superintendent  has  brought  home  to  us  that  neither  the 
best  bandage  nor  the  deft  handling  of  a  wound  will  win  for 
us  a  place  among  those  we  hope  to  assist;  the  keen  and 
ready  sympathy  that  w^e  show  them  will  make  or  mar  our 
mission. 

Wednesday,  September  23.  Bishops  Headlight  has  just 
blinked  a  welcome.  Land, at  last!  One  war  vessel  at  anchor 
in  the  harbor  sent  the  following  message  by  wireless:  "God 
bless  you  and  good  night." 

With  her  flags  unfurled  to  the  brilliant  glare  of  searchlights 
from  land  and  from  battle  craft  in  the  harbor,  the  S.  8.  lied 
Cross  lowered  anchor  on  the  evening  of  September  23  in  the 
Bay  of  Falmouth,  England.  Surgeons  and  nurses  of  four  units 
were  to  leave  her  at  this  port,  D  and  F^  to  report  to  the  American 
Ambassador  in  London  for  assigiiment  to  service  with  the 
British ;  C  and  H  to  proceed  north  by  way  of  Scotland  and 
Sweden  for  Petrograd,  Kussia.  The  remaining  six  units  des- 
tined for  service  in  France,  Gernumy  and  Austria  were  to 
remain  aboard  for  debarkation  at  other  ports. 

Among  the  low  hills  of  southeast  England  lay  Paignton. 
Here  on  October  1,  11!14,  Unit  F  reported  for  duty  at  "Oldway 
House,"  then  a  war  hospital  for  Tommy  Atkins. 


146   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"Oldway  House"  was  formerly  the  country  estate  of  Paris 
Singer,  of  ^ew  York,  and  had  been  loaned  by  him  for  hospital 
purposes  to  the  Committee  of  the  American  Women's  War  lie- 
lief  Fund.  This  group  of  American  women,  then  resident  in 
England,  included  among  others,  Lady  Arthur  Paget,  Lady 
Henry,  the  Duchess  of  Marlborough,  Lady  Randolph  Church- 
ill, Mrs.  Whitelaw  Reid,  Mrs.  John  Astor  and  Viscountess 
Harcourt.  Sir  William  Osier,  Baronet,  served  as  consulting 
physician  and  Lieutenant  Colonel  R.  C.  Gunning,  Royal  Army 
Medical  Corps,  as  military  commandant.  To  this  beautiful 
place  with  its  spacious  parks  facing  the  Channel,  its  broad 
terraces  and  columned  fagades,  its  marble  stairways  and  tapes- 
tried walls,  came  Unit  F  with  Sister  Mabelle  S.  Welsh,  a 
former  superintendent  of  nurses  at  Peter  Bent  Brigham  Hos- 
pital, Boston,  as  supervisor  and  Dr.  Howard  W.  Beal  of 
Worcester,  Mass.,  as  director. 

In  the  meantime.  Unit  D  with  Dr.  Robert  W.  Hinds,  of 
Buffalo,  New  York,  as  director  and  Sister  J.  Beatrice  Bow- 
man, of  the  Navy  Nurse  Corps,  as  supervising  nurse,  had  been 
sent  to  the  Haslar  Royal  Naval  Hospital,  near  Portsmouth. 
This  unit  remained  at  Haslar  for  six  weeks  before  it  was 
called  to  Paignton  to  supplement  the  staff  at  ''Oldway  House." 
A  brief  description  of  the  Haslar  hospital  is  therefore  given 
before  the  work  at  Paignton  of  Unit  F  and  the  combined  work 
of  Units  F  and  D  is  detailed. 

Sister  Beatrice  of  Unit  D  wrote: 

From  owr  hotel  windows  overlooking  Falmouth  Harbor, 
we  saw  tlie  Channel  and  the  Bed  Cross  as  she  steamed  out, 
and  tlie  S.  S.  Tennessee  as  she  swung  into  her  place. 

At  ten  o'clock  on  the  morning  of  October  3,  we  started 
for  Gosport.  Even  tlie  roads  and  foliage  seemed  old-Avorld 
and  quaint.  Lady  Hotham  says  that  Americans  are  not  con- 
sidered foreigners  here  and  indeed  they  do  not  treat  ns  so. 
One  would  think  we  were  some  near  relative  turning  up  after 
years  of  separation. 

This  is  the  largest  hospital,  naval  or  military,  in  England, 
with  a  capacity  of  two  thousand  and  six  hundred  l)eds,  and  a 
possible  emergency  one  of  seven  thousand.  Each  of  the 
ninety-nine  wards  has  twenty-eight  to  thirty  patients. 

Picturesquely  sea-going  was  the  language  at  Haslar.  The 
floor  was  "tlie  deck,"  upstairs  "top-side,"  and  downstairs  "be- 


THE  MERCY  SHIP  147 

low."  The  nurses'  office  was  the  ''Sister's  cabin,"  the  operatiiifr 
room  '"the  theater,"  the  Hospital  Corps  "the  siek  berth  staff.  ' 
Small  wonder  that  the  American  mirses  gasped  to  hear  the 
British  Navy  Sisters  refer  solemnly  to  a  critically  ill  patient 
as  "that  jolly  sick  man  just  gone  below !" 

But  it  was  necessary  to  supplement  the  staff  at  "Oldway 
House,"  Thus  after  six  weeks  of  absorbingly  interesting  work 
at  the  Naval  Hospital,  the  order  came  for  Unit  D  to  proceed  to 
Paignton. 

The  Matron  of  "Oldway  House,"  Gertrude  Fletcher,  was  an 
Australian  woman  whose  long  experience  during  the  Boer  War 
had  helped  prepare  her  for  the  delicate  task  of  directing  the 
work  of  the  English  and  American  nurses.  When  Unit  D 
arrived  on  November  12,  they  found  that  Unit  F  had  previously 
been  given  the  care  of  a  ward  of  sixty-seven  beds,  one-third  of 
the  entire  house.  This  responsibility  was  continued,  but  shifted 
so  that  Sister  jMabelle  Welsh  of  Unit  F  became  Matron's 
first  assistant  on  day  duty  and  Sister  Beatrice  Bowman  of  Unit 
1)  was  app<nnted  general  night  ]\ratron.  Other  menfbers  of 
Unit  1)  were  assigned  to  ward,  night  and  operating  room 
duty. 

An  interesting  analysis  of  the  first  1000  cases  treated  at  the 
American  Women's  War  Hospital  at  Paignton  showed  that  445 
patients  were  wounded,  while  520  suffered  from  miscellaneous 
injuries,  such  as  abrasions,  burns,  dislocations  and  contusions. 
One  hundred  and  seventy-nine  operations,  under  general 
anji-sthesia,  were  performed.  Of  the  results  of  the  treatmcnit, 
only  129  of  this  first  1000  were  pronounced  "unimproved," 
623  were  completely  cured  and  only  3  died.  "On  January  4," 
a  nurse  wrote,  "we  received  one  hundred  new  cases,  coming 
direct  from  the  trenches  through  Boulogne.  One  young  man  had 
lost  both  eyes ;  others  had  terribly  frosted  feet ;  two  came  in 
with  perfectly  cl(>an  wounds,  the  first  we  have  had ;  one  has 
eight  bullet  wounds  in  one  leg,  another  through  the  shoulder, 
and  a  sabre  cut  on  the  arm,  the  only  case  of  this  type  in  the 
hospital." 

At  the  close  of  their  six  months'  service,  four  of  the  Ameri- 
can nurses,  iucliuling  Sister  Mal)elle  Welsh,  asked  to  l)e  rc- 
lieved  from  duty  on  account  of  the  lightness  of  the  work.  In  a 
letter  addressed  February  23  to  ^liss  Delauo,  ^Tatron  Gertrude 
Fletcher  gave  a  penetrating  glimpse  of  the  two  stages  which 
cverv  nurse  in  active,  service  soon  \nidcrirocs: 


148    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

War  nursing  as  a  whole  is  a  demoralizing  experience.  As 
long  as  the  work  is  heavy,  all  is  well,  but  when  long  periods 
of  waiting  arrive,  even  the  most  level-headed  of  women  are 
apt  to  become  lacking  in  judgment  to  a  degree  that  astounds 
one.  The  work  begins  with  such  stirred  up  emotions  and 
enthusiasms,  and  one  can  never  quite  tell  where  that  will  lead. 
This  is  why  I  regard  the  second  stage  of  war  nursing  as 
the  test.  I  have  gone  through  it  all  before,  so  it  becomes  like 
nursing  a  familiar  disease. 

At  Miss  Fletcher's  request,  National  Headquarters  appointed 
Sister  Louise  Bennett  and  Sister  Elizabeth  Weber  as  super- 
visors of  their  respective  units.  With  fifteen  English  sisters, 
seventeen  probationers  and  twenty-six  American  graduate 
nurses,  the  nursing  staff  at  "Oldway  House"  had  been  experi- 
encing difficulties  of  seniority  and  Miss  Fletcher  felt  that  better 
discipline  could  be  secured  by  having  the  remaining  Americans 
work  under  their  own  leaders  rather  than  under  British  nurses. 

During  the  spring,  the  work  grew  heavy.  Three  additional 
nurses  and  two  doctors  from  the  United  States  arrived  April  5, 
1915.  Miss  Fletcher  expressed  her  relief  in  the  following 
letter : 

The  whole  of  England  seems  to  be  preparing  for  heavy 
times  ahead,  and  nurses  apparently  are  going  to  be  difficult 
to  get.  Soldiers  and  everybody  else  can  see  no  other  possi- 
bility than  that  we  must  have  an  immense  amount  of  sickness 
when  the  summer  sets  in.  The  men  say  that  even  already 
while  the  weather  is  so  cold,  the  odor  from  the  dead  horses 
alone  is  dreadful,  and  whenever  they  start  to  dig  a  fresh  trench 
they  come  upon  the  dead.  Therefore,  it  can  be  nothing  short 
of  a  miracle  that  will  prevent  a  summer  of  sickness  and  dis- 
ease. 

However  keen  may  have  been  the  disappointment  of  the 
American  nurses  that  they  w-ere  not  always  busy  to  the  utmost 
capacity  of  their  streuiith,  or  however  delicate  the  relations  be- 
tween probationer,  Sister,  supervisor,  Matron  and  director,  the 
work  with  Tommy  Atkins  '"imself"  was  intensely  satisfying. 
Sister  Beatrice  wrote : 

Our  patients  had  great  fun  at  our  expense  on  Washington's 
Birthday.  One  of  our  probationers,  a  girl  from  Virginia. 
sent  to  London  for  some  artifi<-ial  (iherries  which  she  passed 
among  all  of  us  Americans  and  which  we  wore,  greatly  to 
the  enjoyment  of  our  thirty-two  convalescents.     When  I  came 


THE  MERCY  SHIP  149 

on  duty  the  next  morning,  I  found  every  man  Jack  of  them 
had  tied  about  his  neck  on  a  string  an  apple,  or  an  orange, 
or  a  banana.  When  I  asked  what  the  decorations  meant,  I 
was  greeted  witli  this  answer:  "Well^  yesterday  being  George 
Washington's  birthday,  we  thought  we'd  celebrate  Adam's 
and  Eve's  today !" 

To  the  white  beds  filling  the  reception  halls  and  guest  rooms 
of  that  stately  palace-hospital  came  soldiers  from  the  Seven 
Seas.  Princess  Pat's  troopca*  lay  beside  "those  black  Gurkhas, 
a  fine  lot  of  men  they  be."  Blackwatch  and  Patriot  sunned 
themselves  on  the  terraces,  or  limped  through  the  gardens. 
The  patients  delighted  to  write  poems  which  they  presented 
to  the  nurses.    Among  the  popular  subjects  was  "Frozen  Peet"  : 

Tingle,  tingle,  little  toes. 

Them  wot's  'ad  'em  only  knows 
Nothin's  pleasant,  nothin's  sweet, 

'Bout  a  pair  of  frozen  feet ! 
Standin'  in  trenches  wet  an'  cold 

Is  wot's  caused  'em,  so  I'm  told. 
They   throb  all   night,   and   burn  all   day, 

But  are  cured  by  friends  from  U.  S.  A. 
They  work  all  day  and  watch  all  night, 

To  do  their  bit  to  get  chaps  right. 

A  Corporal  of  the  King's  Own  Eegiment. 

Spring  came  over  the  Devonshire  hills,  bringing  splendid 
Canadian  troops  to  Paignton,  some  of  them  blinded,  others 
choking  with  poison  gas,  and  the  horror  and  weariness  of  war 
grew  harder  to  bear.  "We  don't  say  much  about  it,"  wrote  Sis- 
ter Louise,  "but  we  are  all  heartily  sick  of  tliis  endless  cruelty 
and  wickedness."  The  monotony  of  ten  months'  continuous 
duty  was  broken  by  vacations  and  short  trips  alx)ut  England. 

The  American  Ambassadors  in  the  various  belligerent  coun- 
tries received  word  August  1  that  the  American  Red  (Voss  was 
withdrawing  its  foreign  units  on  October  1,  owing  to  lack  of 
funds.  With  a  record  of  1905  admissions  during  the  period 
the  Anu-rican  Wonu'u's  War  Hospital  was  operatc^d  by  Ameri- 
can lied  Cross,  Enits  E  and   1)  withdrew  September  -'50,  1!)15. 

Early  in  the  spring  of  11*15.  the  American  Red  Cross  had 
assigned  two  units  to  the  Belgian  (iovernment  to  assist  in  the 
care  of  their  wounded  at  La  Pann(\  Belgium.  1'he  personnel 
of  the  S.  S.  licd  Cross  were  recalled  after  a  year's  foreign  ser- 
vice, but  these  later  units  were  retained   in   Belgium  until  the 


150    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

completion  of  their  entire  twelve  months'  duty.  Several  nurses 
of  the  Units  D  and  F  were  accordingly  transferred  by  Miss 
Delano  to  La  Panne.  Five  other  nurses  remained  at  the  invita- 
tion of  the  British  War  Office  at  Paignton.  Other  members 
of  the  units  returned  eventually  to  the  United  States. 

In  a  sunny  valley  below  the  Pyrenees  lay  the  city  of  Pau, 
France.  The  French  units  A  and  B  of  the  Mercy  Ship  Expedi- 
tion were  detailed  for  duty  at  this  famous  winter  resort.  Dr. 
Reynold  M.  Kirby-Smith,  of  Sewanee,  Tennessee,  and  Margaret 
Lehmann,  of  Philadelphia,  were  in  charge  of  Unit  A;  Dr. 
Roades  Fayerweather,  of  Baltimore,  Maryland,  and  Alice 
Henderson,  of  Baltimore,  were  in  charge  of  Unit  B. 

On  their  arrival,  October  3,  1914,  at  Pau,  the  American 
surgeons  and  nurses  were  greeted  by  the  mayor  and  residents  of 
the  town  and  by  many  Americans  then  living  there.  "Pau  is  a 
prosperous  little  city,"  wrote  Sister  Alice  Henderson,  "every 
one  seems  quite  well-off  and  prices  on  food  and  clothing  have 
advanced  little,  if  at  all.  Were  it  not  for  the  soldiers  on  the 
streets,  one  would  never  know  that  a  war  is  raging."  Since  the 
hotels  were  all  liable  to  be  requisitioned  for  the  soldiers,  the 
Palais  d'lliver,  a  pleasure-designed  casino,  was  secured  and 
equipped  as  a  hospital. 

The  Winter  Palace  had  formerly  been  the  center  of  the 
great  gayety  of  Pau  and  its  rooms  and  corridors  were  large 
enough  to  accommodate  1G6  patients.  In  the  center  of  the  palace 
was  a  palmarium;  the  Americans  put  long  tables  down  the 
middle  of  the  room  between  the  palms  and  blossoming  vines 
and  the  convalescents  had  their  meals  there  in  the  warm  sun- 
shine. Every  window  of  the  Winter  Palace  commanded  a  view 
of  the  white  Pyrenees  which  loomed  above  Pau. 

Although  the  nurses  were  all  American-born,  some  of  them 
had  names  of  Teutonic  origin  and  tlie  French  felt  and  even 
expressed  some  doubt  as  to  their  sympathies.  This  was  one  of 
the  reasons  why  the  units  were  assigned  to  southern  France, 
instead  of  to  Paris,  where  professional  nurses  were  greatly 
needed.  Paris  was  the  headquarters  for  the  Government  and 
the  Army.  During  the  first  weeks  of  their  stay  at  Pau,  the 
Americans  received  few  patients.  However,  they  soon  earned 
the  confidence  of  the  local  authorities.  "We  are  not  only 
wanted,"  wrote  Sister  Emma,  "but  we  are  needed.  I  do  not 
think  that  we  will  be  moved  nearer  the  front,"  she  added,  "it  is 
easv  to  understand  now  wliv  we  were  sent  to  Pau.     As  individ- 


THE  MERCY  SHIP  151 

uals  on  our  own  resources,  it  might  have  been  possible  for  us 
to  work  at  the  front  but  as  an  organization  representing  a 
neutral  government,  this  appears  to  be  quite  out  of  the  question." 

Finally  in  the  last  days  of  November,  many  wounded  were 
sent  to  the  Palais  d'Hiver.  Arabs,  Belgians,  Moroccans,  Alge- 
rians and  French  were  unloaded  from  the  hospital  trains. 
"One  has  little  idea  of  what  this  war  really  is,"  wrote  Sister 
Alice,  after  a  convoy  of  110  wounded  had  arrived,  ''until  you 
see  a  train  of  wounded  come  from  the  front,  the  men  so  dirty,  so 
ragged,  so  tired,  so  sick,  yet  not  one  of  them  ready  to  admit  that 
he  is  either  hungry  or  exhausted  or  that  his  wound  is  more 
than  a  scratch !" 

Christmas  in  France  during  this  first  year  of  the  war  was  a 
time  of  anxiety  and  suffering.  The  drive  on  Amiens  was  in 
progress ;  every  province  was  sending  its  men  to  the  defense  of 
la  douce  terre  de  France.  As  Pau  was  a  recruiting  center  for 
the  surrounding  country,  the  streets  swarmed  with  soldiers  of 
every  class  and  type.  From  her  busy  operating-room,  Sister 
Emogene  E.  Miles  wrote  on  December  20 : 

This  past  week  has  been  sad.  Our  ears  are  filled  with  the 
sound  of  drums,  of  bugles,  of  marching  men.  They  are 
mobilizing  all  the  available  recruits  for  the  January  drive, 
calling  boys  eighteen  years  old,  though  volunteers  of  sixteen 
are  accepted.  i)r.  Kirby-Smith  was  absent  one  day  last  week 
and  he  tells  us  that  at  every  station  on  his  way  home  were 
mothers  bringing  their  sons  to  the  train.  After  it  had  pulled 
out,  many  of  those  poor  youngsters  would  weep,  their  heads 
bent,  yet  unashamed. 

Pau  has  tremendous  barracks,  now  filled  with  men  and 
boys  getting  into  uniforms,  drilling  and  being  sent  off  to  the 
Army  at  once.  They  are  in  sore  need  of  more  men.  When 
the  soldiers  go  to  the  train,  their  friends  meet  at  the  barracks 
and  thrust  a  bouquet  into  each  gun. 

A  train  loaded  with  wounded  came  to  Pau  on  December  21, 
direct  from  Amiens.  Before  the  arrival  of  these  grands  blesses, 
a  notice  had  been  posted  from  the  chief  medical  officer  in  the 
Depart  me  nt-Basscs-Pyre  nee  s,  stating  that  in  future  consign- 
ments all  seriously  wounded  men  were  to  be  sent  to  the  Ameri- 
can Hospital.  These  patients  had  truly  undergone  the  rigors  of 
trench  warfare.  One  man's  mud-saturated  clothes  bore  out  his 
statenu'nt  that  he  had  been  standing  in  water-filled  trenches  for 
tlircH'  weeks.     ]\lany  of  the  patients  coming  from  crowded  hospi- 


152    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tals  further  up  the  line,  had  sloughing  bedsores.  A  desperate 
case  of  tetanus,  which  reqiured  special  nursing  day  and  night 
for  several  weeks,  recovered,  to  the  vast  surprise  of  the  French. 
Although  the  First  Aid  dressings  were  uniformly  excellent, 
the  majority  of  the  wounds  were  badly  infected.  This  infection 
was  caused  by  mud-soaked  uniforms  full  of  bits  of  straw  touch- 
ing the  wounds  before  the  dressings  could  be  applied. 

The  hospital  at  Pau  occupied  a  geographical  position  w^hich 
increased  the  professional  difficulties  of  the  American  units. 
Although  they  were  near  enough  to  the  front  to  receive  patients 
forty-eight  hours  after  injury,  often  with  only  First  Aid  dress- 
ings on  their  wounds,  they  were  also  far  enough  back  in  the 
zone  of  the  base  to  be  the  cynosure  of  many  tourists'  eyes. 
Sister  Alice  wrote: 

We  must  always  be  on  dress  parade.  The  scores  of  Eng- 
lish, French  and  American  visitors  who  come  to  visit  us 
each  week  make  it  necessary  that  we  keep  the  hospital  ready 
for  inspection  at 'any  moment.  At  the  present  time,  I  am 
satisfied  that  we  are  doing  all  that  we  could  handle  efficiently. 
Were  we  in  some  isolated  place,  or  at  the  line,  we  could  easily 
take  care  of  many  more  patients.  As  it  is,  however,  we  seem 
to  have  made  a  lasting  impression  on  the  French  in  demon- 
strating the  value  of  trained  nursing  as  opposed  to  volunteer 
effort. 

The  American  units  found  their  French  patients  courteous, 
appreciative  and  simple,  with  the  naivete  of  children  of  the  soil. 
Robert  Ilerrick,  then  American  Ambassador  to  France,  wrote 
that  ''the  popular  nickname  of  jjoilu,  the  unshaved,  has  an  inti- 
mate significance.  The  littlc!  French  soldiers  are  not  parade 
soldiers,  but  common,  plain  men,  careless  of  appearance."  ^ 
Barbusse  described  in  Le  Feu  the  characteristics  which  so  en- 
deared their  patients  to  the  American  nurses: 

They  are  not  soldiers,  they  are  men.  They  are  not  ad- 
venturers, warriors  for  massacre,  butchers  or  driven  cattle; 
they  are  pbjughinen  and  laborers,  easily  recognized  as  such 
under  tlieir  uniforms.  They  are  up-rooted  civilians.  In  tbeir 
silence,  iii  their  immobility,  in  the  masks  of  superhuman  calm 
on  their  faces,  reflection  and  fear  and  longing  are  visible. 
They  are  not  the  sort  of  heroes  they  are  jiopularly  supposed 
to  be.  l)ut  their  sacrifice  is  nohh'r  than  tliose  who  have  not 
seen  them  will  ever  he  able  to  divine, 
'"/'orwrs  (Irs  I'rnlus,"  W.  A.  BiitUrficld,  ]5oston,  Mass.,  p.  3, 


THE  MERCY  SHIP  163 

Sister  Emma  wrote  on  December  31  that  a  man  in  her  ward, 
the  father  of  four  babies,  had  received  not  one  word  from  his 
wife  since  the  war  began.  Another  young-  man,  she  wrote, 
seemed  dazed  after  his  thirty-two  days  in  the  trenches,  where 
he  had  slept  only  in  snatches,  always  drinking  black  coffee  to 
keep  awake.  "He  returns  very  soon.  It  is  dreadful  to  hear 
him  say  with  a  shrug  of  the  shoulders:  'Eli  hien,  1  shall  soon  be 
dead, — I  go  for  France.'  We  see  only  mourning  on  the  streets. 
The  women  do  all  the  work,  driving  oxen  and  mules,  plodding 
through  nnid  and  rain  drawing  loads  of  produce  to  the  city, 
delivering  bundles  of  wood  and  sweeping  the  streets.  Every 
day  more  men  go  to  the  front."  Always  grateful,  always  re- 
spectful, always  appreciative  of  the  slightest  attention,  never 
forgetting  their  merci  heaucuup,  never  failing  in  their  sympathy 
for  their  fellow  wounded,  the  French  soldiers  were  the  wonder 
and  inspiration  of  all  comers.  Sister  Margaret  wrote:  "It  was 
always  a  beautiful  as  well  as  a  most  touching  sight  to  watch 
the  convalescents  welcome  the  new  blesses.  They  hail  them 
hilariously,  telling  them  of  the  good  care  they  are  to  receive, 
assisting  us  in  making  our  French  understood  and  helping 
generally  in  making  the  newcomers  feel  comfortable  and  at 
home." 

When  a  soldier  died  at  Pau,  it  was  the  custom  for  one  surgeon 
and  two  nurses  to  attend  his  funeral.  First  marched  the 
veterans  of  the  little  city,  old  men  scarred  in  former  wars  for 
France,  then  the  slow  chanting  priests,  then  the  military  escort. 
As  very  few  poilus  could  be  attended  to  their  last  sleep  by  mem- 
bers of  their  immediate  family,  the  American  doctor  and  the 
two  nurses  walked  slowly  before  the  flag-draped  casket.  Sister 
Vashti  Bartlett  wrote :  "All  along  the  way,  the  black  dressed 
women  and  children  stood  at  attention.  Even  small  boys  of 
five  and  six  would  drop  their  playthings  and  remove  their  caps. 
As  we  walked  slowly  down  the  road  to  the  burial  ground,  I 
thought  of  the  thousands  of  dead  on  the  battle  fields,  denied 
even  this  last  poor  homage." 

It  was  a  sad  day  both  for  patients  and  nurses  when  a  soldier 
was  dismissed  from  the  American  Hospital.  Every  one  soon 
knew  every  one  else  in  this  small  family  of  theirs.  In  a  letter 
to  Miss  Delano,  Sister  Vashti  enumerated  her  patients: 

No.  I  having  been  a  waiter  in  London,  spoke  luiglish; 
No.  II,  Leclierec.  always  ready  tu  help,  eonies  t'roiu  northern 
France,  now  under  (ierman  oceiijnition.     When   he  was  told 


154    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

that  he  must  leave  Pan,  he  had  no  place  to  spend  his  precious 
eight  days'  leave  before  returning  to  the  front.  As  French 
soldiers  receive  only  one  cent  a  day,  when  one's  family  could 
not  send  one  money,  c'est  dommage,  n'est-ce  pas? 

Xo.  Ill,  Chuzel,  the  baby  of  Salle  D,  holds  the  record  for 
having  killed  sixteen  Germans. 

Xo.  V,  a  twenty-one  year  old  sergeant,  is  a  veteran  in  hos- 
pital experience.  "You  know,  Sister,"  he  said  solemnly,  "to 
be  wounded  twice  means  to  be  wounded  thrice,  and  then  one 
is  killed  and  goes — who  knows  where?" 

As  the  busy  winter  months  slipped  by  in  the  daily  routine  of 
hospital  life,  little  if  any  word  from  the  other  Red  Cross  units 
scattered  over  Europe  came  to  the  American  Hospital  at  Pau. 
A  cablegram  from  Major  Patterson,  at  Xational  Headquarters, 
brought  in  the  latter  part  of  February,  1915,  how-ever,  serious 
news  of  Serbian  Units  2  and  3.  A  severe  epidemic  of  typhus 
was  sweeping  Serbia,  Every  member  of  the  commission  at 
Gevgeli  save  five  had  been  infected.  Until  additional  assistance 
could  arriye  from  the  United  States,  would  not  one  surgeon  and 
three  nurses  from  Pau  report  immediately  at  Xish  ^ 

Every  one  of  the  American  family  volunteered.  Dr.  Kirby- 
Smith,  the  senior  director.  Sister  ^largaret  Lehmann  and 
Annzi  V.  Lofving,  of  Philadelphia,  and  Sister  Rebecca  Watson, 
of  Baltimore,  were  chosen  and  left  Pau  in  ]\Iarch  to  sail  on  the 
CaUdomen  from  ^Marseilles  for  their  destination  in  Serbia. 
After  their  departure,  Dr.  Roades  Faycrweather  took  charge 
of  the  Pahis  d'lliver  as  senior  director,  with  Sister  Alice 
Henderson  as  supervising  nurse.  As  other  yacancies  occurred, 
surgeons  and  nurses  were  assigned  to  till  them  from  Washington 
or  were  transferred  from  Paignton. 

With  a  record  of  having  treated  598  patients  to  a  conclusion, 
the  Palais  d'lliver  was  closed  on  September  16,  1915.  During 
their  twelve  months  of  duty  at  the  Palais  d'lliver  more  than 
225  major,  as  well  as  innumerable  minor  operations,  were  per- 
formed. Throughout  their  stay  at  Pau,  the  American  surgeons 
and  nurses  were  gi'catly  assisted  by  the  untiring  courtesy  and 
(■(xiperation  of  ^layor  Alfred  dc  Lassence  and  his  daughter, 
^Ime.  de  Cabrole.  ^Irs.  Henry  Hutton,  lime,  de  Arizcun  and 
.Margar(>t  Porter,  American  women  living  in  France,  had 
charge  of  the  sewing  room  of  the  hospital  and  did  sph^ndid 
work.  ]\lrs.  Leonard  ]]rown.  ^Irs.  Wadsworth  Rogers,  Presi- 
dent of  the   Comiic  dvs  Danivs,   Mrs.   John  Cushinu-  and  Mr. 


THE  MERCY  SHIP  155 

George  A.  Bucklin,  Jr.,  the  American  consul  at  Bordeaux, 
greatly  furthered  the  work  of  the  American  units  through  their 
personal  service  and  interest. 

Kief,  which  was  a  clearing-house  for  thousands  of  Russia's 
wounded,  is  situated  on  the  Dnieper  Kiver,  with  the  Black  Sea 
to  the  southward  and  the  (^arpathian  mountains  to  the  west. 
This  Russian  city  was  the  destination  of  Units  C  and  H  of  the 
Red  Cross  Mercv  Ship  Relief  Expedition. 

Units  C  and  11  left  the  S.  S.  Red  Cross  at  Falmouth  Harbor 
for  London  on  Wednesday,  September  80,  1914,  and  started  the 
next  day  on  their  long  journey  for  Petrograd  via  Scotland  and 
the  North  and  Baltic  Seas. 

When  the  crowded  little  steamship  Balder  docked  at  Gotten- 
burg,  Sweden,  the  Americans  were  met  with  the  cordial  welcome 
which  was  to  characterize  their  reception  all  along  the  way  to 
Kief.  A  brief  stay  at  Raumo,  Finland,  was  made  pleasant  by 
the  cordial  hospitality  of  the  population.  This  Finnish  village, 
then  used  as  a  port  of  landing  :^or  refugees,  boasted  no  hotel. 
The  women  prepared  food,  however,  for  the  passengers  of  any 
ship  which  came  to  their  wharves,  and  on  many  days  fed  more 
refugees  than  the  town  had  inhabitants.  The  American  sur- 
geons and  nurses  breakfasted  in  small  groups  at  dilierent  houses. 

A  representative  of  the  Russian  Red  Cross  escorted  the  units 
from  Raumo  to  Petrograd.  At  the  capital  city  of  Russia,  the 
Honorable  George  T.  ^larye  and  his  wife  and  Mr.  Winship  of 
the  American  Embassy,  acted  as  hosts.  Her  ^lajesty,  the 
Dowager  Empress  ]\Iarie  Feodorovna,  who  was  the  head  of  the 
Russian  Red  C^ross,  received  the  Americans  at  the  Illagen  Pal- 
ace. Lest  the  field  uniforms  of  the  American  Red  Cross,  not 
then  as  familiar  as  they  grew  to  be  in  later  years  of  the  war, 
should  fail  to  be  recognized  and  the  work  of  the  units  accord- 
ingly hindered,  the  American  surgeons  were  given  high  rank  as 
medical  officers  in  the  Russian  Army  and  the  nurses  were  pre- 
sented certificates  as  Russian  Red  Cross  Sisters. 

At  last  on  October  '1^,  Units  C  and  H  set  out  for  their  final 
destination.  Kief,  a  five  days'  trip  of  nine  hundred  miles.  The 
special  troop  train  on  which  X\\v\  traveled  drew  freight  cars 
containing  furnitur(\  linen,  kitchen  and  laundry  supplies  for  a 
-iOO-lxnl  hospital  and  four  car  loads  of  American  Red  Cross 
medical  supplies  from  the  United  States. 

Dr.  William  S.  Magill  was  scMiior  (lir(>ctor  of  the  Russian 
units  and  Sister  Helen  Scott   Hay  was  senior  su[)ervisor.     Dr. 


156   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Phillip  Newton,  of  Washington,  D.  C,  was  director  of  Unit 
H  and  Sister  Lucy  Minnigerode,  one  time  superintendent  of 
the  City  General  Hospital,  Savannah,  Georgia,  and  later  of 
Columbia  Hospital  for  Women  and  Children,  Washington, 
D.  C,  was  supervising  nurse.  Dr.  Edward  Egbert,  of  Wash- 
ington, D.  C,  was  director  of  Unit  C  and  Sister  Charlotte 
Burgess  was  supervising  nurse. 

During  November,  the  units  set  up  an  American  Red  Cross 
hospital  in  a  wing  of  the  Polytechnic  Institute,  which  crowmed 
the  crest  of  a  hill  just  outside  the  city  of  Kief.  On  the  first 
floor,  they  established  administrative  offices,  pharmacy  and 
living  quarters.  The  second  and  third  stories  were  utilized  as 
operating  and  dressing  rooms  and  as  wards.  In  the  basement, 
large  rooms  were  given  over  to  the  reception  of  patients ;  and 
an  efficient  system  of  baths,  which  awakened  the  interest  of 
many  other  hospitals  in  Kief,  was  set  into  operation.  All 
incoming  patients  received  a  bath,  a  haircut  and  a  shave  from 
the  sanitars  before  they  were,  admitted  to  the  wards  upstairs. 
Seriously  wounded  and  helpless  cases  were  sponged  off  by  the 
nurses  in  rooms  adjoining  the  main  baths. 

To  transform  this  school  into  a  hospital  required  not  only 
equipment  but  genuine  hard  work.  The  rooms  where  the  wards 
were  established  were  large,  with  high  ceilings  and  many  win- 
dows ;  the  amount  of  scrubbing  necessary  was  consequently 
great.  On  one  occasion  the  Red  Cross  officer  who  purchased 
supplies  for  Kief,  sighed  when  he  saw  Sister  Helen  Scott  Hay's 
shopping  list.  "Holy  fathers  I"'  he  ejaculated,  "I  think  that 
Sister  Helen  actually  eats  scrub  brushes !  I've  bought  about  all 
there  are  in  Kief  now !"  In  one  of  her  letters  to  ]\Iiss  Delano, 
Sister  Helen  told  to  what  use  these  articles  had  been  put:  'T 
wish  you  might  have  seen  your  Amerikaii  Spii  Cestriiza 
scrub !  Some  say  we  have  lost  face  thereby ;  but  w^iat  our 
twenty-four  nurses  did  to  those  dirt-littered  wards  is  a  poem 
in  itself  and  a  subject  riaht  worthy  for  epic  or  knighthood  I" 

After  a  month  spent  in  preparation,  the  hospital  was  formally 
opened  in  l)e('eml)er,  l!i]4.  The  majority  were  sent  up  from 
the  Austrian  Front,  tlie  (^irpatlis,  as  they  called  it;  Siberians, 
Great  and  Little  Russians,  Polos,  Tartars,  Eessarabians,  Gruz- 
ins  and  Cossacks  from  the  Don  and  from  the  Caucasus  lay  in 
the  white  cots  and  thanked  the  American  Sisters  for  their  ser- 
vices with  simple,  courteous,  heartfelt  expressions  of  gratitude. 
Sister  Lucv  ^Minnic^erode  wrote: 


THE  MERCY  SHIP  157 

They  tell  us  stories  of  the  war,  hut  never  speak  of  their 
experiences  as  a  hardsliip.  One  man  described  having  been 
wounded  at  a  place  tiie  soldiers  call  "the  mountain  of  death." 
He  lay  among  the  bodies  of  his  company  on  the  field  for  five 
days,  giving  himself  First  Aid,  before  the  firing  lifted 
enough  for  anyone  to  bring  him  in.  Another  owed  his  life 
to  a  peasant  woman,  to  whose  shell-rifled  hut  he  had  crawled. 
A  third  was  buried  in  a  trench  for  dead,  but  managed  in  three 
days  to  dig  himself  out.^ 

The  American  Christmas,  with  its  carols  and  tree,  and  thir- 
teen days  later  the  Russian  holiday,  celebrated  by  a  second  tree 
and  a  vaudeville  show  for  the  patients,  came  and  went  in  the 
busy  routine  of  hospital  life.  The  big  Polytechnical  Institute 
Hospital  was  operated  under  a  nursing  schedule  of  nine  hours' 
day  duty  and  ten  hours'  night  duty,  of  two  weeks  duration  for 
the  American  nurses,  and  ten  days  duration  for  the  Russian 
Sisters. 

The  coming  of  many  visitors  to  the  American  Red  Cross 
Hospital  at  Kief  made  necessary  the  same  "dress  parade  nurs- 
ing" as  at  the  Palais  d'Hiver  in  Pau.  A  large  medical  school 
nearby  sent  its  students  in  groups  of  twenty  and  thirty  to  see 
the  work  of  the  American  surgeons  and  nurses.  Visiting  Army 
officers  of  high  rank  came  to  inspect  the  institution.  One  asked 
if  the  Sisters  were  good  to  their  patients.  A  soldier  replied : 
"i^ot  good, — double  good !"  A  ranking  general  inquired  how 
soldiers  managed  with  nurses  who  could  not  speak  their  lan- 
guage. A  big  Cossack  answered  him :  "What  need  to  speak. 
Excellency  ?  They  do  everything  for  us  without  asking !" 
Sister  Lucy  wrote  of  the  confidence  with  which  the  Russians 
regarded  the  Americans : 

The  patients  themselves  were  quick  to  realize  the  difference 
in  the  nursing  service  given  them  in  tlie  American  and  in  the 
Russian  hospitals.  Xeitlier  ])atient,  sanitar  nor  Russian  sis- 
ter would  have  been  willing  to  return  to  the  way  of  caring  for 
the  wounded  to  which  they  had  been  accustomed.  Letters 
from  ex-patients  testify  to  their  appreciation;  to  their  willing- 
ness to  hel])  as  far  as  they  were  able;  to  tlieir  patience  under 
terrible  sutTeriiig  and  after  months  of  extreme  liardship;  to 
their  unselfishness  witli  each  other  and  tlieir  gratitude  for 
anv  service  rendered. 

'  "Kxppricnccs  of  Unit  C  at  Kiet.  Russia,"  Lucy  Minniperode;  Red  Cross 
Dcpartnu'iit.  American  .Journal  of  Xursing.  December,  101.5,  Vol.  XVI,  p. 
223. 


158    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Of  course^  many  individual  cases  of  special  interest  de- 
veloped. The  top  sergeant  who  had  part  of  his  jaw  and  all 
of  his  tongue  shot  away  and  who  lingered  between  life  and 
death  for  many  weeks,  finally  recovered  and  remained  in  the 
hospital  to  teach  others,  wounded  in  like  manner,  how  to  feed 
themselves  and  to  keep  the  mouth  properly  cleansed.  The 
first  blind  soldier,  who  with  the  aid  of  his  comrades'  direc- 
tion learned  his  way  about  the  hospital,  taught  others,  blinded 
like  himself,  how  to  keep  themselves  and  find  their  way  about 
without  assistance.  Courage,  endurance  and  a  blind  deter- 
mination to  get  well  were  potent  aids  toward  recovery. 

The  organization  and  personnel  of  the  units  underw^ent  im- 
portant changes  following  the  termination  of  the  first  six 
months  of  service.  Dr.  Magill  had  been  relieved  from  duty, 
November  7,  1914,  and  the  units  had  been  without  the  guidance 
of  a  general  medical  director.  A  more  satisfactory  unity  of 
command  was  secured  upon  the  arrival  in  April,  1915,  of  Dr, 
H.  H.  Snively,  of  Columbus,  Ohio,  as  senior  director.  Six  of 
the  original  nursing  staff  had  left  Kief  in  March,  1915,  to 
return  to  the  United  States  and  eleven  relief  nurses  arrived  with 
Dr.  Snively.  Further  vital  changes  occurred  in  June.  Sister 
Helen  Scott  Hay  left  J^iei  on  June  2  to  investigate  the  school 
of  nursing  project  in  Bulgaria.  Sister  j\linnigerode  with 
two  other  members  of  Unit  C  returned  to  the  United  States  in 
June  by  way  of  the  Pacific ;  mines  in  the  IsTorth  Sea  and  sub- 
marine warfare  endangered  the  shorter  route.  Sisters  Char- 
lotte Burgess,  Alma  Foerster,  Rachel  Torrance  and  Alice  Gil- 
bourne  were  transferred  from  Kief  to  the  Serbian  units. 

The  remaining  surgeons  and  nurses  settled  down  to  a  summer 
of  strenuous  activity.  Sister  Mabel  Rich  became  supervisor  of 
Unit  C,  Sister  Sophia  Kiel,  supervisor  of  Unit  H.  The  hospi- 
tal was  increased  on  the  first  of  July  from  400  to  500  beds. 
Tlie  anticipated  activities  on  tlie  Polish  Front  did  not  take 
place,  however,  and  the  ominous  lull  gave  opportunity  for  tlie 
tired  surgeons  and  nurses  in  Kief  to  take  welcome  vacations. 

Of  the  accomplishment  of  the  units  at  Kief,  statistics  show 
that  the  mortality  rate  of  the  American  Bed  Cross  Hospital  was 
three  and  seven  tenths  (3.7)  per  cent.^  During  the  nine  months 
in  which  this  hospital  was  maintained  under  American  manage- 
ment, 4050  cases  were  admitted,  97f)  major  and  53,233  muior 
operations  and  dressings  were  performed. 

'  Ntjicricaii   Red  Cross  Annual   Report.   1015.  p.  18.. 


THE  MERCY  SHIP  159 

When  the  American  Kcd  Cross  recalled  its  foreign  units  in 
October,  1915,  the  American  family  at  Kief  separated  into 
small  groups,  each  going  its  own  way.  Several  of  the  surgeons 
and  inirses  returned  to  the  United  States.  Dr.  Phillip  Newton 
took  charge  of  a  flying  field  hospital  in  the  Ilussian  Army.  Dr. 
Snively,  with  Dr.  Brown  ]\[cClintic,  Dr.  T.  Lyle  Hazlett, 
Sophia  Kiel,  II.  Lee  Cromwell,  Florence  Farmer,  Edwina  Klee, 
Mary  Hill,  Aurel  Baker,  Margaret  Pepper,  Clara  Bamdollar 
and  Eleanor  Soukup  undertook  service  with  the  Russian  Ked 
Cross.  They  were  sent  in  Xovember,  1915,  to  establish  a  200- 
bed  hospital  for  Eussian  soldiers  at  Khoi,  Persia.  In  this  an- 
cient city  seventy-five  miles  from  a  railroad,  with  its  narrow 
arched  streets  and  its  curious  bazars  where  merchants,  with 
long  beards  dyed  red,  squatted  on  rich  carpets  and  cried  their 
wares,  the  Americans  set  up  a  Red  Cross  hospital.  Tiie  build- 
ing they  used  was  a  low  adobe  structure  in  which  camel  drivers 
had  housed  their  caravans.  On  February  12,  1916,  the  Ameri- 
cans left  Khoi  for  Kasbin,  Persia,  where  both  a  military  and  a 
Bed  Cross  hospital  had  been  established.  While  here,  Sister 
Eleanor  had  a  rare  opportunity  to  learn  something  of  Persian 
customs : 

The  Persian  house  was  a  mass  of  mud  walls  with  a  flat  roof, 
built  aroinid  a  (•oni])ound  aiul  surrounded  by  a  ten  foot  mud 
wall  which  excludes  all  view  of  the  yard  or  harem.  l]ntrance 
was  through  a  strong  wooden  gate  in  the  wall,  always  attended 
by  a  keeper. 

The  patient  was  placed  upon  two  narrow  tables  in  a  damp, 
cold  room,  and  a  Ca'sarean  section  performed  in  the  midst 
of  her  entire  family  and  a  molla  who  prayed  all  the  time. 
As  tables,  chairs  aiul  beds  are  not  found  in  Persian  homes, 
when  the  o])eration  was  over,  the  patient  was  put  into  a  bed 
consisting  of  a  narrow  mattress  laid  upon  the  floor.  Every 
family,  whetlier  rich  or  poor,  possesses  many  exquisite  rugs. 
Presuming  that  all  water  was  brought  from  the  well,  I 
hadn't  given  this  much  thought,  but  one  day  when  going  to 
the  house,  1  noticed  at  the  small  stream  running  through 
the  middle  of  tlie  street  (scarcely  wide  enough  for  a  team 
of  horses),  a  woman  wasliing  clothes  by  beating  them  with  a 
club ;  further  down  a  mother  was  bathing  her  child  and  yet 
further  on  a  young  girl  cleaning  the  head  of  a  sheep  for  some 
future  meal.  When  I  arrived  at  my  destination,  the  servant 
was  di])ping  uji  in  an  earthen  urn  water  for  cooking  and 
drinking.  Tliis  shows  how  rapidly  epidemics  may  spread,  as 
we  saw  later  when  cliolera  broke  out. 


160   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  had  another  patient,  a  Persian  woman  recently  mar- 
ried, who  had  made  an  attempt  at  suicide  by  taking  large 
doses  of  opium  and  strychnine.  After  several  days  she  re- 
covered enough  to  tell  us  that  her  husband  whipped  her. 
She  resented  it  very  much.  He,  however,  was  present  and 
said  he  beat  his  wives  once  a  month  whether  they  needed  it 
or  not  just  to  show  them  their  place.  He  divorced  her  the 
next  day  by  commanding  her  to  go  away  with  her  dowry.* 

Again  on  March  24,  the  Americans  moved,  this  time  to  a  hos- 
pital established  in  a  carpet  factory  in  Hamadan.  A  special 
detachment,  consisting  of  Dr.  McClintic,  Eleanor  Soukup  and 
a  Russian  Sister,  started  in  April  to  Kermanshah  for  surgical 
work  at  the  front,  but  the  advance  of  the  fierce  Kurds  in  June 
drove  them  back,  after  many  adventures,  to  Kasbin.  The  fur- 
ther record  of  the  work  of  these  Amerikanskii  Cestritza  in  the 
Persian  desert,  colorful,  vivid,  full  of  the  swift  dangers  and 
sufferings  of  guerrilla  warfare,  became  no  longer  that  of  an 
American  Red  Cross  unit,  but  was  merged  into  the  record  of 
splendid  achievement  of  the  many  men  and  women  who  carried 
on  individually  their  service  for  the  wounded  in  the  European 
War. 

The  smoky  city  of  Gleiwitz,  situated  in  the  wealthy  province 
of  Silesia,  that  thick  finger  of  Prussia  which  extends  southward 
between  Austria  and  Russia,  was  the  destination  of  Unit  I. 
Unit  G,  the  second  of  the  two  detachments  assigned  to  Germany, 
was  destined  for  nearby  Kosel. 

The  Red  Cross  Relief  Expedition  of  1914,  it  will  be  remem- 
bered, was  comprised  of  ten  units,  two  of  which  had  been 
assigned  to  each  of  the  five  belligerent  nations.  The  detach- 
ments destined  for  England  and  Russia  had  left  the  Mercy 
Ship  at  Falmouth.  Erom  the  decks  of  the  S.  S.  Bed  Cross  as 
she  lay  in  the  yellow  waters  of  the  Gironde  River,  France,  the 
units  destined  for  Germany  and  Austria  watched  the  surgeons 
and  nurses  disembark  for  Pau,  Franco.  So,  with  four  remain- 
ing units,  the  Bed  Cross  weighed  anchor  October  4  for  Rotter- 
dam, her  final  port  of  entry.  At  last  the  Mercy  Ship  steamed 
up  the  ^laas  River,  through  level  Holland  fields.  The  Ameri- 
can nurses  as  they  leaned  along  the  rail,  exclaimed  with  pleasure 
at  the  pictures(]_ue  scene,  the  windmills  and  the  children  who 
clattered  along  the  banks  in  their  wooden  shoes  pointing  with 
delight  to  the  great  Red  (h-oss  on  the  ship's  white  sides. 

*  "Witli  llic  Uussiatis  ill  Persia,"  Mlcaiuir  Soukup  MfCIiutic,  American 
J(/Hrn<tl  of  Xiirnhiii.  \  nl.    Will,   jiauc   .'iil. 


THE  MERCY  SHIP  161 

The  four  units  were  formally  welcomed  at  Rotterdam,  Octo- 
ber 10,  by  the  Prince  Consort,  president  of  the  Dutch  Red 
Cross.  Dr.  Henry  van  Dyke,  American  Ambassador,  and  the 
German  and  Austrian  ministers  at  The  Hag-ue  paid  visits. 
Sister  Anna  Reutinger  wrote  of  the  refugees  pouring  down 
across  the  frontier  into  Holland  a  few  hours  before  the  fall  of 
Antwerp : 

From  painting  and  histories  we  had  visualized  war  as  a 
struggle  between  manly  foes,  both  victors  and  vanquished  dis- 
playing heroic  qualities  that  stimulated  the  imagination  and 
sent  the  blood  coursing  rapidly  through  the  veins.  That  was 
the  false  and  artificial  glory  of  war.  Now  we  began  to  see  its 
real,  ugly,  hideous  features.  Here  were  aged  men  driven 
from  their  country,  their  faces  reflecting  their  misery  and 
despair;  here  were  desolate  women  whose  fathers,  husbands, 
sons  and  brothers  were  held  as  hostages  or  shot  as  suspects  by 
a  relentless  conqueror;  here  were  children  emaciated,  gaunt 
and  hungry, — all  homeless  outcasts. 

Under  the  personal  guidance  of  Count  Helie  de  Talleyrand- 
Perigord  and  of  Baron  Goldschmidt  Rothschild,  the  four  units 
entrained  October  10,  1914,  for  Berlin.  There  Units  I  and  G 
parted  company  with  the  Austrian  units  and  started  on  their 
trip  across  Germany  to  Gleiwitz. 

At  noon  of  October  17,  the  long  supply  train  carrying  the 
Red  Cross  surgeons  and  nurses  pulled  into  the  grimy  station  of 
Gleiwitz.  As  they  had  neared  their  destination,  the  nurses  had 
exclaimed  at  the  smoke  and  coal-dust  which  hung  in  a  blue  haze 
over  the  pine  and  birch  forests  of  the  heavily-wooded  country- 
side; and  now  that  they  arrived,  they  looked  about  with  curious, 
delighted  eyes  on  this  busy  city  of  70,000,  the  center  of  the 
rich  mining  and  manufacturing  interests  of  southern  Prussia. 
Here  Unit  G  left  Unit  I  and  proceeded  forty  miles  further  to 
Kosel. 

The  proverbial  German  system  was  at  once  in  evidence  at 
Gleiwitz;  the  Americans  were  immediately  escorted  on  an  in- 
spection tour  of  the  public  buildings  available  for  hospital  pur- 
poses. The  military  authorities  allowed  the  Americans  to 
choose  the  location  of  their  future  Lazaret.  The  city  theater, 
which  could  accommodate  sixty-two  patients  in  the  downstairs 
lobby  and  sixteen  in  an  upper  reception  room,  seemed  to  con- 
tain the  best  possibilities  for  development  and  was  taken  over 
bv  th(>  unit. 


162   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Unit  I  went  on  duty  October  18.  Dr.  Charles  H.  Sanders, 
of  Calvert,  Texas,  was  director  and  Sister  Anna  L.  Reutinger, 
formerly  Directress  of  Nurses,  Lying-in  Hospital,  New  York 
City,  was  supervisor.  Sister  Donna  Bnrgar  described  her  im- 
pressions of  that  first  morning  in  the  wards : 

The  theater  was  a  living  picture  of  the  tragedy  of  war. 
The  stage,  the  boxes  and  the  galleries  were  there  just  as  you 
would  see  them  in  any  theater  at  any  time,  but  there  were  no 
chairs  nor  seats  for  patrons.  In  their  places  stood  low  slatted 
iron  beds  covered  with  straw  ticks,  a  single  straw  pillow  and 
a  bhie  checked  bed  cover.  Nearby  stood  plain  pine  tables,  one 
for  every  two  beds,  in  which  the  last  bare  necessities  of  main- 
taining life  of  man  were  kept;  the  dark  bread,  the  daily  al- 
lowance of  butter,  the  knife,  fork,  spoon,  tobacco,  soap,  pocket- 
comb  and  an  occasional  toothbrush  and  always  a  much  worn 
picture  of  the  wife,  the  children  or  sweetheart.  .  .  . 

If  we  did  not  see  orchestra  chairs,  neither  did  we  see  the 
ordinary  theater-goers,  dressed  comfortably  and  well,  intent 
on  pleasure,  with  laughter  in  their  faces  and  joy  in  their  voices. 
In  their  place  we  saw  many  weary  soldiers  in  worn,  mud- 
stained,  torn  uniforms,  with  dark  dried  blood  stains  telling 
the  tale  of  wounds  of  hours  and  days  before.^ 

Within  a  few  days  Unit  I  had  an  opportunity  to  witness  the 
remarkably  swift  and  thorough  '^turn-over"  of  patients  which 
characterized  the  entire  German  sanitary  service.  Sister  Anna 
Reutinger  described  it: 

A  few  days  after  our  arrival  an  order  came  at  8  A.  M, 
to  prepare  sixty-five  patients  for  discharge  in  two  hours. 
Within  an  hour  after  their  departure,  we  admitted  sixty-eight 
new  stretcher  cases.  The  arrival  of  a  transport  of  seriously 
wounded  is  an  indescribable  scene.  Their  bloodless  and 
haggard  faces  reflected  the  agony  they  were  suffering. 
Woujuled  five  days  previously  in  a  battle  many  miles  from  the 
railroad,  their  first  conveyances  Avere  springless  farm  wagons 
and  crude  home-made  carts.  In  these  they  traveled  twenty- 
four  hours,  without  food  or  drink  and  were  then  packed  in 
freigln  cars  with  little  straw  to  lie  upon,  getting  no  sleep  and 
a  limited  amount  of  food.  Their  dressings,  not  changed 
during  four  days,  were  stiff  and  foul.  One  of  our  patients 
had  Ijcen  lifted  from  the  l)attlefield,  placed  with  three  others 
in  a  wagon,  jolted  ovit  rougli  roads  all  night  long.     He  dis- 

'^"Tn   f;iei\\itz.''   Donna    G.   liurgar,   A?ncrican  Journal  of   yursinr],   Vol. 
XV,   p.    I0!)4. 


THE  MERCY  SHIP  1G3 

covcrefl  at  dawn  tliat  his  comrade  liad  pas,scd  away  in  the 
darkness,  probably  rroni  hemorrhages  and  exhaustion. 

They  hiy  on  tiie  hard  floor  of  the  foyer,  since  they  could 
not  l)e  taken  into  the  wards  until  the  vermin-covered  uni- 
forms and  boots  were  removed — those  sad-looking  uniforms, 
a  few  days  before  so  spotless  and  clean,  now  mud-caked,  bullet- 
pierced  and  blood-stained,  with  here  and  there  an  arm  or  leg 
missing.  On  arrival  they  received  a  cup  of  hot  coffee  and  a 
sandwich.  The  uniforms  were  put  into  bags  and  sent  to  the 
garrison  hospital  for  fumigation.  The  boots,  helmets,  belts 
and  knapsacks  were  kept  in  separate  bags.  Often  the  sol- 
diers' feet  were  so  swollen  it  was  necessary  to  cut  the  boots 
to  remove  them.  Baths  were  given  in  bed  since  we  were  han- 
dicapped by  having  no  bath  tub  or  available  place  to  install 
one.  Fortunately  whenever  largo  transports  arrived,  the 
neighbors  brought  in  buckets  of  hot  water  and  in  such  cir- 
cumstances they  were  of  great  value.  The  first  consignment 
of  men  had  worn  their  uniforms  eight  weeks  without  once 
removing  them. 

At  the  end  of  their  second  week  in  Gleiwitz  in  addition  to 
their  duties  at  the  Vikloria  Theater^  Unit  I  was  phiced  in 
charge  of  two  private  Kliniken.  These  annexes  each  accommo- 
dated twenty-five  officer  patients  and  were  luxuriously  equipped 
and  furnished.  The  twelve  American  nurses  were  distributed 
so  that  one  day  and  one  night  nurse  w^as  always  on  duty  in  each 
KJiiiik.  They  were  assisted  by  young  German  women  of  good 
family,  II el fv rumen,  who  also  acted  as  interpreters.  The 
system  of  volunteers  worked  well  in  Germany ;  because  of  the 
strict  military  discipline,  an  order  given  in  a  military  estab- 
lishment was  obeyed  in  every  detail.  Under  an  American 
graduate  nurse's  constant  supervision,  the  wounded  received 
excellent  care  in  the  face  of  many  emergencies.  "Always  hem- 
orrhages!'' wrote  Sister  Anna. 

Gleiwitz  was  an  important  military  center.  Sister  Anna 
told  of  the  shifting  movements  of  the  Kussian  and  German 
armies : 

At  one  time  tlio  "Russians  were  supposed  to  be  within  thirty 
miles  of  (ilciwitz.  Their  guns  were  heard  all  night.  ^leu 
and  boys  from  fourteen  to  twenty-one  were  ordered  to  the 
interior.  Accompanied  })y  sorrowing  mothers  they  marched 
to  the  station,  each  allowed  to  carry  nothing  but  a  small  pack- 
age. The  atmosphere  was  tense  with  anxiety  and  ai)prehension 
marked  c\ery  feature,     \either  letter,  teh^gram.  t<'lc})lu)ne  nor 


164   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

person  was  permitted  to  leave  the  city  for  seven  days.  We 
were  notified  to  be  prepared  to  depart  within  an  hour's  warn- 
ing. Gloom  and  fear  had  seized  the  people.  The  troop  trains 
were  now  moving  at  fifteen  minute  intervals.  They  con- 
tinued to  pass  for  five  days  and  nights,  two  million  men,  with 
big  and  small  guns,  horses,  supplies  and  all  that  go  to  make 
up  an  army  transferred  from  West  to  East.  At  this  time 
Austrian-Hungarian  soldiers  appeared  before  homes  at  mid- 
niglit,  begging  for  lodging.  Twelve  applied  at  a  private  clinic 
that  had  been  turned  over  to  us  and  the  poor  fellows,  fagged 
and  footsore,  dropped  on  the  cellar  floor,  the  only  vacant  spot, 
and  were  sound  asleep  before  we  could  bring  them  straw  to 
lie  upon.  The  Germans  were  again  driving  the  Russians 
back;  and  again  the  freshly  wounded  were  poured  into  the 
city. 

Gleiwitz  being  a  garrison  town  our  attention  was  frequently 
directed  to  squadrons  of  Uhlans  leaving  for  the  front,  in  full 
war  equipment  with  splendid  mounts  and  uniforms,  their 
banners  unfurled  and  decorated  with  roses,  the  mounted  bands 
on  dappled  greys.  They  were  magnificient  bodies  of  men,  full 
of  buoyancy^  patriotism  and  eagerness  for  the  fray.  What  a 
contrast  to  the  unfortunates  who  returned  to  us  wounded, 
vermin-covered,  helpless,  crippled  and  maimed  for  life,  with 
faces  paled  and  pinched  from  loss  of  blood  and  with  hands 
and  feet  frozen,  arms  and  legs  missing,  eyes  shot  out,  bones 
crushed,  muscles,  tendons  and  nerves  torn,  all  heaping  pain 
and  agony  upon  the  sufferer  ! 

Sister  Anna  made  brief  comment  upon  the  mental  attitude 
in  which  the  patients  arrived : 

Their  lingering  death  and  bodily  injuries  can  be  moderated 
to  some  extent,  but  what  about  scars  of  a  soul  seared  or  brutal- 
ized by  this  awful  lust  of  blood  I  I  cite  one  of  many  similar 
histories  of  a  young  university  student,  twenty-two  years  of 
age.  1  discovered  him  sitting  alone  and  apart  on  several  oc- 
casions in  an  apparently  melancholy  mood.  He  told  me 
finally  tliat  he  had  bayoneted  a  Kussian  in  a  charge  attack: 
"It  was  either  he  or  I  and  I  regret  exceedingly  that  he  did  not 
get  me.  1  still  feel  my  bayonet  going  through  him.  I  will 
never  knowingly  kill  again." 

The  American  nurses  described  their  wounded  as  strong, 
clean,  healthy  men,  patient,  courageous,  frugal  and  childishly 
appreciative. 

Four  nurses  sailed  in  February,  1915,  from  Xcw  York  to 
relieve  members  of  Unit  I,  who  wished  to  return  to  the  United 


THE  MERCY  SHIP  165 

States  at  the  end  of  their  six  months'  service.  The  war  zone 
was  then  full  of  danger;  one  of  the  relief  nurses,  Edith  Wood, 
described  her  passage  in  the  following  letter  to  Miss  Delano: 

The  accident  to  the  S.  S.  Touridne  furnished  us  with  ex- 
citement for  two  (lays.  Of  the  fourteen  vessels  receiving  her 
S.  0.  S.  we  were  tlie  first  to  reach  her,  turning  l)ack  in  a  dense 
fog  eighty  miles  from  our  course.  Our  captain  liad  to  reduce 
speed  one-half  to  allow  Jai  Tonraine  in  her  crippled  condi- 
tion, to  crawl  slowly  behind  us.  Sunday  afternoon,  two 
French  cruisers,  called  by  wireless,  came  up,  swung  about  and 
one  before  and  after,  escorted  our  charge  away  toward  Le 
Havre.  We  congratulated  ourselves  that  we  were  not  on  a 
burning  shij>  carrying  400,000  rounds  of  cartridges  and  in 
momentary  danger  from  German  torpedo  boats ! 

All  night  long  we  have  lain  at  anchor  in  Dover.  Torpedo 
boats  and  destroyers  patrol  up  and  down  near  us,  and  gray- 
hulled  battleships  slip  in  and  out  through  the  fog.  Our  life 
boats  have  been  swung  clear  on  the  davits,  from  the  time  of 
our  entrance  in  Channel  waters.  The  Rotiercknn  has  her 
name  in  three  great  rows  one  below  the  other  on  each  side, 
in  large  letters  about  four  feet  square,  composed  of  electric 
lights.  As  we  moved  out  toward  the  North  iSea  this  morning, 
the  wreck  of  a  liner  drifted  past  us. 

Upon  their  arrival  at  Gleiwitz  in  March,  the  four  new  nurses 
found  that  Unit  I  was  in  sore  need  of  reenforcements.  From 
tlie  Viktoria  Theater,  the  American  Ked  Cross  Flospital  had 
been  moved  to  a  concert  house  nearby,  which  accommodated 
140  beds,  an  increase  of  sixty  beds  over  the  capacity  of  the 
theater-hospital.  Unit  I  retained,  moreover,  the  two  Kliniken. 
Sister  Anna  was  extremely  loath,  in  view  of  the  pressure  of 
work,  to  allow  two  of  the  four  new  nurses  to  go  on  to  Kosel, 
but  they  were  needed  equally  and  had  to  go  there. 

Although  Sister  Anna's  letters  to  Miss  Delano  were  persist- 
ently cheerful,  the  Gleiwitz  L'nit  was  not  without  its  difficulties. 
One  hundred  and  seventy-three  beds,  always  full,  taxed  the 
strength  of  eleven  nurses.  The  ten  hours'  duty  and  the  lack  of 
a  common  languagx^  and  of  recreational  facilities  made  the  ser- 
vice more  severe.  The  presence  of  the  llelferinnen  in  the  wards 
further  complicated  nuitters.     Sister  Anna  wrote : 

The  first  duty  of  our  (Jerman  If cifprinnen  is  to  write  an<l 
keep  histories,  and  to  assist  when  possible  with  ward  work. 
1  am  determined  to  get  on  with  them  in  this  German  military 
hos])ital ! 


166  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

What  we  need  are  conscientious,  skilled  nurses  who  are 
willing  to  accept  without  murmur  the  routine  work  of  making 
helpless  patients  comfortable,  bathing  them,  making  beds, 
dusting,  using  our  improvised  equipment  and  accepting  cheer- 
fully the  general  discomforts  of  war.  Peace  at  any  price  has 
been  my  first  consideration. 

The  American  Ivcd  Cross  Lazaret  Konzertliaus  was  closed 
September  13,  1915,  with  a  record  of  1527  cases  and  the  staff 
of  Unit  I  received  their  recall  with  regret.  Several  members 
returned  immediately  to  the  United  States.  Ten  nurses  and 
one  surgeon  joined  the  group  which  Dr.  Snoddy,  senior  direc- 
tor of  American  Red  Cross  units  assigned  to  Austria,  was 
organizing  for  the  German  Government,  to  render  relief  to 
German  and  Austrian  prisoners  of  war  in  Moscow  and  Siberia. 

The  closing  days  of  the  Konzertliaus  were  as  busy  as  had  been 
the  first  days.  Sister  Anna's  last  report  from  Gleiwitz  to  Miss 
Delano  described  how  the  patients  continued  to  arrive : 

Vermin-covered  as  they  are,  exhausted  and  hungry,  with 
their  wounds  imdressed  for  five  or  six  days,  to  bathe  and  care 
for  these  patients  is  the  most  soul-satisfying  work  I  have  ever 
done. 

We  are  busier  at  present  than  ever.  The  arrival  of  a  large 
transport  is  dramatic.  When  all  else  fails,  I  am  prepared  to 
manage  a  night  lunch  counter !  Eecently  thirty  ravenous, 
wounded,  tired  souls  arrived  well  after  luidnight.  When  we 
had  finished  scrubbing  them,  I  stole  some  bread  and  with  the 
jam  on  hand  and  seventy  huge  mugs  of  hot  tea,  those  weary 
men  declared  this  old  Konzertliaus  Heaven  on  earth! 

Parting  with  the  soldiers  was  hardest  for  me.  We  left 
many  seriously  wounded  from  our  last  frightful  convoy;  their 
e3'es,  full  of  feverish  pain,  haunt  me. 

The  ancient  garrison  town  of  Kosel  lay  forty  miles  from 
Gleiwitz  in  German  Silesia.  Here  in  a  military  hospital  of 
700  beds  the  American  surgeons  and  nurses  of  Unit  G  upon 
their  arrival  on  October  17,  1014,  were  given  the  charge  of  the 
main  Lazaret. 

Unit  G  ([uickly  won  a  place  for  itself  in  Kosel.  Dr.  Bial  F. 
Bradbiu'v.  of  Norway,  Maine,  director  of  Unit  G,  was  ap- 
pointed in  short  order  gciuu'al  consulting  surg(>on  of  the  entire 
military  hospital.  Dr.  II.  H.  Xewnum,  of  Knoxville,  Tennessee, 
was  made  general  operator.  Within  a  few  weeks  of  their  ar- 
rival, a  station  of  jifty  beds  was  ojiened  in  a  public  school  near- 


THE  MERCY  SHIP  167 

by  and  assigned  to  13r.  John  Lancer,  of  New  York,  thereby 
making  a  total  of  1.'30  bods  to  be  cared  for  by  Unit  G.  Sister 
Frances  H.  ^leyer,  of  the  New  York  City  Hospital,  was  super- 
visor of  Unit  G.  A  German  Ked  Cross  sister  was  assigned  to 
the  American  Ked  Cross  Lazaret  to  interpret  for  the  surgeons 
and  to  record  histories. 

The  even  tenor  of  their  days  at  Kosel  was  interrupted  on 
January  7,  1915,  when  Dr.  Bradbury  was  called  home  by  the 
critical  illness  of  his  wife.  Four  nurses  returned  to  the 
United  States  at  the  termination  of  their  six  months'  duty, 
March  3.  As  the  Garrison  Lazaret  was  transformed  in  ^larch 
into  a  central  operating  station  for  Kosel  and  as  all  major  cases 
remained  five  or  six  days  under  the  care  of  the  Americans  be- 
fore they  were  returned  to  their  own  wards,  the  work  was  heavy 
for  the  nine  remaining  nurses.  Dr.  Gilbert  A.  Bailey,  of  Chi- 
cago, appointed  to  succeed  Dr.  Bradbury,  arrived  in  Kosel 
March  12  with  one  relief  nurse,  Sister  Caroline  Bauer.  Dr. 
Xewman  succeeded  Dr.  Bailey  as  director  on  April  22. 

Two  relief  nurses  destined  for  Kosel  sailed  in  July  on  the 
S.  S.  Noordan.  With  them  was  the  first  Harvard  Unit  of 
inO  surgeons  and  nurses,  which  has  been  assigned  independently 
of  th?  American  Bed  Cross  for  service  under  the  British 
Expeditionary  Forces.  To  these  two  nurses,  after  days  of 
danger  in  the  war  zone, — the  Noordam  with  her  life-boats 
swung  out  above  huge  electric  letters  which  proclaimed  her 
neutrality  to  German  submarines, — the  quaint  town  of  Kosel, 
set  among  fields  of  waving  grain,  seemed  peaceful  indeed. 

When  the  Garrison  Laznnd,  was  closed  on  September  15, 
1015,  750  cases  had  been  treated  to  a  conclusion  and  275  major 
operations  p(>rformed.  Only  a  few  of  the  surgeons  and  nurses 
returned  to  the  Uuited  States.  Drs.  Xewman  and  Lien  with 
Sister  Frances  and  seven  of  her  unit  joined  Dr.  Snoddy's  group 
in  Berlin  for  duty  among  German  prisoners  in  Moscow  and 
Siberia. 

Unit  K  of  the  S.  S.  lied  Cross  arrived  on  October  14,  1014, 
in  Vienna,  Austria,  tli(>  gayest  capital  city  of  Europe,  to  estab- 
lish Beservc  Hospital  Xo.  S  for  Austria's  wounded  and  were 
assigned  to  a  brick  and  stucco  school  building  in  the  Johann- 
Hoifmann  Platz.  Here  they  set  up  a  military  hospital  of  400 
beds,  splendidly  eciuipped  through  the  generosity  of  the  Aus- 
trian Bed  (^ross.  Dr.  Gary  A.  Snoddy,  of  Knoxville,  Tennessee, 
was  director.     Three  American  surgeons,  Dr.  Fred  G.   IJenton, 


168   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  Owego,  ^ew  York,  Dr.  Walcott  Denison,  of  St.  Louis,  and 
Dr.  P.  A.  Smithe,  of  Enid,  Oklahoma,  composed  his  staff. 
Sister  Lyda  W.  Anderson,  of  the  Illinois  Training  School  of 
I^ursing,  Chicago,  was  supervisor  of  nurses. 

Wounded  soldiers  coming  by  train  from  the  front  were 
received  in  the  school  gymnasium,  which  had  been  equipped 
with  beds,  benches,  bathtubs,  showers,  diet  kitchen,  dressing 
room  and  steam  sterilizer.  Dr.  Snoddy  described  to  Major 
Patterson  the  arrival  of  a  transport: 

Ambulances  drive  to  the  door  of  the  receiving  department, 
which  is  capable  of  handling  thirty  bed  and  seventy  sitting 
patients  at  one  time.  Here  hot  nourishment,  stimulants  and 
medical  attendance  are  given  immediately.  The  spectacle 
is  one  of  suffering,  exhaustion,  discouragement  and  filth. 

Xext  to  the  physiciaii  and  dietitian  in  the  receiving  line  is 
the  barber,  and  then  the  chemist  comes  with  his  lice-killing 
applications.  The  bath  stewards  are  ready  with  tubs  for  the 
sitting  patients  and  tables  for  the  prone  cases.  The  record 
writer  is  busy.  Surgeons  and  nurses  stand  by  in  three  operat- 
ing rooms,  one  for  aseptic  cases  and  two  for  septic.  The  ward 
nurses  are  at  their  posts  with  beds  prepared.  Patients  are 
handled  at  the  average  rate  of  twelve  per  hour. 

The  American  Red  Cross  hospital  needed  efficient  organiza- 
tion and  high  professional  skill  as  its  work  was  subject  to  con- 
stant comparison  with  the  best  organized  clinics  of  Europe, 
such  as  that  of  Eiselberg  in  Vienna  and  DoUinger  in  Budapest. 
Sister  Lyda's  report  of  November  24  to  Miss  Delano  bore 
testimony  to  the  ease  with  which  the  Americans  cared  for  the 
wounded : 

This  afternoon  we  are  enjoying  a  little  lull  after  a  heavy 
night  and  morning's  work.  We  received  a  message  yesterday 
noon  that  a  transport  would  arrive  at  nine  P.  M.  today. 
They  did  not  come  until  midnight,  but  we  had  them  bathed 
and  their  wounds  dressed  by  three  o'clock  this  morning. 
This  is  our  third  transport,  about  ninety  wounded  in  all. 
They  ba\e  not  Ijeen  severe  cases,  but  all  filthy  with  dirt  and 
vermin.  Many  have  not  had  their  clothes  off  for  weeks,  nor 
have  they  even  had  their  faces  washed. 

It  is  the  greatest  gratification  to  see  them  in  their  com- 
fortable br'(]s  I  Though  scrubbing  from  thirty  to  sixty  men 
makes  us  feel  we  liave  really  done  something,  the  work  so  far 
has  not  been  so  strenuous  but  that  we  have  been  able  to  do  it 
thoroughly.     Good  and  generous  equipment  makes  the  work 


THE  MERCY  SHIP  169 

convenient  and  comfortable.  We  no  doubt  have  harder  days 
in  store  for  us.  Our  f^reatest  difficulty  lies  in  compromising 
on  methods  and  in  adjusting  ourselves  to  military  regulations. 

Home-sickness  was  a  potent  foe  with  which  all  the  nnits  had 
to  combat.  "Like  cool  water  to  the  thirsty,  is  the  sound  of  his 
mother  tongue  to  a  man  in  a  far  country."  Few  of  the  nurses 
spoke  German,  however,  and  Sister  Lyda  urged  the  members  of 
her  unit  to  meet  with  tact  and  diplomacy  situations  that  con- 
stantly arose  because  of  the  lack  of  a  common  language.  Al- 
though they  were  not  in  sympathy  with  the  extremely  practical 
and  systematic  habits  of  the  American  graduate  nurse  as  op- 
posed to  the  more  sentimental  point  of  view  which  Europeans 
entertained  toward  the  care  of  their  wounded  soldiers,  two 
Viennese  volunteers  of  high  social  standing  gave  much  time 
and  energy  towards  making  the  Americans  comfortable.  They 
succeeded  well.  "Our  meals  are  late  and  long  but  very  good 
indeed,"  wrote  Sister  Lyda  to  Miss  Delano,  ''Personally  I 
like  the  life  here  in  Europe,  though  to  be  sure  it  is  abnormal 
now.  Wien  is  not  the  happy  city  I  visited  several  years  ago. 
It  is  in  sack-cloth  and  ashes.  They  are  beginning  to  resume 
their  gayety  to  a  small  degree.  The  Royal  Opera  and  the  con- 
cert halls  are  open  again."  Sister  Lyda's  description  of  the 
bread  lines  alone,  served  as  an  index  to  conditions: 

The  husbandry  of  foodstuffs  was  more  carefully  considered 
as  time  went  on.  Bread  was  issued  at  bakeries,  restaurants 
and  hotels  only  upon  presentation  of  bread  tickets.  These 
cards  allowed  one  a  week's  supply.  Flour  was  obtained  in  the 
same  way.  This  law  was  rigidly  enforced.  On  Tuesdays  and 
Fridays  jio  meat  could  be  purchased.  Cream  could  not  be 
taken  from  the  milk.  Peasants  harl)oriiig  their  crop  of  meal 
were  all  required  to  give  it  in  to  the  general  su])ply  for  com- 
mon distribution.  Bread  lines  formed,  extending  the  whole 
length  of  the  block,  forenoons  and  afternoons,  at  the  several 
hundred  stations  in  the  city,  people  waiting  hours  for  their 
allotment  of  bread.  This  was  a  heavy,  black  bread  made  from 
potato  flour  princii)ally,  and  could  be  prepared  so  as  to  i)e 
quite  ])alatable.  l)ut  when  made  very  cheaply,  was  heavy,  black 
and  soggy.  Foodstuffs  had  more  than  trebled  in  price  during 
our  year  in  Vienna. 

Sup])lies  of  all  kimls,  so  much  wanted  last  winter,  will  1)e 
much  more  needed  this  winter.  Some  months  back  they  issued 
a  call  ill  Vienna  for  all  the  old  linen  to  be  used,  when  fraved 
into  ravelings,  as  a  substitute  for  absorbent  cotton.     House- 


170   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

wives  were  required  to  give  up  all  copper  and  brass  utensils 
to  be  melted  and  sent  to  ammunition  factories.  Some  splendid 
heirlooms,  beautiful  Russian  samovars  and  oriental  urns  were 
sacrificed.  An  especially  designed  iron  finger  ring  worn  by 
anyone  signified  that  this  person  had  thrown  a  jewel  into  the 
coffer  and  accepted  this  war  decoration  instead." 

One  year  later,  horse-flesh  was  selling  in  Vienna  at  fifty-six 
cents  a  pound ! 

Dr.  Snoddy  gave  Major  Patterson  an  interesting  analysis 
of  the  effectiveness  of  projectiles  as  shown  by  the  first  thousand 
cases  which  came  to  Reserve-Spital  No.  8.  He  judged  that  the 
high  velocity  rifie  bullet  was  the  most  destructive  from  hand 
weapons.  Distinguishing  features  of  the  German,  Austrian 
and  Serbian  bullets  were  lead  cores,  ogival  heads  and  flat  tra- 
jectories which  deformed  easily.  The  Russian  bullet,  conical- 
pointed  and  of  smaller  calibre,  was  generally  less  harmful. 
The  French  bullet,  large  in  size,  of  solid  brass  with  high 
penetrating  power,  did  not  easily  deform.  Shrapnel  shells  were 
by  far  the  most  effective  of  projectiles  from  artillery.  The 
octagonal  iron  balls  used  in  French  shrapnel  were  more  destruc- 
tive than  the  lead  or  alloy  balls  of  the  other  nations.  German 
bombs  fired  at  short  range  from  mortar  guns  threw  many  frag- 
ments of  shell  when  exploding  and  literally  swept  the  enemy 
down.'^ 

The  American  nurses  found  the  German-speaking  Austrian 
soldier  particularly  appreciative,  quiet  and  obedient.  Sister 
Lyda  wTote : 

The  Austrian  soldier  accepts  the  war  submissively,  as  the 
inevitable,  lu^ver  questioning  for  what  he  is  fighting,  or 
whether  the  sacrifice  of  his  precious  life  is  adding  to  the 
glory  of  bis  country  or  is  fulfilling  anything  of  value  to  the 
world.  Seeing  troop  after  troop  of  the  best  men  of  the  coun- 
try, as  fine  as  tlie  world  has  to  offer,  talented  men  often  of 
great  minds,  inarching  out  daily,  few  to  return  and  these 
few  maimed  and  useless  citizens,  one  wonders  that  it  did  not 
stir  anarchistic  feelings. '^ 

"  "Kxpcricufcs  nf  I'liit  K  at  Vienna.  Austria,"  a  paper  read  by  Lyda  W. 
Anderson  at  the  I'^leventli  Annual  Meeting  of  tlie  American  Red  Cross, 
]:)cceinl)er   8.    im.'). 

'  "N<jti's  on    tlie   Kuropean   War,"   C'ary   A.   Snoddy,   Red   Cross   Archives. 

"  I'apcr  read  liv  I.vda  Anderson  before  the  American  Red  Cross  Annual 
MeetiiiL'.    I'Jlo. 


THE  MERCY  SHIP  171 

Although  Unit  K  was  among  the  most  successful  of  the 
units  sent  abroad  on  the  Red  Cross  Ship,  Sister  J^yda  had  to 
confess  that  even  in  this  detachment,  there  were  moments  of 
discouragement : 

I  must  admit  that  this  position  of  supervisor  has  caused 
me  more  anxiety  than  other  positions  I  have  hekl  of  far  more 
grave  responsibility.  That  a  number  of  graduate  nurses  who 
have  lived  an  independent  life  for  several  years  are  not  going 
to  adjufst  themselves  to  new  and  unusual  conditions,  such  as 
we  found  here,  or  come  under  authority  (even  though  the 
supervisor  tries  not  to  make  this  authority  felt  enough  to 
arouse  antagonism)  is  a  natural  condition.  It  has  taken  a 
great  deal  of  thought  on  my  part  to  try  to  know  each  in- 
dividual. 

In  listening  to  the  nurses  of  the  different  groups  who  have 
visited  us  on  their  way  home,  it  has  seemed  to  me  that  the 
one  stumbling  block  has  been  that  the  individual  could  not 
forget  herself  for  the  good  of  the  whole.  Is  this  disinclina- 
tion toward  united  effort  a  weakness  especially  of  our  pro- 
fession, or  just  a  natural  human  instinct?  Shall  we  depend 
on  a  few  strong  leaders  to  control  the  number  or  should  the 
individual  be  educated  to  appreciate  more  fully  her  personal 
responsibility  ? 

With  a  record  of  only  five  deaths  among  2050  cases  treated 
(although  they  had  received  largely  only  lightly  wounded 
patients),  the  American  Ked  Cross  Hospital  No.  8  closed  its 
doors  September  18,  1915.  Sister  Lyda  with  several  nurses 
returned  immediately  to  the  United  States.  At  the  request  of 
the  German  Government,  Dr.  Snoddy  with  two  surgeons  and 
nine  nurses  of  Unit  K,  as  well  as  additional  American  Red 
Cross  personnel  from  Budapest,  Gleiwitz  and  Kosel,  went  to 
Petrograd  to  care  for  German  prisoners  in  Russia.  Sister 
Lyda  described  with  considerable  amusement  incidents  of  their 
departure  which  were  in  sharp  contrast  to  the  cordiality  of  the 
reception  given  the  unit  upon  its  arrival  one  year  before: 

Of  the  thoroughness  of  any  system  instituted  by  the  Ger- 
man (Jovernmont.  there  can  be  no  question  left  in  the  minds 
of  travelers  who  have  crossed  her  border  the  last  few  weeks. 
The  only  thing  one  can  think  of  which  they  might  but  didn't 
do,  was  to  apply  the  X-ray ! 

Your  clothes  are  removed  and  every  garment  is  examined, 
for  was  not  a  woman  just  the  day  before,  who  had  come  in 
witli  a  presumablv  broken  arm,  fouiul  with  papers  concealed 


172   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  her  bandages?  Your  body  is  examined,  for  in  the  week 
past  a  woman  was  found  with  her  back  tattooed,  showing  the 
plan  of  the  army.  The  soles  of  your  feet  are  scraped ;  there  is 
the  possibility  of  papers  being  plastered  there  by  adhesive. 
Your  tooth  paste  is  squeezed  out  of  the  tube,  your  candy  pieces 
are  broken,  your  powder  boxes  are  emptied.  You  feel  when 
you  are  through,  that  your  very  soul  had  been  ransacked,  that 
they  know  your  innermost  thoughts.  All  papers,  books, 
printed  and  written  matter  are  held  over  for  more  careful 
reading  and  are  mailed  to  you  later  if  you  leave  the  money 
for  postage.  If  you  remain  in  any  German  city  longer  than 
is  necessary  to  change  trains,  you  are  required  to  report  to 
the  police  department  wlien  you  arrive  and  when  you  leave, 
giving  a  short  sketch  of  your  life  each  time,  assuring  them 
of  your  legitimate  business  and  leaving  your  finger  print. 
Any  war  souvenir  such  as  bullets  or  anything  used  in  the  field 
by  the  soldier,  maps  or  diaries^  they  retain,  giving  you  the 
promise  that  they  will  be  sent  you  after  the  war.  For  the 
civilian  they  have  no  regard;  he  is  a  trouble  to  them  in  their 
serious  business  of  war." 

In  the  rich  plain  of  Hungary  on  the  main  rail  and  water 
routes  from  western  Europe  to  the  Balkans,  lies  Budapest. 
Near  the  beautiful  Varcs  Leget  in  this  city,  Unit  E  of  the 
American  lied  Cross  Kcslief  mission  established  Military  Re- 
serve-i^intal  -NTo.  4  of  2()0-bed  capacity,  in  a  modern  brick  and 
concrete  structure  which  had  shortly  before  been  built  as  an 
asylum  for  the  blind. 

As  with  the  other  units  of  the  Bed  Cross  Ship  scattered  in 
the  several  corners  of  Europe,  so  with  this  group  of  surgeons 
and  nurses  at  Budapest  did  the  geographical  location  and  the 
attitude  with  which  the  military  authorities  regarded  the 
Americans,  entirely  determin(;  the  number  and  condition  of  the 
wounded  assigned  to  tlu;  strangers'  care.  Budapest  boasted 
fifty  niilitarv  hospitals,  which  gave  a  ratio  of  one  soldier  pa- 
tient to  evei'v  eleven  civilians.  As  the  city  was  splendidly 
located^  from  a  strategics  point  of  view,  on  the  Danube  Biver, 
the  wounded  came  from  many  points,  first  from  the  Serbian 
frontiers,  then  from  tlui  Western  trenches  and  later  from  the 
(yarpathian  and  Italian  battle-lieights.  Unit  E  considered  itself 
fortunate  indeed  to  be  assigned  to  the  Hungarian  capital,  which 
war  had  made  a  center  of  hospitals. 

On  October  ;>1,  fourtecui  (lays  after  the  arrival  of  the  unit, 

"  Piipcr  read  hy  Lyda  Anderson  before  tlie  American  lied  Cross  Annual 
Meetiii.Lj,   I'.ll"). 


THE  MERCY  SHIP  173 

Dr.  Charles  MacDonald,  of  Salem,  New  Jersey,  director,  and 
Sister  Alice  Beatle,  of  Cleveland,  Ohio,  supervisor,  opened  the 
doors  of  the  American  Red  Cross  Hospital.  The  iirst  assifrn- 
ment  of  patients  was  made  up  of  soldiers  desperately  wounded 
during  the  Austrian  drive  on  Belgrade.  It  is  significant  of  the 
neutrality  of  the  lied  C^ross  that  its  units  should  bind  up  the 
wounds  of  both  Hungary  and  Serbia  in  the  capitals  of  these 
countries  that  were  fighting  each  other.  Within  ten  days. 
Unit  K  had  received  K^f)  stretcher  cases.  Sister  Katrina  Hertzer 
described  the  condition  in  which  the  patients  arrived : 

Serbs,  All)anians,  Hungarians,  Croatians,  Austrians,  Monte- 
negrins and  Russians  began  tlieir  long  journey  from  the  front 
on  stretchers,  ox-carts  and  hay  wagons  to  the  nearest  rail- 
road, where  hospital  trains  brought  them  filthy,  hungry,  ex- 
hausted to  us.  Many  of  them  had  their  faces  blown  away ; 
pus  flowed  down  their  chests  and  on  tiie  beautiful  new  Ked 
Cross  blankets.  As  they  arrived  with  their  first  dressings 
still  on  their  wounds  after  fifteen  days'  travel,  it  was  ahuost 
impossible  to  protect  the  beds.  We  dressed  many  cases  three 
and  four  times  a  day. 

Hideous  mutilation  was  the  rule,  not  the  exception.  It 
was  a  frightful  thing  to  take  off  foul  dressings  and  see  below 
the  shattered,  yellow  flesh,  the  labored  inspiration  and  ex- 
piration of  the  exposed  lung.  The  thought  of  what  pain  these 
men  were  suffering  used  to  sicken  me. 

Baron  Armin  Popper,  General  Staff,  was  military  com- 
mander of  the  Hcd  Cross  Hospital  at  Budapest.  ]\Iany  former 
American  citizens  residing  in  the  city  opened  their  houses  to 
the  members  of  Unit  E.  Countess  Sigray,  the  daughter  of 
Marcus  Daly,  of  X(>w  York,  and  Countess  Zichy,  formerly  Miss 
Mabel  Wright  of  Boston,  took  a  keen  interest  in  their  com- 
patriots' work.  (V)untess  Szechenyi,  nee  Cxladys  Vandcu'bilt, 
presented  Unit  E  with  a  beautifully  complete  X-ray  apparatus. 
Dr.  Ilertzog,  military  conmiander  of  the  Buda])est  hospitals, 
often  made  rounds  with  his  staff  at  No.  4.  Professor  -lulius 
Dollinger  invited  the  surgeons  and  Sister  Alice  to  attend  his 
famous  clinics. 

Between  the  lines  of  Sister  Alice's  small  leather  diary  ap- 
peared a  brief  story  of  tlu^  first  month's  work: 

O(tol)or  .'')().  1!11  I — Supplies  arriving  all  day  were  li>te(l  and 
put  in  ])lace.     ^lany  gifts  from  peasants  n'ccived. 


174   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

October  31 — Hospital  turned  over  to  American  Red  Cross  by 
II err  Ober.stubsarzt  Hertzog;  forty-two  wounded 
soldiers  arrived. 

November  4 — Nurses  dressed  cases  until  2  A.  M.;  two  leg 
amputations.     Archduchess  called  again. 

November  10 — Twelve  patients  from  Galicia,  badly  frozen; 
heavy  work. 

November  11 — Nurses  had  cholera  vaccine. 

November  13 — Twenty-two  wounded  from  Serbian  Border — 
141  patients  in  all. 

November  24 — Professors  from  University  visited  us. 

Novemljer  25 — Fortress  Przemyzl  in  Poland  has  fallen ! 

November  28 — Twelve  patients  admitted;  172  in  hospital. 

November  2ii — Mrs.  Gerard  from  Berlin  visited  us. 

December  1 — Eighteen  Budapest  hospitals  quarantined  be- 
cause of  typhus. 

The  work  proved  absorbingly  interesting.  Sister  Alice  wrote 
of  the  different  nationalities  which  sifted  through  the  American 
Hospital : 

^loravians,  Slovaks,  Dalmatians,  Magyars,  Germans,  Euth- 
enians,  Poles,  Poumanians,  Italians,  Croatians,  Helvetians, 
Turks,  Serbs  and  Pussians  come  to  us,  and  somehow  we  man- 
age to  find  out  their  wants  and  make  them  comfortable;  Quite 
frequently  we  find  a  man  who  speaks  English.  A  few  days 
ago  I  said  to  a  new  arrival:  "And  so  you  speak  English,  do 
you?"     "Well,  jus'  toPable,  Miss." 

The  Huiigarians  take  excellent  care  of  all  wounded  they 
receive  and  are  very  clever  at  improvising  hospitals  in  school- 
houses,  theaters,  the  Stock  Exchange,  art  galleries,  ware- 
houses, private  homes,  clubs  and  sub-stations  of  banks.  The 
women  do  a  tremendous  amount  of  work  here,  of  a  type 
never  essayed  before.  The  wives  and  children  of  soldiers 
must  be  cared  for;  places  must  be  provided  for  the  blind  and 
crippled  whose  asylums  are  now  being  used  for  hospitals,  and 
em[)l()ynient  must  be  found  for  thousands.  This  requires 
genuine  organizing  ability. 

The  longer  \  stay  here  tlie  more  deeply  am  I  impressed 
with  the  fact  that  the  women  who  undertake  foreign  service 
for  the  American  Pe(|  Crcjss  must  be  fine  women  before  they 
are  good  nurses.  Their  work  does  not  count  for  nearly  as 
much  as  does  their  g(,'neral  bearing  and  conduct,  both  in  and 
out  of  the  liospital. 

Although  th(;  lueuibers  of  the  Budapest  Unit  were  far  re- 
moved from  National   Jleadcpiai'ters  they  were  in  an  excellent 


THE  MERCY  SHIP  175 

position  to  receive  wisps  of  information  regarding  the  other 
American  Red  Cross  personnel.  Sister  Lyda  from  nearby 
Wien  wrote  of  the  interesting  work  accomplished  at  Gleiwitz 
and  Kosel.  Sister  Helen  Scott  Hay,  writing  from  Kief,  as- 
sured Sister  Alice  that  the  Russian  soldiers  were  quite  the  nicest 
patients  she  had  ever  seen.  A  New  York  newspaper  woman 
brought  tragic  word  of  Serbia.  Political  jealousy,  intrigue 
and  cunning  ran  high  in  the  Hungarian  capital.  ^'Small  won- 
der," wrote  Sister  Alice,  "that  they  term  Budapest  the  whirl- 
pool of  modern  Europe."  During  the  early  spring  of  1915, 
the  city  became  a  maelstrom  through  which  gray  hordes  streamed 
down  to  the  Carpathian  and  Italian  frontiers.  Sister  Alice 
wrote  on  March  11  to  Miss  Delano: 

You  have  read  in  the  papers  about  the  movement  of  Ger- 
man troops  to  Galicia,  Serbia  and  Transylvania?  Those  mil- 
lions of  men  keep  marching  past  our  hospital,  week  in  and 
week  out.  Troop  trains  constantly  go  by  night  and  day, 
loaded  with  soldiers  and  ammunition.  Army  wagons,  am- 
bulances, artillery,  automobiles,  ox-carts  and  aeroplanes  form 
a  never-ending  procession.  All  types  of  vehicles  from  an 
imperial  coupe  to  a  Fifth  Avenue  motor  bus  are  used. 

The  German  soldiers  are  always  singing.  At  almost  any 
hour  of  the  night  when  one  awakens,  we  can  hear  "Die  Wacht 
am  Ehein"  or  "]\[orgenroth."  As  they  swing  past  our  hos- 
pital in  the  daytime  the  infantry  smartly  salute  the  Stars 
and  Stripes  above  their  heads. 

Hot  summer  months  brought  no  cessation  of  work  to  Unit  E. 
Sister  Alice's  letters  referred  repeatedly  to  the  unselfish  help- 
fulness of  the  wounded.  When  it  became  evident  that  he  could 
not  recover,  a  critically  ill  soldier  was  removed  in  July  to  a 
hospital  nearer  his  home.  His  comrade  in  the  next  bed,  who 
had  helped  care  for  him  constantly,  came  to  Sister  Alice  the 
next  day  and  asked  if  his  cot  might  not  be  placed  by  the  side 
of  some  other  very  sick  patient.  "Die  Schwestcrn  have  taught 
me  how  to  be  gentle,"  he  said,  "and  I  would  help." 

When  the  American  flag  and  the  Red  Cross  banner  were 
lowered  for  the  last  time,  September  20,  1915,  the  Red  Cross 
hospital  closed  its  doors  with  a  record  of  1543  cases  and  813 
major  operations.  The  death  rate  was  less  than  one  and  one- 
half  per  cent  of  the  total  admissions.  Dr.  Crookston,  Dr.  Met- 
calf  and  Dr.  IMiller,  with  eleven  nurses,  joined  Dr.  Snoddy's 
unit  for  service  among  (i(M'man  prisoners. 


176   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

When  the  American  Red  Cross  had  offered  its  ten  relief 
units  in  August,  1914,  to  the  belligerents  of  the  European  War, 
the  detachment  of  twelve  nurses  and  three  surgeons  destined 
for  duty  in  Serbia,  had  not  been  sent  upon  the  S.  S.  Red  Cross, 
because  of  the  expense  that  would  have  attached  to  an  extended 
trip  of  the  vessel  down  through  the  Mediterranean  for  just  these 
fifteen.  Thus  a  dingy  merchant  vessel  instead  of  the  white 
Mercy  Ship  brought  Unit  ]^o.  1  to  Saloniki  for  its  destination 
further  north,  at  the  time  the  first  overwhelming  tide  of-  suffer- 
ing and  disease  incident  to  the  Serbs'  gallant  part  in  the  war 
rushed  across  the  sunny  agricultural  lands  of  the  little  Balkan 
principality. 

The  Serbian  people  had  always  been  a  nation  of  farmer- 
soldiers.  Pride  in  ownership  of  field  and  cattle-herd  had  bred 
a  fierce  national  love  of  independence.  Manual  toil,  shared 
alike  by  rich  and  poor,  had  developed  a  fine,  upstanding  democ- 
racy. The  people  had  clung  desperately  through  years  of  in- 
ternal and  external  warfare  to  the  hope  of  a  great  Jugo-Slavic 
kingdom.  Since  the  dawn  of  European  history,  the  Balkan 
peninsula  had  constituted  the  natural  trade-gates  to  the  East 
and  its  control  had  been  the  goal  of  ambitious  world-powers 
since  the  days  of  Alexander  the  Great.  Exhausted  by  two 
previous  wars,  Serbia  chose  to  submit  to  the  terms  of  Austria's 
ultimatum  of  July  23,  1914,  rather  than  to  endure  her  power- 
ful neighbor's  "punitive  expedition."  But  in  spite  of  Serbia's 
humble  agreement  to  eight  of  the  ten  Austrian  demands,  Aus- 
tria declared  war  July  28  on  the  seemingly  defenseless  little 
kingdom  to  the  south.  History  records  the  resultant  action  of 
Russia,  Germany,  France,  Great  Britain,  Italy  and  the  United 
States. 

Serbia  swiftly  mobilized  her  five  million  population.  An 
heroic  band  of  !)00  medical  men  marched  away  with  the  new 
Army.  Serbia  had  only  one  doctor  for  every  5500  of  her  sturdy 
peasant-soldiers.  The  government  immediately  accepted  the 
offers  of  sanitary  assistance  which  were  extended  her  by  the 
Red  Cross  societies  of  several  then  neutral  nations. 

Among  these  contingents  of  surgeons  and  nurses  was  the 
American  Red  Cross  Serbian  Unit  Xo.  1,  of  which  Dr.  Edward 
W.  Ryan,  of  Scranton,  Pennsylvania,  was  director  and  ^lary 
E.  Gladwin  was  supervising  nurse.  Miss  Gladwin's  share 
ill  Red  Cross  nursing  in  the  Spanish- American  War  has  already 
been   mentioned.      She   was  graduated  from  the  Boston   City 


THE  MERCY  SHIP  111 

Hospital,  was  in  turn  superintendent  of  nurses  of  the  Woman's 
Hospital,  New  York  City ;  of  the  City  Hospital,  Cleveland, 
Ohio;  and  of  the  Akron  (Ohio)  Visiting  Nurses'  Association. 
At  a  Japanese  base  hospital  during  the  Russo-Japanese  War, 
she  had  received  experience  in  the  lonely,  monotonous,  ex- 
hausting school  of  war  nursing.  As  chief  nurse,  she  had  di- 
rected the  relief  work  of  many  American  Red  Cross  nurses 
during  the  Dayton  flood. 

Upon  the  arrival  of  Unit  No.  1  at  Nish,  Crown  Prince  Alex- 
ander asked  the  Americans  if  they  were  willing  to  report  to 
the  Military  Hospital  at  Belgrade.  The  Austrians  were  at 
that  time  bombarding  the  city.  Unit  No.  1  accepted  the  chal- 
lenge with  alacrity  and  on  October  15,  1914,  took  over  this 
excellently  equipped  institution,  then  filled  with  wounded  Serbs. 

The  Military  Hospital  at  Belgrade  consisted  of  nine  modern 
stone  pavilions,  erected  in  11)07  by  the  military  authorities. 
The  main  building  had  two  wings  in  which  were  two  large 
operating-rooms,  a  laboratory,  a  main  office  and  four  wards 
of  fifty  beds  each  constructed  according  to  modem  standards 
with  white-tiled  floors  and  ample  windows.  Adjacent  to  the 
main  building  were  medical  and  surgical  pavilions  of  one 
hundred  beds  each.  Nearby  were  the  administration  building, 
the  kitchen,  laundry,  chapel  and  morgue.  A  magazine  and 
trenches  plainly  visible  from  the  windows  of  one  pavilion 
brought  home  to  the  Americans  their  closeness  to  war. 

Grave  difficulties  confronted  this  unit  of  three  American 
surgeons  and  twelve  nurses.  During  the  first  seventeen  days 
of  heroic  house  cleaning,  they  cared  for  approximately  one 
thousand  lightly  wounded  Serbs.  Dr.  Ryan's  responsibilities 
were  greatly  increased  by  his  appointment  on  November  25  to 
the  general  directorship  of  the  military  and  civil  hospitals  in 
the  entire  city.  His  and  Miss  Gladwin's  professional  and  ad- 
ministrative duties  were  further  complicated  by  the  fact  that 
they  could  connnunicate  with  National  Headquarters,  Wash- 
ington, D.  C,  only  through  the  already  overtaxed  cables  of 
the  State  Department.  ]\redical  supplies  could  not  be  obtained 
in  Belgrade.  Food  for  the  patients  was  unsuitable  and  inade- 
quate. Overhead  sliri(>ked  the  Austrian  shells.  ]\Iiss  Gladwin 
described  the  bombardment  of  th(^  city: 

There  was  no  time  during  the  first  six  months  that  some 
of  the  guns  were  not  lired.     My  room  was  a  little  white-washed 


178   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

one.  Every  time  one  of  the  big  French  guns  would  fire,  for 
example,  it  would  show  the  flash  on  my  wall.  It  would 
illuminate  the  wall  and  then,  in  a  second  or  two,  I  would 
hear  the  boom  of  the  guns.    That  kept  up  night  after  night.^^ 

At  two  o'clock  on  the  morning  of  November  30,  the  Serbian 
authorities  notified  Dr.  Ryan  that  they  were  evacuating  Bel- 
grade because  their  supply  of  ammunition  was  almost  exhausted. 
They  left  one  hundred  of  their  seriously  wounded  in  his  care. 
Of  the  taking  of  the  city,  Dr.  Ryan  wrote  Major  Patterson: 

Xo  authorities  were  left.  As  there  were  many  robbers  about, 
stores  were  looted.  .  .  .  Many  people  were  being  held  up  in 
broad  daylight  and  it  was  necessary  to  do  something  for  the 
poor  who  had  no  food.  As  we  had  not  enough  for  the  patients 
at  the  liospitals,  I  sent  men  into  the  country  to  bring  in  all 
the  food  they  could  lay  their  hands  upon.  But  before  their 
return  the  Austrians  arrived  and  forty-eight  hours  after  the 
first  troops,  their  wounded. 

We  worked  day  and  night  until  w^e  could  no  longer  con- 
tinue. We  had  wounded  men  everywhere.  Starting  at  six 
o'clock  in  the  morning  we  would  dress  wounds  all  day.  About 
nine  o'clock  at  night  we  would  start  to  operate  and  work 
until  five  or  six  in  the  morning.  Many  nights  we  got  no 
sleep  and  never  more  than  three  hours.  Halls,  floors  of  wards 
and  every  place  a  man  could  fit  in,  we  had  filled.  We  had  in 
this  hospital  for  several  days  three  thousand  wounded  and 
one  day  we  had  nine  thousand  in  the  grounds.  I  was  then 
force;!  to  beg  the  Austrian  officials  to  send  some  of  them  to 
the  hospitals  in  Hungary. 

During  the  Austrian  occupation,  the  American  Red  Cross 
furnished  food,  coal  and  wood  to  all  the  hospitals  in  Belgrade 
and  supplied  six  thousand  loaves  of  bread  daily  for  the  poor. 
Soup,  a  little  meat,  a  few  beans,  and  an  allowance  of  two 
hundred  and  fifty  grams  of  bread,  comprised  the  rations  for 
patients  and  staff  of  the  ^Military  Hospital. 

An  insupportable  burden  of  work  confronted  the  nurses.  The 
Austrians  brought  hundreds  of  cases  of  frozen  hands  and  feet, 
dysentery,  recurr(>nt  fever,  typhus  and  typhoid  to  the  American 
Red  Cross  Hospital.  Other  patients  suffered  from  every  type 
of  rifle,  shrapnel,  grenade  and  bomb  wound.     Ox-carts  and  hay 

'"Paper  read  by  ^liss  Glarlwin  before  the  Nineteenth  Annual  Convention 
of  the  American  Nurses'  Association  held  at  New  Orleans.  La..  101(5; 
later  published  in  the  American  Journal  of  Nursing,  June,  1916,  Vol.  XVI, 
page  Of)."). 


THE  MERCY  SHIP  179 

wagons  had  transported  some  of  the  patients,  often  without 
even  First  Aid  dressings  on  their  wounds,  from  remote  moun- 
tain towns.  Gangrene  set  in  and  the  exhausted  nurses,  on  their 
slow  rounds  to  minister  to  those  who  possessed  at  least  a  fighting 
chance  for  life,  had  to  pass  by  the  doomed  men.  Miss  Gladwin 
wrote  of  the  pitiful  cries  of  the  dying : 

There  was  a  Avard  next  to  mine,  with  a  door  leading  directly 
into  it.  I  could  hear  every  sound  in  it  and  I  used  to  tumble 
into  bed  at  two  or  three  o'clock  in  the  morning  and  hear 
those  men  in  the  ward.  They  begged  and  prayed  in  all 
languages  for  help.  They  swore,  they  tore  their  bandages 
and  the  nights  when  I  got  up  (it  took  all  my  strength  of 
mind  to  stay  in  bed),  I  knew  exactly  what  I  would  find  when 
I  went  in, — the  men  in  their  agony  tearing  off  the  dressings, 
the  dark  streams  of  blood  on  the  floor. ^^ 

In  the  meantime  the  Serbs  had  received  a  fresh  supply  of 
ammunition  from  the  French.  They  rallied  and  advanced  on 
the  too-confident  Austrians  with  a  fury  which  drove  them  com- 
pletely out  of  Serbia.  The  order  to  evacuate  Belgrade  came  as 
quickly  to  the  Austrians  as  to  the  Serbs.  Cannon  began  to 
thunder  afar  during  the  early  dawn  of  December  13.  At 'eleven 
o'clock,  Serbian  and  French  heavy  artillery  had  found  the  range 
and  were  pounding  the  slopes  of  the  city.     Dr.  Ryan  wrote : 

By  one  o'clock,  the  battle  was  raging  on  the  outskirts. 
At  dark,  shells  were  bursting  everywhere.  The  streets  were 
jammed  with  cannon,  soldiers,  supply  wagons  and  horses 
going  toward  the  bridges  that  would  take  them  across  the 
Danube  and  Save  rivers  to  safety.  Tliey  continued  the 
retreat  until  the  next  morning,  when  the  Serbians  destroyed 
the  bridges,  leaving  those  who  had  not  gotten  across,  as  pris- 
oners on  this  side.  About  five  hundred  Austrian  wounded 
were  left  in  our  care. 

The  following  days  brought  lighter  work  to  the  big  military 
hospital.  The  care  of  the  Serbian  wounded  was  not  so  heavy. 
''The  work  has  been  indescribably  hard,"  wrote  Miss  Gladwin 
to  ]\liss  Delano,  "but  it  has  grown  nuich  lighter  during  the  last 
two  weeks,  "^riie  nurs(>s  are  becoming  a  little  rested,  in  readi- 
ness for  the  ]S'(\xt  Thing,  whatever  that  may  be." 

The  Xext  Thing  was  typhus.     Hordes  of  refugees  pouring 

"  Paper  reiXfl  1)v  Miss  (Jladwin  l)oforc  the  Xinctpoiith  Annual  Convention 
of  tlip  AnuTioan  Nurses'  Association  lield  at  New  Orleans.  La.,  initi; 
later  published  in  the  Amrricnn  Journnl  of  Xursincf.  June.  1916,  Vol.  XVI, 
page  90."). 


180   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

down  from  the  frontiers,  a  shortage  of  adequate  food  and  the 
total  dearth  of  Serbian  doctors  and  nurses  favored  the  con- 
tagion until  it  swept  the  little  principality,  A  graduate  of 
Roosevelt  Hospital,  then  in  Nish,  wired  l^ational  Headquar- 
ters: "Tvphus  raging  throughout  country.  Mortality  high. 
Cholera  feared  later.  Help  urgently  needed,  especially  doctors, 
nurses  with  hospital  isolation  equipment,  disinfectors  for 
typhus  clothing."  ]\lr.  Bicknell,  National  Director  of  the 
American  Red  Cross,  then  in  Europe  with  the  Rockefeller  Com- 
mission, cabled :  "Typhus  overshadows  everything  else."  Dr. 
Ryan's  report  for  February  gave  fuller  details : 

During  the  month  we  added  to  our  number  about  800 
patients,  totaling  1850  in  all.  Typhus  has  overrun  Serbia. 
In  Nish  alone  there  are  one  hundred  deaths  a  day  and  I 
believe  at  least  fifty  a  day  here,  though  Belgrade  is  better 
off  from  a  sanitary  standpoint,  than  any  city  in  Serbia. 
Typhoid  claims  its  share.  Many  die  also  from  relapsing 
fever.  There  are  always  shells  passing  over  us,  as  the  Aus- 
triaus  retaliate  on  Belgrade  the  French  fire  on  the  City  of 
Semlin  across  the  river,  now  exceedingly  high.  This  pre- 
cludes the  possibility  of  military  action  for  some  time  to 
come.  Fortunately  it  will  give  us  a  chance  to  try  to  get  rid 
of  the  typhus  upon  us. 

Until  April,  1915,  at  the  height  of  the  typhus  epidemic, 
Unit  1  had  worked  entirely  alone  as  the  only  group  of  American 
surgeons  and  nurses  in  northern  Serbia,  but  circumstances  out- 
lined below  then  drew  to  them  members  of  two  other  American 
Red  Cross  units  which  had  previously  been  assigTied  to  duty  on 
the  southern  frontier  at  Gevgeli.  During  the  autumn  of  1914, 
following  the  success  of  Unit  Xo.  1,  the  Serbian  Government 
had  requested  Xational  Red  Cross  Headquarters  to  send  addi- 
tional surgeons  and  nurses  to  assist  them  in  caring  for  their 
sick  and  wounded.  In  response,  two  units  had  been  sent  to 
Serbia  in  Decomber,  1914,  and  had  been  assigned  to  a  large 
military  hospital  and  prison  camp  at  Gevgeli,  fifty  miles  inland 
from  the  Greek  border.  Dr.  Ethan  Flagg  Butler,  of  Washing- 
ton, I).  C,  was  director  of  Serbian  Unit  No.  2;  Dr.  Ernest 
Pendleton  Alagrnder,  of  the  same  city,  was  director  of  Serbian 
Unit  No.  3;  ]\lathil(le  Krueger,  of  Detroit.  Michigan,  was  super- 
visor of  the  twelve  nurses  who  comprised  the  nursing  staff  of  the 
two  units.  A  detailed  account  of  their  struggles  at  Gevgeli 
will  follow. 


THE  MERCY  SHIP  181 

While  Dr.  Ryan  and  liis  associates  were  endeavoring  to 
check  the  spread  of  the;  typhus  epidemic  in  Belgrade,  word 
came  dnring  the  last  davo  of  February,  1915,  to  the  American 
consul  at  Nish  that  tlu?  majority  of  the  members  of  Units  A'o. 
2  and  3  had  been  infected  with  typhus  at  Gevgeli.  He  im- 
mediately communicated  with  Dr.  Kyan  and  with  National 
Red  Cross  Headipiarters.  JMajor  Patterson  cabled  Dr.  Kirby- 
Smith  at  Pan  to  send  one  surgeon  and  three  nurses  of  t-he 
French  units  to  the  aid  of  the  stricken  Americans,  and  in- 
structed Dr.  Ryan  to  investigate  immediately  the  situation  at 
Gevgeli,  Upon  his  arrival  there,  Dr.  Ryan  found  that  only 
four  nurses  of  the  staff  of  twelve  and  two  doctors  of  the  original 
number  of  six  had  escaped  infection.  These  six  Americans 
still  on  duty  were,  however,  taking  good  care  of  their  own  sick. 
Dr.  Ryan  suggested  that  Units  2  and  3  withdraw  from  Gevgeli 
to  Saloniki  as  soon  as  the  health  of  the  patients  permitted.  He 
then  on  March  3  returned  to  l>elgrade  and  resumed  his  efforts  to 
combat  the  typhus  which  was  becoming  epidemic  in  Belgrade. 

For  the  next  three  weeks.  Dr.  Ryan  was  the  only  American 
surgeon  in  the  big  Military  Hospital.  His  two  assistants  had 
returned  to  the  United  States,  March  3,  in  company  w'ith  three 
nurses  of  Unit  i^o.  1  whose  strength  had  not  been  equal  to  the 
strain  of  the  Austrian  occupation.  The  depleted  unit  tried  gal- 
lantly to  meet  its  responsibilities.  ''Life  is  rather  monotonous," 
Miss  Gladwin  wrote  Miss  Delano,  "we  go  nowhere  and  sec  few 
people,  but  we  get  along  surprisingly  well.  I  am  as  usual 
well,"  she  continued,  ''a  little  thin  perhaps  and  acquiring  gray 
hairs  steadily,  but  happy  and  content  to  be  in  Serbia  and  glad 
to  have  escaped  the  fuss,  feathers  and  festivities  which  seem  to 
have  overtaken  some  of  our  units." 

In  the  m(>antini('.  Dr.  Kirbv-Sniith  and  the  nurses  from  Pan 
had  arrived  at  Saloniki  and  there  luul  found  several  convales- 
cent members  of  Serbian  Units  No.  2  and  3.  Leaving  the 
nurses  there,  he  had  then  gone  on  to  Gevgeli  and  found  that 
the  patients  were  })rogi-essing  well  there  and  that  the  remaining 
members  of  Units  No.  2  and  3  wonld  be  able  within  a  few  days 
to  withdraw  entirely  from  that  ill-fated  Serbian  hospital  camp. 
He  and  Dr.  Butler  then  ])roeeeded  to  In-lgrade  to  consult  Dr. 
Ryan  regarding  the  next  move.  Lliev  arrived  at  the  Military 
Hospital  on  the 'very  day  that  Dr.  Ryan  himself  came  down 
with  typhus.  !Miss  Gladwin  wrote  of  her  emotions  when  she 
first  saw  them  : 


182   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  went  back  to  the  sterilizing-room  and  as  I  entered  I 
looked  up.  There  in  the  doorway  stood  two  men  in  the  uni- 
forms of  American  Ked  Cross  surgeons.  I  rubbed  my  eyes, 
because  I  thought  that  my  wish  for  help  was  making  me  see 
visions,  but  I  went  forward  and  found  Dr.  Kirby-Smith  and 
Dr.  Butler.  It  seemed  the  merest  accident  which  had  brought 
them  there,  but  1  shall  always  believe  it  was  in  answer  to 
prayer. 

The  contagion  swiftly  overtook  other  members  of  the  unit 
at  Belgrade.  On  March  28,  ^liss  Gladwin  wrote  Miss  Delano 
that  Ida  Lusk,  a  Bellevue  nurse,  was  desperately  sick  with 
typhus.  Dr.  Kyan  had  developed  pneumonia.  "It  is  pitiful," 
]\liss  Gladwin  added,  ''to  hear  him  in  his  delirium  going  over 
and  over  again  the  details  of  the  work." 

Immediately  upon  his  arrival,  Dr.  Kirby-Smith  wired  to  Dr. 
]\ragruder  at  Saloniki  for  which  reenforcements  from  Units  2 
and  3  as  might  safely  be  spared.  Then  with  Dr.  Butler,  he  set 
to  work.  In  that  over-crowded  hospital  shelled  by  enemy  fire, 
with  an  exhausted  nursing  staff  and  a  stricken  director.  Miss 
Gladwin  and  the  remaining  seven  nurses  faced  the  rounds  of 
duty  with  cheerfulness  and  equanimity.  Fear  held  their  hearts 
in  a  grip  of  iron,  but  the  discipline  of  their  profession  steadied 
them  and  sent  them  about  their  duties,  which  was  soon  to  in- 
clude the  care  of  other  desperately  ill  nurses  and  the  burial 
of  one  of  their  best-loved  surgeons.  With  the  calmness  of  the 
experienced  sanitarian,  Dr.  Kirby-Smith  reported  to  his  su- 
perior officer  at  Xational  Headquarters : 

The  typhus  situation :  At  the  time  of  my  arrival,  the 
epidemic  was  at  its  heiglit,  with  nine  hundred  cases  under 
treatment  in  the  ty])]uis  pavilions.  These  buildings  were  not 
under  our  administration.  Our  own  wards  were  overcrowded, 
and  patients  liad  iioccssarily  Ijeen  admitted  i]i  such  large  num- 
bers that  tliere  was  no  chance  to  give  them  careful  examina- 
tion. The  result  was  that  typhus  l)ecame  epidemic  in  our 
pavilions.  Iivaii  ])robab]y  contracted  the  disease  by  working 
in  tlie  wards.  This  may  also  be  said  of  Miss  Lusk,  although 
she  had  sj)ecialed  several  (-ases. 

Dr.  ^lagruder  arrived  in  Ikdgrado  ^larch  .31.  He  liad  fever 
of  104  degrees  within  a  few  hours,  in  fact  he  had  not  been 
well  for  several  (];\\<  ]»rior  to  leaving  Ckngeli,  l)ut  notwith- 
standing this,  he  continued  liis  work  of  arranging  transpor- 
tation   for   his   party  and   supplies,   working  hard  at  a  time 


THE  MERCY  SHIP  183 

when  he  should  have  been  in  bed.  During  the  first  days  of 
his  illness,  his  condition  did  not  give  us  undue  alarm,  but 
thirty-six  hours  before  his  death,  he  was  suddenly  over- 
whelmed by  poisons  of  the  disease.  He  died  April  8  and  will 
be  buried  here  in  the  Civil  Cemetery. 

Miss  Helen  Kerrigan,  of  Brooklyn,  Xew  York,  was  taken 
suddenly  ill  April  13.  Typhus  was  positively  diagnosed  a  few 
days  later.  She  evidently  contracted  the  disease  from  work 
in  the  wards. 

Miss  Helen  Smith  became  ill  April  18.  She  had  specialed 
Miss  Lusk  and  had  not  been  on  duty  in  the  wards  for  a 
month. 

j\Iiss  Eebecca  Watson  (from  Pan)  developed  severe  typhus 
May  5. 

The  nurses  have  been  moved  to  a  part  of  the  hospital  espe- 
cially cleaned  and  disinfected  for  their  occupancy.  Only 
occasional  cases  now  develop  in  our  wards,  and  it  is  believed 
that  we  will  soon  have  the  disease  entirely  stamped  out  of  our 
pavilions.  Of  course,  there  remains  the  chance  that  our 
personnel  may  be  bitten  by  an  infected  louse,  conditions  being 
such  tiuit  we  have  not  entire  control  over  every  one  with  whom 
we  come  in  contact. 

Tiie  routine  of  the  hospital  now  runs  smoothly.  Dr.  l^utler 
with  Dr.  Downer  as  his  assistant  is  in  charge  of  the  surgical 
pavilions,  and  the  enclosed  list  of  operations  gives  an  idea  of 
the  work  being  accomplished  [averaging  five  daily  J.  Drs. 
Kirkpatrick  and  Hagler  each  have  a  largo  pavilion.  ^ly 
duties  are  largely  administrative,  but  1  have  given  my  per- 
sonal attention  to  the  members  of  our  party  stricken  with 
typhus.  Dr.  Pyan  is  making  a  good  convalescence,  and  I 
hope  soon  to  turn  over  to  him  the  management  of  his  hos- 
pital. 1  will  at  oiu'c  start  for  home,  with  Miss  Lehmanu 
and  Miss  Lofving  [.May  9,  1915J. 

While  the  routine  work  of  saving  life  and  warding  off  death 
to  the  last  moment  of  resistance,  went  on  as  usual  within  the 
American  Hospital,  spring  came  to  ]^elgrade  with  soft  winds 
and  vivid  sunsets.  Clear  balmy  days  brought  out  the  con- 
valescents in  wheel-chairs  to  watch  the  French  aviators  circling 
the  city  on  their  way  to  and  from  scouting  expeditions  across 
the  Danube  and  the  Save.  Though  the  enemv  made  ready  to 
renew  his  assault,  all  S(>rl)ia  drew  a  vast  sigh  of  relief  and 
faced  the  sunnner  with  hope.  Typlius  was  gone,  thanks  largely 
to  that  band  of  forty-seven  sanitarians  under  Dr.  Ivichard  P. 
StrouiT,   which  the  Hockefeller  Foundation  and  the  American 


184   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Red  Cross  had  sent  during  the  dark  days  of  early  spring,^^ 
And  no  longer  did  the  menace  of  cholera  fill  man,  woman  and 
child  with  paralyzing  fear. 

Upon  the  arrival,  April  13,  of  six  relief  nurses  and  two 
surgeons,  better  days  came  quickly.  Following  their  convales- 
cence, Miss  Smith  and  ]\[iss  Kerrigan  were  transferred  to  an 
American  Red  Cross  hospital  at  Yvetot,  France.  When  tired 
members  from  all  three  units  were  invalided  home  in  June, 
Miss  Delano  sent  others  to  fill  the  gaps.  Miss  Gladwin's  letter 
of  July  7  to  Miss  Delano  differed  greatly  from  those  short 
notes  written  in  previous  months: 

You  are  cordially  invited  to  a  tea  at  the  American  Hos- 
pital at  four-thirty  o'clock.  You  will  have  no  difficulty  in 
finding  us,  as  our  flag  on  the  clock  tower  is  visible  from  many 
parts  of  the  city.  The  sentry  at  the  gate  will  let  you  through 
the  archway.  Come  along  the  drive  under  the  tower.  As 
you  open  the  front  door  leading  into  the  big,  cool  hall,  you 
will  see  Old  Glory  again,  colorful  and  splendid  against  all 
our  whiteness,  giving  you  a  sense  of  protection  and  security. 

Come  straight  down  the  corridor  to  double-doors  opened 
wide  in  welcome.  A  great,  white-tiled  room,  with  enormous 
window  spaces;  a  long  writing-table  covered  with  green  blot- 
ters ;  a  newspaper  table ;  and  a  tea-table  gay  with  bright  chintz, 
a  bunch  of  blue  and  white  larkspur,  another  of  purple  ten- 
Aveeks  stock,  red  and  white  geraniums  in  pots  and  begonias 
covered  witli  coral  blossoms, — that's  our  tea-room  where  you 
may  find  on  any  afternoon  a  warm  welcome  and  many  cups  of 
Sir  Thomas  Lipton's  "best." 

You  will  like  the  Red  Cross  family.  You  know  all  my 
girls,  hut  you  haven't  seen  them  in  their  gray  gowns  as  they 
come  from  their  work  in  the  wards.  You  will  like  the  way 
they  look,  a  little  tired  and  worn,  perhaps,  but  contented  and 
happy,  wonion  who  have  made  a  name  for  good  behavior  and 
hard  work  such  as  belongs  to  no  other  mission  in  Serbia. 

You  may  not  know  the  men  so  well.  Though  he  may  be 
called  away  before  his  second  cup  is  poured,  our  Director  Avill 
come.  The  Second-in-Command  will  drink  his  tea  with  great 
enjoyment.  The  Professor  will  bear  in  his  hands  a  potted 
geranium  wliich  he  carries  from  room  to  room  seeking  sunny 
windows.  IJumor  hath  it  that  he  sings  a  lullaby  to  it  every 
night ! 

The  riiotographer  with  his  big  pipe  in  the  corner  of  his 

"  For  an  account   of  the  work  of  this  commission  see  "tender  the  Red 
Cross   Flag,"  Mabel  T.   Bourdinan,  J.   J3.   Lippincott  Company,    1!)15. 


THE  MERCY  SHIP  185 

mouth  and  his  hands  dripping  "hypo,"  will  hurry  across  from 
the  dark  room  to  show  you  his  latest  picture  of  the  market- 
place. Come  see  our  Student,  our  Atheist,  our  Democrat  and 
our  Boy  lor  yourself ! 

Delay  in  the  long-expected  advance  of  the  Russians  and  Serbs 
upon  Budapest  lightened  nuiterially  the  work  at  the  American 
Hospital  during  the  summer,  but  tried  the  nerves  of  officers 
and  privates  alike. 

During  the  hot  sunmier  months,  the  immaculate  hospital  on 
the  hill  maintained  an  average  of  six  hundred  patients.  Quiet 
days  brought  the  Americans  welcome  opportunity  to  become  bet- 
ter acquainted  with  their  simple-hearted,  generous,  appreciative 
soldier  charges.     One  sister  wrote  of  her  orderly : 

The  linen  closet  on  my  floor  was  not  clean  enough  to  suit 
me.  After  I  had  spent  an  entire  afternoon  on  it,  one  of  the 
"bolachi"  (as  they  call  the  men  who  helj)  us),  came  into  the 
ward  cla])ping  his  hands  and  beckoning  me  to  follow.  I  did 
so,  thinking  that  he  had  seen  the  linen  closet  and  approved. 
When  we  both  got  to  the  door,  he  clapped  his  hands  even  more 
delightedly  and  motioned  me  to  open  it.  To  my  astonishment 
out  flew  two  white  pigeons.  He  had  arranged  a  cozy  nest  for 
them  among  my  immaculate  sheets !  At  intervals  he  would 
come  and  get  me  to  go  with  him  to  see  his  pets  fly  out  and 
light  on  his  head.  When  they  were  banished,  he  seemed  al- 
most heart-broken. 

Every  time  an  Austrian  bullet  is  removed  from  a  Serbian's 
wound  all  the  patients  get  around  his  bed  and  sing  the 
Serbian  national  anthem.  1  had  a  boy  of  seventeen  who  had 
had  a  bullet  removed  from  his  foot.  On  his  return  from 
the  operating-room  he  was  still  half  under  the  ana'sthetic 
and  1  left  him  for  a  few  minutes  to  get  a  hypodermic.  I 
returiied  to  find  him  sitting  up  in  bed,  completely  surrounded 
by  other  patients,  all  whooping  lustily  ! 

The  second  Austrian  oflFensive,  long  expected  by  the  French 
and  Serbian  armies,  was  launched  against  lielgrade  in  Septem- 
ber, IDIT).  The  Anu-rican  Red  Cross  Hospital  quickly  fllled 
with  wounded.  Although  the  American  I^'d  Cross  formally  re- 
called th(ur  foreign  units  on  October  1,  IDIT),  the  Serbian 
^linister  of  War,  in  the  nanu'  of  their  King,  begged  the  Ameri- 
cans to  renuiin,  assuring  them  that  the  Serbian  Crovernment 
would  gladly  defray  expenses.      Ijulgaria   was  on  the  vergt*  of 


186   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  declaration  of  war.  One  hnndred  and  twenty  thousand  Ger- 
man troops  were  massed  across  the  River  Save.  Dr.  Downer 
described  how  the  Anstrians  captured  the  city : 

From  our  vantage  point  we  could  witness  every  move  in  the 
desperate  undertaking.  The  broad  river  lay  beneath  us  and 
to  the  right  rose  the  Kalenegdan,  the  old  Belgrade  fortress, 
with  its  white  tower  and  its  white  walls,  dating  from  the  days 
when  the  Turks  were  masters  of  the  city.  Just  across  the 
river  the  combined  Austro-Hungariaii  and  German  heavy 
artillery  were  hurling  their  great  projectiles,  searching  for  the 
Allies'  artillery  positions.  Allied  artillery  were  dropping 
shell  in  Semlin,  trying  vainly  to  reach  the  guns  that  were 
slowly  battering  down  their  own  defenses.  The  Austrians' 
thirty-point-five  mortars  were  throwing  entire  houses  into  the 
air,  leaving  great  craters  fifteen  feet  deep  and  thirty  feet  in 
circumference.  Added  to  this,  the  city  caught  fire  and  at 
night  was  a  most  wonderful  sight. 

In  this  wild  scene  we  could  see  thin  battalions  of  Hun- 
garians, lying  with  their  feet  still  in  the  river  on  the  Bel- 
grade side  of  the  stream,  held  in  check  by  a  murderous  rifle 
and  machine  gun  fire  from  the  old  walls  of  the  Kalenegdan 
and  the  trenches  along  the  Danube;  the  damaged  pontoons 
full  of  dead  men  floating  down  stream  with  the  swift  cur- 
rent; the  Germans  making  their  bloody  struggle  to  cross  over 
the  Gypsie  Island  and  finally  the  combined  Austro-German 
rush  from  the  river  to  the  trenches  and  the  fearful  hand-to- 
hand  fighting  with  bayonets,  knives  and  club-guns. 

After  that  came  the  street  fighting,  the  rally  of  the  Serbs 
from  Porlock  Heiglits  back  into  Belgrade,  in  which  heavy 
infantry  and  artillery  fighting  raged  around  the  gates  of 
our  hospital  all  night,  until  finally  in  the  morning  the  Serbs 
retreated  for  good.  And  then  we  heard  the  distant  booming 
of  the  cannon  at  Avile,  showing  that  the  Serbs  were  resisting 
to  the  last  the  terrible  onrush  of  the  Austro-German  forces. ^^ 

Under  that  symbol  of  mercy  which  they  had  worn  so  well, 
Serbian  Units  1,  2,  and  8  could  not  at  this  hour  desert  the 
crowded  hospital.  They  remained  at  their  posts  of  duty  when 
the  dusty,  gray  hordes  again  swarmed  the  streets  and  they 
kept  the  doors  of  the  Alilitary  Hospital  open  alike  to  Austrian, 
Ihilgarian  and  Serbian  wounded.  After  six  weeks  of  stress, 
they  turned  over  the  management  of  the  hospital  to  the  Aus- 

""Tlio  'I'liriop-Capturfil  Capital,"  Dr.  Earl  B.  Downer,  Americati  lied 
fyijss   M(t(iazinr,    ID] (I,   N'ol.    XI,   j).   7S. 


THE  MERCY  SHIP  187 

trian  military  authorities  and  entrained  November  28,  1915, 
for  Vienna.  From  Vienna,  in  groups  of  three  and  four,  the 
surgeons  and  nurses  went  their  several  ways  homeward  to 
merited  rest. 

On  the  single  railroad  which  in  1914  cut  directly  north  and 
south  across  Serbia,  lay  the  isolated  depot  of  Gevgeli.  In  this 
dreary  town  near  the  Greek  frontier,  American  Ked  Cross 
Units  No.  2  and  3  established  and  attempted  to  maintain  a 
military  hospital  under  conditions  which  made  their  brief  stay 
a  disastrous  vet  heroic  incident  of  American  Red  Cross  service 
during  the  first  year  of  the  European  War. 

J3uring  the  last  weeks  of  December,  1914,  American  Red 
Cross  Units  No.  2  and  3  arrived  in  Saloniki  and  were  assigned 
by  the  Serbian  Government  to  the  ]\rilitarv  Base  Hospital  and 
Prison  Camp  which  had  been  opened  in  Gevgeli  to  supplement 
the  already  overcrowded  hospitals  scattered  throughout  the 
central  part  of  the  small  principality.  Dr.  P^than  Flagg  Butler, 
of  Washington,  D.  C,  was  director  of  Unit  No.  2;  Dr.  Ernest 
Pendleton  ^lagruder  of  the  same  city,  was  in  charge  of  Unit 
No.  3;  ^lathild  Krueger,  of  Detroit,  Michigan,  was  supervisor 
of  the  twelve  nurses. 

So  highly  developed  were  the  medical  departments  of  the 
armies  of  the  Allied  and  Central  Powers  at  the  outbreak  of 
hostilities,  that  sanitary  conditions  existing  in  the  Balkans 
seemed  at  first  unb(>lievable  to  the  pioneer  surgeons  and  nurses 
who  went  there  in  1914.  Native  standards  of  living,  primitive 
to  a  degree  astounding  to  Americans,  were  lowered  by  the  lack 
of  food  and  other  supplies  of  every  description,  by  the  short- 
age of  lab(^r  and  J)v  the  absence  of  a  native  medical  and  nursing 
personnel. 

Emily  Louise  Simmonds,  a  graduate  of  the  Roosevelt  School 
of  Nursing,  New  Vork  C^ity,  who  undertook  service  under  the 
Serbian  Red  Cross,  wrote  of  her  impressions  of  three  military 
hosj^itals  in  Serbia  during  the  winter  of  1914: 

Cevgeli  is  the  first  Serl)ian  town  across  the  Tirook  frontier; 
it  really  represents  a  station  dejiot  and  a  cigarette  factory 
of  fdiir  stories,  surrounded  hv  a  connnunitv  of  squalid  little 
huts. 

At  KraguycNats  [  nortliern  Serbia).  I  went  for  a  walk  one 
afternoon  wlicn  I  saw  a  dressing-room  orderly  emptying  waste 
cans,  filled  with  the  pus  dressings,  in  a  ditch  ojiposite  the 
main  building.      He  answered  my  question   by   stating  in  a 


188   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

surprised  voice  that  they  luul  never  hurned  them  and  it  seemed 
unnecessary  to  start  now. 

Of  2500  Austrian  prisoners  at  Uskub,  1000  are  dead,  200 
are  on  their  feet  and  the  rest  are  down  with  wounds  and 
typhus.  Here  their  liospitals  are  in  long,  low-roofed  barns 
with  two-foot  windows  on  one  side  only.  Beds  are  often 
pushed  together  so  that  three  men  lie  on  two  cots,  with  200 
in  each  barn,  dying  at  the  rate  of  forty  a  day. 

One  of  their  buildings  was  on  a  steep  hill  and  the  orderly 
used  to  empty  the  dressing-cans  over  the  wall  where  they 
would  l)low  about  in  all  directions.  The  Turks  (Uskub  was 
Turkish  two  years  ago)  used  to  pick  these  over,  taking  the 
cleanest  ones  to  line  their  wadded  waistcoats.  I  don't  want 
to  be  disgusting,  but  I  do  want  to  make  you  appreciate  that 
this  may  be  the  beginning  of  an  epidemic  and  is  an  instance 
of  what  is  happening  all  over  the  country.  If  any  help  is 
cominjr  it  must  come  at  once  and  must  be  of  drastic  measure. 


The  American  Red  Cross  Units  l^os.  2  and  3  were  placed  in 
charge  of  an  improvised  hospital  located  in  the  cigarette  factory 
described  by  Miss  Simmonds.  It  was  without  heat,  water,  or 
drainage  and  it  sheltered  under  its  leaking  roof  1200  surgical 
patients.  Two  days  after  the  arrival  of  the  units,  560  addi- 
tional wounded  raised  the  quota  to  well  over  lYOO  sick  and 
dying  men.  Hospital  equipment  consisted  of  straw  mattresses 
laid  on  the  tobacco-littered  Hoor.  Every  drop  of  water  had  to 
be  brought  from  a  distance.  All  waste  and  excreta  were  carried 
to  a  cesspool  several  hundred  rods  from  the  building.  The 
bas(>ment  was  filled  with  an  accunnilation  of  soiled  clothes 
and  linen  over  which  thousands  of  body  lice  crawled.  When 
Saints'  Days  did  not  forbid,  three  Turkish  women  came  to  wash 
a  fe\v  sheets  and  pajamas  in  small  crib-shaped  tubs  similar  to 
American  chopping-bowls. 

Gevgeli  was  a  snuill  community.  Serbian  oiRcers  occupied 
the  few  wretched  lodging-houses.  Quarters  in  private  houses 
could  not  be  secured.  Tlie  nurses  bad  to  be  assigned  to  a  native 
hotel  in  rooms  approximately  twelv(>  feet  S(iuare,  without  light  or 
heat, — three  women  to  a  room.  The  beds  consisted  of  straw 
mattresses  mounted  ou  wooden  frames.  One  small  tin  basin 
and  a  water  jug  were  the  only  toil(>t  accommodations  furnished 
the  twelve*  nurses,  'j'lic  do<-tors  were  (juartercnl  nearby  at  the 
cholera  barracks.  Their  meals,  cooked  in  the  general  hospital 
kitchen   and  served   in   the  staff  dining  room,   were  adequate, 


THE  MERCY  SHIP  189 

except  perhaps  tlic  traditional   Serbian  breakfast  which   con- 
sisted of  tea  with  lemon  and  toasted  black  bread. 

Miss  Krueger  stated  the  spirit  in  which  the  American  units 
started  to  work: 

In  this  unsanitary  location,  the  bnildinf^  crowded  to  its 
doors,  with  vermin  and  filth  on  every  hand  and  no  prospects 
of  obtaining  vitally  needed  equipment  for  promoting  better 
sanitary  conditions,  we  went  to  work,  not  optimistic  nor 
sanguine  of  results,  but  with  a  determination  to  do  our 
best.  .  .  . 

A  staff  of  two  liundred  nurses  would  have  been  inadequate. 
For  four  days  we  spent  our  entire  time  getting  all  seriously 
wounded  into  one  ward,  averaging  four  hundred  dressings  a 
day.  Badly  infected  wounds  were  the  rule,  not  the  exception. 
Many  had  not  been  dressed  since  temporary  First  Aid  on  tiie 
field  ten  days  to  two  weeks  previous.  Every  day  we  realized 
more  and  more  how  pitifully  inadequate  was  our  force.  Con- 
ditions grew  more  disheartening  with  each  week.^* 

The  tobacco  factory  was  so  dirty  that  the  American  surgeons 
did  not  dare  attempt  there  the  heavy  surgical  work  impera- 
tive for  the  recovery  of  the  patients.  Dr.  Butler  accordingly 
secured,  January  1,  1915,  a  large  tobacco  shed  for  use  as  a 
temporary  surgical  hospital.  At  the  cost  of  much  time  and 
discouragement,  the  Serbian  Government  finally  furnished  a 
small  amount  of  equipment,  including  windows,  a  most  import- 
ant item.  On  the  day  of  the  first  operation,  January  i;>,  the 
American  flag  was  bravely  hoisted  over  this  warehouse.  A 
sifting  process  of  seeking  out  operative  cases  in  the  tobacco 
factory  and  of  scrubbing,  sluiving  and  clothing  them  before 
transportation  to  the  warehouse  for  operation,  soon  filled  the 
so-called  "American  Hospital"  to  over-capacity.  Miss  Krueger 
continued : 

Most  tragic  of  all  was  the  meager  and  unsuitable  food 
supply.  Two  meals  a  day  consisting  of  vegetable  soup  and 
coarse  brown  bread  was  the  allowance  for  all  patients.  They 
were  fed  on  this  diet  and  then  treated  for  dysentery,  typhoid 
and  other  intestinal  diseases  with  a  wisdom  equal  to  that  of 
the  sage  who  dipped  up  water  in  a  sieve.    Possibly  some  notes 

"  Papor  prp])aro(l  liy  Miss  Knicfj^cr  for  the  convention  of  tlio  American 
Nurses'  Association,  \'.U~k  al  San  Francisco,  Calif.:  later  publislied  in 
the  .\7nerivan  Journal  of  \ursing,  Vol.  XV,  p.  1014-1015. 


190   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

taken  from  my  diary  give  a  better  picture  of  things  as  they 
were: 

January  7 — All  the  wards  of  the  tobacco  factory  very  cold; 
patients  suffering;  food  very  scarce;  impossible  to  get 
milk  or  eggs.  No  clean  clothes  for  the  patients  or  beds, 
no  laundry  done  for  four  days,  being  holiday  week. 

Nurses  all  have  bad  colds  and  begin  to  show  strain  of 
work,  which  is  fatiguing,  depressing  and  disheartening. 
I  insist  on  their  having  one  afternoon  and  half  Sunday 
to  get  out  in  the  air  and  sunshine. 

January  20 — New  cases  of  typhus,  pneumonia  and  smallpox 
developing  daily.  Four  hundred  cases  of  recurrent  fever, 
many  of  them  among  Austrian  prisoners  who  have  been 
our  only  helpers.     Sanitary  conditions  indescribable. 

January  28 — Medical  wards  almost  hopeless,  so  many  desper- 
ately sick  patients,  very  little  food  and  no  orderlies  to 
help  with  the  work.  One  of  lOur  doctors  arid  two  Ameri- 
can nurses  off  duty  with  temperatures  103  degrees ;  prob- 
ably typhus.^^ 

The  fight  at  Gevgeli  had  begun  against  overwhelming  odds. 
On  their  arriv^al  Units  Nos.  2  and  3  had  found  the  sick  and 
wounded  in  so  pitiful  a  condition  that  common  humanity  had 
prompted  the  Americans  to  assume  charge  immediately,  with- 
out taking  the  time  necessary  to  render  their  own  living  con- 
ditions at  least  reasonably  safe.  Massed  against  them  were  lack 
of  equipment  and  supplies,  overwork,  a  strange  language  and 
that  potent  ally  of  typhus,  the  body  louse. 

The  members  of  Units  Nos.  2  and  3  went  down  one  by  one 
before  the  fever.  Dr.  Lane  was  unable  to  report  for  duty 
January  28 ;  Clara  Tulloss,  January  29 ;  Clara  Slusher,  Janu- 
ary 30 ;  and  Dr.  King,  February  7.  Anna  Lockerby  wrote 
Miss  Delano : 

On  ^londay,  February  8.  ^liss  Krueger  did  not  feel  well, 
but  was  on  duty  all  day  until  four  o'clock.  Two  hours  later 
her  temperature  was  102  degrees.  Wednesday,  there  was  no 
doubt  that  she  had  pneumonia.  Wilhelmina  Weyhing  did  not 
feel  well  yesterday.  February  12  ;  today  she  had  a  temperature 
of  104  degrees;  typhus,  of  course. 

We  are  very  much  crippled  in  our  work.  Dr.  Butler  says 
we  must  come  first.  Our  dressings  arc  holding  out.  What 
we  need  most  is  niilk.  cocoa,  rice,  eggs  and  any  kind  of  other 

"Paper  proparrd  l)y  Miss  Knioppr  for  the  convention  of  the  American 
Nurses'  Assnciation.  191.").  at  San  Francisco.  Calif.:  later  piiblislied  in 
tlie  Amrriran  Journal  of  Xursivij.  Vol.   X\',  p.   1015-1016, 


THE  MERCY  SHIP  191 

food.  All  diet  we  give  our  patients  is  cabbage  soup.  Sir 
Thomas  Lipton  and  his  nurses  stopped  to  see  us  on  their  way 
to  Xish  and  left  us  siicli  food  as  he  couhl  spare  from  his  ship. 
Dr.  Butler  has  worked  hard  to  get  a  place  at  last  where  we 
can  have  our  cook  and  buy  our  own  rations. 

Teresa  Curley  was  the  next  member  of  the  units  to  become 
infected.  On  February  18,  Dr.  James  F.  Donnelly,  of  New 
York  City,  came  down  with  it;  the  following  day,  Maude 
Ellis;  the  following  day,  ^lary  Siehrs ;  on  February  21,  Mary 
D.  Cox.  The  next  day  ^liss  Krueger  developed  typhus  fol- 
lowing pneumonia.  Of  the  original  eighteen  comprising  the 
units,  four  nurses  and  two  doctors  remained  on  duty.  Miss 
Lockerby  wrote  ^liss  Delano: 

In  two  rooms  we  liave  three  nurses  each  and  across  the 
hall,  two  others,  all  typluis,  some  cases  three  weeks  old  and 
one  eleven  days,  blisses  Fry,  Tetrault  and  I  care  for  them; 
Miss  Canfield  is  nursing  Drs.  King  and  Lane  during  the  day. 
Drs.  !Magrudcr  and  Butler  have  done  everything  in  their* 
power  to  help.  When  the  crises  came,  they  wanted  to  stay  up 
all  night  so  we  four  could  sleep. 

There  have  been  so  many  things  besides  the  sick  nurses. 
I  was  the  second  person  in  Dr.  Donnelly's  room  and  helped 
the  doctors.  Xone  of  the  nurses  know  of  his  death  yet.  That 
was  a  very  hard   day.     Something  has  come  up  concerning 

Dr. which  required  a  firm  stand  from  the  director. 

The  nurses  were  quite  excited  at  first.  I  said  they  must  obey 
or  go  home  and  they  rememl)ercd  what  you  had  said  in  Xew 
York  to  Miss  Krueger.      1   felt  sure  that  in   her  illness  you 

would  want  me  to  make  the  same  stand.       Dr. has 

left  the  unit. 

February  was  a  dark  time  for  all  Serbia.  "We  have  ourselves 
lost  one  hundred  and  five  doctors,"  cabled  the  Serbian  Ked 
Cross  to  American  Xational  lied  Cross  lleadcpuirters.  Four 
of  the  British  lied  Cross  Unit  died  at  Uskub.  Two  surgeons 
and  three  nurses  of  the  Russian  Red  Cross  succundx'd  at  Xish. 
So  tragic  were  the  losses  in  the  Dutch  and  Gr(H'k  contingents 
that  these  units  were  withdrawn  from  the  country.'*'  Sir 
Thonuis  Lipton,  win)  had  lu'onght  over  the  l>ritish  lied  Cross 
units  on  his  yacht  Er'nij  saiil   in  cable  dispatches:   "One  can 

*".l»)rri(«n    Red   Cross   Mdynzinr.  Vol.    X.   p.    ISO. 


192   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

scarcely  imagine  the  terrible  ravages  of  tjphiis,  far  worse  than 
typhoid  and  even  the  Black  Plague."  Only  with  difficulty  was 
Serbia  able  to  bury  her  dead. 

Drastic  measures  were  imperative.  When  Dr.  Ryan  came 
down  from  Belgrade,  a  consultation  was  held  between  the 
American  surgeons  and  two  doctors  of  the  Serbian  Red  Cross 
and  it  was  decided  to  withdraw  Units  Nos.  2  and  3  from 
Gevgeli  to  Saloniki,  Greece,  as  rapidly  as  the  condition  of  the 
sick  would  permit,  for  recuperation  and  reorganization.  Dr. 
Kirby-Smith,  with  three  nurses  from  the  French  units,  were 
on  their  way  to  Saloniki  from  Pau.  He  and  his  party,  in- 
cluding Dr.  George  W.  JMellon,  of  Beaver,  Pennsylvania,  who 
volunteered  his  services  when  he  heard  on  shipboard  of  the 
desperate  need,  reached  Saloniki  on  March  18  and  found  Dr. 
Butler  and  several  convalescent  members  of  Units  Nos.  2  and 
3  in  a  third-class  hotel,  the  only  one  in  the  Greek  seaport  which 
would  receive  the  infected  Americans.  Leaving  the  three  nurses 
there,  Dr.  Kirby-Smith  went  with  Dr.  Butler  to  Gevgeli  where 
Dr.  MagTuder  was  taking  care  of  the  remaining  members  of 
the  two  units.  Miss  Lockerby's  report  of  March  19,  to  Miss 
Delano  told  of  conditions  at  Gevgeli: 

I  am  so  happy  I  am  almost  afraid  to  write.  All  of  our 
sick  were  able  to  sit  at  table  for  dinner.  I  could  hardly  keep 
the  tears  back, — I  felt  sure  this  day  would  never  come.  Seven 
of  our  convalescents  are  in  Saloniki.  Dr.  Xirby-Smith  came 
down  today  leaving  his  three  nurses  with  them  there. 

Now  the  days  grow  warmer  and  the  quaint  native  women 
come  out  in  tlieir  bright  dresses  to  gossip  as  they  stand  knit- 
ting by  tlie  roadside,  clicking  their  tongues  as  fast  as  their 
needles.  .  .  . 

Tills  week  we  were  able  to  do  a  little  hospital  work.  I  gave 
chloroform  for  twenty-one  operations.  Sometimes  this  meant 
that  I  didn't  get  to  ]\liss  Krueger,  whom  I  am  caring  for, 
until  five  o'clock.  She  is  very  anxious  for  us  to  get  back  on 
duty. 

Major  Patterson  cabled  Dr.  Kirby-Smith  to  consolidate  the 
units,  as  the  health  of  the  individual  members  permitted,  at 
Belgrade.  Gradually  strength  returned  to  the  eight  convales- 
cent nurses  and  to  Dr.  King  and  Dr.  Lane  at  Saloniki,  enabling 
them  to  return  early  in  A])ril  to  the  United  States. 

On  March  25,  Dr.  Kirby-Smith  and  Dr.  Butler  had  gone 


THE  MERCY  SHIP  193 

to  Belgrade  to  interview  Dr.  Ryan  about  bringing  the  unin- 
fected nurses  and  doctors  to  Belgrade.  After  wiring  Dr.  Ma- 
gruder  to  bring  up  what  reenforcements  he  could  spare,  they 
remained  at  the  Military  Hospital  to  take  care  of  Serbian 
Unit  No.  1.  Dr.  !^IagTuder  with  the  three  "surviving"  nurses 
reported  at  Belgrade,  !March  81.  "At  last  our  wishes  have  come 
true  and  what  is  left  of  Units  Nos.  2  and  8  are  here !"  wrote 
Miss  Lockerby.  Their  joy  was  short-lived.  On  April  18,  she 
wrote  again :  "All  our  time  since  January  has  been  a  strain, 
but  it  seemed  almost  more  than  we  could  endure  to  have  to 
bury  Dr.  INIagruder.  You  will  never  know  how  much  he 
helped  us,"  she  continued,  "he  was  sick  before  we  left  Gevgeli, 
but  he  wouldn't  give  up,  nor  at  Saloniki.  He  died  after  five 
days'  illness  here  and  was  buried  in  the  Civil  Cemetery." 

Here  ends  the  separate  history  of  Serbian  Units  Nos.  2  and 
3.  Subsequently  they  shared  the  experiences  of  the  Americans 
at  the  Military  Hospital  in  Belgrade. 

Just  as  the  subsequent  history  of  the  three  Serbian  units 
merged  into  one,  so  has  the  record  of  individual  experiences, 
massed  together  in  the  archives  at  Xational  Headquarters,  been 
merged  into  an  awesome  whole.  The  terse  cable  messages,  the 
short  letters  written  in  fear  and  exhaustion  which  recount  the 
fortunes  of  the  gallant  units  at  Gevgeli  and  Belgrade,  picture 
war  surgery  and  war  nursing  with  terrible  reality.  Filth, 
monotony,  hunger,  peril,  agony,  dishonor  and  despair  were 
there ;  so  also  were  courage  and  faithfulness  unto  death.  Let 
the  fact  that  human  strength  faltered  once  or  twice  show  the 
intense  strain  of  th()s(>  days!  For  one  man  w'ho  left  his  post 
of  duty  at  an  hour  of  need,  there  were  eight  surgeons  for  whom 
pestilence  licld  no  terror.  For  one  nurse  demoralized  by  utter 
exhaustion,  there  wei'e  twenty-two  others  brave  and  strong  and 
sane  under  the  lingering  shadows  of  death,  Florence  Nightin- 
gale's experience's  at  nearby  Scutari  were  not  more  difficult 
than  tliose  of  these  Red  Cross  luirses. 

In  far  (jlevgeli,  a  white  stone  cross  marks  the  ivy-covered 
grave  of  an  American  surgeon.  Dr.  James  F.  Donnelly.  In 
an  ancient  burial-ground  in  Belgrade,  where  black  marble  shafts 
point  skyward  among  dark  cedars,  another  Red  Cnv-^s  physician, 
l)r.  Frnest  P.  ]\Iagru(lc>r,  rested  (juietly  until  cessation  of  hos- 
tilities permitted  the  return  of  his  body  to  his  native  soil. 
During  th(>  happy  days  before  the  war,  young  Dr.  ^Fagruder 
had  i:'(>ne  to  Scotland  to  ascertain  whether  he  was  a  descendeut 


194.   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  famous  MacGregor  Clan.  There  he  had  met  and  mat- 
ried  the  daughter  of  Lord  MacGregor  of  Edenchip,  Valquhider. 
A  letter  written  by  his  widow  from  her  father's  home  during 
the  first  days  of  her  loss  bears  testimony  to  the  spirit  of  sacri- 
fice with  which  the  Red  Cross  moves  forward : 

Realizing  as  I  do  how  immense  are  the  claims  on  the  funds 
of  the  American  Red  Cross,  I  have  already  written  Miss 
Boardman  to  acknowledge  my  appreciation  of  the  action  of 
your  committee  in  making  an  allowance  to  me  and  my  little 
son.    I  hope  it  will  enable  me  to  keep  my  small  boy  with  me. 

It  is  my  great  consolation  to  know  that  my  husband  laid 
down  his  life  in  the  service  of  others.  I  feel  I  should  like  to 
express  to  you  the  admiration, — the  deep  admiration, — I 
have  as  a  Britisher  for  the  noble  spirit  that  actuates  the 
American  Red  Cross. 

In  these  days  when  all  Europe  is  in  anxiety  and  mourning 
and  when  a  dreadful  spirit  of  hate  has  raised  its  head  above 
our  boasted  civilization,  one  sees  in  the  selfless  devotion  of 
Americans,  in  no  way  ])ound  to  share  our  suffering,  a  ray  of 
real  comfort  and  hope  and  a  glory  far  greater  than  any  won 
upon  the  battlefield. 

Here  ends  the  experiences  of  the  units  which  had  sailed 
upon  the  Mercy  Ship  for  service  in  European  theaters  of  war. 
Three  other  units  were  assigned,  however,  by  National  Head- 
quarters during  the  winter  of  1914-1915  ;  one  of  them  went  to 
Yvetot,  France,  and  the  other  two  to  La  Panne,  Belgium.  A 
brief  account  of  their  experiences  belongs  in  this  chapter  which 
summarizes  the  service  of  the  American  Red  Cross  to  the 
Central  and  Allied  Powers  before  the  entrance  of  the  United 
States  into  the  World  War. 

The  first  year  of  the  war  had  been  marked  by  the  estab- 
lishment of  many  hospitals  under  organizations  of  varying  types 
and  aims.  Throughout  the  first  six  months,  wounded  had  come 
back  from  the  ]\Iarne  and  from  Ypres  in  increasing  hordes. 
The  existing  capacities  of  the  sanitary  services  of  the  Allied 
Powers  had  been  greatly  overtaxed  by  the  influx  of  patients,  and 
their  development  retarded  by  shortage  of  supplies,  personnel 
and  transportation  facilities.  By  serving  on  committees  in- 
terested in  the  establislinient  of  auxiliary  hospitals  and  con- 
valescent homes  and  by  contributing  lavishly  to  the  support  of 
such  institutions,  men  and  women  in  every  station  of  life,  lx)th 
in  England  and  in  the  United  States,  seized  avidly  the  oppor- 


THE  MERCY  SHIP  195 

tunity  for  dissipating  thoir  own  emotional  tension  and  for 
genuinely  aiding  the  wounded  soldier. 

At  Yvetot,  France,  on  the  Kiver  Seine,  within  easy  reach  of 
Kouen,  one  of  the  principal  military  bases,  the  French  Gov- 
ernment placed  at  the  disposal  of  the  Committee  of  VHopital 
de  V Alliance  Fondation  Atujlaise  et  Americaine  a  large  mon- 
astic school  for  boys,  J  eft  vacant  eight  years  before  by  the 
separation  of  Church  and  State, — this  structure  to  house  a  mili- 
tary hospital  for  the  care  of  British,  French  and  Belgian 
soldiers.  The  hospital  was  supported  by  volunteer  contribu- 
tions from  industrial  workers  in  Great  Britain  and  America. 
The  aim  of  the  committee,  whose  chairman  was  Dr.  F.  S. 
Pearson,  Bishopsgate,  E.  C,  was  to  afford  other  industrial 
groups,  particularly  those  engaged  in  the  manufacture  of  gov- 
ernment supplies  and  munitions  of  war,  an  opportunity  to  give 
"their  bit''  for  something  tangible.  Backed  by  the  influential 
London  committee  and  by  many  Americans  of  wealth,  the 
hospital  was  in  a  splendid  position  to  secure  equipment  and 
personnel.  It  was  later  ranked  second  to  the  American  Am- 
bulance at  Paris,  conceded  to  be  an  ideal  institution  of  its  type. 

Dr.  Ralph  Fitch,  a  Bostonian,  was  director  of  the  Alliance 
Hospital.  He  had  practiced  his  profession  in  Rochester,  i!^ew 
York,  and  was  an  orthopedic  surgeon  of  brilliant  powers.  Be- 
fore sailing  for  France  in  December,  1914,  where  both  he  and 
his  wife  gave  prodigally  of  their  wealth  and  services,  Dr.  Fitch 
had  requested  nursing  assistance  of  the  American  Red  Cross, 
should  the  need  be  great  enough  to  justify  the  expenditure. 
After  his  report  of  conditions  existing  at  Rouen,  France,  Xa- 
tional  Head(piart('rs  contirnicd  his  appointment  as  a  Red  Cross 
surgeon,  in  order  that  Red  Cross  nurses  might  be  assigned  to 
the  Alliance  Hospital,  and  dispatched  on  the  Rochamheau  Feb- 
ruary 2;5,  1015,  a  unit  of  nine  nurses,  with  Mary  M.  Fletcher, 
of  Charlottesville,  Virginia,  as  supervisor. 

Upon  their  arrival  at  Yvetot,  ^larch  2,  1915,  the  American 
nurses  found  a  well-equipped  institution  with  chapel,  admin- 
istration building,  bacteriological  laboratories  and  six  large 
wards  of  fifty  beds  each.  A  separate  wing  of  the  building 
containing  one  hundred  and  eighty  beds,  which  was  operated 
by  the  French  Kcd  Cross,  brought  the  total  capacity  of  the 
liospital  to  five  hundred.  A  convalescent  home  accommodat- 
ing between  thirty  and  forty  patients  was  maintained  at  nearby 
\'euilU'-les-lu)Ses. 


196   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Alliance  Hospital  was  governed  by  a  Board  of  Administra- 
tion consisting  of  the  chief  medical  officer,  Dr.  Dudley 
D'Avergne  Wright,  of  London;  Dr.  R.  R.  Fitch,  Captain 
T.  J.  C.  Warren,  of  New  Zealand,  and  Mr.  George  S.  Taylor 
as  business  manager.  Two  English  surgeons  and  two  students 
or  ''dressers"  completed  the  medical  staif.  Sixteen  English 
Sisters  including  Matron  Adelaide  A.  Wood  and  ten  proba- 
tions, with  the  ten  Americans,  composed  the  nursing  staif. 
Eighteen  infermiers,  French  soldiers  unfit  for  duty  at  the 
front,  served  their  military  term  there  under  a  French  Ad- 
jutant. To  supplement  these  orderlies,  six  young  English 
and  American  men  acted  as  stretcher  bearers  and  ambulance 
drivers  and  did  general  repair  work.  To  volunteers  from  Great 
Britain  and  the  United  States  was  delegated  much  of  the 
routine  hospital  detail  such  as  the  care  of  the  laundry,  the 
kitchen,  linen  rooms  and  the  vestiaire.  Baron  Rothschild's 
chef  was  major  domo  in  the  kitchens. 

During  the  first  weeks,  the  nurses  at  the  Alliance  Hospital 
experienced  the  same  inactivity  which  taxed  the  cheerfulness 
of  the  American  units  at  Paignton  and  Pan,  but  as  the  winter 
of  1915  dragged  on,  the  Americans  gradually  won  the  con- 
fidence of  the  English  and  French  authorities,  so  that  the  care 
of  large  numbers  of  patients  was  entrusted  to  them.  Two  of 
the  American  nurses  were  placed  in  charge  of  one  of  the  wards. 
A  third  was  appointed  night  superintendent,  acting  in  Matron's 
place  when  she  was  absent  in  England  for  several  weeks.  "We 
have  tried  very  hard  indeed,"  wrote  ]\Iiss  Fletcher,  "to  remem- 
ber not  to  spill  our  efficiency  over  onto  the  aprons  of  the  Eng- 
lish sisters  and  probationers." 

The  work  at  the  Alliance  Hospital  was  almost  entirely  sur- 
gical. Many  bone  eases  required  plating,  and  all  wounds  had 
to  be  drained  freely.  After  a  winter  in  the  trenches,  with 
nerves  pounded  thread-bare  by  shelling  and  "wind"  shortened 
by  continual  cigarette  smoking,  the  soldiers  were  in  poor  condi- 
tion for  long  general  antesthesia.  Hence  the  eases  di'agged 
out  while  the  surgeons  waited  for  wounds  to  heal  before  at- 
tempting second  and  third  operations.  Mary  K.  Nelson,  in 
charge  of  Dr.  Fitch's  operating-room,  described  the  patients 
arriving  from  Ypr(\s  as  wretchedly  wounded,  their  mud-soaked 
uniforms  a  torturing,  exhaustive!  burden. 

The  American  nurs(!S  found  a  certain  deep  satisfaction  in 
caring   for  cases   which   they  received   from  hospitals  further 


THE  MERCY  SHIP  197 

up  the  line.  In  writing  to  the  Princeton  Chapter,  which  paid 
the  salaries  of  several  of  the  Pau  and  Yvetot  nnrses,  Miss 
Fletcher  said: 

To  get  cases  whicli  have  been  unavoidably  neglectcfl  in  an 
overcrowded  hospital  for  from  two  days  to  two  months,  may 
seem  uninteresting  and  perliaps  not  (jiiite  fair  from  a  })ro- 
fessional  point  of  view,  it  does,  however,  present  a  wonder- 
fully humanitarian  opportunity  to  give  them  scientific  surgical 
care.  Since  it  is  not  our  country  which  is  at  war,  we  cannot 
all  expect  to  be  at  the  front. 

The  English  Tonnnies  are  marching  througli  under  my 
window,  with  an  unending  procession  of  lorries,  transports 
and  yellow-brown  ambulances,  on  their  way  to  Amiens  and 
Nismes. 

About  every  ten  days  splendid  young,  fresli  men  go  through 
on  machine  guns  from  Havre  straight  for  the  front.  They 
are  usually  about  forty  at  a  time  and  arc  called  the  Sundry 
Brigade.  They  are  all  sure  of  death.  When  they  stay  over 
night  at  Yvetot,  the  hospital  has  an  impromptu  concert.  Any 
one  whom  the  others  think  can  sing  even  a  bit  is  sent  up  to 
perform.  You  always  feel  that  these  boys  who  can  cheerfully 
undertake  to  entertain  this  company  must  have  nerve  enough 
to  do  anything.  They  are  always  given  coffee  and  cakes  aiul 
are  so  appreciative  and  cheerful  it  makes  jour  heart  ache. 
You  know  almost  all  of  them  will  go  down. 

One  of  our  patients,  a  man  of  thirty,  has  lost  both  arms. 
Yesterday  his  wife,  who  had  not  seen  him  for  months,  came 
into  the  ward.  His  face  was  heart-I)reaking  to  look  at.  He 
tried  so  hard  to  keep  the  tears  back,  but  they  would  come  and 
she  had  to  wipe  them  away. 

August,  1015,  brought  many  changes  to  the  Alliance  Hos- 
pital. Of  the  ten  nurses,  one  felt  it  necessary  to  return  to 
the  United  States.  Later  ^liss  Fletcher  turned  over  her  su- 
pervisory duties  to  INIiss  Nelson. 

''Remembering  what  you  said  about  the  on(>  thing  yon  would 
insist  on, — 'no  foolishness',''  wrote  ^liss  Fh^cluM-  to  .Miss  De- 
lano, "it  is  pretty  hard  for  a  supervising  nurse  to  have  to  con- 
fess she  is  engaged." 

"Sever  your  c(Uinection  with  your  unit  at  once,"  answ(u-(^d 
IVliss  Delano;  "under  pres(Mit  conditions,  tliere  is  no  room  in 
the  Red  (^ross  for  s(>rvice  and  romance  at  tlu^  sam(>  time." 

Accompanying  this  official  message,  however,  wiuit  a  personal 


198   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

letter:  ''I  am  delighted  to  hear  of  your  engagement,  my  dear," 
wrote  ]\liss  Delano,  *'and  hope  most  sincerely  that  he  is  worthy 
of  you  and  will  make  you  happy." 

To  fill  the  two  vacancies  caused  by  Miss  Fletcher's  resigna- 
tion and  the  return  of  the  other  nurse  to  America,  Sisters 
Smith  and  Kerrigan  were  transferred  to  Yvetot  from  Belgrade 
after  their  recovery  from  typhus.  The  greatest  change  came, 
however,  on  August  15,  1915,  when  the  French  Government 
requested  Dr.  Fitch  and  the  American  nurses  to  take  charge 
of  ^lilitary  Hospital  Xo.  48  bis,  at  St.  Valery-en-Caux,  a  little 
iSTorman  hshing  town  on  the  Channel,  between  Dieppe  and 
Le  Havre. 

The  nurses  at  once  fell  to  work  house-cleaning  their  new 
hospital.  Streimous  days  and  nights  followed.  Only  two  of 
the  nurses  were  independent  of  their  salaries ;  eight  of  them, 
however,  decided  to  remain  on  at  St.  Valery-en-Caux  without 
remuneration  after  the  Eed  Cross  had  recalled  its  foreign  units 
on  October  1.  Miss  Delano  cabled  that  the  nurses  might  retain 
their  Red  Cross  equipment.  Miss  Xelson  acknowledged  this 
gift  and  in  the  same  letter  described  how  heavy  their  work  had 
become : 

With  onr  constant  influx  of  seriously  wounded  men  directly 
from  the  front,  it  was  almost  impossible  for  us  here  in  this 
little  village  on  the  coast  to  obtain  uniforms  and  aprons 
immediately.  Over  at  home  such  a  supply  is  a  simple  matter, 
but  here  it  is  very  different.  You  will  appreciate  that  our 
entire  thought,  time  and  energy  has  been  given  to  the  work 
itself,  to  the  care  of  the  wounded  and  the  management  of 
the  hospital. 

It  is  iu)\v  long  past  midnight  and  common  sense  reminds 
me  that  at  least  six  hours  of  sleep  are  necessary.  We  all  seem 
to  have  grown  accustomed  very  easily  to  longer  hours  of  duty. 
At  last  we  have  the  work  welioped  to  find! 

During  the  antunni,  l!)!."),  ]\Iiss  Xelson  built  up  a  strong 
nursing  stalF  at  St.  Valery-en-Caux.  To  supplement  the  eight 
from  Yvetot,  she  secured  three  ''casual"  American  ntirses,  two 
Lnglisli  s  sicrs  and  iiiiic  partiallv-trained  women.  The  capacity 
of  rifo/>lln]  A  ii.rilitiri'  Xo.  4:5  was  then  raise(l  from  sixty-five 
to  ono  Inindi'cd  and  sixty-one  beds.  Besides  directing  the 
nursing  stall'.  Miss  Xclson  had  charge  of  the  operating-room. 
The  surgical  department  had  been  greatly  strengthened  by  the 


THE  MERCY  SHIP  199 

acquisition  of  a  portable  X-ray  plant,  with  an  electric  genera- 
tor, from  the  French  Service  de  Sante.  With  the  increased 
nursing  strength  and  witli  this  excellent  equipment,  Dr.  Fitch's 
hospital  received  a  monthly  average  of  one  hundred  and  fifty 
patients.  In  a  letter  written  October  26,  to  Miss  Delano,  Miss 
Nelson  told  of  the  pressure  under  which  they  worked : 

I  scrubbed  up  shortly  after  three  P.  ^l.  and  had  my  gloves 
off  only  about  half  an  hour  for  a  bite  of  dinner  in  tiie  steriliz- 
ing-room  about  eight  that  evening.  It  was  four-thirty  the 
next  morning  before  we  finished,  only  to  begin  again  that  after- 
noon. As  ever  so  many  of  our  grands  blesses  are  bad  joint 
wounds,  the  work  in  the  wards  does  not  lighten. 

The  nurses  have  borne  up  remarkal)ly  well  under  the  strain. 
Dr.  Fitcii  is  very  considerate.  He  planned  no  operations  to- 
day and  placed  his  big  ear  at  our  disposal.  The  four  night 
nurses  went  driving  this  morning  and  six  others  will  get  the 
air  the  rest  of  this  afternoon. 

Until  wo  have  more  nurses,  it  seems  unwise  to  take  more 
patients  or  to  open  our  convalescent  hospital  of  thirty  beds 
at  Veuille-les-Koses.  We  need  it  though,  for  it  is  hard  to 
start  these  boys  away  to  other  hospitals  for  their  convalescence 
just  when  they  begin  to  pull  up.  Such  wounds  as  I  have 
never  seen  before  and  1  thought  I'd  seen  horrible  ones, — 
shattered  hips,  knees  and  shoulders  all  calling  for  expert 
nursing  care. 

"Whenever  there  came  a  lull  in  military  operations  Vllopital 
Auxiliare  No.  4-'5  /;/,s'  drew  patients  from  the  surrounding 
country,  or  nursed  the  saddened  Belgian  refugee  children  in 
nearby  orpiuinag;es.  Three  of  the  American  nurses  returned 
to  the  States  during  the  spring  but  Miss  Xelson,  Helen  Kerri- 
gan, Josephine  Clay,  Helen  Spaulding  and  Marion  M.  Rice 
remained. 

Here,  during  the  summer  of  101  (>,  ended  the  letters  and 
records  which  tell  of  the  events  of  the  Yvetot  Unit.  The  little 
hospital  at  St.  Valery-(Mi-('aux  continued  to  render  yeoman 
service  during  t\w  cnu-ial  winter  of  l'.)l*)-l!)17.  Xearby  Amiens 
was  the  IIead(]uarters  of  the  l>ritish  Expeditionary  Forces. 
The  enemy  was  nuissing  his  streng-th  against  Verdun,  while 
the  Allies  hung  breathless  on  the  outcome  of  that  savag(>  as- 
sault. Pounded  by  ev(U'v  type  of  artillery  fire,  shattered  by 
shrapiu'l,  mowed  by  machine  guns,  poison-gas  and  Fhinmien- 
u-erfer,  France  during  these  months  was  lK»lding  the  heights 


200  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  Verdun  at  a  total  cost  of  550,000  casualties  among  her 
picked  soldiery,  some  of  whom  lay  unburied  among  the  craters 
on  the  shell-plowed  slopes,  while  others  came  straggling  back 
through  casualty  clearing  stations  to  the  French  and  Allied 
bases.  How  gallant  a  part  the  American  staff  of  VHopital 
Auxiliare  No.  43  bis  played  in  later  Red  Cross  endeavor  will 
be  found  in  a  subsequent  chapter. 

When  the  American  Red  Cross  had  first  offered  its  medical 
and  nursing  units  to  Europe  following  the  declaration  of  war, 
Belgium  had  asked  only  for  supplies.  The  Belgian  Red  Cross 
mobilized  with  Albert's  Army,  but  no  sanitary  organization 
could  cope  with  the  wounded  which  flooded  back  to  the  coast 
towns  of  the  Channel  and  the  j^orth  8ea.  By  February,  1915, 
Albert  with  his  forty  thousand  Belgians  held  a  strip  of  land 
forty  miles  long  and  ten  miles  wide  from  the  Yser  to  Holland. 
Directly  in  the  path  of  the  Taubes,  at  La  Panne,  Belgium, 
the  Belgian  Red  Cross  was  reorganized  and  from  this  uncon- 
quered  territory  on  February  21,  came  their  appeal  to  the 
American  Red  Cross: 

We  need  about  twenty  or  thirty  nurses,  four  or  five  sur- 
geons, one  thousand  beds  complete  with  sheets,  covers  and 
rubber  sheeting,  tents  for  housing  one  thousand  beds;  tents 
for  personnel  and  large  quantities  of  surgical  dressings, 
tetanus  sermn. 

(signed)  DePage. 

Antoine  DePage,  a  surgeon  of  Brussels,  and  Lieutenant- 
General  ]\Ielis,  Inspector  General  of  the  Health  Service  of  the 
Belgian  Army,  headed  a  committee  appointed  by  King  Albert 
to  organize  Belgian  Red  Cross  field  hospitals.  While  Dr. 
DePage  was  building  the  pavilions  of  VHopital  de  VOcean  on 
the  sand-hills  four  miles  above  Xieuport,  Madame  ^Marie  De- 
Page,  his  wife,  made  a  flying  tour  of  the  principal  cities  of 
the  United  States  to  raise  funds  to  support  this  medical  city  of 
twelve  hundred  beds.  In  response  to  her  solicitation,  the 
American  Red  Cross  pledged  itself  to  support  two  units,  of 
three  surgeons  and  twelve  Red  Cross  nurses  each,  at  La  Panne, 
as  it  had  done  in  1!)14  for  England,  France,  Russia,  Germany, 
Austria  and  Serbia.  Xational  Headquarters  also  donated  two 
complete  field  hospitals  and  $20,000  for  their  maintenance.  On 
April  17,  lOlT),  I5(']gian  Fnits  Xos.  1  and  2  sailed  on  the 
S.  S.  >7.  Lovis  for   LivciqxK)].      Dr.  Albert  R.  Goodman  had 


THE  MERCY  SHIP  201 

been  appointed  senior  director  of  the  two  vinits,  but  was 
obliged  in  London  to  return  to  the  United  States  and  Dr.  Robert 
Hinds,  of  Buifalo,  succeeded  him  there.  Dorothy  M.  Ferree, 
of  the  Henry  Street  Settlement,  New  York  City,  and  of  Phipps 
Institute,  Philadelphia,  was  general  supervisor  of  the  twenty- 
four  nurses. 

Under  the  shadows  of  war,  the  Belgian  units  were  delayed 
three  weeks  in  London.  Already  VUdpilal  de  I' Ocean  was 
being  shelled  and  it  was  deemed  unsafe  to  send  additional 
personnel  there.  Dr.  DePage  came  over  to  England  in  May  to 
consult  with  the  director  of  the  Belgian  units  and  to  welcome 
his  wife  on  her  expected  return  from  the  United  States  with 
drafts  for  $100,000  which  she  had  raised  for  Belgium's  soldiers. 
Her  eagerness  to  reach  La  Panne  had  made  her  disregard 
Germany's  warning  to  the  passengers  scheduled  to  sail  on  the 
Lusitania  on  her  last  fatal  trip.  The  giant  liner  was  sunk 
and  the  body  of  Marie  DePage  was  recovered  and  was  brought 
in  to  her  husband  on  the  docks.  Payment  of  the  lost  drafts 
was  cancelled  and  the  fruits  of  her  labors  were  later  sent 
over  by  a  more  fortunate  courier,  but  the  American  nurses 
in  London  were  not  soon  to  forget  that  earnest,  intelligent, 
eager  little  woman  who  had  waved  good-by  to  them  in  New 
York  with  her  smiling  farewell :  "I  am  here  so  that  you  can  be 
there." 

Dr.  DePage  brought  his  wife's  body  to  La  Panne  on  May 
20.  The  Belgian  Units  Nos.  1  and  2  had  left  London  the 
day  before  for  the  beach-hospital.  From  Dieppe  to  Nieuport- 
les-Bains,  they  found  themselves  veritably  in  the  war  zone. 
At  Forges-les-Eaux,  where  they  spent  a  night  at  a  hospital 
which  sheltered  three  hundred  wounded,  they  found  hotels, 
busses  and  trains  operated  entirely  by  women  and  convalescent 
soldiers.  Calais  was  in  total  darkness.  A  Frenchman  guided 
them  with  a  small  pocket  flashlight  to  motors  which  carried 
them  to  a  school-house;  there  they  spent  the  night  on  iron 
hospital  cots  which  now  filled  every  available  building.  ^liss 
Ferree  described  the  fifty-mile  ride  in  ambulances  to  La  Panne, 
May  19 : 

The  roads  are  well  guarded  evcrywhore;  thirteen  sentries 
stopped  us  to  see  our  passports.  At  noon  we  drove  straight 
througli  the  ruins  of  Dunkirk. 

La  Panne  has  one  long  street  into  wliicli  run  several 
smaller  ones.     The  houses  appear  to  have  been  set  down  care- 


202   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

lessly  in  the  ?and.     The  beach  and  sea  are  beautiful,  but  all 
else  is  desolate  among  the  ruins  of  shelled  villas. 

The  streets  swarm  with  soldiers  in  from  the  trenches. 
The  population  seems  to  have  swollen  overnight  from  two 
thousand  to  ten  thousand.  Here  too,  all  lights  are  put  out  at 
night  and  curtains  tightly  drawn, 

Marie  DePage  was  buried  among  the  sun-bleached  dunes  of 
the  shining  beach  near  V llopiial  de  I'Ocean.  Between  double 
lines  of  soldiers  moved  the  flower-covered  casket,  followed  by 
American,  British  and  Ijelgian  nurses,  Dr,  DePage,  accom- 
panied by  his  two  sons,  who  had  come  in  from  the  trenches 
for  their  mother's  funeral,  marched  with  officers,  Belgian 
nobility  and  foreign  medical  units  to  the  lonely  grave,  then 
returned  with  resolute  countenance  to  carry  on  the  work  for 
which  his  wife  had  given  her  full,  joyous  life.  The  first  year 
of  the  war  did  not  allow  Belgium's  citizens  the  luxury  and 
comfort  of  prolonged  grief, — there  was  too  much  to  be  done. 

As  viewed  from  the  sea,  J'llopifal  de  F Ocean  rose  high 
above  the  white  sands  on  the  sloping  beach.  A  summer  hotel 
had  been  converted  into  the  main  building.  Four  large  tem- 
porary pavilions,  lightly  constructed  of  wood,  with  corrugated 
iron  roofs  on  which  huge  Ked  Crosses  had  been  painted,  had 
been  erected  around  it  to  form  the  wards.  Surgeons  and  nurses 
were  quartered  in  summer  villas,  taken  over  by  Dr.  DePage. 
''The  hospital  is  very  complete,"  wrote  Dr.  Hinds,  the  director 
of  the  two  Ked  Cross  units,  to  ]\lajor  Patterson,  ''it  has  two 
steam  laundries,  a  bacteriological  laboratory,  a  small  steam 
sterilizer,  and  an  instrument-maker  who  manufactures  from 
steel  strips  excellent  operating-knives  and  even  nickels  them 
afterwards."  A  newly-installed  bath  system  of  twenty-four  tubs 
bathed  Ave  hundred  soldiers  a  day  who  came  in  relays  from  the 
front.  One  regiment  was  always  ([uartered  at  Da  Panne; 
after  scrubbing  up,  the  men  received  clean  underclothing  and 
their  uniforms  were  de-loused  and  mended. 

]\Iiss  Winch,  an  English  nurse  of  tact  and  executive  ability', 
was  ^latron  of  the  hospital.  Her  staif  consisted  of  well  over 
one  hundred  and  fifty  French,  English,  Belgian,  Canadian, 
American,  Danish  and  Swiss  nurses,  speaking  many  different 
languages,  and  trained  under  different  customs.  The  hours 
of  duty  were  from  s  A.M.  to  S  P.^l.,  with  two  hours  off,  be- 
sides ample  tinu^  for  meals  and  four  o'clock  tea. 

La  Panne  lav  in  the  coveted  road  to  Calais  which  commanded 


THE  MERCY  SHIP  203 

the  control  of  the  Channel  beyond.  Three  lines  of  defense 
stretched  their  barbed  wire  entanglements  and  sand  bnlwarks 
between  Vllopital  dc  VOrean  and  the  enemy.  No  one  could 
wholly  nnderstand  duriiiii,-  the  snmmer  of  lOlf)  jnst  exactly 
why  the  Germans  did  not  blow  the  hospital-city  entirely  off 
the  shell-cratered  beach.  Some  said  the  enemy  would  not 
harm  Elizabeth  of  Belgium,  whose  days  were  spent  among  the 
wounded. 

It  was  quite  a  formal  occasion  when  the  Queen  of  the  Bel- 
gians visited  the  pavilions.  Nurses  and  all  patients  whose 
streng-th  permitted,  remained  standing  while  Elizabeth  dis- 
tributed chocolate  and  cigarettes.  Dr.  DePage  carried  ''the 
smokes"  and  ^liss  Ferree  the  candy.  A  lady-in-waiting  always 
followed  the  Queen  from  ward  to  ward.  Dix,  a  sparrow  which 
one  of  the  boys  had  brought  from  Dixmude,  had  little  under- 
standing of  court  etiquette.  It  perched  first  on  Miss  Ferree's 
stitHy-starchcd  Red  Cross  cap  and  persisted  in  remaining  there 
until  she  shook  it  off.  It  flew  to  Dr.  DePage's  head,  then  back 
to  its  vantage  ground  above  Miss  Ferree's  neatly  brushed  hair, 
where  it  sat  in  digiiity  until  the  general  laughter  of  the  ward 
startled  it  again  and  it  flew  to  cling  \\\i\\  cold  thin  claws  to 
Queen  Elizabeth's  hand.  "It  is  remarkable  how  happy  every 
one  is  here,"  philosophized  Miss  Ferree  in  her  reports  to  Miss 
Delano,  ''and  how  soon  one  gets  over  momentary  fear." 

Eleven  mirses  of  Belgian  Units  Xos.  1  and  2  returned 
October  1,  1915,  to  the  United  States  after  six  months'  service 
at  La  Panne,  and  their  places  were  filled  by  nurses  whom 
]\Iiss  Delano  transferred  from  Paignton,  England,  and  Pan, 
France.  Sister  Vashti  Bartlett  took  ]\Iiss  Ferree's  place  as 
supervisor;  Dr.  W.  T.  Fitzsimons,  of  Kansas  City,  ^lissouri, 
succeeded  Dr.  Hind  as  senior  director  of  the  Belgian  units. 

The  Americans  from  Paignton  and  Pau  found  life  at  La 
Panne  vastly  more  exciting  than  that  among  the  Devonshire 
hills  or  the  sunny  vall(\vs  of  the  Pyrenees.  A  fragment  of  a 
German  shell  tore  up  the  bath-room  floor  of  the  Albert  and 
Elizabeth  pavilion.  Another  killed  nine  and  injured  forty 
civilians  in  the  street  outside.  Off-shore  the  British  fleet  lay 
thundering  a  tremendous  response  to  the  long-range  German 
guns.  Half  with  })leasure  and  half  with  dread,  the  nurses 
watched  the  great  whitc^  geysers  flung  up  by  enemy  shells,  sus- 
pended for  a  nionuMit  like  phantom  sails  drifting  on  the  blue 
level  of  the  water.     At  niuht  tlicv  lav  awake  and  listen(Hl  to  the 


204   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"coo-ey"  of  big  Berthas  singing  through  the  air  over  their 
heads.  Their  own  window^  were  zealously  curtained  and  only 
a  dim  candle  flickered  in  the  long,  silent  wards.  The  night- 
nurses  often  paused  to  watch  like  summer  sheet-lightning,  the 
flashes  from  the  trenches  a  few  miles  away.  The  glow  of  an 
occasional  star-shell  often  silhouetted  a  belated  fisherman  com- 
ing home  across  the  lonely,  glistening  beach. 

Throughout  the  winter  of  1915-1916,  Taubes  and  Zeppelins 
released  their  bombs  on  La  Panne  as  they  returned  from 
raids  on  the  Channel  ports.  Sunday  seemed  a  popular  day  for 
bombing  because  sunshine  brought  out  the  crowds  on  the  beaches. 
The  American  nurses  were  not  soon  to  forget  the  horror  that 
one  or  two  well-placed  bombs  made.  The  anti-air  craft  guns 
were  as  noisy  as  the  Taubes,  but  doctors  and  nurses  no  longer 
left  their  busy  wards  to  see  how  many  victims  the  bombing  par- 
ties caused.  Fortunately  the  weather  often  kept  the  air  craft 
behind  the  German  lines.  The  clinging  white  fog  of  the  Flan- 
ders coast  chilled  the  nurses'  heatless  rooms.  The  cold  rains 
and  harsh  winds  sweeping  down  from  the  ]SJ^orth  Sea  sent  them 
shivering  about  the  loosely-constructed  pavilions.  Lydia  Shrope 
could  not  throw  off  a  lingering  cough.  When  Dr.  Fitzsimons 
told  her  that  she  had  developed  tuberculosis,  she  returned  with 
Grace  Bentlcy  to  the  United  States  in  February,  1916,  bitterly 
disappointed  in  having  to  leave  the  Belgian  service.  After  a 
gallant  struggle  at  a  private  sanatorium  and  later  at  Fort 
Bayard,  Xew  ^Mexico,  where  the  Bed  Cross  had  sent  her,  she 
died  at  Fort  Bayard,  July  14,  1918. 

L'II6}/ital  de  I'Orean  received  only  Belgian  soldiers  and 
the  work  was  largely  surgical.  Sister  Emogene  Miles,  who 
had  been  in  charge  of  the  operating-room  at  Pan,  found  the 
service  at  La  Panne  exactly  as  difficult,  as  splendidly  worth- 
while as  she  had  anticipated  that  war  nursing  near  the  front 
would  l>e.  Sixteen  beds  in  a  surgical  ward  which  received 
only  serious  operative  cases  were  assigned  to  her.  An  English 
girl  acted  as  her  aide.  Three  Belgian  doctors  were  in  charge 
of  the  ward.  ''Lliey  surely  work  hard  to  save  these  exhausted 
men,"  concluded  Sister  Kniogene,  "tlie  work  is  sad  and  many 
die.  I  never  before  gave  so  many  hypodermics  as  I  do  here." 
Gas  gangrene  with  its  fetid,  sweetish  odor,  was  omnipresent. 

During  the  early  Flanders  spring,  iSTational  Headquarters 
recalled  Jielgian  Units  Xos.  1  and  2,  after  they  had  completed 
a  year's  service  at  La  Panne.     This  period  of  time  was  equal 


THE  MERCY  SHIP  206 

in  duration  to  that  which  the  units  of  the  Mercy  Ship  had  spent 
in  service  to  the  other  belligerents.  The  nurses  of  the  Belgian 
units  left  La  Panne  in  May,  1910.  Some  joined  the  American 
Ambulance  at  Paris;  others  did  further  war  nursing  in  Eng- 
land; but  the  majority  returned  to  the  United  States,  where 
ominous  clouds  were  gathering.  On  the  Western  Front,  France, 
Belgium  and  England  faced  the  "blood  bath  of  the  Sommc." 

Between  August,  1914,  and  May,  1916,  Miss  Delano  alone 
held  in  her  powerful  hands  the  strands  of  policy  and  admin- 
istration which  extended  like  light  steel  wires  from  Washing- 
ton to  the  fifteen  supervising  nurses  located  in  England,  Russia, 
Germany,  Austria-Hungary,  Serbia  and  Belgium. 

National  Headquarters  of  the  American  lied  Cross  was  then 
located  in  a  three-story  red  brick  house  on  the  corner  of  Seven- 
teenth and  H  Streets.  The  Nursing  Service  occupied  two  me- 
dium-sized rooms  and  a  hall-way  on  the  second  floor.  The 
finances  of  the  Red  Cross  did  not  permit  spacious  offices,  nor 
had  the  beautiful  memorial  building,  furnished  by  contribu- 
tions from  the  government  and  from  public-spirited  citizens, 
been  completed.  Miss  Delano  shared  a  single,  bare,  high- 
ceilinged  room  with  her  stenographer  and  her  assistant,  Anna 
Reeves.  A  rusty  leather  couch  stood  against  the  wall  on  one 
side ;  her  oak  desk  occupied  a  corner.  At  the  back  of  her 
swivel  chair  was  a  commonplace  oak  bookcase.  Directly  in 
front  of  her  desk  was  a  huge,  high-backed  wicker  chair.  By 
reason  of  the  sunlight  slanting  in  from  the  windows  to  the  left 
and  behind  her,  ]\Iiss  Delano  held  the  advantage  sought  by 
many  astute  executives,  of  being  able  to  see  every  change  of 
expression  about  the  eyes  and  mouths  of  the  nurses.  Army 
officers  and  volunteers  who  faced  her  during  the  innumerable 
conferences  held  in  that  busy  office. 

]\Iiss  Reeves  had  been  detailed  by  the  Surgeon  General  of 
the  Army  on  Xovcniber  17,  lOlo,  for  duty  in  connection  with 
the  selection  of  nurses  for  the  Red  (h'oss  Reserve.  She  was  a 
graduate  of  the  Piiiladeiphia  General  Hospital  and  had  joined 
the  Army  Nurse  Corps  in  1910.  Upon  \wr  assignuKnit  to  the 
Red  Cross  she  assisted  ^liss  Delano  with  the  enrollment  and 
helped  to  recruit  and  to  eciuip  the  nurses  for  the  Mercy  Ship, 
Her  desk  and  the  typewriter  table  stood  on  the  other  side 
of  the  room,  between  an  open  fire-place  and  the  main  door. 

Adjoining  Miss  Delano's  office  was  the  hall  in  which  Marion 
Oliver,  of  New  York,  worked  over  the  nnich-discussed  ])roblem 


206   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  mobilization  of  laj-women  for  war  service.  At  ]\Iiss 
Boardman's  request,  Miss  Oliver  had  come  to  National  Head- 
quarters in  1915  to  organize  groups  of  nurses'  aides  similar 
to  the  Voluntary  Aid  Detachments  of  the  British  Red  Cross. 
She  was  appointed  a  member  of  the  National  Committee  on 
Red  Cross  Nursing  Service  in  December,  1915,  and  continued 
a  member  of  Miss  Delano's  family  until  the  Red  Cross  decided 
that  the  service  of  nurses'  aides,  if  such  became  necessary  in  the 
event  of  war,  should  be  directed  by  a  Red  Cross  nurse. 

The  Red  Cross  Town  and  Country  Nursing  Service  occupied 
the  second  room ;  here  Miss  Fannie  Clement  and  her  assistants 
held  sway  until  the  removal  of  this  section  in  July,  1916,  to 
the  Mills  Building.  In  a  small  attic  room  upstairs,  the  files 
of  the  National  Committee,  then  containing  the  names  of  six 
thousand  enrolled  nurses,  were  handled  by  a  Washington  nurse, 
Lily  Kanely,  of  the  New  Haven  Hospital  Training  School, 
who  also  assisted  Miss  Oliver  in  the  details  of  examinations 
and  certificates  of  Red  Cross  instruction  in  Elementary  Hy- 
giene and  Home  Care  of  the  Sick. 

Equal  simplicity  existed  in  other  departments  at  National 
Headquarters.  Miss  Boardman  was  the  guiding  spirit  of  the 
organization.  ]\Iajor-Gcneral  George  W.  Davis,  U.  S.  A., 
retired,  was  chairman  of  the  Central  Committee.  Mr.  Ernest 
P.  Bicknell,  formerly  of  the  Chicago  Bureau  of  Charities, 
was  national  director;  his  duties  kept  him  in  Europe  the 
greater  part  of  1914-1915.  In  a  large  room  on  the  first  floor 
Major  Robert  U.  Patterson,  ]\ledieal  Corps,  U.  S.  A.,  detailed 
by  the  Surgeon  General  of  the  Army  to  the  Red  Cross,  was 
chief  of  the  Bureau  of  ]\ledical  Service.  ^^Ir.  Charles  L. 
]\[agee  was  secretary  of  the  organization  and  also  acted  as  dis- 
bursing officer  for  the  treasurer,  the  Honorable  John  Skelton 
Williams.  The  pay-roll  for  the  entire  National  Headquarters, 
including  the  clerical  staff  and  a  single  messenger,  contained 
barely  fifty  names. 

^[iss  Delano's  official  family  numbered  ten  members  and  an 
efficient  yet  informal  group  it  w:is.  Althougli  she  was  through- 
out her  Red  Cross  labors  a  full-time  volunteer,  Miss  Delano 
appeared  every  morning  at  nine  o'clock;  often  her  arms  were 
full  of  flowers  and  bright  leaves  for  the  vases  on  her  desk  and 
bookcase.  Her  singular  graciousness  of  personality  pi^rvaded 
the  dingy  rooms  and  (>voked  from  her  staff"  an  interc^st  in  the 
Nursing  Service  which  prompted  them  to  work  cheerfully  after 


THE  MERCY  SHIP  207 

office  hours  and  durinfj;  holidays  if  need  existed.  "When  you'd 
once  really  seen  her  big  heart  underneath,"  said  one  of  her 
assistants,  "you  never  noticed  afterwards  how  impatient  she 
got  with  you,  or  how  late  she  asked  you  to  stay."  She  often 
brought  her  "live  stock"  to  the  office.  On  such  occasions  her 
secretary  took  complete  charge  of  her  parrot,  bequeathed  ^liss 
Delano  by  her  mother.  Polly  could  not  be  left  alone  in  the 
apartment  on  Biltmore  Street,  when  her  mistress  was  on  one 
of  those  flying  trips  to  New  York,  nor  could  Patrick,  an  Irish 
terrier,  then  on  an  indefinite  visit  to  ]\Iiss  Delano,  though  the 
property  of  an  intimate  friend.  Patrick  often  sat  in  the  wicker 
chair,  watching  the  Mount  Pleasant  cars  swing  up  Connecticut 
Avenue  from  PI  Street,  or  crawled  across  the  rugless  floor  to 
lick  the  shoe  polish  from  the  glistening  boots  of  Army  officers 
who  came  to  interview  his  hostess. 

Warmth  of  personality  characterized  Miss  Delano's  attitude 
toward  every  one  with  whom  she  came  in  contact.  Her  letters 
to  her  supervising  nurses  brimmed  over  with  cordiality  and  a 
boundless  interest  in  their  welfare.  At  the  time  the  Red  Cross 
Ship  sailed,  she  equipped  with  her  own  hands  all  members 
of  the  various  units.  She  made  innumerable  visits  to  the  offices 
of  foreign  consuls  and  representatives  that  the  nurses'  pass- 
ports might  be  visecd.  She  held  earnest,  protracted  confer- 
ences with  her  supervisors,  warning  them  with  almost  prophetic 
insight  of  the  troublous  days  ahead  of  them.  A  phase  of  her 
many-sided  personality  was  shown  in  a  letter  (May  4,  1915) 
from  Helen  Fidelia  Draper,  herself  a  stanch  friend  of  the 
Nursing  Service : 

I  expect  it  may  have  seemed  almost  too  much  of  an  effort 
for  you  to  come  to  my  house  last  Friday  afternoon.  I  felt 
this  especially  when  1  saw  you  dressed  in  ''your  best  party 
clothes."  1,  too,  feel  repaid  each  time  wc  welcome  the  nurses 
and  send  them  olT  with  a  hearty  Godspeed. 

For  many  nurses  who  sailed  in  intervals  during  1915  as 
well  as  for  those  of  the  Red  Ooss  Ship,  ^liss  Delano's  hand- 
some figure  as  slio  waved  good-by  from  the  docks  or  from  the 
deck  of  a  tug-boat,  was  often  their  last  definite  impression  be- 
fore distance  or  pcrhajis  a  mist  of  tears  blurred  their  vision. 

That  her  "lambs"  were  now  far  removed  from  her  immediate 
solicitous  care,  dismayed  J\liss  Delano  not  a  whit.  She  and 
Miss   Reeves   and   her  secretary   packed   on   the   leather   couch 


208   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  her  office  the  Lig  wooden  Christmas  boxes  which  she  sent 
to  all  the  foreign  units.  With  her  own  money  and  an  even 
greater  expenditure  of  thought,  she  bought  the  articles  which 
went  to  fill  them.  The  contents  of  one  such  box  are  enumerated 
in  her  letter  to  Vashti  Bartlett,  at  La  Panne:  four  dozen  cans 
malted  milk ;  six  dozen  cans  condensed  milk ;  four  dozen  cans 
cocoa ;  four  dozen  cans  coffee ;  one  thousand  beef  cubes ;  four 
dozen  cakes  sweet  chocolate ;  two  dozen  cakes  toilet  soap ;  two 
dozen  tubes  tooth  paste ;  two  dozen  toothbrushes ;  one  dozen 
sweaters.  Not  content  with  this,  she  wrote  to  the  families  of 
the  nurses  then  in  active  service  that  the  Red  Cross  would  gladly 
send  their  presents  through  official  channels  lest  they  be  lost 
in  the  unsettled  shipping  conditions. 

Many  of  the  nurses'  salaries  (sixty  dollars  a  month)  were 
met  through  the  generosity  of  Chapter  and  individual  members 
of  the  American  Red  Cross.  Letters  written  by  Red  Cross 
nurses  to  these  donors  formed  one  of  the  strong  personal  bonds 
by  which  Miss  Delano  endeavored  to  unite  ardent  supporters 
at  home  with  Red  Cross  workers  in  the  field. 

Two  hundred  and  fifty-five  nurses  including  the  one  hundred 
and  twenty-nine  of  the  original  units  and  the  additional  one 
hundred  and  twenty-six  others  who  relieved  them,  were  en- 
gaged in  war  nursing  between  August,  1914,  and  December, 
1915.  Miss  Delano  vigorously  denied  in  a  letter  written  April 
9,  1915,  to  the  editor  of  The  Survey,  the  rumors  of  atrocities 
current  at  that  time : 

I  am  indeed  glad  to  reassure  you  that  so  far  as  we  have 
been  able  to  determine,  no  l?ed  Cross  nurses  from  any  coun- 
try have  met  with  the  mutilation  spoken  of  so  frequently. 
Of"  the  treatment  experienced  by  our  own  units,  there  is 
absohitely  no  truth  in  any  sueli  reports. 

One  of  our  units  was  in  Belgrade  when  that  city  was 
captured  by  tlie  Austrians;  thousands  of  soldiers  poured  into 
the  hospital  and  were  cared  for  in  the  same  wards  with  the 
Serbians  already  there.  Tlie  city  was  recaptured  again  Ijy 
the  Serbian  troops,  again  by  the  Austrians,  and  the  American 
Eed  Cross  remained  inviolate. 

^[iss  Delano  felt  an  intense  personal  responsibility  for  the 
nurses'  health.  Slie  was  greatly  distressed  that  their  rooms 
were  so  often  without  heat,  as  a  letter  of  thanks  written  Janu- 
ary 26,  1915,  to  the  Graduate  Nurses'  Association  of  Charles- 


THE  MERCY  SHIP  209 

ton,  "West  Virginia,  sliowed.  When  cables  arrived  telling  of 
the  typhus  epidemic  at  Gevgeli,  her  anxiety  expressed  itself  in 
an  immediate,  wholly  characteristic  recommendation  to  Major 
Patterson :  "May  I  ask,"  she  wrote,  "that  six  dozen  nightgowns, 
two  dozen  bath  towels,  four  dozen  hand  towels,  four  dozen 
boxes  talcum  powder,  be  ordered  for  the  use  of  the  sick  nurses 
in  Serbia  and  delivered  as  soon  as  possible  to  Red  Cross  Head- 
quarters, New  York,  addressed  to  me,  so  that  I  may  pack  them 
in  a  trunk  to  go  over  with  the  next  unit  of  nurses  ?" 

To  JVIiss  Krueger  she  wrote:  "I  am  more  than  grieved  to 
hear  of  your  illness  and  that  of  the  other  nurses  at  Gevgeli 
and  am  so  worried  for  fear  you  are  not  able  to  get  any  kind 
of  suitable  food.  Were  it  not  for  fear  that  there  would  not 
be  enough  nurses  to  take  care  of  those  who  are  ill,"  she  added, 
"I  should  not  send  other  nurses  into  this  danger,  but  with 
this  thought  in  mind,  we  shall  probably  send  additional  ones 
by  the  first  steamer.  It  often  seems  to  me  that  I  must  go 
abroad  at  once,  if  1  did  not  realize  so  completely  that  my  place 
is  here  at  Headquarters." 

To  Miss  Gladwin  she  wrote: 

I  am  sending  over  with  the  unit  sailing  March  16,  garments 
for  the  nurses  to  wear  when  caring  for  vermin-covered  pa- 
tients. We  liave  evolved  these  garments  with  the  advice  of 
people  who  have  lived  in  these  countries.  While  they  are  not 
es])eeially  beautiful,  I  do  believe  they  will  lessen  the  danger 
of  infection. 

The  skirt  is  made  like  Turkish  trousers,  has  little  exten- 
sions to  fit  in  the  top  of  the  shoes,  tying  tightly  around  the 
ankles.  The  waist  has  no  opening  through  which  vermin 
could  gain  access  to  the  body  except  at  the  neck  and  sleeves. 
These  are  arranged  to  tie  tightly  as  you  see. 

Her  extreme  practicability,  which  expressed  itself  by  having 
these  garments  made  for  the  nurses,  provoked  considerable 
laughter  at  her  expense,  in  which  she  would  have  undoubtedly 
joined  more  heartily  had  s\w  not  been  S(i  distressed.  ''The 
service  at  Gevgeli  has  been  a  perfect  nightmare  to  me,"  she 
wrote  to  J\Iiss  Gladwin  on  April  17,  "and  T  have  been  actually 
afraid  to  read  the  cables  as  they  come  in.  ...  I  have  notified 
the  families  of  all  the  sick  nurses,  as  it  seems  to  inc  they 
have  a  right  to  know  the  conditions.  I  am  simply  hcart-lu'oken 
to  think  that  typhus  has  (extended  to  your  unit  at  I>elgrade." 


210  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

This  intense  maternal  solicitude  did  not  in  any  respect,  how- 
ever, imply  indulgence.  Miss  Delano  was  a  stern  disciplin- 
arian.    To  her  supervising  nurses  she  wrote : 

Do  you  think  the  foreign  authorities  are  pleased  with  the 
service  our  nurses  are  giving?  The  only  thing  that  worries 
me  is  the  possibility  of  conditions  becoming  a  little  lax  if 
our  units  are  not  fully  occupied.  Will  you  impress  upon  the 
nurses  the  importance  of  dignified  and  professional  conduct 
both  on  and  off  duty? 

Please  do  not  hesitate  to  write  to  me  quite  frequently  if 
you  have  any  worries.  Should  any  unexpected  complications 
arise,  cable  me.  If  you  think  it  necessary  for  the  good  of 
the  service  to  relieve  any  nurses  from  duty,  be  assured  that 
I  am  ready  to  support  any  action  you  may  take,  even  to  the 
extent  of  sending  nurses  home.  We  have  many  others  anxious 
for  European  duty,  so  I  do  not  believe  it  would  be  worth 
while  to  temporize  much  should  there  be  any  breach  of 
discipline. 

Three  principal  defects  in  the  organization  of  these  pioneer 
Red  Cross  units  were  apparent  to  Xational  Headquarters  in 
1916,  a  realization  of  which  was  to  save  much  confusion  and 
unhappiness  when  the  Red  Cross  organized  a  medical  and 
nursing  personnel  a  year  later  upon  the  entry  of  the  United 
States  into  the  war.  First,  when  the  Mercy  Ship  sailed,  the 
authority  of  the  chief  nurse  and  the  relation  of  the  medical 
director  to  the  nursing  staff  had  not  been  defined.  Second, 
some  of  the  nurses  themselves  .did  not  seem  to  possess  imagina- 
tion enough  to  perceive  that  this  condition  was  due  to  the  speed 
with  which  the  units  were  dispatched  to  Europe  and  therefore 
called  for  even  greater  exercise  of  their  professional  ideal  of 
loyalty  to  their  immediate  superior  than  would  have  been 
necessary  at  home.  Instead  of  endeavoring  to  live  up  to  this 
ideal,  which  was  one  of  the  foundation  stones  of  nursing  ethics, 
they  took  advantage  of  tlu*  geographic  separation  of  the  super- 
visor from  the  Xursing  Service  at  Xational  Headquarters  and 
were  the  means  of  partially  disrupting  the  discipline  and  lower- 
ing the  morale  of  the  entire  medical  and  nursing  staffs.  Third 
and  most  confusing,  was  tlie  effort  to  enforce  Army  procedure 
upon  groups  of  people  untrained  in  its  complexities  and  wholly 
ignorant  of  its  uses,  as  were  the  surgeons  and  nurses  of  the 
S.  S.  Rod  CroHH. 

The   first   manifestation   of  an   absence  of  esprit   de   corps 


THE  MERCY  SHIP  211 

presented  itself  in  an  open  disloyalty  between  several  nurses 
and  their  supervisors.  This  was  due  in  part  to  a  lack  of  sup- 
port given  by  the-  medical  director  to  the  supervisor  and  in 
part  to  the  attitude  of  a  few  nurses  who  seemed  to  regard  their 
foreign  assignment  as  more  of  a  sky-larking  expedition  than 
a  disci])linod  war  service.  Perhaps  Miss  Delano  and  her  su- 
pervisors in  their  jealousy  for  the  reputation  of  the  American 
Ked  Cross  Nursing  Service  abroad,  may  have  set  up  more  rigid 
standards  than  graduate  nurses,  long  since  freed  from  the 
severe  discipline  of  training  school  days,  would  brook.  At  any 
rate,  individual  nurses  complained  to  the  medical  directors  of 
various  units  and  the  directors,  some  of  them  young  men  whose 
service  as  internes  had  been  completed  only  a  few  years  before, 
undertook  to  adjust  this  ticklish  problem  with  the  supervisors. 
But  these  women  had  enjoyed  many  prerogatives  and  had 
borne  grave  responsibilities  at  home  as  superintendents  of  hos- 
pitals and  training  schools.  They  resented  the  interference 
of  the  youthful  medical  men  in  disciplinary  matters  relating 
purely  to  the  nursing  staff  and  accused  the  directors  of  lack 
of  cooperation  and  the  tale-bearing  nurses  of  disloyalty.  The 
directors  then  reported  their  views  to  Major  Patterson,  while 
the  supervisors  laid  their  cases  before  Miss  Delano.  Lively 
discussions  ensued  at  National  Headquarters.  To  secure  effi- 
cient nursing  service,  [Miss  Delano  maintained,  as  did  her 
supervising  nurses,  that  the  same  system  of  discipline  prevail- 
ing in  every  well  organized  hospital  should  exist  also  in  the 
Red  Cross  organization,  that  all  matters  relating  to  the  discipline 
of  the  nursing  staff  should  be  handled  by  the  supervising  nurse 
through  recommendations  to  the  medical  officer  of  the  unit 
and  to  the  chairman  of  the  National  Committee  on  Red  Cross 
Nursing  Service  at  Washington,  D.  C. ;  and  that  the  director 
of  the  unit  should  support  the  authority  of  the  supervisor  as 
long  as  her  services  were  satisfactory.  After  thorough  investi- 
gation, ]\[ajor  Patterson  in  January,  1915,  issued  the  following 
letter  of  instructions  to  all  directors  for  foreign  units : 

All  of  your  dealings  with  the  nurses  should  be  through 
the  senior  supervisor.  .  .  .  Your  surgeons  shoukl  l)e  in- 
structed to  refer  all  requests  for  detail  of  nurses,  orders, 
complaints,  or  other  matters  regarding  the  nurses  to  you  to 
be  acted  on  by  you  at  your  discretion.  When  these  units 
were  ()ri<iinally  si'iU  to  luirope,  the  surgeons  were  instructed 
to  this  elfect.      In  otlier  words,  if  any  of  the  doctors  desired 


212  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  have  instructions  given  to  any  of  the  nurses  or  to  make 
complaint,  such  matters  were  to  be  brought  to  the  attention 
of  the  senior  director^  who  would  transmit  the  same  to  the 
supervising  nurse,  who  in  turn  would  give  the  necessary 
instruction  to  the  nurses. 

The  matter  of  assignment  to  duty  of  nurses  and  their 
general  supervision  should  be  left  entirely  in  the  hands  of 
the  senior  supervising  nurse.  These  instruetion.s  do  not 
mean  that  doctors  working  with  nurses  should  not  give  them 
the  usual  instructions  and  orders  common  between  ward  sur- 
geons and  the  physicians  and  nurses  working  with  them.  .  .  . 

If  in  the  opinion  of  the  supervising  nurse,  any  of  the 
nurses  under  her  charge  are  deficient  in  conduct  or  unsatis- 
factory to  her  in  any  particular  and  she  so  recommends,  you 
should  return  such  nurses  to  the  United  States,  merely  obtain- 
ing sufficient  information  from  the  supervising  nurse  to 
satisfy  yourself  that  there  has  been  no  miscarriage  of  justice. 

As  long  as  the  supervising  nurse  is  satisfactory  to  you, 
you  should  sustain  her  autliority  on  all  occasions.  If  at 
any  time  her  services  are  unsatisfactory,  she  should  be  re- 
lieved from  further  duty,  a  temporary  supervisor  appointed 
in  her  stead  and  this  office  notified  by  cable. 

A  letter  written  to  one  of  her  supervisors,  April  28,  1915, 
outlined  Miss  Delano's  interpretation  of  these  instructions : 

It  seems  to  me  consistent  and  necessary  for  discipline  that 
the  director  have  the  power  of  removal  of  the  doctors  serving 
under  him  and  of  the  supervising  nurse  of  the  unit.  So 
long  as  the  supervising  nurse  remains  in  charge  of  the 
nurses  in  the  unit,  any  recommendation  made  by  her  should, 
I  think,  be  accepted  by  the  medical  director  without  question. 
All  the  dealings  of  the  medical  corps  with  tlie  nurses,  ex- 
cept in  the  matter  of  orders  for  patients,  should  be  absolutely 
through  the  supervising  nurse  and  she  should  he  held 
responsible  for  the  discipline  and  maintenance  of  order  of 
the  nurses  under  her.  Any  recommendations  for  the  removal 
of  a  nurse  should,  however,  be  made  by  the  supervising  nurse 
through  the  medical  director,  unless  he  should  refuse  to  for- 
ward this  recommendation.  Under  these  circumstances,  I 
think  the  su])ervising  nurse  would  be  quite  justi(i<Ml  in  com- 
municating with  me  direct,  although  every  effort  should  be 
made  to  come  to  an  agreement  with  the  medical  director 
in  regard  to  the  recommendation  so  that  after  ac'tion  was 
taken,  tlie  supervising  iiurse  could  be  sure  of  his  support 
and  approval. 


THE  MERCY  SHIP  213 

Miss  Delano  was  iindoviating  in  her  support  of  the  super- 
visors, even  recommending  the  immediate  recall  of  individual 
nurses  whose  complaints  had  first  brought  about  the  loss  of 
harmony.  The  following  statement  of  IVIiss  Delano's  reasons 
for  her  support  of  the  supervisors  was  contained  in  a  letter 
written  by  her  to  the  supervisor  of  several  nurses  who  had 
been  relieved  from  duty  at  the  end  of  six  months: 

I  think  tliey  were  a  little  surprised  to  find  me  waiting  for 
them  on  tlie  dock,  but  in  spite  of  that  they  seemed  glad  to 
see  me.  I  asked  them  to  report  to  Red  Cross  Headquarters 
as   soon   as   they   had   arranged  for  the   inspection   of   their 

1 11  "■"'M  ""O 

They  came  quite  willingly.  I  asked  them  to  tell  me  exactly 
what  their  diHiculties  had  been.  jSTo  one  seemed  particularly 
anxious  to  talk  and  it  was  only  after  more  or  less  questioning 
that  they  began  a  discussion  of  the  matter.  I  was  really  sur- 
prised at  the  little  they  had  to  say.  I  ex])lained  to  them  my 
idea  of  the  relation  which  should  have  existed  between  nurses 
and  the  director  and  that  the  su])ervis()r  represented  as  far 
as  they  were  concerned  the  authority  of  the  Eed  Cross,  acting 
in  my  place. 

I  also  told  them  that  I  felt  under  obligation  to  support 
to  the  last  any  supervising  nurse  unless  some  definite  charges 
could  be  broivght  against  her,  that  it  was  not  a  question  of 
the  individual  but  of  the  principle  and  that  1  should  have 
supported  any  one  of  them  with  equal  willingness  had  they 
been  selected  as  supervising  nurse.  This  seemed  to  aj)pcal 
to  them  as  reasonable  and  just  and  1  am  hoping  that  they 
went  home  with  rather  a  different  idea  of  their  relation  to 
the  Eed  Cross  Nursing  Service. 

Of  the  seven  nurses  who  were  relieved  from  duty  for  in- 
subordination, she  wrote:  "I  have  not  seen  ]\liss  nor  do 

I  intend  to  do  so  until  you  are  in  this  country.  Xothing  will 
be  done  about  disenrollment  until  both  sides  of  this  qu(>stion 
are  heard."  A  letter  to  a  nurse,  a  close  friend,  who  ditfered 
radically  in  o])inion  from  the  medical  director  of  her  unit, 
illustrated  Aliss  Delano's  impartiality,  a  quality  which  com- 
manded the  respect  of  all  who  kn(nv  her  well : 

I  wish,  however,  to  tell  you  exactly  what  I  said  to  ^lajor 
Patterson,  so  that  you  may  understand  my  position.  Of 
course,  1  know  (and  so  do  you)  that  sonnet inies  you  are  a 
little  '"(litru-ult;""  liut   1   realize  that  in  this  inciilciit   ihciT  liad 


214    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

been  (^reat  provocation  and  I  think  that  you  know  me  well 
enough  to  feel  sure  that  I  have  only  the  good  of  the  service 
at  heart,  even  though  this  meant  the  sacrifice  of  my  dearest 
friends.  I  have  said  that  I  would  not  consent  to  your  re- 
turn, except  on  your  own  request,  until  the  arrival  of  the 
new  medical  director.  If,  when  he  has  looked  all  the  ground 
over,  he  feels  that  your  relief  will  be  a  benefit  to  the  service, 
I  shall  be  willing  to  accept  his  recommendation. 

Had  there  been  time  on  the  part  of  Jiational  Headquarters 
to  establish  a  definite  plan  of  organization  and  communica- 
tion before  the  units  sailed,  much  discouragement  and  unhap- 
piness  would  have  been  avoided  when  the  units  found  them- 
selves face  to  face  with  these  difficulties  in  the  far  corners  of 
Europe.  Miss  Delano  appreciated  keenly  her  share  of  this 
responsibility.  In  a  particularly  trying  instance,  she  wrote  to 
one  of  her  supervisors  with  singular  tenderness  and  sympathy : 

I  do  not  wish  you  to  feel  in  any  way  that  your  work  has 
been  in  vain.  I  am  most  unreconciled  that  things  have  been 
allowed  to  drift  along  to  such  a  futile  ending,  but  if  you 

have  had  difficulties  in ,  I  certainly  have  not  been 

free  from  them  at  this  end.  Xever  for  one  moment  have  I 
faltered  in  my  support  of  you  and  your  policy,  nor  have 
I  doubted  for  one  moment  that  all  would"  have  been  well  if 
you  had  received  from  the  beginning  the  support  due  you, 
not  only  professionally  but  personally. 

Your  letter  of  discouragement  makes  me  feel  as  if  I  had 
failed  you.  1  have  taken  the  liberty  of  reading  the  paragraph 
of  your  letter,  in  which  you  ask  to  be  transferred  to  another 
country  as  one  of  the  "rank  and  file"  to  ^liss  Boardman.  It 
may  comfort  you  a  little  to  know  that  she  regrets  as  much 
as  1  do  all  tlie  unpleasant  experiences  you  have  met. 

Two  years  later,  _Mis3  Delano  said  to  Miss  Hay,  then  re- 
turned from  Europe,  '"Xo  one  will  ever  know  the  difficulties 
I  had  in  trying  to  support  you  supervising  nurses,  nor  what 
^fiss  Boardman  has  done  in  trying  to  secure  for  nurses  the 
proper  relationship  and  authority  which  she  felt  was  due  the 
Xursing  Service  in  th(>  K(h1  Cross  organization." 

Among  the  mass  of  corrospondcnce  at  Xational  IIoad(|uarters 
which  contains  the  history  of  the  ^lercy  Ship,  there  appears 
only  one  letter  of  derogatory  criticism  of  the  nurses  as  a  whole. 
This  estimate  was  aiven   bv  a   British  ^Matron  and   it  will  be 


THE  MERCY  SHIP  215 

appreciated  that  she  was  prejudiced  to  some  degree  by  national 
ditlerences  in  training,  precedent  and  temperament  which  placed 
the  American  nurses  working  under  her  in  a  strange  environ- 
ment, at  grave  disadvantage:  ''I  think  few  of  them  have  the 
real  nursing  instinct  or  love  of  humanity  about  them,"  the 
British  nurse  wrote,  ''they  are  keen  on  their  own  comfort. 
Their  theory,  I  thought,  seemed  better  than  ours,  but  their 
practice  not  nearly  so  finished  as  that  of  a  good  English  nurse. 
Their  discipline  was  nowhere  and  their  independence  too  awful." 

]\Iiss  Dehino  responded:  "1  am  always  glad  to  hear  both 
sides  of  a  question  and  will  take  up  the  matter  with  the  super- 
visors in  charge  of  these  units.     The  service  at  has  also 

tried  the  very  souls  of  our  nurses." 

National  Headquarters  recalled  fourteen  of  the  foreign  units 
October  1,  1915.  Belgian  Units  Xos.  1  and  2  remained  at  La 
Panne  until  the  completion  of  a  year's  service.  The  Yvetot 
Unit  was  no  longer  under  the  American  Red  Cross.  In  the 
Annual  Report  for  1915,  JMajor  Patterson  stated  the  reasons 
for  recalling  the  surgeons  and  nurses  of  the  Mercy  Ship: 

As  the  war  liad  been  in  progress  for  nearly  a  year,  it  was 
felt  that  the  sanitary  service  of  the  various  belligerent 
countries,  as  far  as  personnel  was  concerned,  should  be  well 
organized  and  that  with  few  exceptions  they  were  in  such  a 
position  that  further  assistance  of  surgeons  and  nurses  from 
the  American  Ked  Cross  was  no  longer  greatly  needed.  This 
was  not  true,  however,  regarding  supplies,  which  it  was  felt 
would  steadily  diminish.  These  would  be  increasingly  diffi- 
cult to  obtain  and,  therefore,  would  continue  to  be  needed  in 
varying  amounts  by  all  warring  countries. 

The  money  that  otherwise  would  be  required  for  the  pay- 
ment of  salaries,  travel  and  other  necessary  expenses  would 
be  saved  and  tlie  funds  thus  released  would  be  available 
to  continue  tlie  ])ur(hase  of  medical,  surgical  and  other  hos- 
pital supplies  for  the  Ked  Cross  societies  of  the  belligerents 
for  many  months. 

Although  she  had  expressed  a  fervent  hope  that  the  nurses 
sli(uild  return  immediately  to  the  United  States,  Miss  Delano's 
interest  and  encouraging  letters  followed  many  of  them  through 
their  further  service  in  Europe.  Four  nurses  remained  on 
official  fori'ign  duty  in  Serbia  and  Bulgaria.  ^Imc.  Slavko 
Grouitcli,  wife  of  the  rnder-S(M'retarv  of  Uoreigii  Affairs  in 
.S(>rl)ia,  had  recjuested   in  duly,   1915,  that  the  American  Red 


216    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Cross  organize  a  unit  of  two  doctors  and  two  nurses  to  estab- 
lish in  Nisli  a  hospital  for  infants  and  young  children.  Funds 
raised  bv  Mme.  Grouitch  were  turned  over  to  the  Red  Cross 
to  defray  expenses.  With  Dr.  Louise  Taylor  Jones,  of  Wash- 
ington, D.  C,  as  director,  Dr.  Catherine  Travis,  New  Britain, 
Connecticut,  as  assistant,  ]\Irs.  Maud  Metcalf,  of  Bellevue 
Hospital,  and  Miss  Grace  Utley,  of  Hahnemann  Hospital,  New 
York  City,  as  the  nursing  personnel,  the  Mabel  Grouitch  Baby 
Hospital  was  opened  Augiist  20,  1915,  at  Nish,  Serbia,  there 
to  exist  for  a  few  brief  crowded  months. 

Dr.  Jones  had  started  the  dispensary  under  canvas.  The 
main  building  was  opened  October  1.  Mme.  Grouitch  de- 
scribed this  tirst  Serbian  baby  hospital : 

The  Serbian  Government  has  given  us  a  really  nice  build- 
ing, the  former  Old  Peoples'  Home.  Over  three  hundred  cases 
have  been  treated  in  the  dispensary  during  these  first  five 
weeks.  Women  walk  all  night  from  remote  villages  to  bring 
their  children.  It  is  heart-breaking  to  see  the  wretched, 
absolutely  starved  little  bodies  and  the  fearful  cases  of  hernia 
due  to  the  poor  mother  and  baby  having  been  uncared  for  at 
birth. 

The  white  enameled  cribs  and  beds  are  the  delight  and 
wonder  of  all.  The  diet  kitchen  with  its  stove  and  special 
arrangements,  was  marveled  at  with  almost  religious  awe 
bv'  the  peasant  women  who  heard  for  the  first  time  of  the 
necessary  care  in  the  preparation  of  their  children's  food. 
The  store-room  was  viewed  with  that  respect  always  given 
to  abundance  by  very  poor  people. 

In  September,  1915,  after  the  hospital  and  clinic  were  well 
established,  Dr.  Jones  returned  to  the  United  States,  leaving 
Dr.  Travis  in  charge. 

In  addition  to  being  a  hospital  center  boasting  eleven  mili- 
tary and  civilian  institutions,  Xish  was  the  seat  of  the  Serbian 
Government.  In  nearby  Kraguyevatz  were  located  the  arsenals. 
A  member  of  the  Grouitch  Baby  Hospital  described  the  move- 
ments of  the  Serbian  troops: 

For  ten  days  the  trains  bave  been  constantly  transporting 
soldiers  to  tbo  Bulirarian  frontier,  train  after  train,  day  and 
nigbt.  Miles  of  men  niarcli  tbrough  Xish.  I  have  waved 
to  tbem  from  tbe  bill  wbcre  our  clinic  is  sitnatcd  and  tboy 
answer  with  a  shout.     At  five  o'clock  one  morning,  in  the 


THE  MERCY  SHIP  21T 

pouring  rain,  a  train  filled  to  the  guards  passed  by  with 
soldiers  standing  in  straw  on  open  freight  ears,  all  singing 
at  the  top  of  their  lungs:  "There  is  my  Serbia;  There  is  my 
home !" 

If  the  wounded  are  brought  back  to  Nish,  our  Baby  Hos- 
pital will  at  once  be  turned  into  a  military  one.  I  know  we 
shall  take  care  of  the  grown-ups  with  as  much  zeal  as  we  give 
the  babies.  Even  if  we  have  soldiers  in  every  bed  and  on  straw 
stacks  in  the  halls,  we  will  keep  the  clinic  going  for  the 
mothers. 

The  Austrian-Bulgarian  offensive  was  hurled  against  Ser- 
bia early  in  October,  11)15.  The  Mabel  Grouitch  Baby  Hos- 
pital became  a  field  ambulance  October  13  and  with  mem- 
bers of  the  sanitary  commission  hastened  to  the  front.  Grace 
Utley  described  the  flying  squadron  of  mercy: 

For  ten  days  we  were  on  the  firing  line,  giving  First  Aid 
to  the  wounded  on  the  field.  This  sometimes  meant  imme- 
diate am))utati()n  of  a  limb,  operation  on  the  brain,  emergency 
surgery  of  all  kinds.  The  bravery  of  tlie  men  was  magnificent; 
for  some,  one  prayed  for  swift  death. 

We  saw  the  big  guns  silence  two  batteries.  The  cannonade 
of  the  Austrians  and  Germans  was  a  solemn  thing  to  hear. 
We  evacuated  before  the  on-coming  enemy;  moving  back  a 
station,  we  set  up  our  tents  anew  for  the  wounded,  so  that 
our  "Front"  was  a  constantly  changing  one. 

We  now  await  here  in  Nish  the  arrival  of  the  Bulgars, 
the  Turks,  the  (Germans.  Many  places  around  us  have  fallen; 
our  turn  comes  soon.  The  Baby  Hospital  under  the  Stars 
and  Stripes  and  the  Red  Cross  flag  goes  on  until  we  are 
called  again  to  the  front;  or  until  the  floods  of  wounded 
turn  this  into  a  military  hospital;  or  until  the  Bulgars  shall 
order  us  on  our  walk  with  tliousands  of  other  refugees  to  a 
port  where  a  ship  will  take  us  home;  or  until  we  shall  be 
taken  prisoners  of  war. 

Of  the  lawlessness  which  broke  out  in  Nish  immediately 
before  the  Bulgarian  occupation,  Miss  Utley  wrote: 

Tlie  storehouses  not  under  American  jurisdiction  in  Xisli 
were  thrown  open  to  the  puhlic.  The  i)lace  where  automobiles 
were  kept,  as  well  as  any  other  things  that  could  he  of  use 
to  the  enemy,  were  hurned  uj).  Casks  of  wine  were  broken 
open  and  people  carried  it  into  tlieir  houses  in  ])itchcrs.  ])ails. 
or  anv  utensil   handv.     ^luch  of  it  streanu'd  over  the  mud. 


218   HISTORY  OP  AMERICAN  RED  CROSS  NURSING 

Even  little  children  were  drunk  in  a  short  time.  Some  of  the 
people  broke  the  windows  of  their  own  shops  and  carried 
away  things  without  discrimination,  or  simply  destroyed 
them.  The  powder  magazines  were  blown  up  at  one  o'clock  in 
the  morning  of  the  fourth  of  Xovember.  Add  to  the  terrific 
explosions  the  constant  crackling  sound  of  the  flames  as  they 
licked  up  the  gunpowder;  the  sight  of  mighty  towers  of 
solid  flame  here  and  there  and  at  intervals  a  fresh  explosion ! 
One  can  realize  fully  how  it  might  affect  men  who  were  ill 
and  weak  and  helpless.  For  a  short  time  we  had  almost  a 
panic  within  our  compound. 

Of  their  sole  protection,  Maud  Metcalf  wrote: 

Upon  our  return  from  the  front,  we  were  requested  to 
take  over  a  military  hospital  filled  with  wounded  Serbians. 
We  went  out  to  its  crowded  wards  one  wet  dreary  afternoon 
and  by  the  next  morning  all  the  officials  had  left,  leaving  us 
with  1100  patients.  We  were  not  the  most  cheerful  people 
in  the  world.  To  our  dismay,  moreover,  we  found  that  we 
were  left  without  an  American  flag. 

I  M'alked  three  miles  to  a  village  to  find  all  the  stores 
closed  and  their  windows  tightly  boarded  up.  After  a  great 
deal  of  talk,  a  shop-keeper  pulled  down  one  board  and  let 
me  in.  I  bought  some  red  and  white  sateen  and  a  little  square 
of  blue  cloth.  Back  I  hurried  to  the  hospital  and  we  pro- 
ceeded to  make  a  flag,  the  other  members  of  the  unit  cutting 
out  stars  while  I  sewed  the  stripes  together.  All  of  us  won- 
dered what  our  fate  would  be.  I  sat  up  all  night  to  finish  it 
and  in  the  morning  wo  cut  off  a  limb  of  a  tree  for  a  pole,  nailed 
the  flag  to  it,  fastened  the  pole  to  a  window  frame  and  there 
it  hung  through  sunshine  and  storm  for  five  months  while 
we  stayed  at  our  post. 

At  half-past  ten  o'clock  on  the  night  of  Xovember  7,  1015, 
the  Bulgars  and  Turks  captured  Xish  and  on  the  next  day  the 
Germans  came  in,  00,0(10  strong.  The  military  hospital,  flying 
the  American  and  lied  Cross  flags,  remained  unharmed  and 
the  nurses  and  surgeons  eared  without  discrimination  for  the 
wounded  of  both  the  Allied  and  the  Central  Powers. 

National  Headquart(>rs  cabled  the  recall  of  the  ^[abel  Grou- 
itch  IJaby  Welfare  Unit  in  X()vend)er,  1015.  :\laud  2^Ietcalf 
reported  in  December  to  Helen  Scott  Hay  in  Sofia.  Grace 
Utley  and  the  other  Amcu'icans  returned  home  during  1016 
after  many  delavs. 


THE  MERCY  SHIP  219 

During  the  snmmor  of  1015,  Helen  Scott  Hay  and  Rachel 
Torranc(^  had  undertaken  in  Sofia,  Bulgaria,  under  gracious 
(^ueen  Eleanora's  protection,  the  organization  of  the  training 
school  first  proposed  in  1013.  Before  taking  up  the  details 
of  this  project,  it  is  of  interest  to  read  Miss  Hay's  characteriza- 
tion of  its  sponsor: 

What  Queen  Elizaocth  was  to  Hungary,  that  was  Eleanora 
to  her  adopted  country, — a  woman  whose  constant  thought 
was  for  the  help  of  her  j)eople.  But  for  her  wisdom  and  in- 
comparable strength  and  fearlessness,  the  small  though  con- 
vincing demonstration  of  good  nursing  methods  in  hospitals 
and  in  home  would  not  have  been  possible  in  Bulgaria  in 
1915  nor  j)robably  for  long  years  to  come. 

Of  the  German  house  of  Keuss  and  brought  up  near  Vienna, 
her  family,  father,  brothers  and  sisters,  were  all  iioted  for 
their  kindness  and  gcnerosit}-.  Her  concern  for  the  sick  be- 
gan when  the  parisli  priest  taught  her  the  simple  remedies 
which  she  applied  in  care  of  the  sick  poor  of  the  neighbor- 
hood. In  the  Kusso-Japanose  War,  she  had  good  opportunity 
to  learn  the  value  of  skilled  nursing.  During  the  Balkan 
Wars,  she  as  Queen  was  head  of  the  Bulgarian  Eed  Cross 
and  then  indeed  the  lack  of  good  nurses  and  good  nursing 
schools  was  impressed  upon  her.  That  she  at  once  began  to 
plan  how  this  defect  might  be  remedied  is  characteristic  of 
her  sympatlietic  desires  for  her  people  and  of  her  indefatigable 
purpose.  .  .  . 

In  her  manner,  she  was  simple  and  without  ostentation 
and  repeatedly  surprised  even  her  best  friends  by  her  sound 
wisdom  and  good  sense.  There  was  nothing  of  the  dilettante 
about  her.  in  questions  of  curriculum  and  discipline,  she 
would  have  been  a  helpful  speaker  in  any  group  of  nurse  in- 
structors. .  .  .  No  detail  was  too  insignificant  for  her  at- 
tention if  it  meant  someone's  happiness  or  added  comfort. 
A  village  wedding,  an  insane  soldier,  the  ambition  of  an  or- 
phan girl  for  an  education, — everything  that  would  help  she 
did  at  once.  Schools  for  the  deaf  and  dumb,  help  for  the 
blind,  care  and  cure  of  the  tubercular,  a  thousand  interests 
big  and  little  were  hers  and  of  her  strength  and  her  means 
she  gave  to  the  utmost.  .  .  . 

Two  other  women  instrumental  in  the  organization  of  the 
''Queen's  School"  were  Madame  l>aknietietl',  Avife  of  the  Bul- 
garian di])lomat  who  was  latiu-  Amhassiidor  to  the  Fnited  States. 
an(i  Miss  Inez  Abbott,  directf.ti'  <.>f  the  Girls'  Scho(_)l  in  Samakov. 


220  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Hay  wrote  of  her  assignment  to  Bulgaria   and  her 
reception  there : 

To  Kief  early  in  1915  came  Mr.  Bieknell  from  Bulgaria, 
where  Queen  Eleanora  had  discussed  with  him  her  ardent  de- 
sire to  see  the  School  established,  even  though  the  times  con- 
tinued unpropitious.  As  I  was  then  about  to  return  to 
America,  Mr.  Bieknell  felt  that  I  should  go  to  Sofia  and 
acquaint  myself  witli  conditions  there;  so  early  in  June,  1915, 
I  went  to  Sofia  with  the  understanding  that  my  mission  was 
only  to  inform  myself  of  conditions  such  as  would  be  helpful 
should  the  School  project  be  resumed  later. 

From  the  moment  of  my  arrival  in  Sofia,  the  Queen  was 
most  hospitable.  .  .  ,  During  the  weeks  which  followed,  I 
visited  the  Alexander,  Wed  Cross  and  Clementina  Hospitals, 
met  numerous  men  and  women  favorable  and  unfavorable  to 
our  plan  and  had  many  conferences  with  the  Queen.  At  this 
time  Bulgaria  seemed  to  me  to  be  singularly  peaceful  com- 
pared with  tbe  military  Eussia  I  had  just  left.  True,  she  was 
still  weary  from  the  Balkan  Wars  and  who  could  tell  what 
the  King,  Cabinet  or  ^Minister  might  do  when  faced  with 
the  increasingly  complicated  situation  due  to  the  European 
War? 

Scarcely  had  my  first  week  in  Bulgaria  passed  before  I 
found  that  the  Queen  was  arriving  at  the  same  conclusions 
I  held :  that  the  need  was  beyond  question  and  that  the  time 
was  as  o})portune  as  it  was  ever  likely  to  be.  "You  are 
here,''  she  said,  "and  \vc  should  begin  at  once.  There  will  be 
big  difficulties  and  much  opposition  but  my  shoulders  are 
broad." 

The  plans  proposed  months  before  in  Washington  were 
that  the  Alexander  (the  Government)  Hospital  of  1000  beds 
should  1)0  used  for  the  jiractical  training  and  that  in  turn  the 
Hospital  would  pro\i(le  Inrdvd  and  lodging  for  the  entire 
School  besides  a  stipend  of  10  levs  monthly  for  each  ])upil. 
The  Samaritan  Society  of  Sofia  were  to  provide  uniforms 
and  textbooks  and  to  work  to  secure  funds  for  a  permanent 
nurses'  home.  But  times  had  changed  and  interest  shifted 
and  the  only  concession  whicli  tlie  Queen  could  get  for  the 
Schofd  after  days  of  weary  effort  was  the  nursing  care  of  one 
pavilion  and  tliat  without  return  of  any  sort.  A  private 
house  in  the  nei,i:hborho()(|  -aas  secured  for  the  nurses'  home, 
was  fitted  and  furnislied  in  exquisite  taste  under  her  per- 
sonal direction  and  ail  expenses  with  it,  with  the  pupils'  gen- 
erf)us  uniform  allowance  and  other  items  came  trom  the 
(Queen's  ])rivate  purse. 


THE  MERCY  SHIP  221 

On  September  15,  the  School  was  opened  with  Miss  Hay  as 
Director  and  Rachel  Torrance  as  assistant.  The  pupils  num- 
bered eight;  one  of  them  had  had  full  college  training;  two 
had  had  two  years  in  college ;  two  others  were  graduates  of 
high  schools  and  the  rest  had  had  some  years  in  high  school. 
All  were  Bulgarian  and  all  but  one  spoke  English.  A  course 
of  study  covering  two  years  and  corresponding  to  the  "Standard 
Curriculum"  had  been  adopted  by  Miss  Hay. 

Of  the  fortunes  of  the  School,  Miss  Hay  wrote: 

On  the  very  fust  morning  of  classes,  the  Queen  brought  us 
the  news  that  Bulgaria  was  on  the  eve  of  mobilization,  having 
thrown  in  her  fortunes  with  Germany  and  Austria.  We  must 
therefore  place  our  pupils  at  once,  she  said,  in  the  Alexander 
Hospital  to  assist  in  caring  for  the  soldiers.  I  begged  for  a 
few  weeks,  even  a  few  days,  for  preliminary  training  and  we 
were  able  to  give  almost  a  month  to  it.  In  the  excitement  of 
a  nation  going  to  war,  no  wonder  we  found  our  pupils  un- 
usually apt !  All  day  long  they  made  beds  and  poultices,  gave 
each  other  baths  and  simple  treatments  to  the  music  of  a 
military  band  or  of  fife  and  drum  that  in  the  parade  ground 
hard  by  was  continually  welcoming  troops  of  war-weary  vet- 
erans and  exuberant  recruits  pouring  in  from  all  quarters  ol 
the  kingdom. 

Then  fighting  began  of?  to  the  West  and  North  and  we 
made  ready  our  pavilion  at  Alexander  Hospital.  As  a  good 
nurses'  school,  we  must  stand  for  the  highest  standards  of 
cleanliness  and  order.  Scarcely  was  the  last  yard  of  paint 
scoured  white,  the  last  toilet  made  spotless,  the  last  bed 
benzined,  however,  when  the  German  lied  Cross  with  doctors, 
nurses  and  vast  supplies  began  arriving  in  Sofia  to  take  over 
the  direction  of  all  military  hospitals  in  Bulgaria.  To  Alex- 
ander Hospital  came  the  chief.  Dr.  Goldammer,  and  his  as- 
sistants. With  our  pupils  we  were  left  the  nursing  care  of 
our  pavilion,  l^ut  not  for  long  were  we  allowed  to  enjoy 
our  clean  quart(>rs.  A  nurses'  school  meant  to  the  (icrinan 
direction  undesirable  complications  and  (most  obnoxious  I) 
division  of  autbority  and  they  would  have  none  of  that.  So 
with  tbank-yous  and  good  wishes  all  around,  our  School  was 
transferred  to  Foteenoff  Hospital  nearer  the  center  of  the 
city. 

FoteenofT  Hospital  was  under  the  Queen's  control  and  was 
directed  by  a  sympathetic  Bulgarian  physician,  Dr.  Micliael- 
ovsky.     For  five  months,  the  "Queen's  vSchool"  flourished  there, 


222   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

but  early  in  191G  Dr.  ]\Iichaelovsky  grew  ill  and  a  German 
physician  was  put  in  charge  and  German  Sisters  were  installed 
in  the  operating-room.     Miss  Hay  wrote: 

These  were  the  days  of  increasing  animosity  between  Ger- 
mans and  Americans.  Moreover,  German  methods  of  train- 
ing are  wholly  different  from  ours.  And  again  arose  the 
question  of  divided  authority.  Sad  it  was  but  unquestionably 
true  that  the  building  up  bi  a  good  nurses'  school  under 
American  methods  was  not  then  feasible.  The  Queen,  too, 
came  to  the  same  conclusions,  probably  on  account  of  the  in- 
creasing opposition  of  the  King  and  Prime  Minister  to  her 
giving  any  longer  her  favor  and  protection  to  Americans. 
So  the  transfer  of  the  pupils  of  our  school  was  made  and 
back  they  went  to  the  Alexander  Hospital.  .  .  . 

However,  the  Queen  was  not  the  one  to  relinquish  easily  a 
project  as  dear  to  her  as  was  the  introduction  of  American 
nursing  methods  in  her  country,  so  she  begged  Miss  Torrance 
and  me  to  remain  in  Bulgaria  so  that  the  School  might  l)e 
resumed  speedily  as  soon  as  the  war  was  over.  Even  if  the 
Germans  did  not  further  desire  our  services,  there  were  many 
Bulgarians  whom  she  felt  we  might  assist.  And  was  it  not 
to  help  these  that  we  had  come  to  Bulgaria?  Ami  so  it  was 
decided  that  we  could  help  most  effectually  in  the  care  of  the 
refugees.  In  Phili])opolos,  second  city  of  Bulgaria  in  size, 
with  a  normal  population  of  60,000  there  were  a  large  number 
of  refugees,  some  the  remnants  of  other  Balkan  Wars,  others 
just  arriving  from  the  Greek  and  Macedonian  fronts  where 
fighting  had  already  begun. 

National  Headquarters  cabled  its  approval  to  the  change  in 
assignment  and  authorized  ]\Iiss  Hay  and  ]\Iiss  Torrance  to 
spend  their  small  balance  of  five  hundred  dollars  in  general 
relief  work.     Miss  Hay  wrote : 

The  plan  was  that  we  should  work  in  cooperation  with  the 
American  missionaries  under  the  American  Board;  their 
long  residence  made  them  familiar  with  local  needs.  We 
were  attached  to  a  local  women's  organization,  the  Samari- 
tans, which  endeavored  to  find  the  neediest  sick  and  supplied 
them  with  milk  and  eg,<,^s.  The  women  in  tliis  grou})  under 
the  aide  U'adershi])  of  .Airs.  Stephen  Kaltcheff,  stood  sponsor 
for  us.  two  stran<re  Americans,  ami  muloubtedly  their  intro- 
duction went  far  to  arouse  for  us  feelings  of  respect  and. 
confidence. 


THE  MERCY  SHIP  223 

In  the  disorganization  of  war  days,  there  were  virtually 
no  other  social  agencies  with  which  to  cooperate.  During  our 
stay  in  IMiilipopolis,  a  union  was  eflVcted  of  several  groups 
representing  the  several  religions  of  that  cosmopolitan  city, — 
Jew,  Pravo-Slav,  Catholic,  Armenian,  Protestant,  Moham- 
medan,— and  funds  were  collected,  though  our  work  really  had 
little  helj)  therefrom.  Intentions  were  of  the  best  but  the 
ideas  we  stood  for  were  new  to  the  Oriental  mind  which  could 
not  be  expected  to  act  upon  such  short  notice. 

Jn  Philipopolis,  there  were  two  physicians  for  the  city  poor, 
but  with  enormous  clinics  daily  and  with  the  work  of  sani- 
tary ofhcers  for  a  prodigious  area,  they  could  give  little,  very 
little,  individual  attention  to  anyone  and  the  person  too  ill 
or  otherwise  unable  to  drag  himself  weary  miles  up  the  hill 
to  the  clinic  must  get  along  without  the  assistance  of  a 
physician.  Therefore,  after  the  city  had  been  divided  into 
six  main  parishes,  each  of  us  undertook  to  cover  three  of 
them  as  best  we  could.  Through  the  "poor  lists"  supplied  by 
the  mayor's  office,  the  advice  of  the  parish  priest,  rabbi  or 
!Mohanmiedan  hodji,  we  were  able  to  find  and  to  assist  many 
of  the  most  needy.  At  first  we  sought  them.  Soon  they 
sought  us  and  after  that  the  question  was  how  much  we 
could  manage  to  give  to  all  who  needed  help. 

The  needs  and  problems  were  legion  and  it  took  careful 
planning  to  make  our  efforts  most  effectual.  The  distances 
were  long;  there  were  no  streetcars  or  Fords  and  the 
Turkish  cobblestones  or  foot-deep  mud  was  wearisome.  Our 
clientele  was  a  motley  one, — as  varied  as  the  patches  in 
our  Turkish  Fatimah's  ragged  and  voluminous  trousers. 
Eesident  Bulgarians,  Spanish,  Jews,  Greeks,  Turks  and 
gypsies;  refugees  from  Macedonia,  Greece,  Turkey,  Serbia, 
Poumania,  each  holding  himself  still  a  good  Bulgarian  but 
marked  in  dress,  in  custom  and  often  in  religion  ])y  the 
land  of  most  recent  sojourn.  The  Wallachian  nonuids 
with  their  flocks  and  herds  were  frequently  in  our  district, 
always  knitting,  knitting,  on  horseback,  or  walking  or  stand- 
ing gossiping  with  their  neighbors  ...  To  know  and  be- 
come a  useful  though  a  very  small  part  in  the  lives  of  all 
these  kindly,  neiMly  folk  was  an  experience  interesting  indeed 
beyond  my  power  to  tell. 

Evorv   season   sccnicd   to  bring  forth    its  special   difficulties 
and  its  spcn-ial  crop  of  "miseries."     ^liss  Ilay  continued: 

Xo  sooner  had  wo  gotten  the  (epidemic  of  boils  under  control 
than  mumps  and  whooping-cough  came  along;  always  we  had 


224   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

scabies  and  malaria;  and  starvation  that  showed  in  the  waxy 
ashen  faces  everywhere.  Rations  were  becoming  more  and 
more  scarce  and  with  the  cold  months,  the  great  need  of  soup 
kitchens  was  evident.  And  then  came  to  us  from  our  blessed 
American  Red  Cross  the  sum  of  five  thousand  dollars,  a 
princely  gift  indeed !  At  once  we  secured  and  salted  down 
three  big  hogs,  bought  up  potatoes,  onions  and  beans  and  be- 
gan to  unwind  the  endless  meters  of  red  tape  necessary  to 
procure  through  the  military  authorities  flour  for  our  bread 
to  be  served  with  the  soup.  Securing  kitchens  and  needed 
equipment  was  well  under  way  when  came  a  thunderbolt, — 
we  were  recalled  to  America.  Facing  the  inevitable,  funds 
and  the  soup  kitchens  were  put  in  the  hands  of  a  strong  com- 
mittee who  were  able  to  extend  their  usefulness  over  the  worst 
of  two  winters.  Visiting  nursing  was  given  over  to  three 
Bulgarian  young  women,  one  of  whom  had  acted  as  our 
interpreter  and  assistant.  Two  of  our  old  pupils  from  Sofia 
assisted  for  a  time  and  were  succeeded  by  others  from  the 
Sofia  School  for  two  years  or  more  until  lack  of  funds  made 
necessary  the  closing  of  the  activities. 

Looking  back  over  our  work  in  Bulgaria  certainly  we  saw 
it  not  as  we  had  planned;  it  seemed  unfinished  and  sketchy, 
the  field  too  enormous  for  satisfactory  accomplishment.  But 
we  had  helped  in  a  time  of  great  need  and  that  which  we  had 
done  in  the  Nurses'  School  and  in  our  demonstration  of  visit- 
ing nursing  was  to  create  a  desire  in  the  minds  of  the  people 
for  American  methods  of  skilled  nursing. 

Of  the  resolute  Queen,  Miss  Hay  wrote : 

To  Queen  Eleanora,  it  was  a  sincere  grief  that  war  condi- 
tions interrupted  the  development  of  the  School.  Still  more 
disappointing  was  it  when  we  were  recalled ;  for  as  long  as 
we  were  in  Bulgaria,  she  felt  that  we  could  resume  the  School 
as  soon  as  the  war  was  over.  Her  optimism  and  consuming 
wish  speak  out  in  the  last  letter  received  from  her:  "God 
grant  that  the  work  established  by  you  may  grow  and  remain 
in  good  form,  "til  in  better  times  helpful  American  hands 
may  work  at  it  again  !" 

In  a  beautiful  garden  beside  an  ancient  church  on  the 
slopes  of  Vitosha,  guardian  mountain  of  Sofia,  lies  the  good 
Queen,  watching  perhaps  as  she  said  she  would,  over  her 
dear  Bulgarian  c-hildren.  Truly  the  memories  of  her  alms 
and  lier  good  deeds  arise  like  sweet  incense  to  immortalize  the 
name  of  Kleanora  of  Bulgaria.  And  as  one  who  gave  the 
impetus  to  adequate  nursing  standards  in  Bulgaria,  she  de- 


THE  MERCY  SHIP  225 

serves  a  worthy  place  in  a  history  of  nursing  accomplish- 
ment. 

Many  other  nurses  had  remained  in  Europe  after  their 
official  recall  in  1915.  Thirty-seven  volunteers  from  the  units 
at  Vienna,  Budapest,  Gleiwitz  and  Kosel  went  into  Russia  and 
Siberia  at  the  request  of  the  German  Government  to  distribute 
relief  to  German  prisoners.  The  Russian  Government  had  a 
similar  project  under  consideration  to  send  American  Red 
Cross  personnel  to  care  for  Russian  prisoners  but  the  plan 
did  not  materialize.  "No  higher  tribute,"  stated  an  editorial 
in  the  American  Journal  of  Nursing  (October,  1915),  "has 
been  paid  to  the  service  rendered  by  our  Red  Cross  workers 
than  this  request  from  two  warring  countries  for  a  continuance 
of  their  services  for  the  benefit  of  prisoners  in  exile." 

Sister  Anna  Reutinger  was  supervising  nurse  of  the  Ger- 
man prison  units.  Dr.  Gary  A.  Snoddy  and  eight  American 
surgeons  composed  the  medical  staff.  Before  this  detachment 
was  relieved  during  the  spring  of  1916,  they  had  visited  and 
distributed  medicines  and  supplies  to  German  prisoners  at 
^foscow,  Ugresh,  Ryazan,  Penza,  Saratov,  Astrakhan,  Samara, 
Orenburg,  Omsk,  Xovo-Nicolaievsk,  Tomsk,  Irkutsk,  Tashkent 
and  Kasan.  Sister  Anna  described  to  Miss  Delano  the  kind  of 
work  accomplished: 

Of  the  uninjured  in  transit,  we  gave  comfort  and  relief  to 
1734  officers  and  11,271  soldiers;  of  the  recently  wounded  and 
ill,  bedridden  and  helpless,  we  aided  788  officers  and  24,46(5 
privates;  of  the  incurables  we  aided  78  officers  and  8436 
soldiers. 

The  evacuation  hospitals  where  invalids  were  concentrated 
were  the  school  buildings.  The  recitation  rooms  and  halls 
were  overcrowded  with  victims  of  advanced  tuberculosis,  their 
beds  closely  ranged  side  by  side.  It  was  estimated  that  eighty 
per  cent  of  the  exchange  prisoners  were  affected  by  this  dis- 
ease, the  White  Plague  indeed !  I  can  never  forget  their 
bloodless  faces,  nor  the  sound  of  their  hoarse  voices  l)e>eech- 
ing  in  wliispering  tones:  "Sister,  do  you  think  I  shall  live  tc 
reach  home?  1  want  only  to  live  one  day  at  home  again  in 
Hungary,"  and  then  the  skeleton  hand  and  arm  would  steal 
from  underneath  the  bed  clothes  in  an  attem])t  to  take  m\ 
hand  and  kiss  it  for  the  solace  and  commiseration  oU'ered 
The  psychopathic  cases  were  usually  melancholia  or  the  busy, 
chattering  type,  the  subject  of  their  mania  being  invariably 
the  horrors  of  war. 


226  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Scurvy  worked  great  havoc  among  the  captives.  We  aided 
856  victims  of  this  disease  whose  teeth  had  fallen  out  and 
who  were  unable  to  walk  from  stiff  and  swollen  joints.  In 
fact,  it  seemed  that  every  sickness  known  to  civilized  man 
found  here  a  ready  prey.  A  major  general  suffering  from 
nephritis  told  me  that  the  lieutenant  general  to  whom  he 
had  surrendered  Avas  a  prisoner  in  his  country  and  on  his 
return  to  his  home  he  would  endeavor  to  have  his  captor  re- 
leased and  sent  back  to  Russia.  "We  are  two  broken  men,"  he 
said,  "with  only  perhaps  a  few  months  more,  which  should  be 
spent  with  our  families." 

We  can  readily  comprehend  the  depths  of  their  despond- 
ency, returning  blind,  crippled  and  ill,  many  of  them  to 
destitute  families  and  many  of  them  to  endure  in  pain  and 
poverty  a  living,  lingering  death.  We  often  wondered  if  our 
twentieth  century  civilization  was  but  mockery,  or  if  it  had 
only  endowed  barbarians  with  more  efficient  and  ruthless 
weapons  and  methods  of  slaughter.  Where,  we  asked,  is  the 
culture,  where  the  loving  message  of  Christianity,  where  the 
humanity  that  can  countenance  such  savage  and  infamous 
cruelties?  The  only  answer  from  this  gruesome  slaughter- 
house of  hopes  and  desires  was  the  pathetic  prayer  of  the 
sufferers  for  peace. 

Although  by  Christmas,  1915,  the  Red  Cross  had  closed  its 
foreign  program,  Miss  Delano,  as  chairman  of  the  National 
Committee  on  Red  Cross  Nursing  Service,  was  in  an  excellent 
position  to  gain  a  bird's-eye  view  of  almost  every  phase  of  war 
nursing.  She  saw  the  American  Ambulance  which  had  been 
established  in  September,  1914,  at  Neuilly,  France,  by  the 
American  Ambulance  Committee  of  Paris.  Here  many 
American  Red  Cross  nurses  were  stationed  with  Margaret  Dun- 
lop  of  the  Pennsylvania  Hospital,  Philadelphia,  as  chief  nurse. 
She  saw  the  first  Harvard  Unit  serving  with  the  British  Ex- 
peditionary Forces  at  General  Hospital  No.  2-3.  The  McGill 
University  and  the  Chicago  ^Medical  units  were  their  close 
neighbors.  From  personal  letters  written  by  Red  Cross  nurses 
scattered  with  other  organizations  in  all  parts  of  the  world,  she 
gathered  wdsps  of  information  about  the  nursing  situation. 
Two  members  speaking  for  the  American  Ambulance  might 
well  have  voiced  the  feelings  of  other  nurses  serving  in  the  war: 

We  never  saw  the  flashing  battle-line,  that  arch  of  bright 
steel  that  stretches  300  miles  l)etween  France  and  Germany, 
we  did  not  hear  the  cannon  or  Ion"-  lines  of  men  cheerin"-  as 


iTHE  MERCY  SHIP  227 

they  swept  into  action,  or  the  dying  horses  scream;  we  saw 
none  of  tlie  pageantry  of  war;  but  we  did  get  a  glimpse  be- 
hind the  scenes  of  its  most  real,  its  most  lasting  part.  We 
saw  the  long  ambulance  trains,  those  "rivers  of  pain"  running 
back  from  tbe  lines;  we  saw  strong  men  sobl)ing  with  agony 
like  children;  we  saw  them  crippled,  dying;  we  saw  their 
women  struggling  alone  against  anxiety  and  poverty,  pale 
women  with  that  look  in  their  eyes  which  comes  of  sleepless 
nights  and  unshed  tears;  we  heard  little  children  crying  for 
the  father's  love  they  will  never  know  again.  All  these  things 
are  the  necessary  routine  of  war.  We  have  seen  and  we  caji 
never  forget." 

At  the  close  of  this  first  early  chapter  of  American  Krd 
Cross  participation  in  the  European  War,  ]\riss  Dehmo  summed 
up  the  value  of  the  service  which  had  been  rendered  by  the 
American  Ked  Cross  nurses : 

Two  hundred  and  fifty-five  nurses  have  been  sent  to  Europe, 
When  we  think  of  the  vast  number  of  sick  and  wounded,  the 
thirty  thousand  patients  cared  for  by  our  units  seems  piti- 
fully small.  T  do  believe,  however,  that  we  have  established 
in  European  countries,  where  modern  training  schools  for 
nurses  have  not  yet  been  organized,  a  definite  standard  of 
nursing,  which  will  surely  produce  results  later. 

Our  nurses  have  had  a  valuable  experience  which  should 
be  of  benefit  to  our  own  country.  They  have  learned  how 
to  care  for  large  numbers  of  patients  all  weary,  ill,  hungry 
and  cold  and  to  make  them  comfortable  in  the  shortest  pos- 
sible time  without  disturbing  the  routine  of  the  hospital. 

ITe  have  learned  that  women  can  be  mobilized  without  con- 
fusion;  that  their  chances  of  illness  when  carefully  selected 
seem  to  l)e  no  greater  than  men's ;  that  they  face  danger  with 
equanimity.  We  have  learned  also  the  special  type  of  nurse 
most  desirable  for  service  of  this  kind. 

Out  of  this  experience  we  should  bo  able  to  do  a  splendid 
piece  of  constructive  work  for  our  own  country.  We  should 
be  able  to  guarantee  a  satisfactory  nursing  personnel  not  only 
for  national  relief  in  time  of  calamity,  !)ut  for  etlicient  service 
should  our  country  be  confronted  with  that  greatest  of  all 
disasters— War.^-^ 

For  the  American  Ived  Cross,  the  first  enthusiasm  of  world 
sympathy  had  s})ent  itself.     But  an  all-shadowing  responsibility 

^'  .[mcrinni  Journal  of  Xiosinf/.  \'()1.  X\'.  ]).  ^iriA. 

'"  Ainciuan  Hrd  Cross  Annual  lU'jiort,  11)1."),  pp.  44-45. 


228   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

loomed  ahead.  Although  popular  inclination  clamored  for 
peace,  men  and  women  at  National  Headquarters  stood  looking 
ahead  to  a  day  not  far  distant,  when  American  men  might 
wait  in  a  welter  of  sand,  mud  and  flesh  as  the  trenches  about 
them  crumbled  under  enemy  fire ;  when  American  boys  might 
lie  in  casualty-clearing  stations  under  a  Mexican  sky  or  in  a 
I'lemish  farm-house,  tearing  at  wounds  in  blessed  delirium  or 
biding  their  turn  in  stoic  consciousness  of  physical  agony. 

War,  dimly  visible  through  diplomatic  and  economic  events 
of  1915  and  1916,  was  hurling  at  the  American  Red  Gross 
the  challenge  of  its  charter  obligation :  Look  to  thine  own ! 


CHAPTER   V 


MOBILIZATION 


National  Headquarters  Reorganizes — The  National  Com- 
niittee  on  Red  Cross  Nursing  Service — The  Committee  on 
Nursing  of  the  Council  of  National  Defense — Special  Courses 
— Special  Groups — The  Army  School  of  Nursing — The  Nurses' 
Drives — Surgical  Dressings — The  Nursing  Surveys. 

The  International  Conference  of  Geneva  in  1863  recom- 
mended "that  there  exist  in  every  country  a  committee  whose 
mission  consists  in  cooperating  in  times  of  war  with  the  hos- 
pital service  of  the  armies  by  all  means  in  its  power."  Suc- 
ceeding to  all  the  rights  and  properties  of  the  earlier  organiza- 
tion, the  American  Red  Cross  was  reincorporated  under  Gov- 
ernment supervision  by  an  Act  of  Congress  approved  January 
5,  1905.  In  the  charter  of  that  date  under  which  it  still  acts 
are  enumerated  four  purposes  of  its  creation,  three  of  which 
deal  with  relief  to  the  sick  and  wounded  of  the  Military  Estab- 
lishment, as  follows : 

First.  To  furnish  volunteer  aid  to  the  sick  and  wounded 
of  Armies  in  time  of  war,  in  accordance  with  the  spirit  and 
conditions  of  the  Conference  of  Geneva  of  October,  18G3,  and 
also  of  the  treaty  of  the  Red  Cross,  or  the  treaty  of  Geneva,  of 
August  22,  1S()4,  to  which  the  Ignited  States  of  Aiuorica  gave 
its  adhesion  on  iMarch  1,  1882. 

Second.  And  for  said  purposes  to  perform  all  the  duties 
devolved  upon  a  national  society  by  each  nation  which  has 
acceded  to  said  treaty. 

Fourth.  To  act  in  matters  of  voluntary  relief  and  in  ac- 
cord with  tlie  military  and  naval  authorities  as  a  medium  of 
communication  between  the  ]ie()])le  of  the  T'nited  States  of 
America  and  their  .\rmy  and  Xavy.  and  to  act  in  such  mat- 
ters between  similar  national  societies  of  other  governments 
through  the  ''Coniite  International  de  Secours''  and  the  Gov- 

229 


230   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ernments  and  the  people  and  the  Army  and  Navy  of  the 
United  States  of  America. 

For  two  years  before  the  declaration  of  war,  April  6,  1917, 
the  Red  Cross  underwent  a  period  of  tensely  active  but  silent 
mobilization.  The  experiences  of  the  foreign  units,  which  had 
witnessed  the  initial  collapse  and  subsequent  reorganization  of 
the  sanitary  formations  of  the  belligerents,  had  made  clear 
to  the  xVmerican  Red  Cross  that  it  must  be  ready  to  meet  its 
responsibilities  should  the  United  States  enter  the  conflict. 
Even  a  year  earlier,  namely  in  April,  1914,  Miss  Delano  had 
begun  making  plans  for  an  enlarged  enrollment.  At  a  meeting 
of  the  National  Committee  on  Red  Cross  Nursing  Service  held 
April  24,  she  requested  the  State  Committees  to  send  to  her 
lists  of  all  training  schools  in  the  respective  states  which  fully 
met  the  Red  Cross  requirements ;  also  additional  lists  of  those 
meeting  the  requirements  only  in  part.  She  asked  further 
for  lists  of  nurses  who  were  especially  well  fitted  to  serve 
as  (1)  superintendents;  (2)  head  nurses;  (3)  clinic  nurses; 
(4)   dietitians. 

Under  a  revision  of  the  By-Laws  of  the  American  Red  Cross 
adopted  by  the  Central  Committee  at  the  annual  meeting  in 
December,  1915,  the  National  Committee  on  Red  Cross  Nurs- 
ing Service,  which  had  been  a  subcommittee  of  the  War  Relief 
Board,  was  thenceforth  to  be  appointed  directly  by  the  Red 
Cross  Central  Committee  and  to  work  under  its  direction.  In 
December,  1915,  the  members  of  the  Central  Committee  were: 
William  H.  Taft,  chairman;  Gen.  Charles  Bird;  Mabel  T. 
Boardman ;  Admiral  William  C.  Braisted ;  John  W.  Davis ; 
Robert  W.  DeForcst :  Gen.  William  C.  Gorgas ;  John  Bassett 
Moore ;  Judge  W.  W.  ^hu-row ;  Charles  D.  Norton ;  James 
Tanner ;  John  Skeltoii  Williams.  At  a  meeting  of  the  Central 
Committee  on  l)eceml)er  13,  1910,  the  Surgeon  Generals  of 
the  Army,  Navy  and  Public  Health  Service,  the  presidents  of 
the  three  national  organizations  of  nurses  and  a  number  of 
other  officials  designated  by  title  were  made  ex-officio  members 
of  the  National  Committee  on  lied  Cross  Nursing  Service. 
In  February,  IDIT.  the  National  Committee,  on  its  own  recom- 
mendation to  the  Central  Committee,  was  increased  to  forty-six 
members  1)v  the  appointment  of  twenty-three  additional  repre- 
sentatives from  the  three  national  societies  of  nurses. 

The   three   relief  boards,    i.e.,   War,    National   and   Interna- 


MOBILIZATION  231 

tional  became  advisory  boards.  All  activities  were  grouped 
under  two  main  departments:  Civilian  Kelief  and  Military 
Itelief.  Ernest  P.  Bicknell,  who  had  been  national  director 
of  the  organization  from  his  appointment  in  1908  became  Di- 
rector General  of  Civilian  Relief  and  Colonel  Jeiferson  Ran- 
dolph Kean  of  the  Medical  Corps  of  the  United  States  Army 
was  made  Director  General  of  Military  Relief. 

Col.  Kean  outlined  the  scope  of  the  Department  of  Military 
Relief  in  the  Red  Cross  Annual  Report  of  1916,  as  follows: 

It  has  supervision  of  all  the  work  of  the  Chapters  relative 
to  the  various  branches  of  military  relief  work,  such  as  Euro- 
pean war  relief,  assistance  to  our  own  soldiers,  instructions 
in  First  Aid  and  Home  Care  of  the  Sick,  etc. 

It  deals  directly  and  without  the  intermediation  of  the 
Chapters  with  the  military  units  such  as  base  hospitals, 
ambulance  companies,  hospital  units,  surgical  sections,  sup- 
ply depots  and  naval  and  emergency  detachments  of  nurses 
which  are  organized  with  the  approval  of  tlie  Medical  Depart- 
ments of  the  Army  and  Xavy  to  reinforce  these  services  in 
case  of  war.  It  administers  also  all  agencies  of  assistance  to 
the  sick  and  wounded  soldiers  of  foreign  countries  and  to 
prisoners  of  war. 

These  manifold  activities  were  conducted  through  three 
bureaus:  ^lajor  Robert  U.  Patterson  of  the  Medical  Corps  of 
the  United  States  Army,  who  had  been  Director  of  the  Bureau 
of  ]\Iedical  Service  from  its  creation  in  1914  was  continued 
as  Director;  Dr.  Theodore  W.  Richards,  United  States  Xavy, 
was  in  charge  of  the  Bureau  of  Supplies ;  and  from  September, 
1910,  Clara  1),  Xoyes  was  the  Director  of  the  Bureau  of 
Nursing  Service.  Upon  the  last-named,  newly-organized  Bu- 
reau was  placed  the  responsibility  for  all  work  in  connection 
with  the  selection  of  nurses  for  enrollment  and  the  organization 
of  units  of  nurses  for  service,  the  assignment  of  nurses  to 
duty  and  all  details  relating  to  the  courses  of  instruction  under 
th(>  Red  Cross  in  Home  Hygiene,  Home  Dietetics,  the  ])repara- 
tion  of  surgical  dressings  and  hospital  garments; — evcrvtliing, 
in  short,  except  the  public  health  nursing  (then  the  Town  and 
Country  Xursing  Service). 

The  rush  of  work  of  every  kind  during  191^  is  indicated 
in  the  Annual  Rep^u-t  for  that  year.  It  shows  that  nicnibcr- 
ship  in  the  Red  Cross  had  risen  from  i!2,()U0  to  some  ."UlOjUUU 


232   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

odd  and  even  that  was  only  a  beginning.  The  appointment 
of  Miss  Noyes  as  Director  of  the  Bureau  of  Nursing  was  of 
great  moment  to  the  Service.  To  take  up  this  task  of  infinite 
detail,  untold  anxieties  and  extreme  responsibility,  she  re- 
signed one  of  the  foremost  nursing  positions  in  this  country, 
that  of  General  Superintendent  of  Training  Schools  for  Nurses, 
connected  with  Bellevue  and  Allied  Hospitals,  New  York 
City. 

Clara  Dutton  Noyes  had  had  long  experience  in  the  admin- 
istrative work  of  her  profession.  Born  at  Port  Deposit,  Mary- 
land, she  came  of  Connecticut  parentage.  Her  father  had 
served,  as  had  J\Iiss  Delano's,  in  the  Civil  War.  Miss  Noyes 
was  graduated  from  the  Johns  Hopkins  Training  School  for 
Nurses  in  the  class  of  1896,  where  she  served  for  a  year  after 
graduation  as  a  head  nurse.  She  was  for  some  years  super- 
intendent of  nurses  at  the  Hospital  for  Women  and  Children, 
Boston,  and  later  superintendent  of  St.  Luke's  Hospital  and 
School  of  Nursing,  New  Bedford,  Mass.,  leaving  there  in  1910 
to  accept  the  general  superintendency  of  Bellevue  and  Allied 
Training  Schools.  Trom  1913  to  1916  she  was  president  of 
the  National  League  of  Nursing  Education,  and  president  of 
the  Board  of  Directors  of  the  American  Journal  of  Nursing 
from  1911  to  1918.  As  a  result  of  her  broad  and  many-sided 
interests  she  brought  to  the  Red  Cross  a  keen  appreciation  of 
nursing  problems.  Professional  claims  were  never  ignored 
even  in  the  intense  absorption  of  her  Red  Cross  work.  She  be- 
came president  of  the  American  Nurses'  Association  in  the 
spring  of  1918,  serving  thus  through  the  trying  days  of  war 
and  demobilization. 

On  April  3,  1916,  Miss  Delano  first  approached  Miss  Noyes, 
who  was  at  that  time  also  chief  nurse  of  Base  Hospital  No.  1, 
Bellevue,  the  first  unit  to  complete  the  organization  of  its 
nursing  personnel.  Miss  Delano  had  hurried  to  New  York  to 
confer  regarding  the  Bellevue  and  Presbyterian  units  of 
nurses,  then  being  detailed  with  their  respective  base  hos- 
pitals.   On  her  return  to  Washington,  she  wrote  to  Miss  Noyes : 

Ever  since  I  saw  you  at  Miss  Maxwell's,  I  have  been  won- 
dering if  you  really  would  consider  coming  to  the  Eed  Cross. 

There  is  no  (loul)t  in  my  mind  that  there  is  wonderful 
opportunity  to  develop  for  this  country  a  service  such  as  we 
never  dreamed  of  in  the  hoginning.  It  is  a  piece  of  work 
which  needs  constant  thought  and  1  should  he  very  happy  if 


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Photo,   by  Harris  and  Exnng 


Clara  Dutton  Xoves. 


MOBILIZATION  233 

by  any  chance  you  are  willing  to  consider  coming  to  Wash- 
ington. 

The  Director  General  of  Military  Relief,  Col.  Jefferson 
E.  Kean,  has  under  his  department  two  bureaus, — Medical 
and  Nursing  Service.  Major  Patterson  is  chief  of  the  Medi- 
cal Bureau  and  you  would  be  chief  of  the  Nursing  Bureau. 
I  sliould  still  be  chairman  of  the  National  Committee  on 
Eed  Cross  Nursing  Service,  but  this  committee  would  become 
advisory  and  could  be  called  upon  if  needed. 

For  several  years  Miss  Delano  had  been  hoping  to  free  her- 
self from  the  confining  office  life  which  she  had  led  since  1909. 
Her  resignation  from  the  Army  Nurse  Corps  in  1912  to  de- 
vote her  attention  undividedly  to  the  Red  Cross  had  been  the 
first  step  toward  this  relinquishment  of  executive  detail.  Her 
wish  was  to  establish  a  capable  director  of  the  Xursing  Service 
at  National  Headquarters  and  to  continue  holding  her  own 
position  as  chairman,  thus  releasing  herself  from  excessive 
routine.  She  dreamed,  also,  of  a  little  home  in  the  country  to 
be  prepared  for  her  later  years,  for  she  had  inherited  a  love 
of  rural  peace  and  quiet  from  her  New  England  ancestry. 
The  war  pressure  now  gave  impetus  to  her  plan  for  the  office, 
but  banished  that  for  her  own  future. 

Miss  Noyes,  however,  was  not  at  first  disposed  to  give  up 
the  work  at  Bellev^ie,  with  its  large  branch  hospitals  at  Harlem, 
Fordham  and  Gouverneur,  and  its  specialized  schools  of  mid- 
wifery and  of  male  attendants.  On  June  1  Miss  Delano  took 
up  again  with  Miss  Noyes  the  need  existing  at  National  Head- 
quarters for  an  able  organizer  and  executive.     She  wrote : 

I  am  still  hoping  that  you  will  be  able  to  come  by  the  fall 
and  it  would  be  my  idea  to  build  up  a  definite  group  of  nurses 
who  would  really  be  assistants  to  the  "Chief  of  the  Nursing 
Bureau"'  or  "Superintendent  of  Nurses"  or  whatever  the  new 
position  may  be  called.  This  would  relieve  the  Washington 
Office  of  many  details  and  would  divide  the  work  so  that  local 
interest  would  be  maintained,  still  leaving  the  direction  and 
final  word  at  Eed  Cross  Headquarters. 

We  must  have  a  strong  woman  in  Washington  !  There  is 
too  much  at  stake  now  to  take  any  chances  and  1  feel  in  my 
very  soul  that  you  are  the  person  for  the  place.  ]\Iiss  Board- 
man  adds  her  persuasion  to  mine. 

A  letter  written  five  days  later  gives  a  more  vivid  picture 
of  the  press  of  work  at  Head(]uarters,  and  shows  that  Miss 


234   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Xoyes  was  giving  grave  consideration  to  Miss  Delano's  urgent 
appeals : 

I  am  hoping  that  it  may  not  be  necessary  for  you  to  come 
until  you  can  do  so  with  an  easy  mind  concerning  Bellevue. 
It  is  an  awful  wrench  even  at  the  best  to  give  up  such  an 
important  work  and  I  am  willing  to  do  my  share.  Things 
were  pretty  bad  here  when  the  rush  first  came,  for  it  was 
diflficult  to  get  extra  stenographers, — at  least  good  ones.  So 
many  of  them  had  gone  from  the  Departments  to  "the  front," 
— in  this  case  over  to  Fort  Meyer.  We  are  getting  on  better 
now  and  tlie  feeling  that  you  are  available  if  a  great  need 
comes  makes  it  all  mncli  easier. 

We  can  surely  wait  through  July  unless  new  conditions 
develop  in  Mexico  and  if  I  keep  well,  perhaps  even  longer,  so 
that  you  too  may  have  a  vacation.  I  am  so  tired  I  can  scarcely 
write.  Was  at  the  office  all  day  yesterday  and  Sunday  as 
well. 

Miss  Delano  outlined  the.  new  work  more  definitely  in  a 
letter  written  on  the  seventh : 

Instructions  for  enrolled  nurses  as  members  of  hospital 
units  should  be  prepared.  Outlines  are  needed  for  chief 
nurses  who  are  to  undertake  the  practical  instruction  of 
nurses"  aides. 

Some  method  should  be  developed  for  the  inspection  of 
classes  of  instruction  to  women  so  that  incapable  instructors 
should  not  be  allowed  to  continue. 

There  will  be  a  new  course  in  Dietetics  ready  in  the  fall, 
which  will  make  supervision  more  than  ever  necessary. 

I  believe  there  is  a  distinct  menace  to  our  nursing  standards 
in  the  development  of  this  lay  personnel  unless  it  is  carefully 
directed  and  supervised  and  that  at  this  time  no  work  in 
the  entire  country  compares  with  it  in  far-reaching  results  or 
importance.  T  simply  cannot  do  it  alone  but  will  help  in 
every  way  in  my  power  and  as  1  have  said  before,  am  perfectly 
willing  as  chairman  of  the  Xational  Committee  to  support 
you  to  the  uttermost  in  any  policy  which  you  may  think 
desirable. 

]\riss  Xoycs  came  to  \Vashington  on  June  13  to  interview 
Miss  Delano,  Miss  Iloardnian  and  General  ^Murray,  thou  act- 
ing chairman  of  tlic^  Kxecutive  (^)lnmittee,  regarding  the  Ked 
Cross  appointment.  On  June  24  a  short  note  from  ^liss  Delano 
to  Miss  Xoyes  gives  a  second  picture  of  Xational  Headquarters: 


MOBILIZATION  235 

You  can  imagine  how  busy  v/e  are  and  how  interesting  it 
is!  We  have  just  opened  another  ofliee  across  the  street 
[H  and  17th  |  for  vohmteer  workers.  .  .  .  They  are  address- 
ing envelopes  and  sending  out  hundreds  of  form  letters.  The 
Chicago  Chapter  has  agreed  to  employ  a  nurse  and  Xew  York 
is  also  ready.  There  is  a  tremendous  piece  of  organization 
work  to  be  done  and  your  country  certainly  needs  you ! 

I  am  trying  to  be  patient,  for  I  am  sure  you  will  do  what 
is  best,  but  you  cannot  know  how  many  times  a  day  I  long  for 
your  cool  judgment  and  wise  counsel. 

Miss  Xoyes  accepted  the  directorship  of  the  Bureau  of  ISTurs- 
ing  July  24  and  came  to  Washington  September  10,  191G,  to 
devote  her  whole  time  and  all  her  powers  to  the  Ked  Cross. 
A  woman  of  clear  judgment,  of  excellent  organizing  ability 
and  jealously  ambitious  for  her  chosen  profession,  she  was 
wholly  relied  on  by  jMiss  Delano,  with  whose  more  intense 
and  dramatic  nature  the  exceeding  reserve  of  Miss  Noyes  was 
in  striking  contrast.  Under  the  cool  poise  of  her  outward 
bearing  there  was  a  naivete  and  warmth  of  personality,  only 
appreciated  by  those  who  knew  her  well.  Like  Afiss  Delano,  she 
was  tall  and  of  commanding  presence.  Like  her,  too,  her  gray 
hair  became  snowy  white  during  her  Red  Cross  labors. 

The  nursing  staff  now  mimbered  five,  not  including  the 
Rural  Service.  Besides  Miss  Delano,  Miss  Xoyes,  Miss  Reeves 
and  Joseplrine  Johnson,  Katrina  Hertzer,  a  member  of  the 
Navy  Nurse  Corps,  who  had  served  with  Unit  E  at  Budapest, 
was  detailed  on  September  20,  1916,  by  the  Bureau  of  Medi- 
cine and  Surgery  of  the  Department  of  the  Xavy  to  act  as 
Imison  officer  between  the  Navy  Nurse  Corps  and  the  Red 
Cross,  at  that  time  organizing  Navy  base  hospitals  and  detach- 
ments. ]\riss  Hertzer  was  born  in  Ohio  and  was  a  graduate  of 
the  Illinois  Training  School  for  Nurses.  Before  her  assign- 
ment by  Surgeon  General  Braisted  to  the  Red  Cross,  she  had 
been  superintendent  of  nurses  of  the  City  and  County  Hos- 
pital, St.  Paul,  Minn.,  and  chief  nurse,  U.  S.  Naval  Hospital, 
Chelsea,  Mass. 

On  the  25tli  of  January,  1917,  the  Red  Cross  Headquarters 
organization  moved  from  its  old  location  to  the  beautiful  build- 
ing on  Seventeenth  Street  facing  Potomac  Park,  which  was 
erected  as  a  memorial  to  the  "Heroic  Women  of  the  Civil  War" 
and  d(xlicated  as  the  administration  h(\id(iuart(U's  in  pc^rpctuity 
of  the   American  Red  Cross.      In  common  with  tlit>  other  de- 


236    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

partments  the  Nursing  Service  had  completely  outgrown  its 
old  quarters. 

Singularly  appropriate  is  this  Georgian-Colonial  structure 
of  Vermont  marble,  set  opposite  the  ellipse  of  the  White  House, 
the  second  in  that  fine  chain  of  buildings  which  extends  down 
Seventeenth  Street  to  the  Tidal  Basin.  On  its  left  is  the 
Corcoran  Gallery  of  Art ;  on  its  right,  Continental  Memorial 
Hall,  belonging  to  the  Daughters  of  the  American  Revolution, 
and  just  beyond  that  is  the  Pan-American  Building.  Its 
history  goes  back  to  the  Civil  War,  to  two  of  Lincoln's  volun- 
teers of  1861,  Francis  Barlow  and  James  Scrymser.  Sergeant 
(later  General)  Barlow  was  wounded  at  Antietam  and  again 
at  Gettysburg.  His  wife,  a  member  of  the  Sanitary  Commis- 
sion, went  to  the  battle  line  to  nurse  him,  there  contracted 
typhus  and  died,  1864.  To  her  husband,  she  typified  the  spirit 
of  women  in  war  time  and  in  1896,  not  long  before  his  death. 
Major  General  Barlow  prophetically  said  that  some  day  the 
nation  would  build  a  fitting  monument  to  the  women  of  the 
Civil  War.  His  friend.  Captain  Scrymser,  heard  his  words  and 
was  afterwards  one  of  the  guarantors  for  the  amount  pledged 
for  the  building.  The  story  of  how  the  memorial  was  assured 
and  built  may  be  read  in  Miss  Boardman's  book  ''Under  the 
Red  Cross  Flag." 

On  the  first  floor  to  the  left  of  the  stairway  Miss  Delano 
and  Miss  Noyes  shared  two  spacious  rooms,  green-tinted,  with 
books  and  photographs,  soft-toned  rugs  and  dark  solid  furni- 
ture, all  in  marked  contrast  to  the  scarred  oak  desks  and  worn 
floors  of  the  H  Street  ofiices.  Miss  Delano  then  matched  her 
one  wicker  chair  by  others  equally  comfortable.  She  often 
received  contributions  from  friends  who  were  interested  in 
the  Nursing  Service  and  these  went  into  a  special  fund  for 
equipment,  books,  or  other  things  connected  with  the  welfare 
and  comfort  of  Red  Cross  nurses. 

The  volume  of  routine  work  of  the  Nursing  Sendee  at  this 
time  was  outlined  by  ]\liss  Delano  in  a  letter  written  on 
August  'M,  lOlC),  to  Miss  Boardinan : 

The  only  tliin<i^  tliat  trouliles  me  is  the  question  of  room 
in  the  new  building  and  I  am  wondering  if  by  any  chance  it 
will  be  possible  to  have  the  small  room  which  yon  had  planned 
to  give  to  ]\nss  Oliver  for  Miss  Reeves  and  the  nurse  from  the 
Navy  if  she  comes.  1  shall  have  to  put  a  part  of  the  clerks 
in  the  room  where  the  files  are.     We  have  two  permanently 


MOBILIZATION  237 

for  the  class  work  and  have  heen  obliged  to  employ  a  third  to 
help  out  with  the  additional  work.  It  takes  the  time  of  one 
clerk  for  the  surgical  supplies  and  patterns,  and  should  need 
a  second  clerk  but  for  the  fact  that  we  ha\e  been  able  to  use 
volunteers  in  that  oflice.  It  takes  the  entire  time  of  one  clerk 
for  the  work  of  the  base  hospital  units  and  emergency  de- 
tachments, with  occasional  help  from  others  when  the  pres- 
sure of  work  comes  in.  Unless  the  work  decreases  more  than 
I  have  reason  to  expect,  I  do  not  see  how  it  will  be  possible 
to  get  on.  We  shall  have  more  people,  judging  from  present 
indications,  than  the  top  floor  will  accommodate.  I  am 
greatly  worried  and  only  wish  you  were  here  so  that  I  could 
talk  it  over  with  you. 

To  the  third  floor,  nevertheless,  went  the  Town  and  Country 
Nursing  Service,  the  clerical  force,  class  instruction  and  the 
files  of  the  National  Committee.  The  paraphernalia  of  surgical 
dressings  was  ensconced  on  the  balcony  overlooking  the  As- 
sembly Room.  Even  this  stately  conference  chamber  had  been 
divided  into  offices,  one  of  which  Miss  Hertzer  at  one  time 
occupied.  Temporary  partitions  shut  off  the  Tiffany  memorial 
windows  and  stenographers  from  every  corner  of  the  United 
States  flocked  daily  to  their  crowded  desks  there,  while  wait- 
ing for  better  locations.  Though  the  Nursing  Service  retained 
the  two  large  offices  on  the  first  floor,  the  attaches  and  clerical 
force,  in  turn,  moved  from  the  attic  to  the  basement,  from  the 
basement  to  the  First  Annex,  from  the  First  Annex  to  the 
Third  and  finally  brought  up  in  1919  in  its  present  home  in 
the  permanent  Fourth  iVnnex,  before  its  mushroom  growth 
could  be  accommodated. 

To  aid  Miss  Xoyes  in  the  assignment  of  nurses  and  the  stand- 
ardization of  surgical  dressings,  Vasliti  Bartlett,  of  Johns 
Hopkins,  came  to  National  Headquarters  in  ]\rarch,  1917.  ^liss 
Bartlett  had  begun  her  Red  Cross  service  during  the  Dayton 
flood ;  she  was  a  member  of  Unit  A  at  Pan,  and  of  the  Belgian 
units  at  La  Pann(\  l\cv  reply  to  ^fiss  Noyes'  request  that  she 
come  to  Washington,  brcuight  a  smile  to  the  lips  of  the  over- 
worked Director  of  Nursing. 

''Will  you  answer  a  Macedonian  call?"  Miss  Noyes  had 
wired. 

"I  will  have  to  consult  my  family,"  replied  ^fiss  Bartlett, 
''before  undertaking  further  foreign  service,  especiallv  in 
Greece !" 


238   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

On  April  6,  1917,  the  United  States  entered  the  World  War. 
Immediately  Red  Cross  Headqnarters  was  flooded  by  corre- 
spondence. Stimnlatcd  by  events,  nnrses  from  all  corners  of 
the  United  States  were  volunteering.  Immense  development 
took  place  in  every  branch  of  Red  Cross  work.  On  the  10th 
of  ^lay,  1917,  President  Wilson  had  appointed  a  War  Council 
for  the  American  National  Red  Cross. ^  Their  first  task  was  to 
raise  the  vast  sum  of  money  needed. 

The  personnel  of  the  Xursing  Service  was  now  greatly  en- 
larged. Anna  W.  Kerr,  who  had  been  one  of  Miss  Delano's 
classmates,  came  to  Washington  to  take  over  the  examination 
of  all  applications  for  enrollment.  Miss  Kerr  had  been  assist- 
ant at  Bellevue  when  Miss  Delano  had  been  superintendent  of 
nurses  there.  For  eleven  years  she  had  been  director  of 
nurses  of  the  Bureau  of  Child  Hygiene,  Department  of  Health, 
!Xew  York  City.  Her  devotion  and  great  faithfulness  to  Miss 
Delano  did  not  end  with  the  death  of  her  life-long  friend. 

Agues  G.  Deans,  well  known  to  American  nurses  as  a  former 
secretary  of  the  American  Xurses'  Association,  came,  on  June 
11,  1917,  to  the  office  of  the  chairman  of  the  National  Com- 
mittee. Her  knowledge  of  nursing  organizations  and  training 
schools  throughout  the  country  was  of  the  utmost  value  to  Miss 
Delano  in  the  first  Red  Cross  nursing  survey.  A  graduate  of 
the  Farrand  Training  School  for  Xurses,  Harper  Hospital, 
Detroit,  Michigan,  Miss  Deans  was  a  pioneer  public  health 
nurse,  having  done  visiting  nursing  in  ^Michigan  and  Minne- 
sota. She  was  assistant  to  the  director  of  the  Department  of 
iSTursing  until  July  1,  1920;  six  months  later,  she  became 
director  of  the  Social  Service  Department,  Washington  Uni- 
versity, St.  Louis.  A  devoted  friend  of  Miss  Delano,  !Miss 
Deans  was  an  able  executive  and  a  loyal  upholder  of  the  best 
ideals  of  her  profession. 

The  organization  of  the  base  hospitals  included  a  dietitian 
and  her  assistant.  Public  o])inion  in  all  parts  of  the  nation 
demanded  general  instruction  in  the  elementary  principles 
of  home  dietetics  and  food  conservation,  of  vital  importance  to 
a  nation  at  war.  Elva  Anne  George,  a  graduate  of  Pratt  Insti- 
tute, came  to  the  Bureau  of  i^ursing  on  July  27,   1917,  to 

^  The  orifzinal  mcnibcrs  of  Uie  ^Vilr  Council  wore:  Henry  P.  Davison, 
cliairman:  Charles  D.  Norton.  ^lajor  Grayson.  ^I.-P.  Murj^liy,  Cornelius 
X.  P>liss.  Jr..  and  Edward  X.  TTiirley,  w  itli  William  Howard  Taft,  chair- 
man, and  Eliot  Wadswortli,  vice  chairman  of  the  Central  Committee,  ex- 
oilicio. 


MOBILIZATION  239 

take  charge  of  the  mobilization  of  dietitians  for  the  base  hos- 
pitals and  to  supervise  class  instruction  for  women  in  the  Ked 
Cross  course  of  Home  Dietetics. 

Helen  Scott  Hay  was  the  next  nurse  to  join  that  strong  group 
brought  by  Miss  Delano  to  National  Headquarters.  She  and 
Kachel  Torrance  had  had  an  eventful  trip  home  from  Bul- 
garia, following  the  declaration  of  war  by  the  United  States. 
The  organization  of  the  base  hospitals,  which  called  for  twenty- 
five  nurses'  aides  for  each  one,  had  given  great  impetus  to  the 
class  work  in  Elementary  Hygiene  and  Home  Care  of  the  Sick. 
Miss  ^oycs^  duties  in  the  selection  and  assignment  of  nurses 
were  multiplying  to  dimensions  beyond  the  control  of  one  in- 
dividual. Miss  Hay  accordingly  came  to  Washington  in  July, 
1917,  as  dii'ector  of  the  newly-created  Bureau  of  Instruction. 

In  January,  1918,  ^fiss  Hay  resigned  from  the  Nursing 
Service  to  undertake  at  the  request  of  the  Surgeon  General  some 
special  work  for  the  Army  Nurse  Corps  and  Harriette  Sheldon 
Douglas,  a  graduate  of  the  Boosevelt  Hospital,  New  York  City, 
became  director  of  the  Bureau  of  Instruction.  At  this  time, 
the  scope  of  this  Bureau  was  broadened  to  include  the  assign- 
ment of  nurses'  aides  to  foreign  services  and  the  name  of  the 
Bureau  was  enlarged  to  that  of  the  Bureau  of  Nurses'  Aides 
and  Instruction. 

With  Lliss  Douglas  there  came  an  interesting  link  with  the 
Civil  War  days,  for  she  was  the  daughter  of  the  late  Dr.  John 
Hancock  Douglas,  attending  physician  during  General  Grant's 
last  illness,  who  was  also  one  of  the  three  associate  secretaries 
and  Chief  of  Inspection  of  the  Sanitary  Commission  during 
the  Civil  War.  Though  she  had  not  been  engaged  in  active 
nursing  for  some  years,  ^liss  Douglas  volunteered  her  services 
to  the  Bed  Cross  in  the  early  winter  of  1917.  Her  appoint- 
ment to  the  Bureau  of  Nurses'  Aides  and  Instruction  was  a 
particularly  happy  one,  in  that  she  combined  the  viewpoint  of 
both  the  laywoman  and  the  nurse.  Slender  and  spirituelle,  a 
flame  of  ardor  in  earnest  eyes  lit  the  view  !Miss  Douglas  had  so 
clearly  of  the  human  creature  in  every  lonely  and  neglected  pa- 
tient. As  a  sister  of  Bishop  Harding  of  Washington,  she  was 
also  in  a  particularly  fortunate  position  to  bring  to  the  support 
of  her  work  the  interest  and  enthusiasm  of  many  Washington 
women. 

Lucy  ^linnigerode  (  Im-IIcvuc  )  joined  ^liss  Noyes'  statl'  in 
August,   1917,  to  take  charge  of  the  special  units  tluni  l)(>ing 


240    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

organized  for  the  War  Department  and  for  Red  Cross  foreign 
commissions.  She  too  had  sailed  on  the  Mercy  Ship,  serving 
in  Kief;  she  too  was  intensely  devoted  to  Miss  Delano.  She 
continued  her  Red  Cross  work  until  December,  1918,  when 
she  undertook  a  supervisory  tour  of  the  U.  S.  Public  Health 
Hospitals,  later  becoming  superintendent  of  nurses  of  the  U.  S. 
Public  Health  Service.  Absolutely  fearless,  impulsive  and  out- 
spoken, devoted  to  her  friends,  resolute  toward  opponents,  in 
Miss  Minnigerode  were  found  many  attributes  of  the  typical 
pioneer. 

The  Town  and  Country  Nursing  Service  had  as  its  Director 
Pannie  Clement  and  later  Mary  S.  Gardner  and  Elizabeth 
Fox.  An  account  of  this  Service  and  its  leaders  will  be  given 
in  a  subsequent  chapter. 

Other  nurses  who  assisted  Miss  Delano  and  Miss  Koyes  at 
N^ational  Headquarters  at  various  periods  during  the  war  were 
Lyda  Anderson,  Florence  Patterson,  Virginia  Ward,  A.  Maury 
Carter,  Adeline  H.  Rowland  (Mrs.  Robert  Gourlay),  Josephine 
Johnson,  Sarah  Addison,  Barbara  Sandmaier,  Lulu  J.  Justis, 
Charlotte  Brewer,  Adelaide  Tennant,  May  Claypool,  Charlotte 
Garrison,  Elsbeth  H.  Vaughan  and  Marie  Roder. 

In  that  memorable  summer  of  1917,  thousands  of  letters  in- 
undated National  Headquarters.  Many  were  deeply  touching 
in  their  genuine  desire  to  help ;  others  were  full  of  war-hysteria  ; 
some  were  shocking  in  their  unconsciously  displayed  reversal 
to  the  frame  of  mind  of  the  massed  audiences  at  thrilling  mo- 
ments of  the  gladiatorial  combats  of  the  Coliseum: — all  effer- 
vesced with  "patriotism."  One  woman  stated  as  her  chief  rea- 
son for  volunteering  that  "her  family  had  always  taken  an 
active  part  in  disturbances  of  the  nation."     Another  wrote : 

Will  you  accept  my  servicos  as  an  unprofessional  nurse?  1 
am  a  woman  .'35  years  okl,  have  a  quiet  disposition,  a  clean 
character  and  always  keep  my  nerve  under  some  very  tryin<^ 
circumstances.  T  work  every  day  on  a  milk  wagon,  so  you 
see  I  am  strong  and  not  lazy. 

A  commercial  firm  wrote : 

Kindly  furnish  us  with  lists  of  names  and  addresses  of  the 
nurses  who  are  members  of  your  organization. 

Upon  receipt  of  your  reply,  we  will  be  pleased  to  send  you 
a  full-sized  bottle  of  our  best  grade  of  malted  milk  for  your 
trouble. 


MOBILIZATION  241 

The  flood  of  letters  had,  indeed,  begun  even  a  year  before,  and 
was  stemmed  very  largely  at  first  by  the  steady  work  of  volun- 
teers. Of  the  first  staff"  of  faithful  volunteer  helpers,  Miss  De- 
lano had  written : 

During  the  summer  of  191G,  there  was  such  an  enormous 
increase  in  the  correspondence  coming  to  the  office  of  the 
chairman  of  t!ie  National  Conmiittee  on  Red  Cross  Nursing 
Service,  that  it  was  found  impossible  to  conduct  the  work 
without  a  great  increase  in  the  office  force.  Believing  in  the 
desirability  of  utilizing  volunteer  workers  for  Ked  Cross 
service,  we  asked  for  the  assistance  of  various  groups  of  women 
who  had  had  our  course  of  instruction  in  Elementary  Hygiene 
and  Home  Care  of  tlie  Sick  ami  others  interested  in  Red  Cross 
work. 

Among  the  first  to  volunteer  were  Miss  Joan  Ohls  and  Mrs. 
Callan  O'l^ughlin,  who  came  to  us  when  the  pressure  of  work 
was  greatest,  and  hel])ed  us  to  conduct  a  mailing  bureau 
through  which  thousands  of  letters  and  circulars  were  sent 
out.  Both  Miss  Ohls  and  Mrs.  O'Laughlin  came  to  the 
office  daily  through  the  greater  part  of  the  summer. 

^Irs.  G.  S.  Meloy  and  Mrs.  Richard  Wetherill,  of  Lanham, 
Maryland,  came  regularly  for  several  months,  giving  to  the 
Eed  Cross  an  entire  day  each  week.  They  were  of  the  greatest 
assistance,  as  they  helped  in  many  details  of  office  work  re- 
quiring a  high  degree  of  accuracy.  They  were  assisted  from 
time  to  time  by  Mrs.  F.  N.  Wells,  Mrs.  Edgar  Brown,  and 
Miss  Cross,  also  of  Lanham,  Marylaiul ;  the  Misses  Stewart, 
of  Washington.  D.  C,  and  Miss  P]ugenie  J.  Cuthbert,  of  Chevy 
Chase,  ^Maryland. 

Mrs.  Robert  Walcott  Weeks  devoted  practically  the  entire 
summer  to  Ked  Cross  work  in  the  office  of  the  chairman  of 
the  National  Committee  on  Red  (^ross  Nursing  Service,  com- 
ing as  regularly  as  any  other  member  of  the  office  staff,  assist- 
ing in  every  way  j)ossible. 

The  Misses  Malum.  Haas,  Lloyd,  Hardy,  Harvey  and  other 
enrolled  Red  Cross  nurses  came  frequently  as  volunteers  and 
]\Iiss  Lucy  ^linnigerode  devoted  her  afternoons  to  Red  Cross 
work,  taking  as  her  special  task  the  sending  out  of  api)oint- 
ment  cards  and   badges  to  enrolled   Red   Cross  nurses. 

Volunteer  secretari'js  (»f  this  calibre  were  regularly  available 
tlirougli  the  crisis  and  numy  were  called  upon. 

By  September,  11)17,  more  than  5,000,000  p(H)ple  had  been 
enrolled  as  lied  Cross  members;  by  December,  there  were 
lJw,O00,OOO.     Chapters,  numbering  ."itj^  when  war  was  dt'clared, 


242    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

totaled  3,700  one  year  later,  with  a  quota  of  8,000,000  volun- 
teer workers,  a  man-woman-and-child  power  such  as  no  other 
organization  in  the  world  could  claim.  This  brought,  however, 
an  incalculable  amount  of  detail  to  National  Headquarters, 
which  would  have  been  entirely  ''swamped,"  had  not  the  War 
Council  created  the  new  organization  plan  called  ''decentraliza- 
tion, with  Division  offices."  National  Headquarters  had  main- 
tained a  branch  office  in  New  York  City  as  early  as  1912,  the 
budget  appropriations  for  which  were  contained  in  the  Minutes 
of  a  meeting  of  the  Executive  Committee  held  Decmber  30 
of  that  year.  As  the  need  for  Red  Cross  disaster  relief  in- 
creased, the  following  action  was  taken  by  the  Executive  Com- 
mittee, meeting  October  31,  1913  : 

Mr.  Bicknell  then  presented  to  the  committee  a  suggested 
plan  for  the  extension  of  the  administrative  efficiency  of  the 
Bed  Cross  in  organization  and  emergency  relief.  The  plan, 
as  outlined,  involved  the  employment  of  four  Division  di- 
rectors or  superintendents,  to  be  stationed  in  each  of  the 
following  points :  San  Francisco,  Denver,  Chicago  and  New 
York  or  Washington.  .  .  .  After  some  discussion  by  members 
of  the  committee,  General  Torney  moved  that  the  tentative 
plan  submitted  by  ^Ir.  Bicknell  be  authorized.  Motion  sec- 
onded by  Mr.  Tanner  and  adopted.^ 

When  imperative  need  for  greater  administrative  machinery 
arose  in  1917,  the  now  "decentralization  plan"  elaborated  this 
principle  through  thirteen  instead  of  four  districts.  It  was 
described  by  Mr.  Davison  as  follows : 

The  word  "decentralization"  in  this  case  resolved  itself 
into  the  partitioning  of  the  United  States  into  thirteen  di- 
visions, ea(;h  division  a  smaller  Bed  Cross,  with  all  its  depart- 
ments and  bureaus  under  a  divisional  chief  and  a  force  com- 
plete in  every  detail  with  the  various  lines  of  endeavor  firmly 
and  clearly  outlined.  Wlien  once  the  foundation  was  com- 
plete, the  War  Council  had  no  more  to  do  with  tlie  Chapters 
or  any  of  their  activities,  save  in  the  way  of  judging  the 
needs,  devising  methods  and  fixing  standards.  The  Chapter's 
business  was  regulated  in  the  department  to  which  it  belonged 
by  the  divisioiuil  otlicers.  The  Division  manager  was  ...  to 
his  division  what  the  general  manager  in  Washington  was 
to  the  entire  organization.  Washington  Headquarters  was 
now  free  to  proceed  with  the  handling  of  the  larger  problems 
^Minutes  of  tlic  Executive  Coinmittec,  American  Red  Cross,  page  3G8. 


MOBILIZATION  243 

which  were  daily  growing  to  greater  magnitude  and  impor- 
tance.^ 

Miss  Delano  and  Miss  Noyes  appointed  in  each  Division 
prominent  nurses  who  handled  all  nursing  details  in  their  im- 
mediate states.  Only  vital  questions  of  policy  were  referred 
to  National  Headquarters.  This  group  of  ''Division  Directors 
of  Nursing/'  representing  as  it  did  strong  women  of  nn-ognized 
standing  in  their  districts,  comprised  the  very  backbone;  of  the 
Nursing  Service.  Through  their  hands  passed  all  applications 
for  enrollment  received  from  Local  Committees,  all  manage- 
ment of  class  instruction,  public  health  nursing,  early  surveys 
and  other  details.  On  their  shoulders  rested  the  ultinuite  re- 
sponsibility of  recruiting  the  many  thousands  of  nurses  requi- 
sitioned by  the  Surgeon  General.  To  them  came,  too,  the  well- 
nigh  overwhelming  demands  for  nurses  for  the  influenza  epi- 
demic. 

Miss  Delano  outlined  thus  the  relation  of  the  nursing  repre- 
sentative to  the  Division  manager  and  the  Bureau  of  Nursing 
at  National  Headquarters : 

As  the  success  of  the  Xursing  Service  and  our  ability  to 
secure  the  nurses  in  the  large  number  likely  to  be  needed 
during  the  period  of  the  war  depends  entirely  upon  main- 
taining tlie  interest  and  enthusiasm  of  the  graduate  nurses 
throughout  the  country,  it  seems  to  me  of  primary  importance 
that  the  person  in  charge  of  the  Division  Bureau  of  Nursing 
Service  shouhl  be  a  ]\ed  Cross  nurse  and  should  be  in  truth 
the  representative  of  the  Nursing  Service.  She  should  be 
appointed  by  the  chairman  of  tiie  National  Committee  on 
l\ed  Cross  5s"ursing  Service,  subject,  of  course,  to  the  ap- 
proval of  the  Division  manager. 

Furthermore,  since  the  direction  of  all  the  activities  of  tlie 
Bureau  of  Nursing  Service  within  the  jurisdiction  of  the 
Division  will  be  in  charge  of  this  person,  it  is  liighly  important 
that  we  secure  the  services  of  nurses  who.  by  reason  of  their 
education,  e\[)crience.  professional  standing,  executive  ability 
and  knowledge  of  conditions  in  the  Division,  will  be  highly 
qualified  to  fill  tliesc  ini[)orauit  positions.  I  believe  that  this 
otlice.  tbrough  the  national  organizatii)n  of  nurses,  is  best 
prepai'cd  to  secure  tlie  (lualified  ])ersonnel. 

All  professional  ))bases  of  the  work  of  the  Division  Director 
of   the    Xui'siiig    Service   should    be   subject    to   the    direction 

"■"Tlie    Aiiicricaii     Itcd    Cross    in    tlie    (Jrcat    \\"iir,"    pages     Ui-17.      Tlic 
Mac'inillaii   Coinjiaiiy.    liU!). 


244  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  Bureau  of  Nursing  Service  at  National  Headquarters, 
for  only  in  this  way  will  it  be  possible  to  maintain  the  neces- 
sary standards  and  uniform  policies  of  the  Eed  Cross  Nursing 
Service. 

It  will  be  necessary  for  the  Division  Director  of  the  Nursing 
Service,  in  administering  her  Bureau,  either  personally  or 
through  her  functional  assistants,  depending  upon  the  extent 
of  the  activities  in  her  Division,  to : 

(1)  Supervise  Chapter  work  as  related  to  nursing  activities 
and  advise  Chapters  on  matters  of  policy  and  practice  pertain- 
ing to  nursing  service  as  prescribed  by  National  Headquar- 
ters. 

(2)  Supervise  instruction  of  persoimel  within  her  Division 
and  cooperate  with  Chapters  and  committees  on  Red  Cross 
Nursing  Service  on  matters  relating  to  enrollment  of  in- 
structors. 

(3)  Supervise  the  organization  and  administration  of 
Chapter  instruction  in  Elementary  Hygiene  and  Home  Care 
of  the  Sick  and  in  Home  Dietetics. 

(4)  Advise  and  cooperate  with  Chapters  on  matters  relat- 
ing to  class  equipment. 

(5)  Study  and  advise  on  methods  of  promoting  enroll- 
ment in  classes. 

(6)  Cooperate  with  Local  and  State  Committees  on  Nurs- 
ing Service  in  promoting  enrollment  of  Red  Cross  nurses. 

(7)  Summarize  periodic  reports  relating  to  activities  un- 
der the  Nursing  Service  as  received  from  Chapters  and 
compile  Division  reports  of  these  activities  for  the  Division 
manager  to  transmit  to  National  Headquarters. 

( 8 )  Perform  such  other  duties  as  may  be  designated  by  the 
Bureau  of  Nursing  Service  at  National  Headquarters. 

In  the  December,  1917,  issue  of  the  Journal,  Miss  Delano 
reported  the  appointment  in  October  of  these  Division  represen- 
tatives. Elizabeth  Ross,  a  graduate  of  the  Newton  Hospital, 
and  a  public  health  nurse  of  high  standing,  served  in  the  New 
England  Division,  which  included  Maine,  New  Hampshire, 
Vermont,  Massachusetts  and  Ehode  Island.  Miss  Ross  had 
organized  the  Xursing  Center  of  the  Woman's  Municipal 
League  of  Boston  and  had  also  acted  as  supervisor  of  the  Nor- 
wood Civic  Association. 

Carolyn  C.  Van  Blarcom  (Johns  Hopkins)  resigned  as  secre- 
tary of  the  Illinois  Society  for  the  Prevention  of  Blindness  to 
represent  the  Nursing  Service  in  the  Atlantic  Division,  which 
included    New    York,    Connecticut    and   New    Jersey    (except 


MOBILIZATION  245 

Camden).  Of  Dutch  descent,  she  was  possessed  of  keen  organiz- 
ing ability  and  of  brilliant  processes  of  thought  and  expression. 
At  varying  periods  of  her  uscl'ul  career,  she  was  assistant  super- 
intendent of  nurses  at  her  alma  mater,  then  superintendent 
of  nurses,  St.  Luke's  Hospital,  St.  Louis,  superintendent  of 
the  New  Bedford  Tuberculosis  Sanatorium  and  secretary  of 
the  National  Committee  for  the  Prevention  of  Blindness.  Upon 
her  arrival  in  June,  1U17,  at  Atlantic  Division  Headquarters, 
New  York  City,  she  immediately  set  up  the  organization  of  a 
nurses'  equipment  division  for  the  base  hospitals  then  embark- 
ing for  France  and  to  her  acumen  was  largely  due  the  establish- 
ment of  the  efficient  system  which  characterized  this  important 
detail  of  mobilization  for  foreigTi  service.  Another  conspicu- 
ous piece  of  her  work  was  the  recruiting  of  hundreds  of  Red 
Cross  and  Army  nurses  then  in  New  York  who  marched  in 
the  historic  first  Red  (^ross  parade  of  the  autunui  of  1!)17. 
During  the  later  part  of  that  year.  Miss  Van  Blarcom  under- 
took a  speaking  tour  of  the  United  States  to  interest  nurses  in 
enrolling  for  war  service,  after  which  ill  health  necessitated  her 
resignation  from  Red  Cross  service. 

Florence  Merriam  Johnson  followed  Miss  Van  Blarcom  in 
January,  1918,  as  director  of  nursing  of  the  Atlantic  Division. 
A  graduate  of  Smith  College  and  of  the  New  York  Hospital, 
she  had  been  connected  with  the  Cornell  University  ]\Iedical 
Dispensary,  New  York ;  had  done  social  service  work  for  the 
New  York  Association  for  the  Improvement  of  the  Condition 
of  the  Poor;  and  for  the  Harlem  Hospital.  She  later  became 
a  member  of  the  faculty  of  the  Department  of  Nursing  and 
Health,  Teachers  College,  Columbia  L^niversity,  Her  remark- 
able service  in  facilitating  the  embarkation  and  debarkation 
of  nurses  in  foreign  service  brought  her  the  Florence  Nightin- 
gale Medal  of  the  International  Red  Cross.  A  woman  of  poise, 
intelligence  and  great  charm,  she  combined  sympathetic 
warmth  of  personality  with  firm  executive  ability  to  such  an 
extent  as  to  make  her  one  of  the  most  capable  and  well-loved 
nurses  of  the  "younger  generation"  which  the  war  brought 
forward. 

The  Pennsylvania  Division,  which  included  the  Jveystoue 
State,  Delaware,  and  Camden,  New  ficrsey,  was  represented 
by  Susan  Francis  (Reading  Hospital,  Pennsylvania).  She  was 
long  associated  with  state  organization  work  and  with  early 
Red  Cross  Nursing  Service  projects.     Miss   Francis  had  been 


246   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

superinteudent  of  nurses  of  hospitals  in  the  City  of  Washing- 
ton, in  New  Orleans,  and  in  Philadelphia. 

Georgia  Marquis  Nevins  came  to  the  Potomac  Divison  (Dis- 
trict of  Columbia,  Maryland,  Virginia  and  West  Virginia)  af- 
ter twenty-three  years  of  service  as  the  head  of  Garfield  Memo- 
rial Hospital,  Washington.  Her  name  has  appeared  more  than 
once  since  an  early  point  in  our  text,  in  connection  with  profes- 
sional progress  and  growth.  She  was  one  of  the  first  class 
graduated  under  Miss  Hampton  at  the  Johns  Hopkins.  An 
ardent  sponsor  of  the  Army  Nurse  Corps  and  also  of  the  bill 
for  registration  of  nurses  in  the  District  of  Columbia,  she  was 
at  one  time  president  of  the  National  League  for  Nursing  Edu- 
cation, then  known  as  the  American  Society  of  Superinten- 
dents, and  for  many  years  was  secretary  of  the  American 
Nurses'  Association.  Her  Red  Cross  service  began  in  1909, 
as  secretary  of  the  National  Committee  on  Red  Cross  Nursing 
Service.  A  New  England  woman,  she  represented  a  type  of  all 
the  sturdy  virtues  of  that  section. 

Jane  Van  de  Vrede  (Milwaukee  County  Hospital,  Wauwa- 
tosa,  Wisconsin)  was  the  nursing  representative  for  North  and 
South  Carolina,  Florida,  Georgia  and  Tennessee.  Miss  Van 
de  Vrede  was  for  nine  years  assistant  bacteriologist  of  the 
Department  of  Health,  Savannah,  Georgia.  As  secretary  of 
the  State  Board  of  Examiners  of  Nurses  for  Georgia,  and  as 
vice  chairman  of  the  Savannah  Red  Cross  Chapter,  and  secre- 
tary of  the  Local  Committee  on  Red  Cross  Nursing  Service  of 
that  city,  she  brought  to  her  duties  a  wide,  extremely  practical 
knowledge  of  southern  nursing  resources. 

The  Gulf  Division,  to  which  L.  Agnes  Daspit  (Touro  Infir- 
mary, New  Orleans)  was  appointed,  included  Alabama,  Mis- 
sissippi and  Louisiana.  ]\Iiss  Daspit  had  long  been  associated 
with  the  Red  Cross  Nursing  Service,  as  chairman  of  the  Loui- 
siana State  and  Local  Committees.  She  was  at  one  time 
president  of  the  Louisiana  State  Nurses'  Association  and  chair- 
man of  the  Advisory  Board  of  the  State  Board  of  Examiners. 

The  Southwestern  Division,  covering  the  immense  distance 
of  Texas,  ]\Iissouri,  Kansas,  Arkansas  and  Oklahoma,  was  for- 
tunate in  securing  so  able  and  tireless  an  organizer  as  Lyda 
W.  Anderson,  already  known  to  rc^aders  of  this  history  as  super- 
visor of  Unit  K  of  the  jMercy  Ship, 

jMarv  ^r.  Roberts  (Jewish  Hospital,  Cincinnati)  served  as 
nursing  representative  in  the  Lake  Division,  embracing  Ohio, 


MOBILIZATION  247 

Indiana  and  Kentucky.  Both  as  superintendent  of  nurses 
in  the  Savannah  Hospital,  and  assistant  superintendent  of 
nurses  of  the  Jewish  Hospital  in  Cincinnati,  she  had  had  long 
experience  in  administrative  work.  As  a  former  president  of 
the  Ohio  State  Association  of  Graduate  Nurses  and  a  member 
of  the  State  Board  of  Nurse  P^xaminers,  she  too  was  excellently 
fitted  for  the  tasks  before  her, 

A  child  •welfare  nurse  of  national  reputation,  Minnie  H. 
Ahrens  (Illinois  Training  School  for  Nurses;  Teachers  Col- 
lege) directed  Red  Cross  activities  in  Illinois,  Wisconsin,  Iowa, 
Nebraska  and  Michigan,  the  states  comprising  the  Central 
Division.  Though  Miss  Ahrens'  name  had  been  long  asso- 
ciated with  high  standards  of  nursing  education,  she  was  per- 
haps best  known  as  an  organizer  and  the  first  superintendent 
of  the  Infant  Welfare  Society,  of  Chicago. 

The  Northern  Division,  ^linnesota,  North  and  South  Da- 
kota and  Montana  had  as  its  nursing  representative  Edith  A. 
Barber.  A  graduate  of  the  Garfield  Park  Hospital,  Chicago, 
IVIiss  Barber  was  at  one  time  superintendent  of  nurses  of  the 
Green  Gables  Sanatorium,  Lincoln,  Nebraska,  and  a  member 
of  the  training  school  staff  of  the  Li^niversitv  of  Minnesota. 

Lettie  G.  Welch  (Illinois  Training  School)  w^as  appointed 
to  the  Mountain  Division  including  Colorado,  Wyoming,  New 
^^Fexico  and  Utah.  Formerly  superintendent  of  nurses  of  the 
City  and  County  Hospital,  Denver,  she  had  served  for  several 
years  on  the  Colorado  State  Committee  on  Red  Cross  Nursing 
Service. 

Lillian  L.  White  (Protestant  Episcopal  Hospital,  Philadel- 
phia), also  long  associated  with  nursing  education,  gave  up  her 
position  as  assistant  superintendent  of  nurses  of  the  Univer- 
sity of  California,  to  represent  the  Red  Cross  Nursing  Service 
in  the  Pacific  Division,  embracing  Nevada,  Arizona  and  Cali- 
fornia. Miss  White  had  at  various  periods  of  her  career  been 
superintendent  of  nurses  of  the  Knoxville  (Tennessee)  Gen- 
eral Hospital ;  of  the  Merritt  Hospital,  Oakland,  California, 
and  head  of  the  ]3aby  Hospital  of  that  city. 

Including  Washington,  Idaho,  Oregon  and  Alaska,  the 
NorthwestcM'u  Division  had  as  its  nursing  representative  ^May 
S.  Loomi.s  (Illinois  Training  School).  She  was  a  surgical 
inirse  of  long  experience.  Chairman  of  the  Washington  State 
conunittee  on  Red  Cross  Nursing  Service  since  1015.  she  gave 
up  her  pf)sition  as  supervisor  of  nurses  at  the  City  Hospital, 


248   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Seattle,  to  accept  the  Red  Cross  appointment.  Miss  Loomis 
was  for  several  years  president  of  the  Washington  State  Nnrses' 
Association. 

Following  the  estahlishment  of  the  Divisions,  the  Executive 
Committee  voted  on  December  6,  1917,  to  create  the  Depart- 
ment of  Nursing,  combining  under  one  executive  all  phases 
of  the  nursing  program.  ]\Iiss  Delano  became  the  director,  her 
vision  of  a  lightened  responsibility  and  a  country  home  relin- 
quished for  the  time,  and  the  representatives  in  the  Division 
offices  were  given  the  title  of  Division  Directors  of  the  Depart- 
ment of  i^ursing.  This  organization  was  put  into  effect  in  the 
spring  of  1918.  Miss  Noyes,  who  had  been  on  a  speaking 
tour  since  December,  1917,  returned  to  ^National  Headquarters 
in  February,  1918,  and  became  director  of  the  newly  created 
Bureau  of  Field  Nursing,  through  which  the  selection  and  as- 
signment of  all  nurses  for  war  duty,  either  military  or  civilian, 
were  carried  out.  Some  of  the  changes  then  occurring  have  al- 
ready been  mentioned.  The  reorganization  of  the  Town  and 
Country  Nursing  Service  will  be  spoken  of  under  its  own 
chapter  heading. 

With  the  National  Committee  on  Red  Cross  Nursing  Ser- 
vice acting  in  an  advisory  capacity,  with  the  strong  Head- 
quarters' organization  at  Washington  and  with  corresponding 
Departments  in  all  Divisions,  the  Red  Cross  Nursing  Service 
now  faced  the  greatest  nursing  needs  of  American  and  world 
history.  From  its  inception  in  the  scattered  efforts  of  the  Civil 
and  Spanish-American  wars,  its  peace  time  development  from 
1909  to  1917,  one  step  toward  more  complete  organization  had 
followed  fast  on  the  heels  of  another,  until  the  creation  of  the 
Department  of  Nursing  marked  the  final  perfection  of  this 
great  "machine,"  so  cffitMcnt  and  withal  so  silent  and  unobtru- 
sive, that  few  indeed  realize  how  vital  and  far-reaching  were 
its  workings  and  how  great  its  results  in  the  alleviation  of  hu- 
man suffering. 

The  Niitional  C\)mniittee  on  Tved  Cross  Nursing  Service 
guided  th(>  policies  of  developuKMit  of  American  Red  Cross 
nursing  service.  The  members  of  the  National  Committee 
who  served  at  the  outbr(>ak  of  the  war  were  Jane  A.  Delano, 
chairman;  William  C.  Oorgas,  Surgeon  General  of  the  Army; 
W.  C.  Rraisted,  Surg(Hui  General  of  the  Navy;  Rupert  Blue, 
Surgeon  General  of  the  Public  Health  Service;  Annie  Good- 
rich, president,  American  Nurses'  Association;  S.  Lillian  Clay- 


MOBILIZATION  249 

ton,  president,  National  League  for  Nursing  Education ;  Mary 
F.  Beard,  president,  National  Organization  for  Public  Health 
Nursing;  Colonel  Jefferson  li.  Kean,  Director  of  Military  Re- 
lief, American  Red  Cross;  W.  Frank  Persons,  JJirector  of 
Civilian  Relief,  American  Red  Cross;  Major  C.  H.  Connor, 
Director,  Bureau  of  Medical  Service,  American  Red  Cross; 
Dr.  T.  W.  Richards,  Director,  Bureau  of  Naval  Service,  Ameri- 
can Red  C^ross;  (ylara  1).  Noyes,  Director,  Bureau  of  Nursing 
Service,  American  Red  Cross;  Fannie  F.  Clement,  Director, 
Bureau  of  Town  and  Country  Nursing  Service,  American 
Red  Cross;  Enmui  IL  Gunther,  chairman,  Committee  on  Dieti- 
tians; (appointed  for  three  years)  IMabel  T.  Boardman ; 
Mrs.  Wm.  K.  Draper,  New  York  City;  Mrs.  Wm.  Church 
Osborne,  Ntnv  York  City ;  Anna  C.  Maxwell,  Presbyterian 
Hospital,  New  York  City;  Mary  E.  Gladwin,  Akron,  Ohio; 
]\Irs.  Frederick  j\I.  Tice,  Chicago;  Lillian  D.  Wald,  New  York 
City;  M.  Adelaide  Nutting,  New  York  City;  Amy  Milliard, 
Bellevue  Hospital,  New  York  City;  Susan  C.  Francis,  Phila- 
delphia; Louise  M.  Powell,  New  York  City;  Jane  E.  Nash, 
l^altimore ;  (appointed  for  two  years)  Julia  Stimson,  St. 
Louis ;  Emma  Nichols,  Boston  City  Hospital ;  Dora  E.  Thomp- 
son, head  of  Army  Nurse  Corps;  Lenah  S.  Iligbee,  head  of 
Navy  Nurse  Cor])s;  l^]lhi  Phillips  Crandall,  New  York  City; 
Georgia  ]\L  Nevins;  Anna  L.  Reutinger,  New  York  City;  Eliz- 
abeth G.  Fox,  Visiting  Nurses'  Association,  Washington;  Har- 
riet Leete,  Cleveland.  Ohio;  Anne  H.  Strong;  Sinnnons  College, 
Boston;  (a])pointe(l  for  one  year)  Alma  E.  Wrigley.  Pasadena, 
Cal. ;  Carrie  M.  Hall,  Peter  JJent  Brigham  Hosi)ital,  Boston; 
Lucia  Jac(jnith.  Memorial  Hospital,  Worcester,  Mass. ;  Anna  C. 
Jannne,  State  Board  of  Health,  Sacramento,  Calif.;  Menia  S. 
Tye,  Sparks  .Meinorial  Hospital,  Ft.  Smith,  Ark. ;  Ennna  L. 
Wall,  ^ew  Orleans,  La.;  Mathild  Krueger,  JMenomonie,  Wis.; 
Agnes  (r.  Deans,  Detroit,  ^lich.  ;  Eth(>l  S.  Parsons,  Division  of 
Health,  San  Antonio,  Texas;  ^fary  C.  Wheeler,  Illinois  'J' rain- 
ing School,  Chicago.     Duties  of  the  committee  were: 

1.  To  organize  and  supervise  the  Xursing  Service  of  the 
/Vnierican  Ii<mI  Cross,  and  to  estahlisli  uniform  standai'ds  for 
the  cnroMineiil  of  nurses,  dietitians  and  other  personnel  needed 
for  tlu»  nursinjj-  aeti\ities  of  the  AiniM-iean  I'ed  Cross. 

2.  To  secure  annually  from  the  American  Nurses'  Associa- 
tion, the  National  League  for  Nursing  l-lducation  and  the 
National  Organi/.ati(Ui  for    Puhlie  Health    Nursing.   iu)niina- 


250   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tions  to  fill  vacancies  as  they  occur  in  the  National  Committee 
on  Nursing  Service  and  to  submit  these  nominations  with 
recommendations  to  the  Central  Committee  for  appointment. 

3.  To  appoint,  annually,  State  Committees  on  Ked  Cross 
Nursing  Service,  of  not  less  than  six  members,  who  are  en- 
rolled Ked  Cross  nurses  from  names  submitted  by  the  execu- 
tive committee  of  State  Nurses'  Associations.  When  possible, 
the  nurses  selected  should  consist  not  only  of  members  of  the 
American  Nurses'  Association,  but  of  training  school 
superintendents  and  public  health  Nurses.  In  order  that 
the  work  of  committees  may  not  be  interrupted,  a  complete 
change  should  be  avoided. 

4.  To  appoint  such  committees,  not  otherwise  provided 
for,  as  may  be  necessary  to  supplement  the  work  of  the  Na- 
tional Committee,  and  to  specify  the  duties  of  all  committees. 

5.  To  issue  the  necessary  instructions,  circulars  of  infor- 
mation and  blank  forms  of  application  for  the  enrollment  of 
the  Eed  Cross  personnel  of  women. 

G.  To  appoint  local  headquarters  recommended  by  Local 
Committees  where  lists  of  enrolled  nurses  and  other  person- 
nel may  be  kept  on  file.  Such  headquarters  should  be  pre- 
ferably registries  for  nurses,  or  training  school  offices. 

7.  To  pass  upon  all  applications  for  enrollment  forwarded 
to  Red  Cross  Headquarters  and  to  issue  cards  of  appointment 
and  Red  Cross  badges  or  pendants  to  nurses  meeting  the  re- 
quirements, to  issue  cards  of  appointment  to  approved  dieti- 
tians and  to  annul  the  appointment  of  any  member  of  the 
Nursing  Service  for  causes  which  it  may  deem  sufficient. 

8.  To  keep  a  card  catalogue  of  all  committees  and  of  local 
nursing  headquarters  witb  a  list  of  all  nurses  and  other 
personnel  on  file  witb  each. 

9.  To  keep  on  file  lists  of  Sisterhoods  and  other  orders,  and 
women  volunteers  available  for  Red  Cross  relief  work  in- 
volving the  care  of  the  sick  or  wounded,  either  in  time  of 
war  or  calamity,  the  names  of  Red  Cross  nurses  employed  by 
chapters,  other  Red  Cross  organizations  or  those  authorized 
to  use  the  Red  Cross  insignia,  together  with  tlie  names  of 
meml^ers  of  the  Army  and  Navy  Nurse  Corps  who  are  also 
enrolled  Red  Cross  nurses  and  to  refer  the  latter  to  Local 
Committees  when  their  term  of  service  expires. 

10.  To  provide,  in  cooperation  with  the  medical  depart- 
ments of  the  Army  and  Navy,  instruction  for  enrolled  nurses 
in  such  special  duties  as  would  be  required  of  them  in  time 
of  war. 

11.  To  adopt  courses  of  instruction  for  women  oilier  iluin 
nurses,  which  will  aid  iji  the  care  of  the  sick  in  their  own 


MOBILIZATION  251 

homes  and  prepare  them  to  render  assistance,  as  required 
under  the  supervi.^ion  of  the  Nursing  Service  of  the  Kcd 
Cross. 

12,  To  study  the  Nursing  Service  of  the  Ked  Cross  in  this 
and  other  countries;  to  report  on  the  efliciency  and  needs  of 
our  own  services  and  make  such  recommendations  to  the 
Central  Committee  as  tlie  exigencies  of  the  service  may 
indicate. 

I'A.  To  advise  concerning  the  administration  of  the  Town 
and  Country  Nursing  Service,  to  interest  nurses  in  this  phase 
of  IJed  Cross  work,  and  to  aid  in  securing  opportunities  for 
the  special  preparation  necessary  to  qualify  for  Ked  Cross 
Service  as  public  health  nurses, 

14.  To  make  recommendations  to  the  Central  Committee 
of  the  American  Ik'd  (^ross  in  regard  to  the  selection  of  Di- 
rectors of  Bureaus  of  the  Nursing  Service,  and  other  nurses 
employed  at  Ked  Cross  Headquarters, 

15.  To  share  with  the  Directors  of  Nursing  Bureaus  the 
responsibility  for  the  assignment  to  duty  and  supervision  of 
all  personnel  included  in  the  lied  Cross  Nursing  Service, 

Details  of  the  time  of  annual  meeting  and  other  routine 
matters  completed  the  schedule.  The  duties  of  State  Com- 
mittees were  thus  defined : 

16.  State  Committees  consist  of  not  less  than  seven  mem- 
bers, appointed  by  tlie  National  Committee,  from  names  sub- 
mitted by  the  executive  committee  of  State  Nurses'  As- 
sociations at  tlie  time  of  their  annual  meeting,  such  members 
to  be  enrolled  Ked  Cross  nurses, 

17.  To  appoint  anmially  such  Local  Conmiittees  on  Kcd 
Cross  Nursing  Service  as  may  be  needed  for  the  enrollment  of 
nurses  in  their  own  state  and  to  designate  the  chairman  of 
each  committee.  .  .  . 

lit.  To  have  general  supervision  over  Local  C'ommittees  and 
to  stinudate  interest  in  the  Ked  Cross  Nursing  Service. 

30.  To  re])ort  all  T^ocal  Committees  appointed,  and 
vacancies  filled,  to  tbe  chairman  of  the  National  Committee, 
giving  the  names  and  addresses  of  all  members,  and  indicating 
the  chairman  and  secretary  of  each  Connnittee. 

21.  [This  clause  dealt  with  meetings  and  re]iorts.] 

22.  State  Xurses'  Associations  organized  for  the  enrollment 
of  Ked  Cross  nurses  are  members  of  the  .\merican  Ked  Cr(^ss 
and  entitli^l  to  be  represented  by  one  delegate  at  tbe  Ainiual 
^Meeting  of  tbe  ]>(-<]  Cross. 

It  is  desirable  tbat  the  delegate  selected  should  be  a  mem- 


252    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ber  of  the  State  or  a  Local  Committee  on  Eed  Cross  Nursing 
Service. 

Local  Committees  consist  of  at  least  six  nurses  appointed 
by  State  Committees  on  Red  Cross  Nursing  Service. 

The  duties  of  Local  Committees  on  Red  Cross  Kursing  Ser- 
vice were: 

23.  To  make  recommendation  to  the  National  Committee 
as  to  the  appointment  of  headquarters,  where  a  list  of  enrolled 
nurses  and  other  personnel  of  the  Nursing  Service  may  be 
kept  on  file,  siicli  headquarters  to  be  preferably  registries  for 
nurses  or  training  scliool  offices,  as  it  is  important  that  a 
place  should  ])e  selected  where  nurses  may  be  secured  at  all 
times  day  and  night. 

2-i.  To  issue  circulars  of  information  and  blank  forms  for 
enrollment  to  applicapts,  and  to  decide  whether  applicants 
fulfill  the  requirements  and  are  desirable. 

25.  To  receive  applications  for  the  enrollment  of  nurses 
and  to  secure  the  required  credentials  except  from  nurses 
interested  in  the  Town  and  Country  Nursing  Service,  w^hose 
applications  should  be  forwarded  direct  to  Eed  Cross  Head- 
quarters, Washington,  D.  C,  where  credentials  will  be  se- 
cured.* 

Of  the  numbers  and  activity'  of  the  Committees  Miss,  Delano 
said,  in  the  Annual  Report  for  the  year  ending  December  31, 
1917: 

In  addition  to  the  National  Committee,  we  have  forty- 
eight  State  Committees  and  one  hundred  and  two  Local 
Committees  on  Eed  Cross  Nursing  Service,  four  State  and 
thirty-four  Local  Committees  having  been  appointed  since 
January  1,  1917.  About  one  thousand  nurses  are  serving  the 
Eed  Cross  gratuitously  on  these  committees. 

After  the  war  she  wrote  of  the  work  of  the  State  and  Local 
Committees: 

To  the  State  Committees  on  Eed  Cross  Nursing  Service, 
and  the  Local  Committees  representing  local  nursing  organi- 
zations, the  Nursing  Service  of  the  Eed  Cross  owes  much 
during  the  past  years.  TJie  large  enrollment  of  Eed  Cross 
nurses  was  due  in  a  great  part  to  the  activities  of  these  com- 
mittees. Approximately  one  thousand  graduate  nurses  are 
serving  gratuitously  as  members  of  State  and  Local  Com- 
*A.  R.  C.  159,  July  12,  1917. 


MOBILIZATION  253 

mittees  on  Red  Cross  Xursing  Service,  and  the  value  of  tlieir 
services  cannot  be  overestimated.  Durin*,^  tlie  period  of  the 
war,  these  committees  held  frequent  meetings  to  pass  on  the 
application  of  thousands  of  nurses  and  sacrificed  their 
vacations,  and  often  their  positions,  in  order  to  do  this  vol- 
unteer work  of  the  Eed  Cross.  When  the  need  for  nurses 
for  active  service  hecamc  pressing,  during  the  period  of  the 
war,  the  Nursing  Service  of  the  Ked  Cross  appointed  on  its 
Local  Committees  those  women  especially  who  were  unable 
to  accept  active  service,  but  who  had  given  generously  of  their 
time  and  money  to  carry  on  this  important  part  of  the  Ked 
Cross  work.  These  Local  Committees  in  this  way  prepared 
thousands  of  nurses  for  active  service;  advised  them  in  regard 
to  their  home  conditions  and  their  release  from  positions ;  and 
it  was  only  through  their  cooperation  and  assistance  that  the 
work  at  National  Headquarters  was  made  possible. 

The  size  of  the  ISTational  Committee  on  Red  Cross  Nursing 
Service  and  the  widely-separated  locations  of  its  members  made 
it  imperative  to  have  a  small  but  efhcient  Executive  Committee. 
Organized  July  28,  1917,  this  was  composed  of  any  members 
then  stationed  in  Washington,  with  the  presidents  of  the  three 
national  societies  of  nurses.  This  small  committee  shared 
the  responsibility  of  the  problems  of  the  Red  Cross  Nursing 
Service  as  they  arose  day  by  day. 

Soon  after  the  appointment  of  the  War  Council  by  Presi- 
dent Wilson  on  ^lay  10,  1017,  its  chairman,  ^Ir.  Henry  P. 
Davison,  arranged  special  conferences  designed  to  bring  the 
difierent  Red  (Voss  Departments  together  to  consider  nursing 
problems  and  to  make  recommendations  in  regard  to  the  Ser- 
vice. On  this  committee  there  were  representatives  of  the 
War  Council;  the  R(>d  Cross  Committee  on  Co()peration ;  the 
Red  Cross  JNTedical  Advisory  Committee;  and  the  National 
Committee  on  Red  (^ross  Nursing  Service.  Dr.  Simon  Flexner, 
Chairman  of  the  Red  Cross  jMedical  Advisory  Committ(>e,  pre- 
sided at  a  meeting  of  this  conference  which  was  held  at  Head- 
([uarters,  July  2-'},  1017.  A  nundx'r  of  mendters  of  tlu>  Na- 
tional Committee  on  Nursing  Service  had  been  invited  to 
attend.  Those  ])resciit  were:  (from  the  R(>d  C^'oss  National 
Committee  on  Nursiug  Service)  ]\Iiss  Delano,  chairnnm;  Miss 
Noyes,  Director,  Bureau  of  Nursing  Service;  ]\riss  Clement, 
l)ir(H'tor,  Bun^ftu  of  Town  and  Country  Nursing  Service;  ]\riss 
Hay,  DircH'tor,  Bureau  of  Histructi(ui  for  Women:  Miss 
Deans;  ^Irs.  William  K.   Drap(>r;  ]\liss  Nutting;  ^liss  Good- 


254   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rich;  Miss  Beard;  Miss  Clayton;  Miss  Wald;  Miss  Hilliard; 
Miss  Thompson;  Mrs.  Higbee;  (from  the  Red  Cross  Com- 
mittee on  Cooperation)  Jndge  Robert  S.  Lovett;  Messrs. 
A.  D.  Hodenpvl,  George  Wharton  Pepper,  Edward  1). 
Butler,  John  F.  Moore,  and  L.  K.  Frankel;  (from  the  Red 
Cross  Medical  Advisory  Committee)  Doctors  Biggs,  Chapin, 
Flexner,  Kerr,  Rose,  Ryan,  Rosenau,  Smith,  Pearce  and 
Richards;  (from  the  War  Council)  Messrs.  Davison  and  Wads- 
worth. 

The  entire  field  of  nursing  needs  and  desirable  standards  of 
nursing  qualifications  for  Red  Cross  war  enrollment  was  thor- 
oughly g-one  over.  It  was  agreed  that  there  was  no  immediate 
shortage  in  well-trained  nurses  and  that  the  Red  Cross  was 
adding  to  its  available  reserves  in  every  w^ay  that  foresight 
could  dictate.  It  was  found  that  the  real  crisis  of  the  nursing 
situation  lay  in  the  future  and  that  while  present  needs  were 
being  met  the  war  demands  would  increase  rapidly  and  it  w^as 
of  the  greatest  importance  that  well  educated  women  should 
be  urged  to  take  the  nurse's  training.  At  the  end  of  the  con- 
ference the  chairman  (Dr.  Flexner)  was  directed  to  appoint 
a  small  conference  committee  to  meet  on  a  later  day  in  that 
same  week  and  settle  finally,  if  possible,  the  war  nursing 
policy  of  the  Red  Cross  in  regard  to  the  standards  for  enroll- 
ment and  to  report  its  conclusions  to  the  War  Council. 

Dr.  Flexner  appointed  Miss  Delano,  Miss  Xutting,  ^liss 
Beard,  Dr.  William  H.  Welch,  Dr.  Herman  M.  Biggs  and 
Dr.  Winford  H.  Smith. 

On  Friday,  July  27,  all  except  Dr.  Welch  and  Dr.  Biggs  who 
were  unable  to  be  present,  met  at  Red  Cross  Headquarters. 
Dr.  Flexner  took  the  chair  and  Dr.  R.  M.  Pearce  (of  the 
Medical  Advisory  Committee)  acted  as  secretary.  The  con- 
ference committee  examined  its  nursing  problems  in  a  frank 
and  thorough -going  way  and  in  due  time  its  report  was  laid 
before  the  War  Council  and  accepted  by  that  body.  The  ques- 
tions considered  were : 

1.  Size  of  liospitals  in  wliich  nurses  are  trained,  i.e.,  aver- 
age nunil)er  of  patients  per  day. 

2.  Age  limit  at  tlie  time  of  enrollment. 

3.  Early  graduation  of  classes  iii   (a)   three  year,   (b)   two 
year  schools. 

-1.   Short  trainin<j  courses  for  aides. 


MOBILIZATION  256 

5.  Public  health  nurses — should  they  be  urged  to  decline 
service  with  hospital  units  abroad? 

1.  Hospital  training  schools. 

The  committee  discussed  first  the  Eed  Cross  requirements 
for  enrollment  in  its  nursing  service  with  such  modifications 
as  have  been  found  necessary  to  meet  war  conditions.  The 
chairman  of  the  National  Committee  on  lied  Cross  Nursing 
Service  reported  tiiat  in  cooperatio^i  with  State  Boards  of 
Registration  provision  has  been  made  for  the  acceptance  of 
graduates  from  schools  recommended  by  the  Boards  as  giving 
sufiiciently  thorougli  training  to  qualify  such  graduates  for 
War  Service.  This  modification  has  been  made,  she  reported, 
without  a  definite  requirement  as  to  the  size  of  the  hospital. 
It  is  estimated  that  approximately  five  hundred  training 
schools  will  be  added  to  the  acceptable  list  through  this 
change. 

2.  Age  limit  of  enrolling  nurses. 

The  chairman  of  the  National  Committee  on  Ked  Cross 
Nursing  Service  also  reported  that  tlie  age  limit  for  enrolling 
nurses  has  been  reduced  to  twenty-one  years  and  extended 
beyond  forty  years,  depending  upon  the  qualifications  of  the 
individual  nurse  in  each  case, 

3.  Early  graduation  of  nurses. 

The  question  of  an  earlier  graduation  of  the  pupils  already 
in  training  in  order  to  increase  the  supply  of  nurses,  was 
discussed,  it  was  the  oi)inion  of  the  s.})ecial  committee  that 
schools  gi\ing  a  three  year  course  of  training  might  later, 
should  the  exigencies  of  war  make  such  action  necessary,  be 
requested  to  advance  the  date  of  graduation. 

!Miss  Nutting  sul)mitted  a  report  of  the  ell'orts  now  being 
made  by  the  Committee  on  Nursing  of  the  Council  of  Na- 
tional Defense  to  increase  the  output  of  the  training  sciiools. 
In  cooperation  with  the  Ked  Cross  it  has  addressed  an  apjieal 
to  college  women  and  to  graduates  of  technical  schools,  high 
and  private  schools,  urfring  them  to  enter  training  schools  as 
student  nurses  in  training,  and  thus  aid  in  meeting  the  need 
of  civil  hos])itals  as  well  as  sup])ly  a  large  body  of  women  of 
exceptional  ability  trained  for  the  reconstruction  work  which 
will  follow  the  war. 

The  chairman  of  the  National  Committee  on  l\ed  Cross 
Nursing  Service  rejiorted  that  provision  has  been  made  for  a 
complete  listing  of  tlie  nursing  Sisterhoods  throughout  the 
T'nited  States.  A  questionnaire  is  to  be  sent  to  these  Sister- 
hoods to  deterniiiie  the  approximate  number  of  nursing  Sis- 


256   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ters  and  lay  Sisters  trained  in  their  hospitals  who  are  available 
for  Eed  Cross  service.  Provision  has  also  been  made  to  utilize 
colored  nurses  for  service  in  caring  for  colored  troops  in  base 
hospitals  and  the  Red  Cross  will  enroll  such  nurses  as  needed. 
It  was  also  reported  that  the  Red  Cross  has  organized  com- 
mittees for  the  enrollment  of  nurses  in  Hawaii,  the  Philip- 
pines and  in  France,  in  order  to  utilize  American  nurses  resi- 
dent in  those  regions. 

4.  Training  of  nurses'  aides. 

The  system  of  training  nurses'  aides  was  considered.  The 
chairman  of  the  National  Committee  on  Red  Cross  Xursing 
Service  reported  that  authority  has  already  been  given  to 
forty-five  hospital  centers  around  which  base  hospitals  have 
been  organized  to  provide  practical  hospital  experience  to 
women  volunteering  as  nurses'  aides.  These  hospitals  will  be 
urged  to  complete  their  lists  of  twenty-five  aides  each  on  first 
call*  and  to  carry  a  reserve  of  twenty-five  or  more.  This  will 
give  approximately  twenty-two  hundred  and  fifty  aides  avail- 
able for  service. 

A  questionnaire  is  being  prepared  to  send  to  these  vol- 
unteers in  order  to  determine  how  many  of  them  are  ready 
for  service,  in  either  the  military  or  civil  hospitals  in  this 
country.  The  course  in  Elementary  Hygiene  and  Home  Care 
of  the  Sick  forms  the  basis  of  selection  for  admission  to  this 
service,  and  some  idea  of  the  possible  resources  may  be  gained 
from  the  fact  that  about  thirty-four  thousand  women  have 
completed  this  course  of  instruction. 

5.  Public  health  nurses. 

The  question  of  utilizing  public  health  nurses  for  service 
both  in  this  country  and  abroad  was  considered.  The  chair- 
man of  the  Xationa!  Committee  on  Red  Cross  Nursing  Service 
reported  tliat  in  order  to  utilize  public  health  nurses  to  the 
best  advantage  a  special  enrollment  has  l)een  provided  exempt- 
ing them  from  other  service.  Tinder  this  enrollment  put)lic 
health  nurses  will  be  held  available  for  service  in  and  about 
military  cantonments  in  this  country  and  for  service  in  activi- 
ties in  Europe. 

Summary. 

In  sul)mitting  the  foregoing  report,  the  Special  Commit- 
tee on  Nursing  appointed  by  the  Red  ('ross  War  Council 
desires  to  express  its  approval  of  the  general  plan  of  enroll- 
ment of  nurses  as  adopted  by  the  N^ational  Committee  on  Red 
Cross  Nursing  Service.  The  modifications  included  in  this 
plan  may  be  summarized  as  follows: 


MOBILIZATION  257 

1.  That  the  lower  ago  limit  for  Red  Cross  nurses  be  reduced 
to  twenty-one  years;  that  the  upper  a^^e  limit  be  left  in- 
definite, to  be  dealt  with  separately  in  each  case  according  to 
the  character  of  the  service  and  the  physical  qualifications  of 
the  applicant. 

2.  That  the  requirements  governing  training  schools  be 
modified  so  as  to  qualify  for  Red  Cross  enrollment  the  grad- 
uates of  schools  which  are  recommended  by  State  Boards  of 
Registration  as  giving  courses  sufficiently  thorough  to  pre- 
pare nurses  for  Red  Cross  service. 

3.  That  in  order  further  to  increase  the  supply  of  nurses, 
the  schools  giving  a  three  year  course  of  training  be  re- 
quested to  advance  the  date  of  graduation  of  pupil  nurses, 
should  the  exigencies  of  war  make  such  action  seem  desir- 
able. 

4.  That  in  addition  to  the  steps  already  taken  to  supply 
volunteer  nurses'  aides,  which  the  committee  approves,  it  is 
recommended  that  the  period  of  practical  hospital  experience 
for  these  volunteers  be  increased  to  one  month  of  eight  hours* 
service  each  day  under  the  supervision  of  the  Red  Cross,  and 
that  the  Red  Cross  volunteer  aides  be  used  for  service  in  our 
own  country  only,  and  that  women  under  twenty-one  years 
of  age  shall  not  be  selected. 

In  view  of  the  provision  already  made  for  the  instruction 
of  volunteer  aides  in  connection  with  Base  Hospitals  and  the 
large  number  of  women  who  have  completed  the  required 
course  of  theoretical  instruction  and  whose  names  are  on  file 
in  Washington,  the  committee  believes  that  the  immediate 
extension  of  this  service  is  not  pressing,  but  approves  of  the 
authorization  of  civil  hospitals  to  give  this  instruction  to 
nurses'  aides  as  needed,  subject  to  the  approval  and  under 
the  direction  of  the  American  Red  Cross,  and  recommends 
that  only  those  liospitals  ap])r()ved  by  the  State  Boards  of 
Registration  of  Nurses  shall  receive  such  authorization. 

5.  The  committee  a])provcs.  of  the  plan  adopted  by  the 
National  Committee  on  Red  Cross  nursing  for  a  special  en- 
rollment of  public  health  nurses  who  shall  be  held  available 
for  public  health  work  under  the  Red  Cross  either  in  this 
country  or  abroad. 

This  program  has  been  approved  by  the  officers  of  the  Red 
Cross  Nursing  Service;  by  officers  of  the  Committee  on  Xurs- 
ing  of  the  Council  of  Xational  Defense;  by  Annie  Coodrich, 
president  of  tlie  American  Xurses'  Association:  Mary  F. 
Beard,   president   of  the   National   Organization    for   Public 


258   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Health  Nursing ;  S.  Lillian  Clayton,  president  of  the  National 
League  for  Nurse  Education;  Amy  Hilliard,  formerly  in- 
spector of  training  schools  in  New  York  State;  Dora  E. 
Thompson,  superintendent  of  the  Army  Nurse  Corps ;  Lenah 
S.  Higbee,  superintendent  of  the  Navy  Nurse  Corps  and  by 
the  lied  Cross  Medical  Advisory  Committee  and  the  Red 
Cross  Committee  on  Cooperation. 

The  members  of  the  Red  Cross  departments  were  gratified 
by  this  endorsement  and  by  the  letter  that  had  been  written  a 
little  earlier  by  Miss  Nutting,  here  reproduced,  for  the  anxiety 
and  responsibility  of  executive  work  often  formed  an  almost 
crushing  burden  for  Miss  Delano  and  her  co-workers,  who,  de- 
sirous on  one  hand  of  maintaining  high  professional  require- 
ments, were  on  the  other  under  the  obligation  of  meeting  every 
instant  necessity  in  the  matter  of  a  supply  of  nurses,  no  matter 
how  difficult. 

Teachers  College, 
Columbia  University, 

July  16,  1917. 
Miss  Jane  A.  Delano,  Chairman, 
National  Committee  on  lied  Cross  Nursing  Service, 
Washington,  D.  C. 

My  dear  Miss  Delano : 

At  the  last  meeting  of  the  Committee  on  Nursing  of  the 
General  ^Medical  Board,  of  the  Council  of  National  Defense, 
a  motion  was  passed  expressing  our  approval  of  the  method 
of  enrollment  adopted  by  the  Nursing  Service  of  the  Ked 
Cross. 

I  am  very  glad  to  transmit  this  motion  to  you  and  to  add 
that  those  of  us  who  have  watched  the  careful,  thorough  work 
of  the  past  seven  years  which  has  gone  to  building  up  this 
important  branch  of  the  Eed  Cross,  feel  that  a  very  great 
national  service  has  been  rendered.  For  not  only  has  there 
been  created  a  large  body  composed  of  trained,  skilled  and 
competent  nurses  to  form  the  Nursing  Service  of  the  Eed 
Cross,  but  the  estaljlishment  and  maintenance  of  proper  re- 
quirements for  enrollment  in  this  service  have  acted  as  a 
valuable  stimulus  to  hospitals  and  training  schools  in  urging 
them  to  improve  their  standards  of  training  in  order  that 
their  graduates  might  be  eligible  for  such  enrollment. 

In  no  other  country  in  the  world  has  the  Red  Cross  such  a 
record.  On  the  contrary,  its  effort  throughout  history  has 
generally  tended  to  weaken  instead  of  to  strengthen  good 
nursing  standards,  and  consequently  and  inevitably  to  impair 


MOBILIZATION  259 

the  efficiency  of  its  nursing  service.  It  is  our  hope  that  you 
may  be  able  to  maintain  tlio  high  standards  you  liave  set  for 
your  life-saving  work  and  that  our  great  dependence  for 
nursing  the  sick  and  wounded  men  of  our  army  may  con- 
tinue to  be  placed  upon  skilled  and  capable  workers. 
Faitlifully  yours, 
(signed)   ^r.  Adklaide  Nutting,  Chairman, 

Conmiittee  on  Nursing,  the  General 
iledical  Board  of  the  Council  of 
National  Defense. 

The  immediate  steps  taken  during  the  early  part  of  the  sum- 
mer of  1917  by  the  A'^ational  Committee  on  Ked  Cross  Nursing 
Service  and  its  smaller  executive  group  were  directed  toward 
the  one  main  purpose  of  increasing  enrollment.  To  this  end, 
all  State  Boards  of  Examiners  were  urged  to  announce  more 
frequent  examinations  of  graduate  nurses  desiring  to  register 
under  state  acts  and  to  pass  upon  examination  papers  with 
the  utmost  dispatch  so  that  nurses  might  enroll  without  delay. 
State  Boards  of  Registration  were  asked  to  furnish  the  Red 
Cross  with  three  classified  training  school  lists,  giving  in  one 
the  names  of  all  those  schof)ls  which  met  the  Red  Cross  require- 
ments, in  another  those  on  the  border  line  and  in  the  third  those 
Avhich  were  below.  Local  Committees  were  written  to  and  asked 
to  select  nurses  for  service.  Letters  were  sent  to  a  selected 
group  of  women  in  close  touch  with  National  Headquarters, 
urging  them  to  take  the  nurse's  training.  A  special  committee 
of  nurses  in  New  York  City,  all  of  whom  were  Red  Cross 
members,  and  who  afterwards  became  leading  figures  in  the 
Committee  on  Nursing  under  the  Council  of  National  Defense, 
undertook  to  arouse  educators  and  educational  institutions  espe- 
cially and  so  to  direct  large  numbers  of  applicants  to  training 
schools. 

With  the  end  of  the  war  the  executive  committee  of  the  Na- 
tional Committee  on  Red  Cross  Nursing  Service  summed  up 
its  meetings  and  recommendations  as  follows: 

Light  nu'otings  of  tlio  executive  connuittoe  of  the  National 
Committee  on  h'ed  Cross  Nursing  Service  have  been  held 
since  its  autliorization. 

Action  was  taken  on  tlio  following  questions,  in  each  in- 
stance a  quorum  of  the  National   Committee  being  present: 

L  Plan  for  publicity  cam]iaign^beginning  with  a  syndi- 
cated article  in  magazines  and  newspapers. 


260   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

2.  Definite  request  to  be  made  to  the  American  Red  Cross 
for  an  expert  publicity  man  to  assist  the  committee. 

3.  Resolution  adopted  and  sent  to  the  president  of  Yassar 
College  on  establishing  a  preparatory  course  in  nursing  for 
college  women  (Yassar  Plan). 

4.  Letter  submitted  to  the  Surgeon  General's  office  re- 
questing that  some  action  be  taken  to  combat  the  rumors  of 
nurses  returning  from  Europe  pregnant. 

5.  Xurses  not  eligil)le  for  active  military  service  and  in 
charge  of  training  schools  for  nurses  to  be  enrolled  as  re- 
cruiting agents. 

6.  "Special  enrollment''  for  nurses  through  Divisions  for 
Home  Defense  (pliysically  unfit  for  military  service,  over 
age,  married  and  those  holding  important  positions  who 
should  not  be  disturbed). 

7.  Uniform  of  Dietitians. 

8.  Recommendation  that  receipts  from  the  Metropolitan 
Life  Insurance  Company  for  Town  and  Country  Xursing  be 
paid  to  the  organizations  supporting  nurse,  rather  than  to 
Headquarters. 

9.  Recommendation  that  Miss  Clement,  Director  Town  and 
Country  Xursing  Service,  draft  all  recommendations  with  her 
personal  opinion  regarding  the  further  development  of  rural 
nursing. 

10.  Service  Flag. 

11.  Cooperation  with  the  ^Yoman's  Committee  of  the  Xa- 
tional  Coimcil  of  Defense  in  their  campaign  on  Infant  Wel- 
fare, as  far  as  possible. 

12.  Plan  to  secure  rank  for  nurses. 

13.  Circularize  Boards  of  Registration  for  Xurses  and  State 
Associations;  circularize  the  superintendents  of  training 
schools  for  nurses;  circularize  the  Sisterhoods;  circularize 
the  non-registered  nurses;  circularize  the  subscription  list  of 
the  American  Journal  of  Xursing. 

14.  Pre])are  ])lans  for  |niblicity  campaign  and  launch  as 
soon  as  the  committee  on  ])iiblicity  (consisting  of  chairman 
of  Xational  Committee  on  Ivcd  Cross  Xursing  Service  and 
representatives  from  tlie  three  national  organizations)  de- 
cided it  was  ])racti(al  and  if  possible  immediately  following 
the  drive  for  Liberty  Ronds. 

The  most  important  details  covered  by  some  of  the  above 
resolutions  \vill  be  dealt  with  in  later  pages. 

Of  all  the  subjects  named  in  the  list  above  as  taken  up  by 


MOBILIZATION  261 

the  National  Committee  on  Red  Cross  Nursing  Service,  none 
was  more  perplexing  than  that  one  alluded  to  in  paragraph 
four.  Elusive  whispers  of  scandal  touching  Kcd  Cross  nurses 
and  gruesome  tales  of  mutilation  suffered  by  them,  reached  the 
Nursing  Service  early  in  lt)17,  persisting  throughout  the  war 
and  even  after  the  Armistice.  The  Red  (^ross  tilers  liave  an 
extraordinary  series  of  letters  written  to  Miss  Delano  or  sent 
to  her  bv  the  recipients,  with  her  answers.  The  letters,  usually 
written  by  friendly  loyal  persons,  related  with  indigiuition  yet 
often,  too,  with  misgivings  the  alarming  rumors.  Fifty  such 
letters,  analyzed  for  th(>  purposes  of  this  history,  may  be  thus 
summarized.  The  rumors  fell  under  three  heads.  First, — 
that  Red  Cross  nurses  abroad  had  become  victims  of  forcible 
outrage  by  enemy  soldiers,  or  even  by  Allied  officials,  and  that 
numbers  of  them  (the  numbers,  always  mentioned,  varied  from 
fifty  to  several  hundred)  had  become  pregnant  and  were  being 
brought  home  to  be  cared  for  in  American  hospitals.  Names 
of  hospitals,  especially  two  well-known  ones  in  New  York 
City,  were  sometimes  specified.  Second, — that  Red  Cross 
nurses,  as  a  result  of  forcible  outrage  or  personal  immorality,  or 
both,  had  become  infected  with  venereal  disease  and  were  quar- 
antined at  a  French  port,  usually  named.  In  this  legend  also 
the  numbers  ran  high ;  the  writer  personally  heard  that  nine 
hundred  such  victims,  all  nurses,  were  behind  stockades  at  a 
locality  in  France.  Third, — that  Red  Cross  nurses  had  come 
back  to  their  homes  with  eyes  gouged  out,  tongues  slit,  or  hands 
and  toes  cut  off. 

It  soon  became  clear  that  these  rumors  constituted  a  definite 
propaganda,  arising  from  an  unknown  source.  This  might 
have  had  one  of  two  purposes ;  one,  to  add  fuel  to  the  flames  of 
hatred  against  an  enemy ;  two,  to  retard  the  enrollment  of 
nurses  in  the  Red  (^ross  and  thus  endeavor  to  cut  off  at  its 
source  the  supply  of  nurses  to  serve  in  military  hospitals. 

The  Committee  on  Nursing  S(>rvice  concluded  that  while 
both  purposes  w(^re  served,  the  latter  was  the  one  directly  aimed 
at  and  indeed,  while  (Mirollmeiit  was  not  prevented,  its  c(nirse 
was  often  made  infinit(>ly  difficult  by  the  popular  reaction  to 
the  rumors. 

The  Nursing  v^ervice,  desirous  of  avoiding  pn])licity  in  the 
daily  press  as  tending  to  assist  the  propagandists,  took  u]i  each 
report  separately  as  it  reached  Ilcadipiartin'S.  Such  word  usu- 
ally came  in  from  some  nurse  or  Red  Cross  member,  indignant, 


262   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

shocked  and  incrednlons,  yet  having  at  hand  no  way  of  making 
authoritative  denial.  They  were  then  given  a  categorical  denial 
by  the  Nursing  Service  and  were  requested  to  obtain  and  for- 
ward to  Headquarters  the  names  of  persons  from  whom  the 
rumor  was  heard,  with  dates  and  names  of  places  involved. 
Every  such  clue  was  painstakingly  followed  up  and  invariably 
ended  in  nothing. 

It  was,  however,  learned  that  the  mode  of  starting  the  rumors 
on  their  way  was  this :  On  a  railway  train  of  some  small  rail- 
road, in  a  remote  or  provincial  region,  a  well-appearing  woman 
traveler,  getting  into  conversation  with  other  travelers,  would 
modestly  mention 'herself  as  a  Red  Cross  worker  from  abroad 
and  would  then  with  deep  feeling  relate  most  confidentially  the 
horrid  tales,  presently  alighting  at  some  small  town,  there  to 
disappear  without  trace.  Or  again,  travelers  in  a  far  distant 
locality,  again  on  the  railway,  would  be  attracted  by  the  sight 
of  two  apparent  invalids,  so  heavily  bandaged  as  to  be  practi- 
cally invisible  and  would  learn  from  a  kindly  woman  or  man 
in  charge  that  they  were  Red  Cross  nurses  whose  eyes  had  been 
put  out,  tongiies  slit,  or  hands  chopped  off.  In  no  instance  did 
any  one  see  beneath  the  bandages. 

As  these  tales  were  whispered  from  one  to  another  they 
sometimes  got  into  local  papers  and  were  often  given  credence 
by  well-meaning  but  ill-balanced  persons.  Statements  based 
upon  them  were  occasionally  recklessly  made  at  public  meet- 
ings, sometimes  even  at  local  Red  Cross  meetings.  An  embar- 
rassing detail  in  counteracting  them  was  that  members  of  an- 
other national  society  of  the  highest  standing  more  than  once 
disseminated  these  absurdities,  as  proving  the  need  of  their 
own  ministrations  and  of  the  enlargement  of  their  own  facilities 
in  the  war  zones. 

The  rumors  were  dealt  with  almost  entirely  by  the  Red 
Cross.  In  several  instances  the  Department  of  Justice  was 
called  on  for  assistance.  One  quite  prominent  woman  physi- 
cian was  called  before  a  federal  jury  and  reprimanded  and  in 
another  case  a  man  was  fined  $1000  and  costs.  Similar  rumors 
M'cre  set  on  foot  regarding  Canadian  nurses  and  Government 
circles  in  Canada  luul  the  same  difticulty  in  denouncing  them. 
The  tah>s  were  usually  repeated  with  no  malicious  intent  and 
were  well  known  in  nursing  circles,  but  there,  naturally,  were 
not  believed.  The  following  hotter  written  by  ]\liss  Delano  is  a 
type  of  the  many  that  she  wrote  in  this  connection: 


MOBILIZATION  263 

December  4,  1917. 
My  dear  Mr 

Your  letter  addressed  to has  been  referred  to  me 

for  reply. 

Similar  rumors  have  come  to  this  office  from  time  to  time, 
and  I  can  only  assure  you  as  emphatically  as  possible  that 
there  is  absolutely  no  truth  in  the  statement.  We  have  alto- 
getber  about  four  thousand  nurses,  about  three  thousand  of 
these  in  service  in  France.  They  are  definitely  assifj^ned  to 
base  hospital  units  under  military  authority,  or  under  the 
direct  supervision  of  the  lied  Cross.  Of  all  our  nurses  in 
France  only  two  or  three  have  returned,  and  it  would  be 
impossible  for  any  large  number  to  be  brought  back  in  the 
condition  mentioned  in  your  letter  without  the  Eed  Cross 
being  fully  informed  of  the  matter. 

Would  it  not  be  possible  to  take  up  quite  definitely  with 
T .  . .  .  F .  . .  . ,  who  has  circulated  the  report,  this  matter, 
compelling  him  to  give  the  source  of  his  information  and  as 
a  lawyer  interested  in  lied  Cross  activities  take  such  steps  as 
may  be  necessary  to  prevent  the  repetition  of  this  untruth 
in  your  community?  I  can  well  understand  that  you  would 
hesitate  to  do  this  without  definite  information  from  Head- 
quarters. 

I  may  assure  you  that  there  is  no  foundation  for  the  rumor. 
A  similar  rumor  is  being  circulated  concerning  Canadian 
nurses  and  I  wrote  to  the  Department  of  Militia  and  De- 
fense, Ottawa,  Canada,  for  a  definite  statemont,  whicli  was 
promptly  received,  denying  absolutely  all  foundation  for  the 
rumors.  It  seems  evident  that  it  is  a  definite  propagaiula 
which  should  be  met  as  promptly  as  possible.  We  have  tried 
to  avoid  any  newspaper  publicity,  as  it  would  only  spread 
the  rumor. 

I    shall   appreciate   greatly    any    further    information    you 
may  secure,  and  bopc  for  your  cooperation  in  branding  such 
rumors  as  malicious  falsehoods.     Appreciating  greatly  your 
having  written  to  the  Wed  Cross  direct, 
Believe  me. 

Sincerely  yours, 

(signed)   Jaxe   A.    Delaxo,    Chairman 
Xational  Committee  on  Ked  Cross  Xursing  Service. 

As  the  magiiitudc  of  the  war  tasks  became  plain,  extensive 
systems  of  coordinated  ('ft'ort  were  woven  into  the  social  fabric 
and  the  energies  of  nurses,  bent  to  the  support  of  the  Ked  Cross 
Xursing  Dejiartmcnt,  or  to  associated  war-Wdi'king  gronjis,  gave 
results  that  are  distinctive  in  international  lied  Cross  nursing 


264  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

history,  not  only  for  the  bold  and  original  methods  adopted, 
but  also  for  the  proof  that,  even  in  war  emergency,  an  exten- 
sive increase  in  nursing  personnel  is  possible,  without  seriously 
lowering  the  hard-won  standards  of  professional  competency. 

Early  in  June,  1917,  an  Emergency  Committee  on  I^ursing 
was  organized  by  Miss  Nutting  and  Miss  Wald  in  New  York 
City  to  include  a  number  of  prominent  nurses,  all  of  whom 
were  members  of  the  Red  Cross  National  Committee  and  one  of 
whom  was  Miss  Delano,  as  also  several  prominent  physicians, 
with  Miss  Julia  Lathrop,  Chief  of  the  Federal  Children's 
Bureau.  The  purposes  of  the  Committee  were :  "to  devise  the 
wisest  methods  of  meeting  the  present  problems  connected  with 
the  care  of  the  sick  and  injured  in  hospitals  and  homes;  the 
educational  problems  of  nursing;  and  extraordinary  emergen- 
cies as  they  may  arise." 

The  founders  of  this  Emergency  Committee  had  been  fearful 
that  under  the  great  excitement  of  war,  the  usual  objects  of 
their  care  might  be  neglected  and  they  planned  to  guard  those 
objects;  i.e.,  the  daily  nursing  of  the  sick  in  the  homes  and 
hospitals  and  the  teaching  and  preparing  of  nurses  for  their 
fields,  while  the  Eed  Cross,  officially  charged  by  the  govern- 
ment to  be  directly  responsible  for  war  nursing  would  naturally 
be  absorbed  in  that  immense  obligation.  With  the  formation 
of  the  Council  of  National  Defense  (composed  of  the  Secre- 
taries of  War,  Navy,  Interior,  Agriculture,  Commerce  and 
Labor)  an  Advisory  Commission  of  seven  specialists  was  nomi- 
nated and  appointed  by  President  Wilson.  Dr.  Franklin  Mar- 
tin, as  one  of  the  seven,  organized  the  General  Medical  Board 
and  this  Board  took  over  tlie  Emergency  Committee  and  made 
it  the  National  Committee  on  Nursing  of  the  Council  of  Na- 
tional Defense  with  ]\Iiss  Nutting  as  .its  chairman,  to  function 
under  tlie  direction  of  the  cliairman  of  the  General  Medical 
Board.  Dr.  ^lartin  himself  being  chairman  of  the  Committee 
on  ^ledicine  and  Sanitation  of  the  Board,  came  into  close 
e(jrrespondence  and  professional  contact  with  the  nurses  on  all 
the  committees.  There  was  also  under  the  Council  of  National 
Defense  a  subcommittee  on  Pulilic  Health  Nursing  and  a  com- 
mittee on  Home  Nursing.  ]\riss  Delano  had  a  place  on  each 
and  her  special  part  in  their  conferences  was  to  prevent  as  far 
as  possible  overlapping  and  duplication  of  effort,  as  from  her 
post  at  Red  (h-oss  Ileadcpiarters,  she  had  a  knowledge  of  the 
entire  field  which  none  of  the  others  could  possess. 


MOBILIZATION  265 

As  the  national  pace  speeded  up,  frictional  reduplication  of 
activities  was  not  always  preventable  and  it  may  be  reasonably 
concluded  that  the  single  task  of  nursing  during-  the  war  would 
have  evolved  more  smoothly  and  expeditiously  had  the  Xursing 
Committee  of  the  Council  of  National  Defense  organized  itself 
for  its  special  interests  under  the  Red  Cross  (as  a  subcommittee 
of  the  National  Committee)  and  this  the  more  as  they  were  all 
Red  Cross  Nurses  and  the  majority  of  them  members  of  the 
National  Committee  on  Red  Cross  Nursing  Service. 

Miss  Nutting's  committee,  as  it  was  informally  called,  had 
from  the  beginning  a  special  concern  for  the  underlying  edu- 
cational factor  in  nursing  and  to  its  leaders  it  could  not  have 
seemed  otherwise  than  that  they  were  specially  responsible  for 
that  trust,  for  clearly  the  Red  Cross  alone,  as  then  organized, 
could  not  have  cultivated  the  educational  field  in  addition  to 
its  vast  administrative  domain,  but  its  readiness  to  cooperate 
and  contribute  show  that  the  second  commJttee  would  have  had 
equally  wide  scope  had  it  been  a  special  Red  Cross  committee. 
Miss  Nutting's  committee  stood  close  to  the  educational  world 
and  its  activities  bore  the  impress  of  her  original  and  boldly 
resourceful  mind.  Her  suggestions  and  plans  gave  great  im- 
petus to  those  intensive  yet  educationally  sound  courses  opened 
for  nurses  in  women's  colleges,  in  connection  with  hospital 
training,  of  which  Vassar  gave  the  most  highly  perfected  ex- 
ample, to  be  presently  described  and  known  as  the  Vassar 
Plan,  Tn  the  recruiting  of  pupils  for  the  trainiug  schools,  in 
the  movement  to  induce  schools  for  nurses  generally  as  a  war 
duty  to  admit  college  women  for  training  on  a  two-year  instead 
of  three-year  basis,  and  in  the  inception  of  the  Army  School 
^liss  Nutting's  committee  did  original  and  distinctive  work. 
Of  permanent  value  to  nursing  literature  are  th(^  committee's 
nine  pamphlets,  most  of  which  were  prepared  by  Isabel  Mait- 
land  Stewart,  a  professor  in  the  Department  of  Xursing  and 
Health  at  Teachers  College.  Their  studies  of  war  nursing 
problems  should  make  them  useful  to  the  Red  Cross  societies 
and  nursing  associations  of  other  countries  as  well  as  to  our  own. 

The  committee  on  Home  Nursing,  ^liss  Wald  its  chairnian, 
was  closely  tied  to  the  Department  of  Labor  and  concerned 
itself  primarily  with  all  aspects  of  industrial  nursing,  so  called, 
especially  in  those  industries  which  were  engaged  in  war  work, 
and  with  strengthening  public  health  nursing  in  industries  and 
in  the  homes. 


266   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  purposes  of  the  subcommittee  on  Public  Health  Nurs- 
ing and  some  parts  of  its  plans  are  told  in  the  following  ex- 
cerpts : 

This  committee  was  created  by  Surgeon  General  Blue  for 
the  purpose  of  relating  the  work  of  the  public  health  nurse 
to  the  many  problems  of  hygiene  and  sanitation  brought  into 
prominence  by  the  war.  These  problems  are  suggested  by  the 
names  of  the  other  sub-committees  of  the  Committee  on 
Hygiene  and  Sanitation,  for  example,  the  Committee  on 
Alcoholism,  the  Committee  on  Venereal  Disease  and  the  Com- 
mittee on  Drug  Addiction. 

The  public  health  nurse  must  be  the  instrument  which  will 
make  preventive  medicine  effective.  It  is  wise,  therefore,  to 
create  a  body,  the  function  of  which  shall  be  to  study  the 
changing  conditions  produced  by  the  war  and  to  be  ready  to 
recommend  to  any  given  community  a  plan  for  establishing 
a  public  health  nursing  agency  whenever  these  changing  con- 
ditions demand  it.  First :  The  purpose  of  the  committee  is : 
To  collect  and  edit  material  relating  to  the  disastrous  effects 
of  the  last  three  years  of  war  on  the  community  health  of 
the  European  nations  at  war.  Second :  To  procure  informa- 
tion of  the  present  status  of  community  health  work  in  this 
country  and  of  the  extent  to  Which  such  work  is  endangered 
by  a  state  of  war,  and,  further,  to  procure  information  as  to 
the  need  of  the  greater  extension  of  it  by  a  state  of  war. 

Community  health  work  in  areas  about  the  cantonments 
must  be  imdertaken  by  public  health  nurses.  Therefore,  the 
Nursing  Bureau  of  the  Red  Cross  is  asking  the  help  of  this 
committee  in  enrolling  all  public  health  nurses  for  pul)lic 
health  nursing  service  either  here  or  in  Europe,  and  is  further 
turning  to  the  secretary  of  this  committee  to  act  in  an  ad- 
visory capacity  for  the  selection  of  public  health  nurses  for 
these  areas. ^ 

This  subcommittee  gathered  important  data  bearing  on  pub- 
lic health  activities ;  made  a  special  census  of  public  health 
resources,  agencies  aiid  nurses  at  home ;  assisted  the  Red  Cross 
in  securing  nurses  for  the  sanitary  zones  surrounding  canton- 
ments;  initiated  at  Teachers  College,  with  the  help  of  Miss 
Nutting  and  through  scholarships  donated  bv  the  Red  Cross, 
the  educational  preparation  for  ten  nurses  neccssarv  in  the 
campaign  against  venereal  diseases  conducted  bv  Surgeon  Gen- 
eral Blue ;   gave  impetus  to  the  long-discussed   plan  of  intro- 

"  Report  of  Subcommittee  on   Public  Iloaltli  Xursing.  November,   1917. 


MOBILIZATION  267 

ducinp:  preliminary  public  health  instruction  into  the  senior 
year  of  training  schools  for  nurses  and  was  especially  promi- 
nent in  urging  that  public  health  nursing  should  be  accepted 
as  the  equivalent  of  active  military  duty. 

^liss  Delano  wrote  of  nursing  groups  cooperating  in  mobili- 
zation : 

The  Red  Cross  is  working  in  close  cooperation  with  the 
American  Xurses'  Association,  an  affiliated  body  with  whicli 
it  has  for  many  years  enjoyed  intimate  and  harmonious  rela- 
tions. Practically  all  of  the  enrolled  Red  Cross  nurses  are 
included  in  tlic  membership  of  this  association. 

Another  organization  with  which  the  Red  Cross  is  co- 
operating is  tlie  Xational  Committee  on  Nursing,  recently 
appointed  by  the  Council  of  National  Defense  with  M.  Ade- 
laide Xntting  as  chairman  and  Ella  P.  Crandall  as  secretary. 

The  Red  Cross  is  cooperating  with  this  committee  in  a 
movement  to  enlist  young  college  women  in  nursing  as  a 
patriotic  service.  As  the  Red  Cross  sees  it,  the  l)ig  problem  is 
not  only  providing  for  the  present  nursing  needs  but  safe- 
guarding against  the  possible  needs  two,  three  and  five  years 
from  now.  Therefore,  it  is  urging  the  young  women  of 
America  to  prepare  themselves  for  the  most  efficient  work  as 
nurses  by  submitting  themselves  to  the  training  courses  of 
high  class  schools  of  nursing.  Several  of  our  leading  schools 
have  agreed  to  admit  graduates  of  approved  colleges,  who  are 
otherwise  acce})table  as  candidates  for  nursing,  to  special 
courses  which  will  grant  them  credit  for  one  academic  year. 

The  Red  Cross  will  rely  upon  the  thousands  of  Red  Cross 
Chapters,  branches  and  auxiliaries,  the  Women's  Conuuittee 
of  the  Council  of  Xational  Defense,  and  similar  organizations 
of  women  to  supply  lists  of  volunteer  workers  when  needed. 
These  organizations  are  already  compiling  lists  of  volunteers 
in  the  various  communities. 

To  give  a  complete  list  of  all  the  groups  and  associations 
that  aided  the  Red  Cross  Nursing  Service  would  mean,  in 
effect,  listing  almost  all  those  engaged  in  war  service,  but  three 
names  that  must  be  especially  mentioned,  aside  from  the  na- 
tional nursing  groups,  as  cooperating  agencies  entitled  to  special 
appr(>ciation  were :  the  American  Council  of  Education ;  the 
Association  of  (^)llegiate  Alumna? ;  the  United  States  Food 
Administration. 

Of  the  special  courses  designed  to  facilitate  mobilization  bv 
shortening  the  period  of  hospital  training  and  giving  instruc- 


268  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tion  under  college  auspices,  that  at  Vassar  was  the  first  and 
set  the  most  excellent  example  to  others.  The  generous  inten- 
tion of  the  college  to  offer  its  ample  facilities  during  the  sum- 
mer of  1918,  ''as  a  training  school  for  young  women  for  patri- 
otic service  in  whatever  lines  of  work  offer  the  greatest  oppor- 
tunities or  present  the  greatest  needs"  had  been  declared  by 
resolution  at  a  meeting  of  the  Provisional  Alumnae  Council  on 
June  9,  1917.  The  committee  who  recommended  the  nursing 
course  as  finally  established  were :  Mrs.  John  Wood  Blodgett, 
chairman,  Frank  li.  Chambers  and  Frank  L.  Babbitt.  To  this 
decision  Miss  Nutting's  counsel  had  largely  contributed,  and 
toward  the  success  of  the  course  Mrs.  Blodgett's  brilliant  ser- 
vices were  inestimable. 

The  course  offered  pupils  twelve  weeks  instruction  in 
anatomy  and  physiology,  bacteriology,  chemistry,  hygiene  and 
sanitation,  elementary  materia  medica,  nutrition  and  dietetics, 
the  psychology  and  sociology  of  nursing,  nursing  ethics  and 
history,  elementary  imrsing  procedures  with  models,  and  spe- 
cial lectures.  This  was  combined  with  a  disciplinary  regime 
and  physical  training.  It  was  followed  by  two  years  of  work  in 
selected  schools  of  nursing  connected  with  hospitals.  Those 
consenting  to  join  in  the  plan  were  called  Cooperating  Schools 
and  Hospitals. 

The  League  of  l^ursing  Education  gave  three  of  its  members, 
Isabel  ]M.  Stewart,  A.  ^I.,  professor  of  Nursing,  Teachers 
College,  Columbia  University ;  Elizabeth  Burgess,  B.  S.,  State 
Inspector  of  Training  Schools,  New  York,  Education  Depart- 
ment, and  Anne  Strong,  A.  B.  (Bryn  Mawr),  assistant  pro- 
fessor of  Public  Health  Nursing,  Simmons  College,  Boston,  as 
an  advisory  committee  to  arrange  the  curricukmi  in  coopera- 
tion with  the  Vassar  faculty  members.  The  expenses  were  also 
cooperatively  met.  The  Associated  Alumnie  of  Vassar  bore 
the  cost  of  the  publicity  and  recruiting  campaigns;  the  pupils 
paid  moderate  fees  and  the  Red  Cross  War  Council  on  January 
9,  1918,  appropriated  $75,000  for  the  general  expenses. 

By  the  time  the  Armistice  was  signed  nearly  fifty  colleges, 
as  reported  by  ^liss  Nutting's  committee,  had  com})leted  their 
plans  for  opening  similar  courses  to  student  nurses,  if  such 
should  have  been  made  necessary  by  the  continuance  of  the 
war.  Courses  in  ciglit  colleges  had  been  formally  approved  by 
the  Surgeon  General. 

An  encampment  for  lay  women  was  that  of  the  Women's 


MOBILIZATION  269 

Section  of  the  Navy  Loagiio  next  to  be  mentioned.  Its  official 
leaflet  gave  the  following  statement  of  its  plan: 

The  National  Service  School,  Inc.,  was  organized  by  the 
Women's  Section  of  the  Navy  League  in  1910,  to  train 
American  women  for  the  duties  which  come  to  them  in  war 
times  and  in  other  national  disasters.  The  first  National 
Service  School  was  held  at  Chevy  Chase,  Maryland,  in  May, 
19 1().  Nearly  one  thousand  students  were  trained  there  and 
the  American  Ked  Cross,  the  Army,  the  Navy  and  tiie  Marine 
Cor])s  cooperated  in  the  instruction  and  running  of  the 
school.  Thus  the  instruction  and  methods  used  were  standard 
and  official  and  had  been  worked  out  by  experts.  Since  May, 
the  following  National  Service  Schools  have  been  held :  Sec- 
ond National  Service  School,  The  Presidio,  San  Francisco, 
California;  Third  National  Service  School,  Lake  Geneva, 
Wisconsin ;  P'ourth  National  Service  School,  Narragansett 
Pier,  Khode  Island. 

There  were  three  courses,  any  one  of  which  might  be  selected 
at  the  preference  of  the  student.  They  included  First  Aid ; 
making  surgical  dressings ;  signal  work ;  wigwagging  and 
semaphore;  knitting  and  plain  sewing;  bicycling;  plain  teleg- 
raphy and  wireless ;  household  hygiene  and  home  care  of  the 
sick. 

The  question  of  the  instruction  of  Ked  Cross  nurses'  aides 
is  rooted  in  the  early  history  of  the  Nursing  Service.  After 
the  Red  Cross  became  affiliated  with  the  American  Nurses' 
Association  (100!)),  there  had  been  no  mention  until  the  year 
1912  of  the  volunt(H>r  aide  so  familiar  in  Europe.  Then,  fol- 
lowing the  Ninth  International  Ked  Cross  Conference  in  Wash- 
ington, there  was  a  movement  to  form  Women's  Detachments 
on  the  European  plan.  This  step  was  questioned  by  ]\[iss  De- 
lano, as  shown  in  tlic  following  letter  written  by  her  at  that  time. 
(Letter  from  ^liss  Delano  to  ]\Iiss  Boardman,  September  27, 
1912)  : 

...  T  do  feel  that  tlie  outline  of  instruction  gives  a  wrong 
impression  of  the  object  of  the  course  and  can  only  rc]H'at 
wliat  1  said  this  afternoon  in  regard  to  the  possibh^  dangers. 
This  jiaper  will  reach  a  great  number  of  ])eople  and  I  con- 
fess that  tlie  i)()ssible  results  worry  me.  I  did  not  speak  tliis 
morning  of  tlie  effect  this  new  undertaking  may  liave  npon 
tlie  nursing  s»M'\i(e.  but  with  no  ])rovision  for  eoiiperation.  I 
see  ])ossibilit  ies  of  future  misunderstandiiiLi's  and  friction.     If 


270  .HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

we  have  Red  Cross  nursing  committees  located  in  various 
cities  and  towns  throughout  the  country,  working  as  we  hope 
in  cooperation  with  the  Red  Cross  Chapters,  the  institutional 
members  and  the  committees  appointed  by  the  American  Medi- 
cal Association,  would  not  this  detachment  of  women  working 
apparently  independently,  be  a  source  of  confusion  and  mis- 
understanding? How  could  one  be  sure  that  work  would 
not  be  duplicated  with  inevitable  friction  and  misunderstand- 
ing? I  know  so  little  of  the  details  of  this  present  organiza- 
tion that  my  opinion  may  be  valueless,  but  I  see  nothing  to 
indicate  cooperation  or  definite  supervision.  In  organizing 
the  Red  Cross  enrollment  of  nurses  and  in  planning  for  the 
rural  nursing,  it  has  always  seemed  most  important  to  me  to 
have  the  advice  and  support  of  physicians.  In  the  same  way, 
I  can  scarcely  imagine  the  organization  of  courses  on  home 
nursing  without  the  cooperation  and  interest  of  nurses. 

We  can  scarcely  compare  the  conditions  in  this  country 
with  those  in  France.  The  training  given  their  nurses  is 
most  inadequate. 

In  the  written  schedule  of  work  I  am  in  doubt  whether 
the  term  "nurse"  refers  to  graduates  or  to  members  of  the 
women's  detaclmients.  If  the  latter,  I  am  wondering  how  it 
will  be  possible  to  teach  aseptic  surgical  technique  in  the  time 
allowed  for  First  Aid  and  home  nursing.  I  do  not  mean  to 
make  difficulties.  I  am  sure  you  will  believe  this,  but  think- 
ing only  of  the  ultimate  good,  my  mind  is  filled  with  doubts 
and  misgivings.  I  have  spent  three  years  in  building  up  the 
Red  Cross  enrollment,  and  have  always  believed  that  the  suc- 
cess of  the  Red  Cross  and  its  activities  depends  primarily 
upon  the  coordination  and  the  cooperation  of  all  its  depart- 
ments. 

Miss  Delano  brought  this  subject  before  the  American 
Nurses'  Convention  in  1912  and  on  November  14,  of  that  year, 
the  members  of  the  National  Committee  on  Nursing  disap- 
proved the  plan  of  a  separate  Women's  Detachment,  but  gave 
unqualified  approval  to  the  organization  of  classes  of  women  for 
instruction  in  First  Aid,  home  care  of  the  sick  and  allied  sub- 
jects designed  to  aid  women  in  the  care  of  their  ow^n  families, 
and  pledged  the  cooperation  of  nurses  for  such  teaching.*' 

It  was  subsequently  agreed  by  the  Red  Cross  that  indepen- 
dent Women's  Detachments  should  not  be  organized ;  that 
classes  for  women  (except  those  in  First  Aid)  should  be 
directed  by  the  Nursing  Service  and  that  a  volunteer  service 

'^American  Journal  of  Xursing,  December,  1912. 


MOBILIZATION  271 

of  women,  if  such  should  ever  be  required  in  war,  should  be 
under  the  direction  of  the  Ked  Cross  Nursing  Service. 

The  classes  for  women  in  Home  Care  of  the  Sick  and  Home 
Hygiene,  which  later  developed  widely,  thus  partly  arose  from 
the  relinquished  plan  of  Women's  Detachments.  With  the 
threatened  warfare  of  the  ^lexican  border,  1916,  and  the  estab- 
lishment of  base  hospitals  there,  the  National  Committee  on 
Red  Cross  Nursing  Service,  at  a  special  meeting  during  the 
Convention  of  the  American  Nurses'  Association  at  New 
Orleans,  19 IG,  had  agreed  that  the  nurses'  aides,  if  needed, 
should  be  a  responsibility  of  the  nursing  profession,  which  they 
would  not  evade,  provided  that  their  teaching  and  duties  were 
justly  defined  in  relation  to  the  actual  care  of  the  sick. 

''Volunteer  nurses'  aides"  were,  in  fact,  called  for  in  1916 
and  their  status  was  thus  defined  by  Colonel  Jefferson  Randolph 
Kean,  Director  of  Military  Relief: 

Volunteer  Nurses'  Aides.  Provision  has  been  made  for  the 
assignment  to  our  base  hospital  units  of  a  limited  number  of 
women  who  are  not  nurses  by  profession.  They  will  serve 
without  pay  but  may  be  furnished  with  transportation,  lodg- 
ing and  subsistence,  when  tbe  unit  to  which  they  are  attached 
is  called  into  active  service.  Nurses'  aides  will  be  prepared 
for  duty  under  the  supervision  of  the  nursing  service  of  the 
Eed  Cross  and  will  be  required  to  take  at  least  the  course 
of  instruction  in  Elementary  Hygiene  and  Home  Care  of  the 
Sick  and  pass  a  satisfactory  examination  in  the  same.  It  is 
also  desirable  tliat  they  take  such  other  courses  of  instruction 
as  may  be  provided  by  the  Ked  Cross.  The  chief  nurse  of  the 
base  hospital  \init  will  be  responsible  for  the  selection  of 
all  nurses'  aides  attached  to  her  unit  and  will,  if  necessary, 
arrange  for  their  instruction.  .When  called  into  service  they 
will  serve  under  the  direction  of  the  chief  nurse  of  the  unit.'' 

To  this  explanation  ]\riss  Delano  added: 

Practical  experience  as  nurses  or  partial  training  as  such 
cannot  be  accepted  in  lieu  of  our  course  in  Elementary 
Hygiene  and  Home  Care  of  the  Sick,  as  one  of  the  chief  ad- 
vantages of  this  instruction  given  by  a  Eed  Cross  nurse  is  to 
enable  the  Eed  Cross  by  observation  to  judge  of  the  qualifica- 
tion of  those  taking  the  course  and  their  probable  fitness  for 
service. 

'^liss  Delano  in  Ai)icric<ni  Journal  of  yursiitg,  Soptcniber,   1916. 


272    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

While  most  lay  women  volunteering  for  service  imagine 
themselves  giving  aid  on  the  battlefields,  as  a  matter  of  fact 
they  will  not  be  assigned  to  duty  within  the  zone  of  military 
operations.  Their  chief  sphere  of  usefulness  will  be  in  supply 
rooms,  linen  rooms,  diet  kitchens,  laundries  and  the  wards 
of  base  hospitals  located  considerably  in  the  rear  of  military 
operations.  Assignments  to  duty  both  of  nurses  and  nurses' 
aides  will,  in  all  cases,  be  made  through  the  Eed  Cross  Head- 
quarters, Washington,  D.  C.  .  .  . 

As  the  organization  of  Red  Cross  base  hospitals  progressed, 
the  ^National  Committee  on  Red  Cross  ISTursing  Service,  at  a 
meeting  held  in  jSTew  Orleans  in  April,  1916,  recommended  that 
practical  instruction  for  nurses'  aides  be  limited  to  seventy-two 
hours  a  month,  for  three  hours  daily  in  the  morning  in  consecu- 
tive days,  Sundays  and  holidays  excepted.  This  training  was 
optional  with  the  parent  hospital  authorities  and  these  volun- 
teer aides  formed  no  part  of  the  civilian  hospital  staff  except 
when  as  a  base  hospital  unit  they  were  called  into  active 
service.  The  following  guide  to  practical  instruction  which 
was  prepared  by  ^Miss  Xoyes  as  one  of  her  first  duties  in  the 
Kursing  Service  in  September,  1917,  was  recommended  by  the 
National  Committee : 

Service  in  Wards:  Sweeping  and  dusting;  cleaning  lavatory 
utensils;  cleaning,  airing  and  making  beds;  care  of  soiled 
linen;  care  of  clean  linen,  l)lankets,  rubber  goods;  serv- 
ing trays,  feeding  helpless  patients;  serving  water  and 
nourishments;  washing  nourishment  dishes;  preparing 
patients  for  the  night ;  care  of  heads ;  bed  baths. 

Service  in  Surgical  Supply  Koom :  Preparation  of  surgical 
dressings,  mending  rubber  gloves;  preparation  of  goods 
for  sterilization. 

Service  in  Central  Linen  Room:  Folding,  examining  and 
stacking  linen;  sewing  on  buttons,  tapes;  assisting  with 
exchanges. 

Service  in  Coimection  with  Operating-Room:  Assorting  and 
folding  linen;  dusting  and  cleaning;  cleaning  rubber 
gloves  and  instruments;  admission  to  operations  not 
approved. 

Service  in  Diet  Kitchen,  Sewing  Rooms  and  Laundry  may  be 
arranged  for  sucli  nurses"  aides  as  have  indicated  special 
preference  for  work  i]i  these  departments. 

Additional  Suggestions.  Careful  records  as  to  liours  aiu] 
duties  performed,  interest  displayed  and  attitude  toward 


MOBILIZATION  273 

the  service  should  he  kept.  As  service  with  a  base  hos- 
pital in  time  of  war  is  a  serious  one,  it  is  important  that 
the  aides  selected  to  accompany  such  should  be  women 
of  dignity  and  purpose.  In  order  to  maintain  interest, 
the  practical  work  nuiy  be  repeated  eacli  year.  Confer- 
ences witli  a])pr()i)riato  talks  or  lectures  mi<,dit  ])e  held 
during  the  interval  between  practice  periods.  Permanent 
vacancies  which  may  occur  should  be  filled  from  the  re- 
serve list  and  under  these  circumstances  the  muster  roll 
may  be  signed  by  card. 

When  the  United  States  entered  the  World  War  the  jSTational 
Committee  on  Ked  Cross  Xursing  Service  on  April  28,  1917: 
"recommended  that  courses  in  practical  work  for  lay  women 
shall  be  given  in  hospitals  selected  by  the  Nursing  Service  and 
that  such  courses  shall  be  on  the  same  basis  as  planned  in 
connection  with  base  hospitals"  and  the  following  regulations 
were  agreed  upon: 

The  term  "Red  Cross  nurses'  aide"  is  applied  to  those 
women  who  have  voluntarily  pledged  themselves  to  service 
after  meeting  the  following  definite  requirements  of  the  Eed 
Cross : 

First :  The  satisfactory  completion  of  the  course  in  Elemen- 
tary Hygiene  and  Home  Care  of  the  Sick,  authorized  by  the 
Eed  Cross  (A.  IJ.  C.  704). 

Second :  Selection  for  service  and  eight  hours  daily  of 
practical  hospital  experience  for  one  month  (this  was  later 
extended)  in  a  hospital  authorized  by  the  Red  Cross. 

Selection 

Women  who  have  had  the  course  m  Elementary  Hygiene 
and  Home  Care  of  the  Sick  may  be  recommended  for  service 
as  nurses'  aides  by  the  chief  nurse  of  a  base  hospital  unit, 
by  tbe  superintendent  of  the  training  school  of  the  hospital 
around  which  a  unit  may  have  been  organized,  or  by  a  Di- 
vision Director  of  Xursing.  The  final  decision  rests  with  the 
Department  of  jSTursing,  American  Red  Cross,  Washington, 
D.  C. 

Qualifications  for  Service 

1.  Age.      Preferably   between    twenty-five   and   thirty-five. 

2.  Freedom  from  houw  tics  wliicli  might  interfere  with 
uninterrupted  servire.  Unmarried  women  or  widows  will  b*^ 
given  j)referen(e  in  assignment  to  duty. 

3.  Satisfactory  physical  condition. 


274    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

4.  Adequate  education  and  credentials. 

5.  Special  fitness  for  such  work. 

Exceptions  to  these  general  requirements  may  be  made 
by  the  Department  of  Xursing  in  the  case  of  candidates  pos- 
sessing special  qualifications.® 

In  midsummer,  1918,  the  directions  relative  to  nurses'  aides 
were  sent  out  by  the  Department  of  Cursing  as  shown  in  the 
following  letters : 

August  15,  1918. 
To  All  Division  Directors  of  Xursing, 

From        Director,  Department  of  Xursing, 
Subject:  Placing  Xurses'  Aides  in  Service. 

It  has  been  decided  by  the  War  Council  that  the  Eed  Cross 
should,  through  its  Divisional  officers,  undertake  at  once  the 
training  of  a  sufficient  number  of  nurses'  aides  to  meet  the 
needs  of  the  Eed  Cross  in  Europe.  This  personnel  is  not 
intended  in  any  way  for  service  in  military  hospitals,  but  to 
supplement  the  work  now  being  carried  on  abroad  in  the  care 
of  refugees,  infant  welfare  work,  and  similar  activities  con- 
ducted under  the  auspices  of  the  Eed  Cross. 

The  assignment  of  nurses'  aides  as  provided  for  in  this 
letter  and  the  accompanying  instructions  must  in  no  way 
interfere  with  the  enrolling  of  Eed  Cross  nurses  for  service 
under  tlie  Army  and  Xavy,  or  under  the  Eed  Cross.  The 
War  Department  has  asked  us  to  increase  our  assignments  of 
nurses  to  one  thousand  a  week,  and  it  is  most  urgent  that 
the  greatest  effort  be  directed  to  meet  this  requirement. 

Each  Division  Director  of  Xursing  should  arrange  imme- 
diately to  recommend  two  hospitals  located  in  the  Division, 
to  be  selected  as  schools  for  instructing  applicants  for  this 
work.  .In  making  this  recommendation  it  is,  of  course,  essen- 
tial that  you  consult  and  secure  the  approval  of  your  Division 
manager.  In  order  to  avoid  duplication  of  work,  it  is  sug- 
gested that  hospitals  at  which  this  experience  is  now  given, 
be  recommended.  Only  hospitals  having  training  schools  for 
nurses,  which  are  on  the  accredited  list  with  the  State  Boards 
of  Eegistration  and  are  in  other  respects  acceptable,  will  be 
considered.  If  necessary,  in  order  to  reach  a  conclusion, 
final  decision  in  the  selection  of  the  hospitals  where  this 
experience  is  to  be  given  may  be  requested  from  Xational 
Headquarters. 

You  should  secure  the  service  of  a  capable  lay  woman  and 
any  necessary  additional  assistants  (also  lay  women),  to  assist 
^  A.  R.  C.  "07,  Instructions  for  Xurses'  Aides. 


MOBILIZATION  275 

you  in  the  supervision  of  the  selection  of  nurses'  aides.  It 
it  is  expected  tliat  nurses'  aides  will  be  recruited  largely  from 
women  who  have  taken  the  Ked  Cross  course  in  Home  Care 
of  the  Sick.  A  part  of  this  assistant's  duties,  therefore,  could 
include  the  development  and  stimulation  of  interest  in  this 
instruction  course. 

In  each  of  the  two  hospitals  in  your  Division,  there  should 
be  under  instruction  continuously  twenty-five  selected  can- 
didates for  nurses'  aides.  Only  women  should  be  selected 
for  such  experience  as  give  promise  of  being  desirable  for 
assignment,  and  otherwise  meet  the  requirements  prescribed. 

Tlie  accompanying  instructions  for  the  Division  Bureau  of 
Nursing  provide  the  necessary  procedure  for  recruiting  and 
supervising  the   instruction   of  candidates. 

After  receiving  tlie  required  hospital  experience,  candidates 
will  be  enrolled  for  foreign  service  under  the  direction  of  the 
Division  Bureau  of  Nursing  and  the  Division  Bureau  of 
Personnel  will  participate  in  the  enrollment  and  assignment 
of  nurses'  aides  in  the  manner  prescribed  by  the  accompanying 
instructions. 

Ten  copies  of  the  "^Memorandum  Eoutine  for  Placing 
Nurses'  Aides  in  Service''  are  forwarded  herewith  and  an 
initial  supply  of  forms  is  being  forwarded  by  express  to  the 
Division  office.  A  complete  copy  of  the  Eoutine  should  be 
transmitted  immediately  to  the  Division  Bureau  of  Personnel. 
Very  truly  yours, 

(signed)   Jane  A.  Delaxo, 
Director,  Department  of  Nursing. 
Approved:  G.  E.  Scott, 

Acting  General  Manager. 

August  29,  1918. 
To  Division  Directors  of  Nursing. 

In  my  letter  of  August  G,  I  stated  that  the  War  Council 
desired  the  selection  of  two  hospitals  in  each  Division  to  give 
practical  experience  to  women  who  have  had  our  course  of 
instruction  in  Home  Care  of  the  Sick  and  wlio  are  willing 
to  accept  service  as  needed.  I  realized  that  there  miglit  be 
difficulty  in  securing  the  admission  of  twenty-five  pupils  to 
each  of  two  hospitals,  and  that  it  would  probably  be  easier 
to  use  a  larger  number  of  hospitals,  admitting  fewer  pupils. 
The  de(isi(jn  in  regard  to  two  hospitals  was,  however,  based 
on  a  request  from  the  Surgeon  (Jeneral's  office.  Satisfactory 
arrangements  have  recently  been  made  to  allow  for  a  change 
of  plan,  leaving  the  Division  Directors  of  Nursing,  in  con- 
sultation with  the  Division  managers,  free  to  make  such 
selections  of  hos})itals  as  they  think  most  desirable,  without 


276    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

reference  to  the  number  of  hospitals  admitting  pupils.  It  is, 
however,  understood  that  fifty  women  will  be  admitted  each 
month  for  the  required  period  of  hospital  experience,  making 
six  hundred  women  to  be  prepared  as  nurses'  aides  each  year 
in  your  Division.  While  the  Eed  Cross  wishes  to  have  this 
number  available  for  service  through  the  Division  olhces, 
it  is  impossible  to  guarantee  assignment  to  duty. 

As  they  will  be  used  for  service  abroad  under  the  auspices 
of  the  American  Eed  Cross,  largely  in  France,  they  should 
have  a  conversational  knowledge  of  French.  It  is,  therefore, 
suggested  that  as  far  as  possible  a  tentative  selection  of  de- 
sirable women  be  made,  even  before  they  begin  the  course  of 
instruction  in  Home  Care  of  the  Sick,  and  that  they  be 
urged  to  review  and  perfect  their  knowledge  of  French  in 
order  that  they  may  be  eligible  for  admission  to  the  hospitals 
for  practical  experience,  upon  the  completion  of  the  course 
in  Home  Care  of  the  Sick.  It  is  the  desire  of  the  Surgeon 
General's  office  that  we  should  admit  for  practical  experience 
in  hospitals  only  such  women  as  have  a  conversational  knowl- 
edge of  French. 

Yours  very  truly, 

(signed)  Jane  A.  Delano, 
Director,  Department  of  Nursing. 

The  orders  coming  from  the  War  Department  regarding 
nurses'  aides  were  variable.  Aides  were  first  called  for,  then 
countermanded,  then  called  for  again.  They  were  not,  how- 
ever, in  the  end  placed  in  military  service  through  regular 
channels  either  at  home  or  abroad.  When  the  Eed  Cross 
organized  its  extensive  civilian  relief  service  in  France,  many 
aides  served  there  as  secretaries,  interpreters,  friendly  v^isitors, 
etc.,  with  great  acceptability.  In  all,  up  to  July  1,  1018, 
fifteen  hundred  nurses'  aides  enrolled  and  were  assigned  to 
active  duty  with  the  Red  Cross.  Their  motives  and  spirit  were 
excellent  and  as  most  of  them  spoke  French  and  were  gently 
reared  women  of  social  tact,  their  usefulness  was  often  very 
great. 

As  the  cantonments  of  the  United  States  were  developed,  a 
tide  of  popular  emotional  demand  for  volunteer  "nurses,"  with 
a  short  course  training,  made  its(>lf  felt  and  was  difficult  to 
stem.  It  was  finally  counteracted  by  the  plan  for  an  Army 
School  of  Kursing  to  he  described  in  another  section. 

After  protracted  conference  witli  the  Surgeon  OeneraFs  office 
during   the   early    summer   of    1018,    the   Red    Cross   ]^ursing 


MOBILIZATION  277 

Service  made  an  attempt  to  organize  a  group  of  Reconstruction 
aides,  women  especially  trained  to  give  remedial  exercises, 
either  in  physio-  or  occupational  therapy,  prescribed  for  the 
care  of  patients  in  hospitals  and  other  sanitary  formations  of 
the  Army.  Lists  of  nurses  expert  in  this  specialized  work 
were  first  collected  by  M\ss  Noyes.  A  tentative  plan  of  the 
Red  Cross  embraced  the  training  of  college  women  in  these 
branches.  Josephine  Saunders,  of  New  York,  was  finally 
given  an  appointment  in  the  Surgeon  General's  office  to  develoj) 
these  groups  entirely  within  the  War  Department,  but  the  Red 
Cross  cooperated  with  the  Army  in  mobilizing  them,  as  is 
shown  in  the  following  description  of  these  aides  and  their  field 
of  work : 

At  a  meeting  of  the  War  Council  held  June  27,  1918,  the 
following  vote  was  passed  and  communicated  to  Miss  Delano : 

VOTED :  That  Appropriation  ISTo. for  the  purchase  of 

equipment,  including  uniforms  for  the  outfitting 
of  nurses  be,  and  it  is  herewith  amended  to  cover 
Eeconstruction  aides  (female)  who  are  being  or- 
dered for  service  overseas  by  the  Surgeon  General's 
oflieo,  with  the  understanding  that  the  Director  of 
the  Department  of  Nursing  shall  confer  with  the 
Otfice  of  tlie  Surgeon  General  of  the  Army  as  to  the 
necessary  uniform  and  equipment. 

The  War  Department  wrote  to  JMiss  Noyes : 

I  am  enclosing  a  circular  sent  to  Reconstruction  aides  re- 
garding overseas  and  domestic  equipment.  Please  let  me 
know  if  this  meets  with  your  approval. 

I  am  having  mimeographed  a  signed  authorization  without 
which  no  aide  should  be  allowed  to  purchase  equipment  at 
cost  from  the  Hed  Cross. 

(signed)   Fuaxk  B.  Granger. 

Through  the  Bureau  of  Xurses'  Equipment  in  Xew  York  City, 
the  Red  Cj-oss  furnislicd  complete  (Miuipment  free  of  charge  to 
Reconstruction  aides  assigTied  overseas  and  supplied  ward  uni- 
forms at  cost  to  aides  employed  in  Army  hospitals  in  this 
country. 

L(>aders  and  assistants  in  recreational  therapy,  a  highly 
expert  and  specializ(>(l  form  of  aid  to  invalided  so](li(>rs,  had 
taken  up  the  entrance  to  a  iicld  in  which  the  R(>d  Cross  antici- 


278  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

pated  developing  an  extensive  and  useful  service.  These  plans 
were,  however,  terminated  with  the  Armistice  and  subsequent 
reconstruction  of  the  Army  hospitals. 

On  April  23,  1917,  the  Red  Cross  Committee  on  N^ursing 
Service  considered  the  whole  aspect  of  the  public  health  nursing 
service  in  its  relation  to  the  war  and  at  subsequent  meetings 
throughout  1917,  the  exemption  of  public  health  nurses  from 
military  service  always  called  forth  lively  discussion.  A  sub- 
committee of  the  National  Committee  on  Red  Cross  Nursing 
Service  was  accordingly  appointed,  which  recommended  a  plan 
by  which  various  groups  of  nurses  then  performing  essential 
service  were  placed  in  a  Special  Service  group. 

There  were  already  certain  groups  of  nurses  who  were  re- 
garded by  the  Red  Cross  as  exempt  from  active  military  duty, 
i.e.,  those  at  Red  Cross  Headquarters  and  in  Division  offices; 
Chapter  supervisors ;  members  of  the  Rod  Cross  State  and  Local 
committees;  members  of  the  Red  Cross  Town  and  Country 
Nursing  Service,  and  those  holding  important  positions  in 
hospitah,  training  schools  and  public  health  organizations. 

The  Special  Service  group  as  now  defined  gave  public  health 
nurses,  as  well  as  those  serving  in  hospitals,  a  recognition  simi- 
lar to  that  accorded  the  nurses  who  enrolled  for  war  nursing. 
Such  recognition  had  been  asked  for  by  the  subcommittee  on 
Public  Health  Nursing  of  the  Council  of  National  Defense 
(Miss  Beard's  committee),  on  May  28  when  it  recommended  to 
the  Committee  on  Hygiene  and  Sanitation  the  advisability  of 
seeking  to  obtain,  from  the  Council  of  National  Defense,  a 
"pronouncement"  recognizing  public  health  nursing  as  a  war 
service. 

Brief  extracts  from  the  correspondence  between  ]\Iiss  Delano 
and  Miss  Beard  give  the  clearest  statements  of  this  special  enroll- 
ment.    Miss  Delano  wrote,  September  12,  1917: 

In  view  of  the  probable  demand  for  pi;blic  health  nurses 
for  work  in  the  zones  surrounding  the  military  cantonments 
and  possibly  for  public  health  work  in  France,  the  National 
Committee  on  Red  Cross  Nursing  Service  has  provided  for 
a  special  enrollment  of  public  h(>alth  nurses  exempting  them 
from  other  service,  as  has  already  been  done  for  tlie  nurses 
enrolling  as  instructors. 

It  would  seem  desirable,  however,  that  a  communication  be 
sent  from  tlie  subcommittee  on  Public  Tlealtli  Nursing  or  the 
General  Medical  Board  of  the  Council  of  National  Defense, 


MOBILIZATION  279 

bringing  the  importance  of  this  service  to  the  public  health 
organizations'  attention,  and  urging  that  they  release  a  cer- 
tain proportion  of  the  nurses  upon  their  staffs  for  enrollment 
with  tlie  Ked  Cross  for  this  service.  I  will  in  turn  communi- 
cate with  our  Local  Committees  authorizing  them  to  enroll 
nurses  for  this  special  service. 

In  response  to  this  letter  ^fiss  Board  sent  to  the  various 
organizations  for  public  health  nursing  a  questionnaire,  and  an 
appeal,  in  which  she  said: 

So  pressing  is  the  immediate  need  for  carefully  selected 
nurses  for  public  health  duty  that  the  Eed  Cross  has  asked 
this  committee  to  send  out  an  appeal  to  public  health  nurses 
to  enroll  in  a  special  class  exempted  from  all  other  service. 
This  does  not  mean  that  a  public  health  nurse  may  not  en- 
roll for  other  duty. 

It  will  be  a  high  mark  of  patriotism  to  serve  in  our  own 
countr}'.  It  may  even  ])ecomc  the  supreme  test  of  devotion 
to  remain  at  one's  regular  post  of  duty.  It  is  certain  that 
the  greatest  discrimination  must  be  exercised  in  the  "selective 
draff  in  order  to  avoid  disrupting  or  seriously  depleting  the 
home  work  wliile  providing,  from  the  already  inadequate 
ranks  of  public  liealth  nursing,  our  full  proportionate  quota 
for  war  duty  wherever  needed. 

This  committee  urgently  requests  you  to  answer  the  en- 
closed questionnaire  within  three  days  of  receipt  and  begs 
that  your  decision  l)e  made  in  the  light  of  the  nation's  two 
great  equal  needs,  i.e. :  first,  to  guard  the  health  of  our  sol- 
diers and  sailors  and  those  of  our  allies;  second,  to  protect 
our  home  defenses  in  the  face  of  new  dangers  and  increased 
demands.® 

The  regulations  framed  and  issued  by  the  Red  Cross  !N'ursing 
Service  in  regard  to  this  special  group  were  these : 

1.  A  nurse  shall  ])e  eligible  for  enrollment  in  the  Special 
Service  grouji,  providing  she  is  an  enrolk'd  l?ed  Cross  nurse, 
eligible  for  active  duty,  vet  holding  a  position  in  which  in  the 
opinion  of  the  Ked  Cross  she  is  more  valuable  at  present  than 

•A.  R.  C.  filo.  ScptpinlxT  15.  1017;  also  Koports  of  :Mis9  Nutting's 
committee.  The  quest  iomiaire  asked  for:  1.  Name  of  orfranization. 
2.  Names  of  *  staff  niemlxrs  indispensable  loeally.  3.  Members  wlio  could 
be  spared  and  wlien  available.  4.  Cbaracter  of  service  rendered  by  each, 
fi.  Names  of  members  tlien  in  active  duty  with  the  Red  Cross.  6.  Names 
of  those  enrolled.  7.  Those  who  liad  applied  for  enrollment,  8.  Those 
iutendini,'  to  apply  for  enrollment. 


280   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  war  service.     Nurses  physically  or  otherwise  disqualified 
for  active  war  service  are  not  eligible  for  this  enrollment.  .  .  . 

4.  A  committee  appointed  by  the  Division  Director,  Bureau 
of  Nursing  Service,  shall  act  upon  applications  and  shall 
issue  a  chevron  to  each  nurse  whose  application  has  been 
approved. 

5.  The  names  of  all  nurses  in  the  Special  Service  group 
will  be  forwarded  to  the  American  Eed  Cross,  Department  of 
Nursing,  at  Washington,  in  order  to  prevent  the  assignment 
of  these  nurses  to  active  war  service. 

6.  The  Special  Service  enrollment  of  a  nurse  relates  to 
the  position  she  holds  at  the  time  the  chevron  is  issued.  If 
a  nurse  changes  her  position,  the  person,  organization  or  in- 
stitution which  employs  her  shall  immediately  inform  the 
Bureau  of  Nursing  of  the  change  of  status  and  shall  also  re- 
turn the  chevron.  Nothing  shall  prevent  the  filing  of  another 
application  should  the  nurse  assume  a  new  position  in  which 
she  may  be  essential  to  a  community. 

Before  making  application  for  nurses  in  the  Special 
Service  group  which  entitles  them  to  the  chevron,  consider- 
ation should  be  given  to  adjustments  with  the  view  of  con- 
serving graduate  nurses,  i.e. : 

1.  For  utilization  of  student  nurses  wherever  possible 
for  positions  as  head  nurses,  social  service  and  visiting  nurses. 

2.  Consideration  of  other  assistants  to  graduate  nurses, 
such  as  Home  Defense  Nurse,  and  attendants. 

The  Special  Service  Chevron  is  to  be  issued  by  a  com- 
mittee appointed  by  the  Division  director  to  such  enrolled 
Eed  Cross  nurses  as  are  fit  for  active  service  but  are  fulfilling 
important  responsibilities  in  their  present  positions. 

After  the  committee  has  granted  a  chevron  no  call  for 
active  military  service  will  be  sent  a  nurse,  without  consulta- 
tion with  the  Board  by  whom  she  is  employed.  By  establish- 
ing this  ''Chevron  Service"  the  Eed  Cross  hopes  to  give 
nurses  and  organizations  a  freedom  to  develop  the  most  im- 
portant teaching  in  training  schools  and  in  ])ublic  health 
centers  in  order  to  conserve  tbc  health  of  our  own  country. 

If  a  nurse  is  not  physically  fit  for  active  service  or  has 
personal  responsibilities  that  make  it  impossible  that  she 
should  go,  she  should  apply  for  enrollment  in  the  Home 
Defense. 

The  form  of  the  letter  sent  by  the  Department  of  J^iirsing  to 
public  healtli  associations  was: 

In  view  of  the  very  great  demands  for  nurses  for  military 
service  and  considering  the  many  nurses  disqualified  for  this 


MOBILIZATION  281 

service,  the  committee  respectfully  recommend  that  every 
institution  prepare  now  to  meet  the  even  greater  need  in  the 
future  and  wherever  possible,  a  nurse  eligible  for  military 
service  and  now  exempt  from  such  service  be  substituted  by 
one  who  is  not  qualified  for  such  service.  Our  nursing  re- 
sources being  limited  such  readjustments  will  be  absolutely 
necessary. 

Witli  tlie  assurances  that  the  Department  of  Xursing  of 
the  American  Ked  Cross  has  the  interest  of  your  institution 
at  heart,  1  beg  to  remain, 

Very  truly  yours, 

(signed)  Jane  A.  Det^no, 
Director,  Department  of  Nursing. 

The  form  of  the  letters  sent  to  nurses  entering  the  special 
service  group  was: 

Upon  the  recommendation 

you  have  been  })laced  in  the  Special  Service  group  of  tlie 
American  Eed  Cross  Xursing  Service  and  you  are  temporarily 
exempt  from  active  military  service.  You  are  hereby  privi- 
leged to  wear  the  enclosed  chevron  imtil  such  time  as  you  are 
released  for  active  service. 

With  good  wishes  for  the  success  of  your  present  work, 
I  am, 

Very  sincerely  yours, 

(signed)  Jane  A.  Delano, 
Director,  Xursing  Service.^'* 

The  form  of  the  letter  sent  to  nurses  eligible  for  a  special 
service  chevron  was : 

I  note  tliat  you  are  holding  an  important  position  at  present 
and  since  it  is  the  wish  of  the  Xursing  Service  of  the  Ameri- 
can Ecd  CVoss  to  disturb  as  little  as  possible  the  work  of 
organizations  such  as  yours,  I  am  writing  to  learn  if  it  is 
your  wisli  to  he  considered  for  exemption  from  active  mili- 
tary service  at  present  ? 

We  wish  to  associate  all  our  good  nurses  definitely  with 
the  American  Ked  Cross  and  are  therefore  plaeing  nurses 
holding  important  positions  in  a  S])ecial  Service  group,  issu- 
ing to  them  a  chevron  to  wear  denoting  their  exemption  frcmi 
active  military  s(>rvi(e  temporarily, 

I  judge  from  your  a])plication  that  this  is  your  desire 
but  since  we  can  only  consider  siu'h  requests  uiton  the  recom- 
mendation of  the  head  of  the  institution,  I  will  ask  you  to 
^"Special  SiTvicf  <xr(iup.  Xo.  5. 


282   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

forward  the  enclosed  to  your  president.  When  this  blank 
is  properly  filled  out  and  returned  to  us,  this  recommendation 
will  be  acted  upon  by  the  Committee  on  Exemption  and  you 
will  be  duly  notified. 

The  Red  Cross  assumes  that  the  president  of  every  institu- 
tion and  every  nurse  keeps  in  mind  the  fact  that  with  many 
nurses  disqualified  for  military  service,  readjustments  must 
be  considered  whereby  every  nurse  eligible  for  active  military 
service  is  substituted  for  by  a  nurse  not  so  qualified. 
Awaiting  your  attention  to  this,  I  am, 
Sincerely  yours, 

(signed)  Jane  A.  Delano, 
Director,  Xursing  Service.^^ 

An  interesting  example  of  the  response  met  by  these  letters  is 
the  answer  of  Archdeacon  Hudson  Stuck,  Fort  Yukon,  Alaska : 

September  18,  1918. 

...  In   accordance   with   your   suggestion   of   August   18 

addressed  to  our  one  remaining  nurse,   Miss  jST at  St. 

Stephen's  Hospital  at  this  place,  I  make  request  that  a  "Spe- 
cial Service  chevron"  be  granted  her. 

This  hospital,  located  a  mile  above  the  Arctic  Circle,  is  the 
only  place  where  medical  relief  can  be  obtained  in  something 
like  fifty  thousand  square  miles.  The  nearest  physician  up 
the  Yukon  is  at  Dawson,  three  hundred  fifty  miles  distant, 
the  nearest  one  down  the  river  is  at  the  Army  Post  Fort 
Gibbon,  another  three  hundred  and  fifty  miles  away.  And 
in  all  the  wide  winterland,  northward  to  the  Arctic  Ocean 
and  southward  to  Fairbanks,  there  is  no  nurse.  The  explorer 
Stefansson,  lying  ill  at  Herschel  Island,  had  himself  hauled 
four  hundred  miles  by  dog-sled  to  reach  our  little  institution. 

Miss  X.  has  been  urged  by  her  conscience  and  by  some 
of  her  friends  to  give  herself  up  to  war  work.  She  would, 
however,  be  fortified  in  her  resolve  to  remain  here,  I  feel 
confident,  did  your  organization  distinguish  her  from  mere 
slackers  and  absentees  by  the  award  of  your  "Special  Service 
chevron." 

*  Another  special  group  mobilized  by  the  Red  Cross  was  that 
of  the  Home  Defense  nurses.  The  most  important  details  of 
their  enrollment  plan  are  given: 

1.  Purposes  of  Enrollment : 

The  Ped  Cross  Department  of  Xursing  recognizes  that  in 
every  community   there   are  graduate  nurses  who   for   some 

"  Special  Service  group,  No.  8. 


MOBILIZATION  283 

reason  are  not  eligible  for  military  duty  but  who  are  able  to 
render  valuable  service  in  connection  with  emergencies,  in- 
cluding local  disaster,  all  forms  of  visiting  and  instructive 
nursing,  institutional  work,  and  as  instructors  in  Elementary 
Hygiene  and  Home  Care  of  the  Sick.  A  special  enrollment 
for  such  nurses  has  been  authorized  with  the  designation  of 
Home  Defense  nurse.  This  enrollment  is  not  intended  for 
those  who  meet  the  regular  requirements  for  enrollment  as 
Eed  Cross  nurses. 

.  .  .  Division  Bureaus  of  Nursing  have  the  responsibility 
for  the  enrollment  of  these  nurses. 

.  .  .  An  applicant  must  hold  a  diploma  from  an  accredited 
school  of  nursing  in  the  State  from  which  she  was  graduated 
and  be  a  member  of  the  American  Eed  Cross,  and  able  to 
render  some  regular  service. 

.  ,  .  Approved  applicants  for  enrollment  will  receive  a 
membership  badge  with  a  bar  bearing  tlie  title  "Home  De- 
fense Xurse,"  which  will  be  issued  by  the  Division  Director 
of  Nursing. 

.  .  .  Nurses  who  have  married  or  are  beyond  the  age  limit, 
physically  disqualified  or  otherwise  ineligible  for  military 
duty  or  other  active  service,  will  be  enrolled  by  the  Red  Cross 
Division  Department  of  Nursing  for  their  territory  under  the 
special  classification  of  Home  Defense  nurses. 

The  Red  Cross  instituted  the  Home  Defense  nurses'  en- 
rollment because  it  believed  and  still  maintains  that  the 
skill  and  experience  of  every  woman  who  has  had  a  nurse's 
training  nnist  be  made  available  to  the  nation  in  some  direct 
way.  .  .  .^2 

]\riss  Delano  made  special  appeals  for  the  Home  Defense 
Service  and  her  prevision  was  borne  out  by  the  experiences  of 
the  influenza  epidemic.  To  meet  that  emergency,  married, 
old,  and  retired  nurs(>s  came  forth  and,  as  was  often  declared 
bv  a  Ked  Cross  lecturer,  Dr.  Thomas  E.  Green,  helped  greatly 
to  save  the  day. 

The  Army  School  of  Xursing,  though  not  originating  with 
the  Ked  Cross,  was  a  prominent  feature  of  the  mobilization 
of  nurses  for  war  and  in  its  inception  and  growth  was  closely 
woven  together  with  the  processes  of  Ked  Cross  enrollment  and 
assignment  for  sen-vice.  The  constructive  idea  which  gave  rise 
to  the  Army  School  was  Miss  Goodrich's,  for  she  had  been 
delegated  by  the  Surgeon  General  as  chief  inspecting  nurse, 
with  an  assistant,  also  a  nurse,  to  visit  and  inspect  nursing  iix 
^,\.,  K.  C.  Form  4!t.l.  ^Nlarcli,  1018.. 


284   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  cantonments.  Their  appointment  had  been  made  in  re- 
sponse to  a  recommendation  of  the  Committee  on  Nursing  un- 
der the  Council  of  National  Defense  and  a  similar  proposition 
offered  by  the  Hospital  Division  of  the  Medical  Department 
of  the  Council  of  National  Defense.  The  report  made  by  Miss 
Goodrich  after  the  inspection  included  these  words :  'Tt  is 
therefore  recommended  that  an  Army  school  of  Nursing  be 
created  and  that  wo  be  permitted  to  present  a  detailed  plan 
relating  to  the  same." 

The  report  and  its  recommendations  were  considered  at  a 
conference  of  Medical  and  Army  officers  and  nurses,  the  latter 
being  ^liss  Delano,  Miss  Thompson,  superintendent  of  the 
Army  Nurse  Corps,  ]\Iiss  Clayton,  president  of  the  National 
League  of  Nursing  Education,  Miss  Burgess  and  Miss  Good- 
rich. Miss  Goodrich  submitted  full  plans  to  the  Surgeon  Gen- 
eral, March  24,  1918,  but  for  reasons  of  space  only  a  part  of 
her  outline  can  be  here  given : 

A  plan  whereby  through  an  Army  School  of  Nursing  the 
most  complete  nursing  care  may  be  provided  for  the  sick  and 
wounded  soldiers  at  home  and  abroad,  for  the  period  of  the 
war  and  for  as  long  thereafter  as  the  Government  may  de- 
cree. .  .  . 

The  plan  to  provide  for  an  easy,  constant  and  almost  un- 
limited expansion  of  training  fields  and  consequent  increase 
in  student  and  graduate  nurses,  in  order  that  the  arising 
demands  of  the  service  may  be  fully  met. 

Through  the  provision  of  the  student  Ixjdy  to  have  in  the 
process  of  training  large  groups  becoming  increasingly  compe- 
tent thereby  enabling  tlie  release  of  the  most  experienced 
nurses  for  the  foreign  and  other  demanding  fields  without 
lowering  the  efficiency  of  the  base  hospitals. 

To  raise  immediately  the  standard  of  the  nursing  care  of 
the  sick  in  tlie  1)ase  hospitals  by  the  provision  of  an  increased 
nvmiber  of  persons  to  render  such  care. 

The  plan  as  presented  provides  that  the  school,  to  be  known 
as  the  Army  School  of  S'ursing  shall  be  located  in  the  office 
of  file  Surgeon  (iencral.  Through  this  office  the  enrollment 
of  the  students  will  take  place  and  all  matters  relating 
to  the  general  management  of  the  school  shall  be  dealt  with. 
The  faculty  jiresided  over  by  the  dean  of  the  school  is  to 
determine  all  questions  relating  to  the  course  of  instruction; 
the  general  administration  of  the  school  being  entrusted  to 
the  dean.  It  is  suggested  that  an  Advisory  Council  lie  a]> 
poinfed  com])ose(l  of  members  of  the   ]\ledical  Department; 


MOBILIZATION  286 

the  superintendents  of  the  Army  and  Navy  Nurse  Corps; 
the  Director  of  the  Department  of  Nursing,  American  Red 
Cross;  tlie  presidents  of  the  American  Nurses'  Association, 
the  National  League  of  Nursing  Education  and  the  National 
Organization  for  l'ubli(;  Health  Nursing;  tlie  dean  of  the 
school  of  nursing  and  other  members  of  the  nursing  pro- 
fession conversant  with  the  problems  of  nursing  education, 
to  make  recommendations  concerning  the  appointment  of  the 
faculty,  the  relations  between  the  military  and  civil  hospitals 
and  other  matters  relating  to  the  general  policy  of  the 
school. 

In  order  that  the  scliool  may  come  into  immediate  existence 
and  that  as  large  a  group  of  students  as  possible  may  be  ob- 
tained before  the  heat  of  the  summer,  the  committee  makes 
the  following  recommendations:  (1)  The  immediate  appoint- 
ment of  a  dean  or  acting  dean  of  the  school.  {2}  Details. 
(3)  That  the  l\ed  Cross  Department  of  Nursing  be  asked  to 
issue  to  those  who  have  successfully  completed  a  course  in 
Elementary  Hygiene  and  Home  Care  of  the  Sick  the  applica- 
tion blanks  and  announcement  in  order  that  should  these 
applicants  desire  to  enter  the  Army  School  of  Nursing  and 
should  they  meet  the  requirements  for  admission  they  may 
be  immediately  enrolled.  (4-5-0.  Details).  (7)  That  the 
dean  be  authorized  to  recommend  for  appointment  a  director, 
an  assistant  director,  a  full  time  instructor,  and  one  or  more 
part  time  instructors  in  addition  to  the  regular  nursing  staff 
of  each  base  hospital  selected  as  a  branch  of  the  school  of 
nursing. 

That  the  deaii  be  authorized  to  confer  with  the  command- 
ing otlicer  and  the  chiefs  of  the  medical  and  surgical  staffs 
of  such  base  li()Sj)itals  as  are  selected  concerning  the  ap- 
pointment of  medical  lecturers  and  instructors.  .  .  . 

The  Sccretarv  of  War  approved  the  plan  on  ^lay  '24:,  1918, 
and  the  Surgeon   General   appointed  the   advisory   committee: 

War   Department 
Office  of  the  Surgeon  General 
Washington. 

June  0,  1018. 
Office  Order  No.  53. 

The  Advisory  Council  of  the  Army  School  of  Nursing  is 
hereby  appointed,  the  members  of  which  shall  be  as  follows: 
Colonel  \V.  II.  Smith,  cliainnan;  Colonel  C.  L.  l-\irbush; 
Ccdonel  W.  T.  Longcope;  Miss  M.  Adelaide  Nutting:  Miss 
Lillian   D.  W'aM  ;  Miss  Anna  C.  Maxwell;  the  superintendent 


286    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  Army  Xurse  Corps;  the  superintendent  of  the  Xavy 
Nurse  Corps;  the  director  of  the  Department  of  Nursing, 
American  Eed  Cross;  the  president  of  the  American  Nurses' 
Association ;  the  president  of  the  National  League  of  Nursing 
Education;  the  president  of  the  National  Organization  for 
Public  Health  Nursing;  the  dean  of  the  Army  School  of 
Nursing. 

By  direction  of  the  Surgeon  General, 

(signed)   C.  L.   Furbush, 
Colonel,  Medical  Corps,  N.  A. 

At  its  second  mooting,  February,  1919,  the  advisory  council 
recommended  placing  the  school  on  a  permanent  foundation  by 
Act  of  Congress  and  submitted  this  their  resolution,  together 
with  an  outline  draft  of  a  suitable  act,  to  the  Surgeon  General 
for  his  approval.  ]\Iiss  Delano,  Miss  Goodrich  and  ]\[iss 
Thompson  were  appointed  a  committee  of  three  to  present  the 
plan  for  the  proposed  school,  but  its  outline  and  details  as 
completed  followed  Miss  Goodrich's  suggestions. 

The  Army  School  of  Nursing  was  made  a  Division  in  the 
Surgeon  General's  office.  On  May  27,  1918,  Miss  Goodrich 
was  placed  at  its  head  Avith  the  title  of  Dean  and  was  directly 
responsible  to  the  Hospital  Division. 

In  a  meeting  of  the  Committee  on  Nursing,  Council  of  Na- 
tional Defense,  September,  1918,  it  was  decided  "that  a  com- 
mittee be  appointed  by  the  chair  to  develop  a  program  for  the 
participation  of  the  civilian  hospitals  in  the  training  of  pupil 
nurses  or  hospital  assistants  for  army  service  in  affiliation  with 
the  Army  School  of  Nursing."  The  members  of  this  committee 
were :  Jane  A.  Delano,  Annie  W.  Goodrich,  Lillian  Glavton, 
Ella  P.  Crandall,  Dr.  S.  S.  Goldwater,  Colonel  W.  H.  Smith. 

The  first  meeting  was  held  on  September  20,  1918,  and  the 
minutes  for  that  meeting  embody  the  coordination  plans  ar- 
rived at  between  the  Kcd  Cross  and  the  school.  From  them 
have  been  taken  only  those  details  which  illustrate  this  adjust- 
ment for  smooth  working  and  the  avoidance  of  duplication : 

^linutes  of  the  Special  Committee 

Appointed  to  develop  a  program  for  participation  in  civilian 
hospitals  in  tlie  training  of  pupil  nurses  or  hospital  assistants 
for  Army  Service  in  affiliation  with  the  Army  School  of 
Nursing,  Council  of  National  Defense,  Washington,  D.  C, 
10:30  A.  M. 


MOBILIZATION  287 

September  20,  1918. 

The  chairman  stated  tlie  purpose  of  the  meeting  and  asked 
for  suggestions  from  those  in  attendance.  Upon  request, 
!Miss  Goodrich,  Dean  of  the  Army  School  of  Nursing,  pre- 
sented a  suggestive  plan  of  affiliation  of  civilian  schools  with 
the  Army  School  of  Nursing.  .  .  .  Miss  Delano  urged  the 
importance  of  enrolling  afliliated  students  for  military  duty 
through  the  Ked  CVoss  only  and  not  directly  into  the  Army 
Nurse  Corps  in  order  to  secure  a  permanent  registration  of 
future  nursing  forces;  she  also  urged  the  enrollment  in  the 
Ked  Cross  of  all  senior  classes  pending  graduation,  subject 
of  course,  to  the  individuals  who  wish  to  be  enrolled. 

Miss  Delano  raised  the  question  of  enrolling  hospital  as- 
sistants through  the  Eed  Cross.  While  this  matter  was  gen- 
erally felt  not  to  be  pertinent  to  the  main  issue  and  should 
therefore  be  left  for  consideration  with  other  details  of  de- 
velopment, the  chairman  ruled  that  in  the  absence  of  ob- 
jections. ]\liss  Delano's  urgent  request  for  its  consideration 
at  this  time  would  be  granted. 

Dr.  Goldwater  moved  as  follows:  "Resolved  that  civil  hos- 
pitals which  have  the  necessary  facilities  be  encouraged  to 
arrange  for  the  training  and  use  of  hospital  assistants  accord- 
ing to  the  plan  and  (lualifications  of  the  Army  School  of  Nurs- 
ing that  such  hospital  assistants  should  be  enrolled  through 
the  American  Ked  Cross  with  the  understanding  that  they 
will  acce})t  service  as  required  either  in  hospitals  in  which 
they  are  trained,  with  the  American  Red  Cross,  or  in  the 
Army  Hospitals."'  The  motion  was  seconded  by  Miss  Nutting 
and  carried  unanimously. 

]\riss  Delano  moved  that  the  students  in  schools  for  nurses 
contemplating  atliliating  with  the  Army  School  of  Nursing 
be  given  an  ()})p()rtunity  to  enroll  as  Red  Cross  Student 
Nurses,  such  enrollment  to  constitute  graduate  enrollment 
n])on  com])letion  of  this  course,  and  the  recommendation  of 
the  dean  of  the  Army  hospitals.  The  motion  was  seconded 
by  ]\Iiss  Nutting  and  carried. 

^liss  Nutting  made  the  following  motion:  "Having  lieard 
from  approximately  three  hundred  training  schools  of  the 
country  and  a])])r().\imately  two  hundred  having  expressed  a 
desire  to  afhliate  with  the  Army  school,  this  committee  ap- 
proves in  general  tlie  ]ilan  of  affiliation  as  ]iresented  by  ]\Iiss 
C.oodrich.  Dean  of  tlie  Army  School  of  Nursing,  with  the 
nnderstanding  that  it  is  subject  to  further  modifications  as 
later  cxperienc(^  may  inake  advisable."  The  motion  was 
seconded  bv  Miss  Clavton  and  carried. 


288   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

To  provide  for  the  public  health  nursing  instruction  of  stu- 
dents of  the  Army  school  at  Henry  Street  Settlement,  New 
York  City,  the  Red  Cross  through  the  Xew  York  County  Chap- 
ter contributed  $40,000  for  each  of  the  school  years  of  1919 
and  1920.  A  provision  of  $0000  was  also  made  by  the  Ameri- 
can Red  Cross  in  San  Francisco  with  the  University  of  Cali- 
fornia for  the  Army  School  at  Letterman  General  Hospital. 
The  full  details  of  these  gifts  are  found  in  the  Annual  Report 
of  the  iVmerican  Red  Cross  for  the  year  ended  June  30, 
1921. 

In  compliance  with  a  request  from  the  Surgeon  General 
of  the  U.  S.  Army,  the  Executive  Committee  of  the  American 
Eed  Cross  on  January  13,  1921,  authorized  the  chairman  to 
make  available  for  the  New  York  County  Chapter  funds  not 
to  exceed  $40,000,  or  such  part  thereof  as  might  be  necessary 
to  cover  assistance  through  the  New  York  County  Chapter 
to  nurses  in  the  Army  School  of  Nursing  taking  the  course 
in  public  health  nursing  at  the  Henry  Street  Settlement  and 
Teachers  College,  New  York  City.  This  was  in  continuation 
of  assistance  which  had  been  given  through  the  same  channel 
and  under  the  same  conditions  during  the  previous  year  and 
was  to  come,  if  feasible,  from  funds  which  had  been  set  aside 
by  the  Xational  Organization  for  financing  the  work  of  the 
New  York  County  Chapter  by  special  arrangements  with  this 
Chapter.  Up  to  December,  1920,  eighty  students  had  taken 
the  course,  and  seventy-nine  more  to  June,  1921. 

Scholarsliips  amounting  to  $()000  for  1919-20  were  given 
to  ^lajor  Julia  C.  Stimson,  Dean  of  the  Army  Nurse  Corps 
to  be  used  for  thirty  students  of  the  Army  School  of  Nursing 
at  the  Letterman  General  Hospital  for  incidental  expenses 
in  connection  with  the  course  in  public  health  nursing  at  the 
University  of  California;  $2250  were  given  in  ]\Iarch,  1921, 
and  $2280  in  August,  1921,  for  the  same  purpose. 

The  Army  school  had  an  immediate  and  pronounced  suc- 
cess. The  foremost  civilian  training  schools  for  inirses  affiliated 
with  it  and  by  tlie  date  of  the  Armistice,  it  had  1099  students 
on  duty  in  twenty-five  hospitals,  507  more  awaiting  assign- 
ment and  a  total  of  10,089  applications  filed.  One  of  the 
valued  pieces  of  work  accomplished  by  the  Red  Cross  Bureau 
of  Information  for  Nurses,  established  during  demobilization, 
was  to  refer  to  civilian  schools  of  nursing  these  5G7  accepted 
candidates  for  the  Arniv  school. 


MOBILIZATION  289 

Following  the  plans  for  tho  contiiniance  of  the  Army 
school,^""*  it  was  luadc  a  pcniiaiicnt  school  in  July,  l.)li>,  and 
Miss  (iroodrich  thou  rcturnod  to  hor  work  at  Teachors  College. 
She  was  succooded  hy  .lulia  Catherine  Stinison  as  dean. 

By  the  early  part  of  lit  18  the  Surgeon  General's  office  had 
given  ont  the  word  that  fifty  thousand  graduate  and  student 
nurses  must  he  enrolled  and  availahle  during  the  period  up 
to  January,  11)10. 

Tho  Red  Cross  Xursing  Service  had  .already  taken  definite 
steps  toward  enrolling  a  quota  of  five  thousand  nurses  that  had 
been  asked  for  by  the  Surgeon  General's  office;  for  the  period 
ending  June  1,  1918.  On  March  14  Miss  Delano  reported  these 
steps  as  follows: 

A  letter  to  the  superintendents  of  2000  or  more  training 
schools  urging  them  to  increase  the  supply  of  nurses  for 
inmiediate  service  by   advancing  the   date  of  graduation. 

A  letter  to  the  hoards  of  registration  urging  early  ex- 
aminations and  as  promj)t  action  upon  papers  as  possible. 
(The  provisional  enrollment  has  been  authorized  to  accept 
nurses  pending  the  return  of  the  result  of  their  examination.) 

A  special  letter  to  the  State  iSTurses'  Associations  explaining 
the  necessity  of  close  cooperation  Avith  the  Divisional  di- 
rectors. 

A  circular  letter  was  also  sent  to  the  ten  thousand  sub- 
serihers  of  the  Jounidl  calling  attention  to  the  need  of 
nurses,  the  War  l\isk  Insurance  and  the  necessity  of  registra- 
tion. 

A  small  enrollment  leaflet  has  been  sent  o\it  in  the  general 
correspondence  of  the  Divisional  directors  and  also  in  the 
correspondence  of  the  Amcricnn  Journal  of  Nurs-ing  and  to 
the  siil)seril»(>rs. 

A  special  letter  from  the  director  of  the  Bureau  of  Fi(^ld 
Xursiiig  was  also  sent  out  to  the  superintendents  of  2000  or 
more  trainiuir  schools  urging  them  to  organize  training  school 
units  from  the  senior  class  and  the  alumna'  associations. 

Xow  in  view  of  the  greatly  increased  re(iuisitions  the  Red 
Cross  decided  to  conduct  an  intensive  "drive"  for  nurses  be- 
tween the  dates  of  Jniie  '■)  and  July  17,  11)18.  Miss  Delano 
wrote  in  April  in  the  -Journal: 

""Xo  act  of  Coii;i:rcss  antliori/.injr  tho  Army  Scliool  of  Nursiii^r  lias 
Iiceii  jiasscd  1(>  (late  f  1 '.)-2 1  ) .  It  is  contimicd  as  a  group  of  'civiliaii  pin- 
ployt'cs  of  tlic  Mcilical  I )fjiartiii('iit.' " 

J.  C.  Stimson. 


290  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  survey  which  has  recently  been  made  [by  nursing  so- 
cieties] indicates  that  there  are  not  more  than  65,000  regis- 
tered nurses  in  the  United  States.  If  we  are  to  meet  the 
needs  of  the  Army  and  the  Xavy  with  registered  nurses  alone, 
it  will  be  necessary  to  withdraw  not  far  from  fifty  per  cent 
of  the  total  number  of  registered  nurses.  Even  though  we 
include  all  graduate  nurses  who  are  not  registered,  placing 
the  total  at  about  one  hundred  thousand,  at  least  thirty-three 
per  cent  of  the  entire  number  must  be  secured,  if  we  are  to 
provide  nursing  care  for  our  Army  and  Xavy. 

In  view  of  these  figures  it  seems  evident  that  a  special 
campaign  for  the  enrollment  of  nurses  must  be  undertaken, 
not  only  to  bring  to  the  nurses  the  great  need,  but  to  insure 
the  cooperation  and  assistance  of  the  public  and  physicians 
of  the  country  as  well.  It  does  not  seem  fair  to  place  upon 
■  the  nurses  the  entire  responsibility  of  a  decision.  We  believe 
that  the  community  must  share  with  the  nurse  the  responsi- 
bility for  her  withdrawal  from  the  community  and  protect 
her  as  far  as  possible  from  too  great  a  financial  sacrifice.  The 
Red  Cross  is  therefore  taking  steps  toward  organizing  a 
definite  campaign  which  we  hope  to  undertake  in  the  early 
spring. 

A  special  committee  has  been  appointed  by  the  chairman 
of  the  Xational  Committee  on  Eed  Cross  Xursing  Service, 
representing  the  three  national  organizations  of  nurses,  to 
aid  in  preparing  the  publicity  material  and  in  carrying  out 
this  special  campaign.  The  representatives  of  the  three  or- 
ganizations are  Katharine  DeWitt,  secretary  of  the  nurses' 
association  and  assistant  editor  of  the  American  Journal  of 
Nursing;  S.  Lillian  Clayton,  president  of  the  Xational  League 
for  Xursing  Education ;  and  Ella  Phillips  Crandall,  executive 
secretary  of  the  Xational  Organization  for  Public  Health 
Xursing  and  of  the  Committee  on  Xursing  of  the  Council  of 
Xational  Defense.^* 

The  Surgeon  General  himself  wrote  an  appeal  to  the  Eed 
Cross  in  behalf  of  the  drive.    He  said : 

May  25,  1918. 
I  am  informed  that  on  the  third  of  June  it  is  the  intention 
of  the  Red  Cross  to  start  a  Drive  for  Xurses  for  the  Army. 

The  American  Red  Cross  is  a  great  recruiting  agency  for 
Army  Xurses  and  through  this  agency  I  wish  to  ap])eal  to  the 
nurses  of  the  country  to  enroll  for  service  in  the  Xurse  Corps 
of  the  Army. 
"Rod  Cross  Department;  Atncrican  Journal  of  yursing,  .April,   1918. 


MOBILIZATION  291 

The  need  of  a  great  number  of  nurses  is  acute,  and  any 
assistance  the  Ked  Cross  can  render  the  War  Department  in 
obtaining  for  the  Army  Nurse  Corps  the  number  of  nurses 
required  will  be  a  service  to  the  country. 

(signed)   William  E.  Gorgas, 
Surgeon  General,  U.  S.  Army. 

The  machinery  used  for  the  drive  was  very  largely  the  organi- 
zation of  the  Red  Cross  Chapters,  which  had  taken  on  vast 
dimensions  under  the  war  stimulus.  In  August,  Miss  Delano 
summed  up  the  methods  used  for,  and  the  results  obtained  by, 
the  drive: 

It  was  decided  to  call  upon  the  Chapters  of  the  American 
Eed  Cross  to  cooperate  in  securing  the  required  number  (it 
may  not  be  generally  known  to  the  nurses  of  our  country 
that  the  Eed  Cross  now  has  a  membership  of  more  than 
22,000,000  adult  members  and  9,000,000  junior  members, 
with  3885  Chapters,  14,208  chapter-branches,  and  auxili- 
aries) ;  in  order  that  the  vital  need  of  our  country  for  nursing 
service  might  be  brought  to  practically  every  graduate  nurse 
in  the  country.  It  was  understood,  of  course,  that  the  formal 
applications  for  enrollment  should  come  in  through  the  usual 
committees  on  Red  Cross  Nursing  Service  and  the  Division 
ofKcers. 

This  was  a  new  departure,  and  the  results  have  confirmed 
us  in  the  belief  that  our  nursing  service  will  be  greatly 
strengthened  by  this  close  contact  with  the  general  member- 
ship of  the  American  Eed  Cross.  We  have  found  the  Chap- 
ters throughout  the  United  States  most  cooperative  and 
anxious  to  assist,  and  we  feel  that  the  Nursing  Service  of 
the  Eed  Cross  will  be  permanently  benefited  by  the  relation- 
ship which  has  been  established  in  this  way.^^ 

Results  of  the  ''Xurses'  Drive"  can  best  be  appreciated  bv  a 
brief  comparison  of  enrollments  during  the  fiscal  year  of  1917- 
1918  and  the  subsequent  five  months  terminating  Xovember 
1,  1918.  No  method  for  determining  the  exact  returns  of  the 
drive  was  attempted,  but  the  unparalleled  increase  in  enroll- 
ment over  previous  months  was  due  in  large  part  to  this  pub- 
licity campaign  and  to  the  unceasing  labors  of  local  Chapters 
and  comniittees  on  Red  Cross  Nursing  Service. 

During  the  fiscal  year  of  1917-1018,  11,213  nurses  were 
enrolled,   an   average  of   817   a  month.      The   impetus  of  the 

"Miss  Delano  in  American  Journal  of  Xursing,  August,   1',)1S. 


292   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"nurses'  drive"  was  first  felt  in  June,  1918,  when  enrollment 
increased  from  approximately  900  to  1500  nurses.  During 
July  2664  nurses  were  enrolled  and  in  August  2700,  the  highest 
figure  reached  during  the  war.  For  the  five  months  beginning 
July  1  and  ending  December  1,  11,118  nurses  joined  the  Red 
Cross  reserve,  an  average  of  2220  nurses  a  month — an  in- 
crease of  almost  300  per  cent  over  previous  months  and  a 
number  equal  to  the  entire  enrollment  in  1917. 

By  the  autumn  many  Division  directors  reported  that  they 
had  reached  and  passed  their  qiiota,  but  the  cessation  of  hostili- 
ties then  made  it  needless  to  enroll  further  members.  In  speak- 
ing before  an  audience  of  nurses  a  year  later,  Miss  Noyes  gave 
some  interesting  details  of  the  immense  and  fatiguing  labor 
involved  in  the  enrollment  and  the  intensive  ''drive."  Alluding 
to  Miss  Delano  she  said : 

^Yorking  with  her  at  Xational  Headquarters  for  over  two 
years,  it  was  my  privilege  to  see  something  of  her  devotion 
to  the  cause  which  she  served.  Many  times  when  we  reached 
the  end  of  a  weary  day's  work  and  the  pressure  seemed  almost 
more  than  human  power  could  stand  I  have  heard  her  say, 
when  asked  if  she  were  tired,  ''Well.  I  suppose  it  is  no  harder 
for  us  to  die  at  our  desks  than  for  the  boys  to  die  in  the 
trenches." 

When  the  Armistice  was  signed  the  papers  of  six  hundred 
nurses  were  in  the  War  Department  ready  for  assignment  and 
several  thousand  more  had  given  their  date  of  availability 
between  that  time  and  January  1,  1919.  With  the  addition 
of  those  who  had  entered  the  Army  (3000)  and  the  Navy 
Nurse  Corps  (500)  direct,  the  total  number  of  nurses  in 
service  at  the  time  the  Armistice  was  signed  was,  as  nearly 
as  it  is  possible  to  estimate,  about  25,000. 

The  Army  had  asked  for  the  phenomenal  number  of  25.000 
nurses  by  January  1,  1919,  and  50,000  1)y  the  first  of  June, 
1919.  Great  anxiety  had  been  felt  on  the  part  of  tliose  who 
were  working  close  to  the  scene,  as  to  the  possil)ility  of 
meeting  this  demand  and  at  tlie  same  time  meeting  the 
civilian  needs  of  our  Allies  and  of  our  own  country. 

Figures  speak  for  themselves.  The  response  by  the  nurses 
to  the  call  of  the  colors  is  a  conclusive  refutation  of  any 
criticism  that  tliey  failed  to  meet  their  war  obligations.  It 
is  easy  to  speak  of  20. 000  nurses,  hut  impossible  for  anyone 
to  j)icture  the  tremendous  amount  of  work  in  connection  with 
the  enrollment  and  assiuiinient  of  these  to  service.     The  or- 


MOBILIZATION  293 

ganization  at  Tfed  Cross   Headquarters  had  to  be  developed 
with  the  utmost  regard   for  complete  cooperation. 

Ill  order  to  ])re])are  a  nurse  tor  duty  with  the  military 
establishment  it  was  frequently  necessary  to  send  many 
communications  both  by  lett<-!r  and  telegram  back  and  forth 
before  the  nurse  became  sufliciently  stable  to  refer  her  papers 
to  the  War  Department.  This  was  necessary  lest  some  accident 
occur  whereby  the  transportation  which  was  issued  from 
Washington  might  go  to  an  address  at  which  tiie  nurse  could 
not  be  found.  To  prepare  a  nurse  for  service  directly  under 
the  Hod  Cross  was  even  more  dillicult,  as  the  precautions 
adopted  by  the  State  and  War  Departments  before  a  passport 
could  be  issued  were  extremely  complicated.  Investigations 
through  the  Military  Intelligence  Department  for  loyalty  were 
required  for  everyone,  and  it  frequently  took  weeks  and  even 
months  to  secure  the  passport  of  a  nurse  for  overseas  duty 
with  the  civilian  population  in  those  countries  tliat  were 
turning  to  the  Red  Cross  for  help.  I  mention  thus  briefly 
some  of  the  purely  routine  procedures  tliat  held  the  individ- 
uals in  charge  of  the  various  bureaus  under  the  Department 
of  Xursing  at  their  desks  from  early  morning  until  late  at 
night,  holidays  and  Sundays,  from  the  time  diplomatic  rela- 
tions with  Germany  were  broken  until  several  months  after 
the  signing  of  the  Armistice.^'' 

The  Student  iSTurse  Reserve  campaign,  like  that  for  the 
creation  of  the  Army  School,  was  stimulated  electrically  bv  the 
v(>rv  high  hgur(>  issued  from  the  Surgeon  (ienerars  office  early 
in  litis,  in  estimating  the  probable  need  for  nurses  and  assist- 
ants. A  formal  statement  of  the  launching  of  the  campaign  is 
found  in  a  letter  from  Dr.  Franklin  ^lartin,  member  of  the 
Advisory  Commission,  Council  of  Xational  Defense"  to  ^Ir. 
Henrv  P.  Davison.  It  was  dated  June  27,  1918,  and  ended 
with  the  words : 

.  .  .  Immediately  following  these  re})orts.  "Miss  Patterson, 
director  of  the  Womairs  Connnittce,  Council  of  Xatidiial 
Defense,  iirescntcd  an  outline  of  a  caiu])aign,  as  extensive 
in  its  scope  as  that  of  t\\o  Red  Cross  enrollment  of  nurses. 
for  recruiting  t^.j.ooo  students  for  both  military  and  civilian 
hospitals,  whicli  her  committee  is  al)out  to  launch  at  the 
request  of  the  Coniniitte(>  on  Xursing  of  the  Council.  As 
you  know.  th(>  Surgeon  (ieiKTal's  otlice,  the  Ked  Cross  and 
the  (i(>neral   Medical   Pxjard  are  coo|)('rating. 

"Tlip  T\(h]  Cross  Xuisiiiix  Service.  Twenty-tifth  Aiimuil  Report.  Na- 
tional League  for  Xursiinr   Kdiuatinii,   lUlU. 


294    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Red  Cross  cooperated  by  circularizing  all  of  its  Chapters, 
bv  opening  Chapter  offices  as  recruiting  centers  and  by  assign- 
ing Red  Cross  workers  to  help  carry  on  the  campaign.  The 
publicity  material  was  the  work  of  Miss  Nutting's  committee 
and  was  submitted  for  approval  to  the  Publicity  Department  of 
the  American  Red  Cross.    An  example  of  the  material  follows : 

The  Government  is  now  calling  for  25,000  young  women 
to  join  the  United  States  Student  Nurse  Reserve  and  hold 
themselves  in  readiness  to  train  for  service  as  nurses. 

Age:  The  call  is  for  women  between  the  ages  of  nineteen 
and  thirty-five. 

Qualifications :  Intelligent,  responsible  women  of  good  edu- 
cation and  sound  health  are  wanted — the  pick  of  the  country. 
A  college  education  is  a  valuable  asset  and  many  hospitals 
will  give  credit  for  it.  Credit  will  also  be  given  for  a  special 
scientific  equipment  or  for  preliminary  training  iu  nursing, 
such  as  that  given  in  special  courses  now  being  conducted  by 
various  colleges  and  schools. 

Enrollment :  Women  will  be  given  an  opportunity  to  enroll 
in  the  United  States  Student  Reserve  in  any  one  of  three 
ways : 

1.  As  engaging  to  hold  themselves  in  readiness  until  April 
1,  1919,  to  accept  assignments  to  nurses'  training  schools  in 
civilian  hospitals. 

2.  As  desiring  to  become  candidates  for  the  Army  Nursing 
School  recently  established  by  authority  of  the  War  Depart- 
ment, with  branch  schools  in  selected  military  hospitals. 

3.  As  engaging  to  hold  themselves  in  readiness  until  April 
1,  1919,  to  accept  assignments  to  either  a  civilian  training 
school  or  the  Army  Nursing  School. 

The  Student  Nurse  Reserve  campaign  was  a  work  of  infinite 
detail  and  in  its  course  many  puzzling  and  exceedingly  com- 
plicated obstacles  of  an  educational  or  economic  nature  were 
mot  with.  Its  results  shed  light  upon  our  own  professional 
problems  and  may  even  be  found  helpful  in  other  countries. 
For  this  reason  some  parts  of  the  final  report  are  here  given: 

The  entire  protrram  as  outlined  was  dependent  upon  keep- 
ing up  a  large,  steady  su])ply  of  candidates  of  superior  quality 
for  both  our  civil  training  schools  and  the  Army  sehooj,  and 
it  was  soon  evident  that  the  latter  would  arouse  great  interest 
and  attract  many  do-irahle  applicants.  .  .  . 

.  .  .  There  arc  many  practical  difficulties  to  be  overcome. 
For  example  many  j^-raniniar  school  graduates  are  not  eligible 


MOBILIZATION  g95 

in  the  state  in  which  they  enlisted,  and  they  may  be  unabld 
to  bear  their  expenses  even  to  an  adjacent  state.  Thus  while 
vacancies  still  exist  and  applicants  await  a[)pointnient,  it  is 
often  impossible  to  accommodate  either.  The  large  number 
of  reassignments  are  due  chiefly  to  three  causes,  i.e. :  (a)  Lack 
of  information  on  the  application  forms  regarding  denomina- 
tional preference,  (b)  Inability  of  the  candidates  to  meet 
the  expenses  of  travel  and  equipment,  (c)  Direct  recruiting 
in  localities,  in  many  instances,  into  their  own  schools  in- 
stead of  through  this  committee. 

Disappointing  delays  have  arisen,  due  largely  to  four 
causes,  i.e.:  (a)  Incomplete  application  forms,  (b)  Incom- 
plete and  often  inaccurate  information  regarding  age  and 
educational  requirements  and  the  number  of  students  needed, 
(c)  An  utter  lack  of  precedent  for  or  experience  in  such  a 
piece  of  work,     (d)   Inadequate  staff  of  workers. 

However  the  fact  remains  that,  whereas  in  June,  July  and 
August,  many  hospital  training  schools  were  suffering  for  lack 
of  students,  there  are  now  thirteen  states  (this  number  was 
later  increased  to  seventeen),  in  which  needs  of  all  schools 
have  been  met. 

As  the  need  for  large  numbers  was  urgent  and  immediate, 
and  as  fourteen  state  laws  called  for  only  grammar  school 
education,  the  committee  thought  it  necessary  not  to  exclude 
such  applicants  in  the  first  drive.  Later  two  years  of  high 
school  was  made  the  minimum  requirement.  By  common 
consent,  the  thousand  and  more  ineligible  candidates  were 
urge<l  to  accept  positions  as  attendants  or  to  enter  for  train- 
ing as  attendants  in  liospitals  for  the  mentally  sick,  children's 
orthopedic  hospitals  and  tuberculosis  sanitaria,  institutions 
in  wbich  an  almost  tragic  need  of  workers  existed.  !Many 
letters  from  these  institutions  have  expressed  the  greatest 
aijpreciation  of  and  gratitude  for  the  committee's  oll'er  of 
assistance.  Unfortunately  very  few  of  these  young  women 
were  willing  to  accept  such  service. 

A  little  less  than  thirty-three  per  cent  of  the  candidates 
Avere  referred  to  tiie  Army  School  of  Xursing  and  the  re- 
mainder to  civilian  schools,  each  candidate  luning  l)een  given 
the  privilege  of  choosing  which  slic  would  enter.  1"]\  en  tliough 
many  states  failed  to  recruit  the  necessary  numbers  to  fill  all 
vacancies  within  their  schools,  though  a  consideralile  number 
of  candidates  ])rove(l  ineligible,  and  though  there  have  been 
other  inadequacies  as  the  work  jjroceeded,  of  wliich  the  ((nn- 
niittee  has  been  constantly  aware,  there  is  ani])le  evidence 
that  tile  campaign  met  a  very  great  need  at  a  time  of  both 
local  and  national  emergency.    A  com])h>te  report  of  canditlates 


296   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

recruited  and  assigned  has  been  prepared  by  states  and  by 
schools  and  copies  sent  to  each  state.^^ 

The  campaign  was  closed  on  December  15,  1918.  Some  14,000 
or  more  applications  were  dealt  with  and  of  these,  13,800  odd 
candidates  were  enrolled  for  entrance  into  schools  for  nurses. 
Those  who  met  all  the  requirements  numbered  5380  and  were 
assig:ned  to  the  Army  school.  To  the  civil  schools  of  nursing 
5185  were  directed.  The  others  were  on  a  waiting  list.  Much 
was  learned  of  the  hospitals.  In  one  state  alone,  for  example, 
twelve  hospital  training  schools  were  dropped  from  the  ac- 
credited list,  as  undesirable  for  the  training  of  Student  Nurse 
Reserve  candidates. 

The  instructions  and  demonstrations  to  volunteers  for  mak- 
ing surgical  dressings  for  the  Army  were  first  given  by  Red 
Cross  nurses.  As  the  work  spread  over  the  country,  it  was  stand- 
ardized by  regulations  from  the  Nursing  Service  in  consulta- 
tion with  Army  surgeons.  It  was  estimated  that  8,000,000  women 
working  in  Red  Cross  Chapters  made  253,000,000  surgical 
dressings  between  April  0,  1917,  and  October  1,  1918,  while  for 
twenty  months  ending  February  28,  1919,  the  number  was  306,- 
966,759.  There  were  more  than  30,000  workrooms,  where  asep- 
tic conditions  were  maintained  as  in  the  surgical  workrooms  of 
a  hospital.  In  addition  to  the  dressings,  many  millions  of  other 
articles  of  clothing  and  hospital  equipment  were  made. 

When  the  Mercy  Ship  sailed  at  the  outbreak  of  the  war,  a 
small  group  of  Washingtonians  went  immediately  to  work  to 
prepare  surgical  dressings  for  the  Red  Cross.  Admiral  M.  E. 
Mason,  chairman  of  the  District  of  Columbia  Chapter,  ap- 
pointed a  committee  composed  of  Abbie  B.  and  Edith  M.  Mc- 
Cammon,  Annie  Power  and  Mary  Randolph  to  develop  this 
activity.  In  a  little  shop  on  Eleventh  Street,  donated  through 
the  generosity  of  Mr.  M.  A.  Leeso,  they  opened  on  December  1, 
1914,  the  first  official  Rod  Cross  workroom — the  parent  of 
hundreds  of  supply  depots,  later  set  up  in  libraries,  railroad 
terminals,  department  stores,  clubs,  Sunday  School  rooms  and 
remote  country  sclioolhouses. 

At  a  meeting  of  the  National  Committee  on  Red  Cross  Nurs- 
ing Service,  held  June  20,  1917,  in  New  York  City,  Miss 
Delano  described  the  work  of  this  first  committee  on  surgical 
dressings : 

"Report  of  the  Committee  on  Nursing,  General  Medical  Board,  Council 
of  National  Defense,  April,  191!). 


MOBILIZATION  297 

A  circular  was  issued  in  1915  and  distributed  generally  to 
Red  Cross  ('hapters.  This  was  used  as  a  hasis  of  work  until 
the  publication  early  in  1!)1(),  of  a  second  panipidct  intended 
for  United  States  War  l\elief.  At  this  time,  the  standard 
boxes  were  also  adopted  and  their  contents  defined.  In  order 
to  maintain  a  definite  standard  for  the  preparation  of  these 
dressings,  we  realized  that  a  course  of  instruction  must  be 
adopted.  A  plan  was  accordingly  worked  out  and  appoint- 
ment cards  authorizing  their  recipient  to  act  as  instructors, 
were  issued  to  those  recommended  for  this  work  by  the  com- 
mittees in  charge  of  our  surgical  dressing  workroom. 

During  the  spring  of  191(i,  classes  were  organized  not  only 
in  connection  with  our  Chapters  but  in  cooperation  with  the 
Woman's  Section  of  the  Navy  League.  It  may  be  interesting 
to  state  the  method  followed  in  the  adoption  of  standard 
dressings.  In  cooperation  with  the  Supply  Department  of 
the  Eed  Cross,  I  visited  various  hospitals  in  Boston  and 
elsewhere,  such  as  the  Boston  City  Hospital  and  the  Presby- 
terian and  Bellevue  Hospitals  in  Xew  York  City,  and  selected 
samples  of  their  various  dressings,  operating-room  gowns, 
helmets,  etc.  We  then  secured  complete  sets  of  dressings  from 
the  Army  and  ?^avy  Hospitals,  so  that  we  had  typical  dress- 
ings from  about  twelve  different  hospitals. 

A  conference  was  then  held  between  surgeons  and  nurses 
from  the  Army  and  Xavy,  Eed  Cross  personnel  and  several 
nurses  who  had  had  experience  in  Europe.  The  various 
dressings  were  examined  and  those  which  seemed  common  to 
a  majority  of  hospitals  were  selected.  A  sample  box  was  pre- 
pared and  submitted  to  directors  of  units  such  as  Dr.  Crile 
of  the  Lakeside  Hospital  in  Cleveland.  Slight  changes  were 
made  on  their  suggestions,  and  the  so-called  Red  Cross  dress- 
ings were  adopted. 

In  September,  lOKi,  the  responsibility  for  hospital  sup- 
plies was  turned  over  to  ^liss  Xoyes.  Slie  and  Dr.  Bichards, 
a  representative  of  the  Xavy,  revised  the  supply  circular,  but 
no  radical  changes  seemed  necessary. 

Throughout  the  winter  months  of  lOlG  and  1017,  the  in- 
terest of  women  in  all  parts  of  the  United  States  in  the  prepa- 
ration of  surgical  dr(>ssing^  developed  beyond  the  capacity  of 
a  central  office  at  Xational  ircadquartcrs  to  handle.  ]\[iss 
Noyes  had  prcpar(>d  a  special  course^  in  the  making  of  these 
dressings  and  also  a  second  c()nrs(\  after  satisfactory  comple- 
tion of  which  the  student  was  certified  as  being  able  to  act  as 
an  instructor  for  other  classes  in  the  preparation  of  dressings. 


298    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Hundreds  of  certificates,  one  for  the  general  course  and  a  second 
for  the  instructor's  course,  went  out  under  Miss  Noves'  signa- 
ture to  all  sections  of  the  country  and  became  the  keystone  over 
which  the  Red  Cross  workrooms  sprang  up  in  schoolhouses, 
churches,  clubs  and  industrial  centers. 

Before  a  woman  was  certified  as  an  instructor,  she  was  re- 
quired to  submit  a  sample  box  of  the  various  types  of  surgical 
dressings.  No  sooner  had  Miss  Noyes  examined  and  cleared 
her  desk  of  these  samples  than  the  Mail  Division  would  send 
up  a  hundred  more.  The  top  floor  of  the  "]\Iarble  Palace" 
billowed  with  cotton  and  gauze.  Vashti  Bartlett  was  the  first 
nurse  to  assist  Miss  Noyes ;  later,  volunteer  nurses  from  Wash- 
ington lightened  the  burden  of  the  overtaxed  director  and  her 
assistants.  Among  these  was  Mrs.  Charles  Silliman  (Mary  V. 
Lee,  Johns  Hopkins).  After  examination,  these  innumerable 
white  pads  and  neatly-folded  bandages  were  passed  on  in 
clothes-baskets  to  Mrs.  Theodore  W.  Richards,  who  sorted  out 
the  perfect  articles  and  packed  them  into  complete  model  boxes 
to  be  returned  to  Chapter  workrooms. 

To  zealous  women  waiting  impatiently  in  Red  Cross  Chap- 
ter and  Branch  headquarters  for  their  certificates,  the  Nursing 
Service  may  have  seemed  over-exacting  in  their  insistence  upon 
perfect  dressings.  Sharp  adherence  to  standards  resulted,  how- 
ever, in  great  economy  of  materials  and  time.  Overworked 
nurses  in  evacuation  and  base  hospitals,  moreover,  could  not 
stop  to  refold  a  pad  whose  ravelled  edges  might  result  in 
discomfort  and  danger  to  their  patients.  Great  pressure  was 
being  brought  to  bear  at  this  time  upon  the  Nursing  Service 
to  change  the  types  of  dressings  to  suit  the  preferences  of  in- 
dividual surgeons.  The  aim  of  National  Headquarters  had 
always  been  to  prepare  a  type  of  dressing  which  anyone  could 
use.  As  this  standard  had  been  reached  after  conference  with 
leading  authorities  of  the  Army,  the  Navy  and  civilian  insti- 
tutions, Miss  Noyes  turned  a  polite  but  deaf  ear  to  protesting 
physicians  who  came  to  interview  her.  After  the  Nursing 
Service  had  given  over  this  work  to  the  Women's  Bureau,  a 
special  committee  went  to  Europe  to  study  the  entire  question, 
and  the  Red  Cross  models  were  later  changed. 

On  June  23,  1017,  Miss  Noyes  wrote  as  follows  to  Col.  Kcan: 

Since  Jamiarv  1,  the  work  of  the  Surgical  Dressings  and 
Garments  Division  of  the  Bureau  of  Nursing  Service  has  ex- 
panded with  groat  rapidity.    Thousands  of  inquiries  are  com- 


MOBILIZATION  299 

ing  to  us  from  Chapters,  branches  of  Chapters,  auxiliaries, 
groups  of  workers  and  individuals  who  are  interested  in  the 
preparation  of  surgical  dressings  and  hospital  garments. 
Every  new  Chapter  and  auxiliary  at  once  desires  this  jiarticu- 
lar  work,  Althougli  circulars  of  information  and  detailed 
directions  are  sent  concerning  the  organization  of  classes  and 
the  manufacture  of  dressings  and  garments,  questions  are 
constantly  arising  which  must  be  referred  to  an  authoritative 
head. 

We  have  divided  the  country  into  eight  districts — Boston, 
New  York  City,  Philadelphia,  Baltimore,  Cleveland,  Chicago, 
Colorado  Springs  and  San  Francisco,  for  distribution  of 
sample  boxes  of  dressings,  patterns,  emblems  and  informa- 
tion. As  the  pressure  upon  these  Chapters  has  increased,  it 
has  seemed  desirable  to  authorize  other  distributing  ceiiters 
and  the  following  are  preparing  to  qualify  as  such — Atlanta, 
New  Orleans,  St.  Louis,  ^Minneapolis  and  Seattle. 

It  would  be  safe  to  say  that  workrooms  have  not  only 
been  established  in  all  of  our  cities,  but  towns  and  country 
districts  have  developed  in  the  same  direction.  The  following 
workrooms  stand  out  conspicuously  as  models  of  efficiency: 

New  York  City  as  developed  under  "Sirs.  Belmont  Tiffany. 

Chicago  as  developed  under  Mrs.  John  Glass. 

Washington,  D.  C,  as  developed  under  Mrs.  T.  W.  Richards. 

Baltimore  as  developed  under  ]\[rs.  Thos.  S.  Cullen. 

Cleveland  as  developed  under  ^frs.  E.  S.  Burke. 

There  are  many  others  equally  proficient. 

The  statistics  appended  show  the  status  of  the  work  at  the 
present  time : 

Since  December  15,  19in. 

No.  of  completed  surgical  dressings  classes 330 

No.  of  pupils  qualified 4799 

No.  of  enrolled  Red  Cross  nurses  qualified 15f) 

No.  of  lay  instructors  qualified 3G3 

No.  of  sample  boxes  sent  from  this  office 4.")  I 

You  will  note  that  lo()  Red  Cross  nurses  have  Ijccmi  qualified 
and  enrolled  as  instructors  in  this  course,  but  we  believe  that 
the  instruction  and  management  of  workrooms  could  safely 
be  entrusted  to  our  qualified  workers  and  lay  instructors. 
Red  Cross  nurses  are  required  for  the  more  important  work 
of  caring  for  sick  and  wounded  soldiers  and  sailors. 

To  provide  administrative  channels  through  which  this  trans- 
fer could  1)0  effoctcd,  t\w  Executive  Committoo  established 
duly   l\    1'.>17.   uiidiT   tlic    1  )(']tartnicnt   of   Chapters,    a    bureau 


300   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

through  which  all  women's  activities  for  the  Red  Cross  (other 
than  professional  nursing)  should  be  recognized  and  developed. 
The  vice-chairman  also  appointed  a  Woman's  Advisory  Com- 
mittee, consisting  of  the  following  members :  Mrs.  William  K. 
Draper,  chairman ;  ^[iss  Mary  Goodwillie,  vice-chairman ; 
Miss  Mabel  T.  Boardman,  ]\rrs.  Joseph  M.  Cudahy,  Mrs.  Frank 
V.  Hammar,  ]\Irs.  E.  H.  Harriman,  Mrs.  George  Wharton 
Pepper,  Mrs.  Leonard  Wood,  Miss  Lavinia  H.  ISTewell,  Mrs. 
William  H.  Crocker,  ^[rs.  Preston  S.  Arkwright,  Mrs.  August 
Belmont,  Mrs.  J.  Randolph  Coolidge,  Jr.  To  the  Woman's 
Bureau,  of  which  Miss  Florence  M.  Marshall  was  director, 
was  immediately  delegated  all  work  connected  with  surgical 
dressings,  hospital  garments  and  refugee  clothing. 

In  the  Red  Cross  Annual  Report  for  1917,  Miss  Delano 
summarized  the  benefits  derived  from  this  transfer: 

This  reorganization  served  two  purposes;  it  released  a 
large  number  of  nurses,  who  have  been  acting  as  instructors 
in  surgical  dressings  and  hospital  supplies,  for  other  service, 
and  it  marshaled  the  forces,  not  only  of  women  volunteers, 
who  were  fitted  to  become  instructors,  but  of  the  great  army 
of  volunteer  workers  throughout  the  country  just  when  the 
emergency  demanded  such  a  realignment.  It  left  the  Xursing 
Service  free  to  deal  with  its  purely  professional  duties. 

During  the  period  in  which  the  United  States  was  at  war, 
several  surveys  of  the  nvirsing  profession  were  made  in  order 
to  obtain  a  working  estimate  of  the  nursing  strength  of  the 
country.  Immediately  after  the  declaration  of  war  by  this 
country,  the  Xational  Committee  on  Red  Cross  Xursing  Serv- 
ice, as  a  first  step,  carried  out  a  preliminary  classification  of 
its  own  enrolled  members  under  the  heads  of  nursing  special- 
ties.    Miss  Delano  wrote  :-^* 

With  tlie  declaration  of  war,  there  was  a  decided  increase 
in  the  aitplif-ation  of  nurses  for  enrollment  with  the  Red 
Cross.  Tlip  enrollment  from  January  1  to  October  31,  11)17, 
has  been  over  TOOO,  <riving  us  a  total  enrollment  on  Octoben 
31  of  1  l.'i"28.  To  meet  the  demands  for  mirses  with  special 
training,  a  classified  list  of  the  entire  enrollment  has  recently 
been  made  and  s])ef-ial  groups  of  nurses  selected  for  the  fol- 
lowing services:  ])ediatrif  work;  orthopedic  work;  nervous 
and  mental  diseases;  head  aiul  neck  surgery;  contagious  dis- 
eases; public  health  work;  eye  and  ear  work. 
"  Eiglith  Annual  lU'port,  American  Ked  Cross.  Ucccmber,   1917. 


MOBILIZATIOxV  301 

Further  than  this,  the  first  census  of  the  entire  nursing  re- 
sources of  the  country  was  set  on  foot  early  in  June,  1917,  by 
the  Nursing  Department  of  the  Red  Cross.  This  consisted 
of  an  exhaustive  survey  of  all  the  hospital  training  schools  in 
the  United  States.  It  was  Miss  Delano's  own  idea  and  was 
carried  out  entirely  under  her  direction  by  Miss  Deans,  whose 
exceptional  knowledge  of  training  schools  and  nursing  stand- 
ards made  her  an  unusually  capable  worker  on  such  lines.  This 
survey  was  completed  by  August  18,  1917. 

The  survey  was  conducted  by  tirst  writing  to  the  Boards  of 
Examiners  of  the  dilferent  states,  to  ask  for  complete  lists  of 
all  accredited  and  non-accredited  training  schools  of  the  state. 
The  Boards  of  Examiners  replied  with  promptitude  and  accu- 
racy to  this  request  and  the  survey  was  then  pushed  further 
by  sending  a  questionnaire  to  all  the  training  schools  thus  listed, 
asking  for  careful  and  d(^tailed  statements  of  their  educational 
standards,  practical  services  and  nursing  resources.  An  alpha- 
betical list  by  states  was  then  made  showing  all  the  hospital 
training  schools  by  name  and  address.  From  the  replies  re- 
ceived to  the  questionnaire  the  training  schools  were  classified 
under  six  headings. 

Prior  to  the  war,  the  Red  Cross  Nursing  Service  had  simply 
listed  training  schools  whose  graduates  were  eligible  for  Red 
Cross  enrollment ;  where  supplementary  training  was  neces- 
eary,  this  information  had  been  placed  upon  the  tile  card.  But 
now  the  classification  was  as  follows : 

Class  A.  Schools  which  meet  Eed  Cross  requirements. 
Class  B.  Schools  whose  graduates  are  of  a  high  grade  and 

the  training  general   in   character,   including  men, 

but  daily  average  number  of  patients  below  fifty. 
Class  C.  Schools  which  are  small  but  training  good  as  far 

as  it  goes. 
Class  1).   Schools    connected    with    ])rivatc    hospitals    having 

afliliation  with  general  hospitals. 
Class  E.   Schools  not  accredited  but  likely  to  be. 
Class  F.  Schools   whitli  are  undesirable. 

The  care  and  tlioi'oughness  with  which  this  survey  was  con- 
ducted, as  well  as  the  helpful  readiness  of  ^liss  Delano's  otHce 
to  point  out  ways  ol"  raising  standards,  may  be  deduced  from 
the  following  illnstrativc  selections  from  the  letters  sent  out 
from  and  received  by  the   Department  of  Nursing: 


302   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

(Letter  Sent  to  Boards  of  Examiners)  : 

The  Red  Cross  is  making  every  effort  to  anticipate  the 
demands  which  will  be  made  for  nurses  not  only  in  Europe, 
but  in  our  own  country  should  the  war  be  of  several  years' 
duration. 

With  this  in  view  we  are  asking  for  the  cooperation  of  the 
American  Nurses'  Association,  state  associations  of  nurses, 
State  Boards  of  Examiners  for  Nurses  and  hospitals  to  assist 
us  in  meeting  all  emergencies  which  may  arise. 

We  are  enclosing  a  list  of  schools  accredited  by  your  State 
Board  of  Examiners,  together  with  a  questionnaire  to  be  used 
in  supplying  the  information  we  require,  also  a  copy  of  the 
requirements  for  enrollment  in  the  Ked  Cross. 

Would  it  be  possible  to  conduct  special  examinations,  as 
many  nurses  are  eligible  as  soon  as  graduated,  but  have  to 
wait  several  months  to  take  this  examination?  The  Red 
Cross  would  greatly  regret  the  necessity  of  lowering  its  stand- 
ard for  enrollment  without  this  requirement  of  registration. 

Could  you  furnish  us  witli  a  list  of  nurses  as  soon  as  they 
have  passed  their  examinations,  in  case  there  should  be  an 
unavoidable   delay  in   issuing  their  certificates? 

It  is  absolutely  essential  that  we  have  definite  information 
on  file  of  all  the  nurses  in  the  country,  and  believe  there  is 
no  one  in  a  better  position  than  the  Board  of  Examiners  to 
furnish  the  probaljle  number  of  nurses  available  in  its  state. 

It  may  be  necessary  to  supplement  the  nursing  service  both 
in  military  and  civil  hospitals  with  women  who  have  had  at 
least  the  course  in  Elementary  Hygiene  and  Home  Care  of 
the  Sick.  This  theoretical  instruction  should  be  supple- 
mented by  72  hours  in  a  carefully  selected  group  of  hospitals 
and  we  shall  appreciate  your  interest  in  suggesting  training 
schools  which  can  be  safely  entrusted  to  give  this  instruction. 

Assuring  you  of  my  sincere  appreciation  of  your  efforts  in 
behalf  of  the  Red  Cross,  believe  me,  to  be. 

Yours  very  truly, 

(signed)  Jane  A,  Delano, 

August  4,  1917. 
My  dear  IMiss  : 

I  appreciate  greatly  your  letter  received  this  morning  and 
your  willingness  to  take  for  post-graduate  work  some  of  the 
registered  nurses  who  are  graduates  of  the  liospitals  some- 
what under  our  required  average. 

We  arc  interpreting  this  requirement  a  little  more  leniently 
and  have  decided  to  accept  schools  recommended  by  Boards 
of  Registration  as.  giving  a  sutliciently  tlioroiigh  training  to 


MOBILIZATION  303 

qualify  its  graduates  for  Rod  Cross  service.  A  number  of 
other  schools  have  expressed  their  willingness  to  provide 
some  post-graduate  work  for  their  nurses,  and  we  shall  be 
very  glad  to  accept  tlie  four  montiis'  experience  in  your  hos- 
pital for  such  nurses  as  you  may  recommend  for  service. 

Assuring  you  of  our  sincere  appreciation  of  your  service, 
believe  me, 

Yours  sincerely, 

(signed)  Jane  A.  Delano, 

August  29,  1917. 
My  dear  Miss  : 

Your  second  list  of  the  small  schools  in  with 

other  information  received  for  wliich  I  thank  you. 

We  have  a  large  number  of  applications  from  nurses  grad- 
uating from  small  schools  who  might  be  eligible  for  enroll- 
ment, provide(J  they  have  some  subsequent  experience  or 
training  and   1   should   be   glad  to  have  the   names  of  the 

schools    in ' —   which    offer    post-graduate    work    for 

nurses. 

We  are  urging  these  nurses  that  do  not  meet  the  require- 
ments to  take  this  subsequent  training  and  recently  have  hoard 

that  the Hospital  of and  the  

Hospital  of are  offering  special  post-graduate  work 

to  graduates  who  do  not  meet  the  requirements  of  the  Ameri- 
can Red  Cross. 

Thanking  you  again  for  your  helpful  information,  I  am, 
Yours  very  truly, 

(signed)  Jane  A.  Delano, 

December  7^  1917. 


In  view  of  the  tremendous  demands  now  being  made  upon 
us  for  nurses  in  the  cantonment  hospitals,  we  are  waiving 
the  requirement  of  alliliation  with  the  American  Nurses'  As- 
sociation. I  feel  sure  that  this  requirement  can  be  far  better 
sacrificed  than  that  of  registration,  or  the  character  of  the 
school  from  which  the  nurse  graduated. 

Will  you  therefore  forward  to  Division  office  at  once  any 
papers  which  you  are  holding  pending  affiliation,  securing 
at  the  same  time  their  physical  examination  blanks  together 
with  a  reliable  address  and  a  statement  concerning  their 
availability  for  service?  Will  you  also  announce  to  the  nurses 
in  your  comnninity  that  the  ap])lications  of  those  meeting 
other  requirements  except  affiliation  will  be  considered  and 
forwarded  to  Washington,  thus  stimulating  increased  en- 
rollment ? 


304    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  would  suggest,  in  view  of  the  fact  that  practically  all  of 
the  cantonment  hospitals  need  additional  nursing  personnel, 
that  you  request  each  member  of  your  committee  to  secure 
at  once  the  enrollment  of  as  many  nurses  as  possible.  Kindly 
ask  the  nurses  securing  these  enrollments  to  write  their  names 
and  addresses  at  the  top  of  the  applications,  so  that  as  the 
papers  come  in  we  may  be  able  to  give  due  credit  on  a  chart 
which  we  are  preparing,  to  the  various  individuals  and  com- 
mittees. 

The  organizations  of  nurses  in  this  country  have  assumed 
a  definite  responsibility  for  service  in  time  of  war,  a  far 
greater  responsibility  than  rests  upon  any  other  group  of 
women,  and  I  feel  sure  that  if  the  need  is  brought  to  them 
clearly,  they  will  not  fail  at  this  time.  If  they  do,  we 
shall  be  responsible  for  any  breaking  down  of  nursing  stand- 
ards which  may  follow,  and  do  inestimable  harm  to  the  schools 
and  nurses  of  the  country. 

May  I  ask  that  you  send  me  a  telegram  on  the  receipt  of 
this  letter,  assuring  me  that  you  are  taking  the  matter  up 
promptly  and  vigorously?  I  would  also  suggest  that  applica- 
tions of  desirable  nurses  should  be  forwarded,  even  though 
not  meeting  our  age  requirements. 

Yours  sincerely, 

(signed)  Jane  A.  Delano, 

Brief  mention  of  this  survey  and  its  results  was  made  by 
Miss  Delano  in  the  following  lines  taken  from  her  Annual 
Report :  "Through  the  cooperation  and  assistance  of  State 
Boards  of  Registration,  a  classified  list  of  all  the  training 
schools  in  the  country  has  been  secured." 

With  the  formation  of  the  Emergency  Committee  on  l^ursing 
in  iSTew  York  City,  a  nursing  census  was  planned  by  it  to  be 
carried  out  on  national  lines  according  to  a  method  which  had 
been  developed  in  a  nursing  survey  of  Greater  New  York  by 
]\Iiss  Goodrich,  a  member  of  the  (then)  Emergency  Commit- 
tee on  Xursing,  for  what  was  known  as  "The  ^favor's  [^Fayor 
Hylan]  Committee  of  Women  for  ISTational  Defense."  When 
that  committee  of  nurses  evolved  into  the  Xational  Committee 
on  Xursing  under  the  Council  of  Xational  Defense,  its  census 
plan  was  continued  on  a  national  scale  during  the  summer  of 
1!)17.  The  machinery  used  was  that  of  the  American  Nurses' 
Association  and  its  state  branches.  The  association  made  itself 
responsible  for  collecting  the  information  asked  for  by  Miss 
Nutting's  committee  and  .Miss  Goodrich,   as  president  of  the 


MOBILIZATION  305 

American  Nurses'  Association,  directed  the  survey  and  com- 
municated the  results  to  the  respective  committees  cooperating 
in  war  service. ^'"^ 

That  census,  carried  out  entirely,  as  it  was,  by  unpaid 
volunteers,  all  of  whom  were  in  active  nursing  work  and  making 
no  claim  to  be  expert  statisticians,  was  a  creditable  piece  of 
work,  of  substantial  practical  vahie.  While  not  a  scientifi(;ally 
perfect  survey,  it  was  approximately  accurate  and  suffi(;ed  for 
the  immediate  purpose.  Jn  contrast  to  the  first  lied  Cross  sur- 
vey, which  was  a  survey  of  training  schools,  this  one  was  a 
census  of  individual  nurses. 

The  information  asked  for  was:  (1)  the  total  number  of 
registered  nurses;  (2)  the  total  number  of  gi*aduate  nurses,  not 
registered;  (3)  numbers  of  pupils  in  registered  or  accredited 
training  schools;  (-ia)  in  non-accredited  training  schools; 
(4)  the  total  number  of  pnpils  graduating  in  1918;  (5)  the 
total  immbcr  of  pupils  that  could  be  enrolled  in  the  fall  classes; 
(G)  the  total  number  of  pupils  that  could  be  enrolled  during 
the  year. 

The  census  figures  showed  that  there  were  66,017  registered 
nurses  and  17,758  nurses  not  registered,  making  a  total  of 
83,775  nurses.  From  the  1579  accredited  schools,  13,288  nurses 
had  been  graduated  in  1918,  and  from  the  414  non-accredited 
schools,  1099  had  been  graduated,  making  a  total  of  14,387 
of  the  1918  classes,  which  brought  the  total  number  of  grad- 
uate nurses  available  at  the  end  of  1918  to  98,162. 

As  to  the  numbers  of  student  nurses,  38,938  were  in  accred- 
ited schools,  while  3633  were  in  non-accredited  schools,  making 
a  total  number  of  42,571  student  nurses  in  the  United  States. 
No  figures  were  obtained  from  thr(>e  states  wlun-e  State  nurses' 
associations  did  not  exist.  The  census  was  completed  in 
March,  1918. 

Early  in  1918  Congress  inquired  into  the  nursing  reserves 
of  the  nation: 

Mr.  Trannnoll  submitted  the  following  resolution  (S.  l?os. 
185),  wliich  was  read,  considered  ])y  unanimous  t'oiisont  and 
agreed   to : 

KESOLVFl):  That  the  Senate  Committee  on  Military 
AfTairs  be,  and  it  is  hereby,  directed  to  investigate  and  re- 
port to  the  Senate  at  the  earliest  practicable  date  the  avail- 

"  See  Report  of  Coniinittee  on  Xursiiig  (Council  of  National  Defense) 
July  29,   1<»17. 


306   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

able  number  of  trained  nurses  for  service  with  the  United 
States  Army;  and  whether  or  not  this  present  available 
number  will  be  adequate  for  the  needs  of  the  Army  when 
increased  by  the  anticipated  future  increments,  taking  into 
consideration  the  increased  demand  when  the  Army  shall 
more  largely  engage  in  active  conflict;  and  to  investigate 
and  report  on  the  advisability  of  at  once  establishing  train- 
ing sources  or  schools  for  nurses  for  future  service  with  the 
Army  Hospitals ;  and  to  investigate  and  report  what,  if  any, 
provisions  have  been  made  to  this  end  by  the  War  Depart- 
ment.'° 

As  the  summer  wore  on  and  the  Red  Cross  continued  to  draw 
nurses  from  institutional  fields  for  the  Military  Establishment, 
Miss  Noyes  was  confronted  by  the  imminent  possibility  of 
breaking  down  completely  the  efficiency  of  the  nursing  sys- 
tems in  already  overcrowded  civilian  hospitals.  General  Gorgas 
in  August,  1918,  was  calling  for  one  thousand  nurses  a  week. 
The  civilian  population  constituted,  however,  the  second  line  of 
defense.  Their  health  might  be  seriously  undermined  by  this 
exhaustive  drain  upon  the  supply  of  physicians  and  nurses. 
"We  have  only  one  graduate  nurse  left,"  wrote  superintendents 
of  smaller  schools  of  nursing  to  Miss  Koyes,  "and  if  you  call 
her  into  service,  w-e  shall  be  forced  to  close  our  doors."  Some 
institutions  had  already  done  so. 

To  secure  scientifically  accurate  data  by  which  the  Nursing 
Service  might  be  guided  in  its  withdrawal  of  nurses  from  civil 
establishments,  !Miss  Delano  and  ]\Iiss  Noyes  suggested  early 
in  the  summer  of  1918  to  the  War  Department  and  to  offi- 
cials at  National  Headquarters  that  the  Red  Cross  make  a 
complete  survey  of  the  nursing  resources  of  the  nation.  On 
August  27,  1918,  the  Surgeon  General  wrote  to  Mr.  Davison, 
chairman  of  the  War  Council : 

Because  of  the  increased  military  programs  it  is  necessary 
that  there  sliould  be  immediately  available  definite  informa- 
tion as  to  tlie  number  of  graduate  nurses  available  for  mili- 
tary service;  also  supplementary  nursing  personnel,  trained 
hospital  attendants,  and  all  others  who  are  qualiiied  to  render 
aid  under  the  direction  of  graduate  nurses  in  the  care  of 
the  civilian  popnlation. 

As  the  Red  Cross  is  the  agency  for  recruiting  nurses  for 
the  Army  Nurse   Corps  I  wish  you  would  take  immediate 
** Congressional   Record,  January   10,   lOlS,  p.  OtiT. 


MOBILIZATION  307 

steps  to  make  a  natioii-wido  survey  of  the  nursing  resources 
in  order  tliat  a  sulTicient  number  of  graduate  nurses  may  be 
withdrawn  for  military  service  with  the  least  interference 
to  the  possible  needs  of  the  civilian  population. 

(signed)   William  C.  Gorgas, 
Surgeon  General,  U.  S.  Army.^^ 

Immediate  steps  were  taken  for  complying  with  Dr,  Gorgas' 
request.  The  ^linntes  of  the  War  Council  meetings  for  the 
119th  meeting,  held  September  20,  1918,  give  a  full  account 
of  what  was  done: 

.  .  .  under  date  of  August  29,  1918  (D.  R.,  p.  14G9),  the 
chairman  had  replied  to  the  above  letter  of  the  Surgeon 
General  of  the  Army,  stating  that  the  Ked  Cress  deeply 
appreciated  the  importance  of  the  work  suggested,  and  that 
the  acting  general  manager  had  been  instructed  to  set  up 
special  machinery  at  Headquarters  under  expert  guidance, 
to  manage  the  survey  which  will  be  conducted  through  Red 
Cross  Chapters. 

The  chairman  further  stated  that  a  comprehensive  plan 
had  now  been  submitted  (I).  E.,  p.  1538)  by  the  assistant 
general  manager  for  the  making  of  such  a  survey;  that 
questionnaires  had  been  prepared  which  would  be  sent  out 
througli  the  Chapters,  through  which  very  comprehensive 
information  on  the  nursing  resources  would  be  made  avail- 
able; that,  under  this  plan,  an  executive  manager  of  the 
nursing  survey,  ^Ir.  Frederick  C.  ]\Iunroe,  had  been  ap- 
pointed, and  a  special  organization  had  been  set  up  at  Xa- 
tional  Headquarters,  at  the  Divisional  Headquarters,  and 
thence  to  every  Chapter  and  branch  in  the  country;  that 
the  work  of  canvassing  the  field  to  secure  facts  about  every 
nurse  would  involve  a  house  to  house  canvas  in  many  parts 
of  the  country,  and  hence  would  require  large  forces  of 
workers;  that  if  all  tlie  facts  that  can  be  useful  are  to  be 
gathered  from  this  survey,  the  tabulation  work  would  be 
very  great;  that  the  number  of  questionnaires  that  would  be 
sent  to  Xational  Headquarters  to  be  classified  and  analyzed 
is  estimated  roughly  at  3(i0.000;  tliat  tabulation  of  "'this 
great  number  of  questionnaires  can  be  done  only  by  mechan- 
ical means,  and  that  ]ilaiis  were  now  being  comi)leted  to  use 
the  so-called  'Tlollerith  System."  which  would  involve  ma- 
chines, punches,  special  cards,  filing  cases,  and  a  force  of 
fifty  or  sixty  clerks  for  al)out  two  month's. 

"  Documents   uf    Record,    pp.    14GS-G9. 


308   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

He  further  stated  that  a  request  for  an  appropriation  of 
$60,000  had  now  been  received  from  the  director  of  the 
Department  of  Nursing,  approved  by  the  assistant  general 
manager,  to  cover  the. cost  of  making  this  survey,  including 
the  printing  and  distributing  of  questionnaires,  Headquar- 
ters' expense  for  machines,  punches,  cards,  filing  cases,  and 
clerical  hire,  and  Division  expenses  for  clerks,  traveling  and 
publicity.     [The  appropriation  was  granted. ^^] 

The  statistical  division  was  under  the  direction  of  Mr.  C.  S. 
Qiiinn. 

In  a  letter  sent  to  all  the  Division  directors,  Miss  Delano 
said  in  part: 

The  survey  is  quite  apart  from  the  enrollment  of  Eed 
Cross  nurses  and  will  be  conducted  more  nearly  like  a  census 
than  an  enrollment,  and  for  this  reason  it  will  be  necessary 
to  secure  the  assistance  of  people  who  have  had  experience 
in  conducting  surveys  and  compiling  statistics.  Mr.  Munroe, 
of  Boston,  who  is  an  expert  along  these  lines,  has  been  placed 
in  charge  of  the  work  at  Red  Cross  Headquarters.  I  have 
already  appealed  to  the  State  nurses'  associations,  who 
made  the  former  survey,  urging  their  cooperation  and  we 
are  advising  with  the  Committees  on  Nursing  of  the  Ameri- 
can Red  Cross  and  the  Council  of  National  Defense  and  the 
Surgeon  General's  office.   .    .    . 

We  are  anxious  to  secure  definite  information  concerning 
all  the  nursing  resources  of  the  community,  including  not 
only  graduate  nurses,  registered  and  unregistered,  but  pupil 
nurses,  practical  nurses,  trained  attendants,  midwives,  etc. 
This  places  the  whole  work  on  a  difl'erent  basis  from  any 
previous  survey  and  will  make  available  the  information  so 
greatly  needed  at  this  time  to  meet  military  necessities  and 
protect  the  welfare  of  the  communities. 

Definite  plans  outlining  the  work  will  be  issued  as  soon  as 
possible. 

The  coming  of  tlie  Armistice  with  its  welcome  relief  from 
high  tension  had  an  inhibiting  etfect  on  the  processes  of  the 
survey  and  when,  in  the  spring  of  1011)  the  Bureau  of  Nurs- 
ing Survey  reported  that  field  activities  were  drawing  to  a 
close,  it  had  received  but  57.0%  of  the  expected  returns.  The 
questionnaires   filled   out   in   sufficiently   complete   form  to   be 

"See  Minutes  of  the  llOth  Meeting  of  the  War  Council,  September  26, 
1918,  pp.   1556-1557. 


MOBILIZATION  309 

utilized  showed  155,918  women  broadly  classed  as  nurses,  and 
coming  under  all  the  various  headings  indicated  in  the  letter 
quoted  above,  from  Miss  Delano  to  the  Division  directors. 
From  the  averages  it  was  computed  that  the  whole  number 
of  nurses  of  all  grades,  in  the  country,  would  be  about  209,288, 
but  the  minute  classifications  could  not  be  pushed  to  a  con- 
clusion, nor  was  the  final  completion  of  the  survey  as  a  whole 
possible,  after  the  return  of  peace. 


CHAPTER  VI 

EELATIOX    OF    THE    NURSING    SERVICE    TO    THE    ARMY 

Organization  of  Units — Base  Hospitals — Hospital  Units — 
Emergency  Detachments — Training  School  Units — Special 
Units — Cantonment  Zone  Service — Mexican  Border  Service 
— Equipment  and  Insignia. 

POPULAR  opinion  has  made  of  the  American  Red  Cross 
nurse  a  romantic  embodiment  of  personal  beauty,  of 
steadfast  courage  and  sympathy,  of  womanly  sweet- 
ness and  gentle  strength.  It  has,  moreover,  pictured  her  at 
the  forefront  of  war,  set  high  above  the  ugliness  and  stench  of 
combat,  unperturbed,  serene  and  holy  by  reason  of  this  beauty 
of  person  and  character,  a  shining  ideal  toward  which  the  dy- 
ing soldier  turned  his  glazing  eyes. 

Among  the  eighteen  thousand  American  Red  Cross  nurses 
who  served  with  the  American  Armies  during  the  European 
War,  sentimentalists  could  have  foiind  scarcely  a  single  woman 
who  fulfilled  in  outward  appearance  at  least  this  radiant  con- 
ception of  the  angel  of  the  battlefiMds.  Instead  of  the  flowing 
white  veil  and  the  immaculate  uniform  of  popular  fancy  and 
postered  fame,  the  Red  Cross  nurse  wore  the  utilitarian  cap  of 
the  graduate  nurse  and  the  practical  gray  uniform  of  the  field; 
sometimes  she  was  muffled  up  in  slicker,  with  storm  lx)ots  on 
her  feet  and  sou'wester  pulled  down  over  her  eyes ;  or  again 
she  had  drawn  a  sagging,  weather-beate^i  sweater  about  her 
shivering  body.  Instead  of  a  seraphic-faced  girl,  she  was  far 
more  frequently  a  woman  of  mature  years,  long  familiar  with 
the  seamy  side  of  human  relationships,  long  acquainted  with 
the  sadness  born  of  working  day  and  night  with  the-  two  supreme 
realities  of  human  existence.  Life  and  Death.  She  had  little 
opportunity  for  gentle  speech  to  the  wounded  in  moments  of 
stress,  only  time  and  streniith  to  utter  brief  words  of  instruc- 
tion to  corpsmen  and  stretcher-bearers  who  assisted  her.  Highly- 
trained   instrument    in   the   care   of   the    sick   that    she   herself 

310 

I 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  311 

was,  she  could  manifest  no  reactions  of  her  own  personality  or 
of  her  own  emotions.  Though  her  throat  might  ache  with  sym- 
pathy, her  mind  must  be  alert,  her  eyes  must  be  clear,  her  hands 
steady  for  the  performance  of  her  manifold  duties. 

As  the  personality  of  the  individual  woman  was  lost  in  the 
efficiency  of  the  expert  nurse,  so  was  the  identity  of  the  Ameri- 
can lied  Cross  Nursing  Service  lost  in  that  of  the  Army  Nurse 
Corps.  So  close  was  its  relationship,  so  whole-hearted  was  its 
cooperation  with  the  United  States  War  Department  that  its 
nurses,  during  the  last  months  of  the  duration  of  hostilities, 
cheerfully  laid  aside  the  Ked  Cross,  that  symbol  of  humani- 
tarianism  which  had  led  them  to  pledge  loyalty  and  service  to 
an  ideal  of  patriotic  altruism,  that  they  might  conform  in  all 
particulars  to  the  regulations  of  the  Military  Establishment. 

How  the  individualistic  humanitarian  instincts  of  the  relief 
worker  during  the  Civil  and  Spanish-American  Wars  crystal- 
ized  into  the  Ked  Cross  ideal,  how  the  affiliation  of  the  Ameri- 
can nursing  profession  brought  this  shadowy  vision  of  the  care 
of  the  sick  and  wounded  of  armies  in  war  from  the  realm  of 
vague  aspiration  into  that  of  definite  actuality,  how  this  germ- 
idea  developed  into  the  official  reserve  of  the  United  States 
Army  and  Navy  Nurse  Corps,  has  already  been  shown.  Into 
this  complex  pattern  of  American  war  nursing,  the  lives  and 
accomplishments  of  many  women  have  been  woven.  Among 
the  seven  who  in  turn  have  stood  at  the  head  of  the  Govern- 
ment's nursing  forces, — Dorothea  Dix,  Anita  Newcomb  Mc- 
Gee,  Dita  Kinney,  Jane  Delano,  Isabel  McTsaac,  Dora  E. 
Thompson,  and  Julia  C.  Stimson — the  World  War  brought  into 
sharp  relief  the  last  two  as  superintendents  of  the  Army  Nurse 
Corps. 

By  training  and  temperament,  these  women  were  both 
uniquely  fitted  for  the  work  each  accomplished  in  the  Army 
Nurse  Corps.  ^liss  Thompson  was  a  veteran  member  of  this 
organization.  After  post-graduate  work  in  operating-room 
methods  at  her  alma  mater,  the  City  Hospital,  BlackwelFs  Is- 
land, New  York  City,  she  did  private  duty  nursing  for  four 
years  in  New  York  City.  She  was  enrolled  as  a  nurse  April 
22,  1002,  in  the  then  infant  Army  Nurse  Corps  and  was  ap- 
pointed as  a  chief  nurse  in  August,  1005.  Service  followed  at 
Letterman  General  Hospital,  where  her  work  as  eliicf  nurse 
during  and  after  the  San  Francisco  eartlnpuike  was  highly 
coinnuMided.      Lat(>r,  she  was  sent  to  ^lanila  to  serve  as  chief 


312   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nurse  of  the  Division  Hospital.  In  May,  1914,  she  became 
a  member  of  the  American  Red  Cross  Nursing  Service.  Dur- 
ing the  same  year,  she  was  appointed  Superintendent  of  the 
Army  Nurse  Corps,  following  the  death  of  Miss  Mclsaac.  In 
this  capacity,  she  served  until  December  30,  1919,  when  she 
tendered  her  resignation.  She  then  took  extended  leave  of 
absence,  at  the  expiration  of  which  she  was  appointed  as- 
sistant Superintendent  of  the  Army  Nurse  Corps  and  at  her 
own  request  was  assigned  to  duty  in  the  Philippines. 

Painstakingly  faithful  to  minutiae.  Miss  Thompson  pos- 
sessed that  type  of  mind  often  described  as  the  first  pre- 
requisite to  genius.  Hers  was  an  infinite  capacity  for  detail, 
which  made  her  invaluable  in  the  performance  of  her  sharply 
defined  duties  in  the  Surgeon  General's  ofiice.  Iron-clad  regu- 
lations handed  down  by  the  high  ofiicials  of  the  War  and 
State  Departments  controlled  to  the  last  detail  the  complicated 
process  by  which  an  American  Red  Cross  nurse  was  assigned 
to  active  Army  service.  Miss  Thompson  piloted  the  Army 
Nurse  Corps  through  these  narrow  channels  with  a  faithfulness 
characteristic  of  the  "Army  mind."  Beneath  a  certain  cold 
reserve  of  manner  born  of  her  exacting  tasks,  she  possessed  gen- 
tleness and  sweet  restraint.  She  was  absolutely  free  from  what 
may  be  termed  the  politician's  instinct. 

The  meteor-like  ascendency  of  Julia  Catherine  Stimson  of- 
fered sharp  contrast  to  the  unobtrusive  rise  of  her  predecessor. 
In  the  blinding  light  of  war,  her  dominant  personality  stood 
out  in  the  same  bold  outlines  as  did  her  Amazonian  physique. 
Her  regular,  boyish  features  habitually  wore  a  thoughtful  ex- 
pression, which  brought  to  the  observer  an  impression  of  dig- 
nity and  power.  Her  well-trained  mental  processes,  clean-cut 
often  to  the  point  of  brusque  speech,  were  as  direct  in  their 
focus  as  were  her  keen  blue  eyes. 

The  daughter  of  a  New  York  clergyman.  Miss  Stimson  was 
gTaduated  from  Vassar  College  and  from  the  School  of  Nurs- 
ing of  the  New  York  Hospital,  New  York  City.  For  three 
years  she  was  superintendent  of  nurses  at  the  Harlem  Hos- 
pital. She  went  to  St.  Louis  in  October,  1911,  to  do  social 
sen^ice  work  in  Wasliina-ton  University  and  in  the  St.  Louis 
Children's  Hospitals,  and  later  became  superintendent  of 
nurses  of  the  Washington  University  Training  School  for 
Nurses.  She  volunteered  in  1009  for  patriotic  service  under 
the  Red  Cross,  when  enrollment  of  nurses  was  being  under- 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  313 

taken  through  Red  Cross  Chapters.  Her  first  opportunity  for 
active  duty  under  the  ]{ed  Cross  flag  came  in  1913  during  the 
Ohio  flood. 

When  the  Red  Cross  Department  of  Military  Relief  author- 
ized the  organization  of  Base  Hospital  No.  21,  within  the 
Washington  University  ^ledical  School,  Julia  Stimson  was  ap- 
pointed chief  nurse.  She  served  with  distinction  during  its 
subsequent  assignment  to  the  British  Expeditionary  Forces. 
Her  successful  work  in  the  Washington  University  School  of 
Nursing,  as  well  as  the  fact  that  she  was  an  alumna  of  Vassar, 
caused  her  name  to  be  brought  forward  during  the  spring  of 
1918  as  a  natural  selection  for  the  head  of  the  preparatory 
course  of  the  Vassar  training  school  project.  The  Chief 
Surgeon,  American  Expeditionary  Forces,  however,  assigned 
Miss  Stimson  in  April,  1918,  tq  the  office  of  the  American 
Red  Cross  in  Paris  at  the  request  of  the  Red  Cross  commis- 
sioner to  serve  as  Chief  Nurse  of  the  American  Red  Cross  in 
France.  On  November  15  of  the  same  year.  General  Ireland, 
who  throughout  his  service  as  Chief  Surgeon  of  the  American 
Forces  in  France  and  later  as  Surgeon  General,  United  States 
Army,  had  been  a  stanch  friend  of  the  Red  Cross  Nursing 
Service,  appointed  ]\Iiss  Stimson  Director  of  the  Nursing  Ser- 
vice of  the  American  Expeditionary  Forces.  In  July,  1919, 
Miss  Stimson  returned  to  the  United  States  to  succeed  ^liss 
Goodrich  as  Dean  of  the  Army  School  of  Nursing.  Secre- 
tary of  War  Baker  appointed  her  Superintendent  of  the  Army 
Nurse  Corps  five  months  later. 

The  special  relationship  between  the  Army  Nurse  Corps  and 
the  American  Red  Cross  Nursing  Service  was  defined  in  a 
paragra])h  drafted  by  ^liss  Delano  when  she  was  su])erint('n(l- 
ent  of  the  Army  Nurse  Corps  and  was  printed  in  the  (1910) 
^lanual  of  the  .\ledical  Department,  United  States  Army.  The 
paragraDh  follows: 

102.  The  enrolled  nurses  of  the  American  National  IJed 
Cross  Nursing  Service  will  constitute  the  reserve  of  the  Army 
Nurse  Corps,  and  in  time  of  war  or  other  emergency  may 
with  tlu'ir  own  consent  be  assigned  to  active  duty  in  the 
Military  Mstatdisluncnt.  When  the  emergency  necessitating 
the  cnij)loyment  of  reserve  nurses  is  iinniin(>nt.  th(>  Surgeon 
General  will  rt-quest  the  propt'r  oflicer  of  the  Red  Cross 
Society  to  nominate  from  anu)ng  the  enrolled  nurses  (jualilied 
for  the  work  to  he   done  as  many  as  the   Siin:eon   (leneral 


314   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

may  deem  necessary  to  enable  him  to  choose  those  for  as- 
signment to  active  duty. 

(a)  When  called  into  active  service  they  will  be  subject 
to  all  the  established  rules  and  regulations  for  the  govern- 
ment of  the  Xurse  Corps,  and  will  receive  the  pay  and 
allowance  of  nurses  on  the  regular  list. 

(b)  A  reserve  nurse  will  not  be  relieved  from  active  serv- 
ice except  by  order  of  the  Surgeon  General.  Except  in  case 
of  misconduct  she  will,  if  she  so  desires,  be  furnished  travel 
orders  to  her  home  before  the  order  of  relief  shall  take 
effect.  .  .  . 

(c)  When  a  reserve  nurse  is  assigned  to  active  service  the 
Surgeon  General  will  by  letter  promptly  advise  the  proper 
officer  of  the  Eed  Cross  Society  to  that  effect.  When  she  is 
relieved  from  active  service  he  will  communicate  that  fact 
likewise  by  letter,  stating  the  cause  of  her  relief  and  whether 
her  services  have  been  satisfactory,^ 

On  December  18,  1916,-  Secretary  Baker  issued  Eegiilations 
Governing  the  Employment  of  the  American  Red  Cross  in 
Time  of  War,  which  contained  the  following  paragraph: 
''10.  The  Red  Cross  units  organized  for  service  with  the  Army 
or  for  the  purpose  of  training  personnel  therefor  are :  1,  am- 
bulance companies;  2,  base  hospitals;  3,  hospital  units;  4,  sur- 
gical sections;  5,  emergency  nurse  detachments;  6,  sanitary 
training  detachments ;  7,  information  service ;  8,  refreshment 
units  and  detachments ;  9,  supply  depots :  10,  general  hospi- 
tals;  11,  convalescent  homes." 

EiScient  and  friendly  cooperation  of  the  closest  type  existed 
during  the  European  War  between  the  Army  Xurse  Corps  and 
the  American  Red  Cross  Xursing  Service.  By  letter,  by  tele- 
phone, by  special  messenger.  Miss  Thompson  and  Miss  Delano 
and  Miss  Xoyes  kept  in  touch  with  each  other.  Calls  went 
from  the  Surgeon  General's  office,  first  located  in  the  ^Mills 
Building  and  later  moved  to  temporary  offices  flanking  the 
Botanical  Gardens  at  Eighth  and  B  Streets,  to  Xational  Red 

^Manual  for  the  ^Icdical  Dcpartmpnt.  U.  S.  A.,  1916,  p.  47. 

*  These  Regulations  of  December  IS,  lOlG,  were  later  rephiced  by  Speeial 
Refrulations,  Xo.  CI.  War  Dei)artnient,  October  8,  1917,  wliich  Regulations 
'"include  and  are  identical  with  the  Regulations  Governing  the  P^inploy- 
inent  of  tlie  American  Red  Cross  in  Time  of  War  (Uecemlier  18.  1916) 
and  General  Orders  Xo.  82,  War  Department,  1917."  Special  Regulations 
Xo.  61  formed  the  oflicial  guide-book  of  tlic  American  Red  Cross  during 
tlie  remainder  of  the  participation  bv  the  United  States  in  the  European 
War. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  315 

Cross  Headquarters;  IMiss  Xoyes  in  turn  sped  these  demands 
to  Division  oltices  and  Local  Committees;  while  the  Red  Cross 
publicity  organization  spread  the  appeals  broadcast  over  the 
leng-th  and  breadth  of  the  land,  until  on  November  11,  1918, 
the  United  States  Army  Nurse  Corps  totaled  the  largest  body 
of  professional  women  ever  mobilized  for  patriotic  service. 

Far  removed,  however,  from  its  final  war  strength  of  21,- 
480  members  was  the  Army  Nurse  Corps  on  April  G,  1917. 
Only  235  regular  and  165  reserve  members  constituted  the 
Government's  nursing  forces  when  the  United  States  declared 
war. 

jMilitary  science  decreed  that  the  sanitary  personnel  within 
the  armies  of  civilized  countries  should  constitute  ten  per  cent 
of  the  strength  of  the  forces.  Secretary  Baker  confirmed  this 
opinion  by  his  orders  of  June,  1917.  The  General  Staff,  Ameri- 
can Expeditionary  Forces,  finally  agreed  that  the  total  sani- 
tary personnel,  ofiicers,  nurses  and  enlisted  men,  should  be 
seven  and  sixty-five  hundredths  per  cent  (7.05%).  The  Chief 
Surgeon  in  a  letter  submitted  August  11,  1917,  to  the  Chief 
of  Start"  stated  that  for  an  army  of  one  million  men,  22,430 
nurses  would  be  required.  He  added  that  ''it  is  believed  that 
if  this  calculation  is  erroneous,  the  error  will  be  on  the  side 
of  conservatism."  ^ 

The  Army  estimated  that  the  ratio  of  one  nurse  to  every 
ten  hospital  beds  was  a  safe  one.  In  a  memorandum  prepared 
in  February,  1918,  by  the  Surgeon  General's  office  for  Secre- 
tary Baker,  the  following  statement  w^as  made : 

The  ten-bed-to-one-niirso  ratio  is  admittedly  a  restricted 
allowance,  offering  scant  margin  of  safety  to  take  up  a  serious 
epidemic.  As  shown  on  the  tabular  sheet,  the  present  actual 
ratio  in  the  I'nited  States  is  one  nurse  to  15.8  beds.  To 
meet  an  epidemic  emergency,  additional  nurses  must  be  re- 
quested after  the  need  has  appeared,  making  at  least  tem- 
porary inadequacy  inevitable.* 

The  assi£i:nment  to  active  dutv  of  fiftv  base  hospitals  orcran- 
ized  by  the  Jied  (^ross  in  1916  and  1917  for  the  Army  formed 
the  skeleton  of  the  hospitalization  of  the  United  States  Medi- 
cal Department  in  France.     When  these  massive  colunnis  were 

^"History  of  Xursino:  Activities,  A.E.F.,  on  tlio  \Vo8torn  Front  during  tiiu 
^^'ar  I'l'iiod,"  J.  ('.  Stini-^oii.  p.  7.  Suri^'coii  (Jcncrars  otlice.  W  iisli..   I).  C. 

*  See  letter  written  hy  Jane  A.  Dehuio  on  February  1"),  1018,  to 
General  William  C.  Uori'as;   Ked  Cross  Archives,  Wash.,  D.  C, 


316   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ordered  overseas  during  the  summer  of  1917  and  to  the  can- 
tonments of  the  National  Army,  Surgeon  General  Gorgas  au- 
thorized the  organization  of  fifty  additional  ones,  beginning 
with  Number  Fifty-four.  These  base  hospital  units  were  to 
be  organized  on  a  basis  of  five  hundred  beds,  with  a  nursing 
personnel  of  sixty-five  members.  The  Surgeon  General's  office 
stated  that  they  did  not  believe  that  these  units  would  be  or- 
dered into  the  field,  however,  until  after  the  original  fifty  base 
hospital  units  which  the  Red  Cross  had  organized  and 
equipped  had  been  called  into  active  service.^ 

The  first  branches  of  the  American  Army  to  see  foreign 
service  were  six  base  hospital  units  which  were  assigned  to 
duty  with  the  British  Expeditionary  Forces  several  weeks 
after  the  United  States  declared  war.  Upon  arrival  in  France, 
these  units  were  placed  in  charge  of  six  British  general  hos- 
pitals, of  from  fifteen  hundred  to  twenty-five  hundred  bed 
capacity,  which  were  located  in  the  Rouen  and  Le  Treport 
areas.  The  original  nursing  staff  of  sixty-five  members  was 
found  to  be  inadequate,  so  the  Surgeon  General's  office  called 
for  additional  nurses  in  sufficient  numbers  to  raise  the  staffs 
to  one  hundred  nurses  each.  Nurses  from  Red  Cross  hospi- 
tal units  were  used  for  this  purpose  and  "casuals"  were  also 
sent  over.  The  organization  of  all  future  base  hospital  units 
was  undertaken  on  a  basis  of  one  hundred  nurses  rather  than 
sixty-five. 

On  February  21,  1918,  Miss  Thompson  wrote  Miss  Delano 
of  the  first  change  in  method  of  assignment  of  reserve  nurses 
to  active  service  from  the  former  system  of  unit  organization. 
The  Surgeon  General's  office  suggested  that,  in  the  future, 
the  nurses  who  were  enrolled  by  the  Red  Cross  should  not  be 
assigned  to  specific  base  hospital  units,  as  had  been  done  with 
the  first  fifty,  but  that  they  should  be  held  as  a  general  nursing 
reserve,  to  be  called  upon  as  available  and  as  needed.  "The 
advantage  of  this  procedure,"  wrote  Colonel  Winford  Smith, 
then  in  charge  of  the  Base  Hospital  Division  of  the  Surgeon 
General's  office,  "would  be  that  it  would  not  be  necessary  to 
keep  track  of  specific  groups  which  might  have  to  be  with- 
drawn from  sei"\nce  at  some  place  to  go  with  the  base  hos- 
pital to  which  they  had  been  assigned,  nor  would  it  be  neces- 
sary   to    hold    nurses    on    the    inactive    list    because    of    their 

^  Soe  letter  written  by  Dora  E.  Thompson  to  Clara  D.  Noves,  October 
8,   1017. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  317 

assignment  to  base  hospitals  not  yet  in  service.  If  the  nurses 
are  enroHed  in  a  general  reserve,  they  can  be  called  as  needed 
and  assigned  where  they  are  needed  most."  "  Under  this  plan, 
the  Surgeon  General's  office  hoped  to  develop  a  reserve  supply 
in  the  cantonment  hospitals,  from  which  nurses  would  be  drawn 
when  a  base  hospital  was  to  be  organized  for  service  in  Great 
Britain  or  France. 

The  method  by  which  the  Surgeon  General's  office  advised 
the  ^N^ursing  S(>rvice  of  the  needs  of  the  Army  is  well  illus- 
trated in  two  rcHjuests  for  imrses  which  were  received  in  the 
late  winter  and  early  spring  of  1!)18.  On  February  28,  1918, 
Colonel  Smith  wrote  !Miss  Delano  that  the  Surgeon  General 
would  require  approximately  five  thousand  nurses  between 
!March  and  June,  in  addition  to  those  already  assigned  to  base 
hospital  units.  jMiss  Thompson  partially  echoed  this  request 
in  a  letter  written  to  Miss  Noyes  on  March  4,  in  which  she 
asked  that  the  Red  Cross  ''nominate  as  soon  as  possible  450 
mirses  needed  for  innnodiate  assignment,  in  addition  to  the  one 
hundred  nurses"  a  month  which  the  Red  Cross  was  mobilizing 
during  January,  February  and  March  for  immediate  assign- 
ment to  the  American  Expeditionary  Forces. 

During  the  middle  of  December,  1917,  ]\Iiss  Xoyes  had  ex- 
perienced difficulty  in  convincing  nurses  that  the  time  had 
arrived  for  them  to  relinquish  their  civilian  affiliations  and  to 
undertake  active  military  service.  The  Red  Cross  enrollment, 
then  of  eight  thousand  nurses  pledged  to  active  service  upon 
call,  was  at  this  time  wholly  unclassified.  Two  methods  of 
utilizing  this  nursing  reserve  confronted  Miss  jSToyes;  on  the 
one  hand  she  migh^  weed  out  from  the  general  files  of  the  Xurs- 
ing  S(>rvice  by  detailed  and  tedious  correspondence  the  names 
of  all  women  who  met  the  citizenship  and  physical  require- 
ments of  the  Surgeon  General's  office  and  who  were,  more- 
over, w'illing  to  respond  to  an  immediate  call ;  on  the  other 
hand  she  might  present  the  military  nec^l  to  the  nursing  pro- 
fessicm  by  speaking  personally  to  large  groups  of  nurses  in  all 
parts  of  the  country.  She  finally  decided  to  take  a  speaking 
trip  during  DccfMnbcM-,  1917,  and  January,  1918,  through  the 
principal  cities  of  tlie  Unit(Hl  States  to  address  mass  meetings 
of  nurses.  Slie  returned  to  Headquarters  during  the  middle 
of  February,   1918. 

"Sep  IcttiT  written  ])v  Dora  E.  Thompson  to  Jane  A.  Delano,  February 
21,    1018, 


318   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Hardly  had  she  begun  when  she  found  out  the  reasons  why 
nurses  were  slow  to  volunteer  for  the  additional  base  hospitals 
and  the  groups  of  "casuals"  for  which  the  War  Department 
was  then  pressing  the  Red  Cross.  To  her  appeals  for  nurses 
for  cantonment  hospitals  in  this  country,  members  of  her 
audiences  responded  with  the  statement  that  three  thousand 
nurses  were  known  to  be  listed  upon  the  muster-rolls  of  the 
fifty  base  hospitals  then  awaiting  assignment  to  active  duty, 
and  that  several  hundreds  of  these  very  women  had  been  mark- 
ing time  for  weeks  at  the  port  of  embarkation,  Ellis  Island. 
Their  transportation  was  delayed  on  account  of  orders  to  hold 
all  non-combatants  and  to  rush  the  combatants  overseas,  but 
this  information,  of  course,  was  not  given  out  to  the  public 
for  obvious  reasons ;  nor  was  it  known  in  the  Surgeon  General's 
office  when  the  nurses  would  be  sent  overseas.  Notification 
as  to  accommodations  on  the  transports  was  often  sent  but  a 
few  hours  before  sailing.  As  long  as  the  services  of  these 
women  remained  unutilized,  argued  Miss  Noyes'  listeners,  the 
demands  of  the  cantonments  could  not  be  so  urgent.  Direct 
foreign  assignment,  moreover,  appeared  far  more  picturesque, 
more  desirable.  On  the  other  hand,  the  Surgeon  General's 
office  held  to  the  policy  that  the  nursing  staffs  of  base  hospitals 
should  not  be  scattered  among  the  cantonments  at  this  time, 
as  the  sailing  of  their  units  was  imminent  and  it  was  thought 
that  their  assigmnent  and  almost  immediate  withdrawal  would 
add  to  the  already  heavy  burden  at  the  camps.  Miss  Thomp- 
son and  Colonel  Smith,  naturally,  knew  that  an  initial  experi- 
ence in  military  routine  in  the  cantonment  hospitals  for  nurses 
as  well  as  for  officers  and  enlisted  men  would  heighten  their 
efficiency,  so  in  order  to  correct  the  general  misunderstanding 
that  the  Red  Cross  was  in  no  great  need  for  nurses  for  the 
Army,  the  nurses  of  the  various  units  were  finally  sent  to  the 
cantonments  and  Army  general  hospitals  throughout  the  coun- 
try for  duty  pending  the  sailing  of  their  units.  Miss  Thomp- 
son wrote  Miss  Delano  on  jNlarch  8,  1918:  "In  order  to  meet 
the  need  for  nurses  in  this  country,  the  entire  group  of  nurses 
attached  to  base  hospitals  not  yet  ordered  out,  will  be  ordered 
into  service  upon  receipt  of  their  names  in  this  office.  It  is 
thought  advisable,  however,  that  no  more  than  ten  (10)  nurses 
from  any  one  base  hospital  be  ordered  to  any  one  cantonment 
hospital,  lest  we  cripj^le  the  hospital  when  the  nurses  must  be 
withdrawn." 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  319 

By  the  late  spring  of  1918,  the  Surgeon  General's  office  had 
estimated  the  ininibcr  of  nurses  which  the  Army  would  require 
of  the  Ked  Cross  reserve.  In  a  letter  written  March  8,  Colonel 
Smith  stated  that  "the  number  of  nurses  estimated  for  our  re- 
quirements up  to  January,  1919,  including  those  now  in  ser- 
vice and  the  5000  asked  for  by  June  1,  is  25,000."  Early  in 
the  summer  of  1918,  this  number  was  greatly  increased.  On 
July  27,  Brigadier  General  Robert  E.  Noble  advised  the  Di- 
rector General  of  ^lilitary  Relief  that  at  least  2500  additional 
nurses  would  be  needed  between  that  date  and  September  15. 
On  August  1,  1918,  Surgeon  General  Gorgas  issued  to  the  Red 
Cross  his  historic  appeal : 

I  call  upon  your  organization,  as  the  chief  nurse  recruit- 
ing agency  of  the  Army,  to  employ  every  possible  means  to 
increase  the  enrollment  of  nurses  for  immediate  assignment 
to  duty. 

With  the  contemplated  increase  in  the  Army  both  at  home 
and  overseas,  there  must  be  a  proportionate  increase  in  the 
number  of  nurses  in  the  service.  The  Army  today  is  grow- 
ing faster  tban  the  Xurse  Corps  is  increasinj?,  and  as  the 
Armies  overseas  enter  the  front  line  trenches  in  jrreater  num- 
bers, the  greater  will  be  the  need  for  nurses  in  the  Army 
Nurse  Corps. 

I,  therefore,  urge  upon  the  American  Eed  Cross,  through 
its  agencies,  to  l)ring  to  the  attention  of  tlie  trained  nurses 
of  the  country,  tlie  necessity  of  immediate  offer  of  service, 
and  tlien  enrollment  in  tlie  Army  Xiirse  Corps. 

I  hesitate  to  deal  in  concrete  numbers,  but  I  desire  to 
emphasize  the  fact  tbat  I  need  today  a  very  material  in- 
crease in  the  Army  Xurse  Corps,  and  desire  this  increase 
in  the  ratio  of  at  least  a  thousand  a  week  for  the  next  two 
months. 

These  requests,  together  with  the  assistance  which  the  Amer- 
ican Red  Cross  was  giving  the  Women's  Committee  of  the 
Council  of  National  Defense  in  recruiting  student  nurses  for 
the  Army  School  of  Nursing  and  for  civilian  hospital  schools,'^ 

'  Soo  letter  written  July  S.  IHIS.  by  the  aetinir  general  nianairer 
Xatioiial  Rod  Cross  nea(I<iuarters.  to  tlie  Division  tnana^^ers  repardinjz  a 
jilan  to  assist  tlie  Women's  Coniiniltee  of  the  C'onneil  of  National  Defense 
to  reci-uit  student  nurses  feu*  the  Army  Srhool  of  Nursinfr  iind  '^ivilian 
hospital  schools  of  nursing''.  See  also  letter  written  by  Jane  A.  Delano  to 
Division  Directors  of  Xursin^r.  attached  to  and  transmitted  by  the  above. 
See  also  sufrjzested  h>tter  to  Cliapters  attached  to  and  transmitted  by  the 
above  letter  of  the  act  in''  ":eneral  manager. 


320   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

brought,  by  July,  1919,  the  total  needs  of  the  Army  to  fifty 
thousand  graduate  and  student  nurses.  Fifty  thousand  grad- 
uate and  student  nurses !  This  was  the  responsibility  which 
fell  to  Miss  Delano,  more  than  to  any  other  woman.  As  chair- 
man of  the  N^ational  Committee,  the  American  Red  Cross  and 
the  American  nursing  profession  had  entrusted  to  her  vision 
the  development  of  Red  Cross  nursing  service.  If  now  at  the 
supreme  moment,  this  organization  which  her  brain  and  hand 
had  created  and  nurtured,  failed  to  meet  the  obligations  which 
war  laid  upon  it,  to  her  more  than  to  any  other  woman  would 
belong  the  overwhelming  catastrophe  and  despair  of  its  failure ; 
and  in  crowded  wards  of  base  hospitals  and  evacuation  sta- 
tions, American  men  would  have  to  endure  the  agony  of  modern 
battle  casualties,  unalleviated  by  adequate  nursing  care. 

A  definite  problem  of  supply  and  demand  confronted  the 
Red  Cross.  On  one  side  of  the  equation  were  the  nursing  re- 
sources of  the  country,  distributed  in  the  fields  of  private  duty 
nursing,  in  institutional  work,  in  public  health  nursing  and  in 
the  advanced  classes  of  schools  of  nursing.  On  the  other  side 
were  the  needs  of  the  Military  Establishment.  The  responsi- 
bility of  the  Red  Cross  was  to  select  from  these  fields  nurses 
sufiicient  in  number  to  meet  war  needs,  yet  to  withdraw  them 
in  such  a  way  that  the  health  of  the  civilian  population  would 
not  be  jeopardized. 

According  to  the  Regulations  Governing  the  Employment  of 
the  American  Red  Cross  in  Time  of  War,  which  Secretary 
Baker  issued  on  December  18,  19 IG,  the  four  types  of  unit 
through  which  the  Army  secured  nurses  from  the  Red  Cross 
were  base  hospitals,  hospital  units,  surgical  sections  and  emer- 
gency nurse  detachments. 

After  steps  had  been  initiated  to  meet  the  general  demands, 
groups  of  nurses  expert  in  the  care  of  special  diseases  were  or- 
ganized by  the  Xursing  Sem-ice  for  duty  in  four  special  hos- 
pitals of  the  ]\ledk'al  Corps,  the  Orthopedic;  the  Fracture;  the 
Eye,  Ear  and  Throat ;  and  the  Psychiatric  Hospitals.  Public 
health  nurses  also  were  called  for  by  the  U.  S.  Public  Health 
Service  for  duty  in  extra-cantonment  zones. 

Paper  charts  and  pamphlets  outlining  the  requirements,  pur- 
pose and  probable  future  service  of  each  type  of  unit  were  sent 
out  to  Local  Committees  on  Red  Cross  jSTursing  Service  and 
to  civilian  hospitals  from  National  Headquarters,  and  later 
to   the  same   Local   Committees  from   Division   offices.      With 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  321 

unremitting  energy,  the  field  workers  set  out  to  fill  the  units. 
Individual  luirses  were  approached  with  the  suggestion  that 
they  undertake  military  service  in  some  one  of  these  units.  If 
they  met  the  requirements  of  the  Army,  they  were  enrolled 
in  the  Red  Cross  Nursing  Service  and  their  names  checked  off 
against  given  positions  in  the  organization  charts  of  the  units. 
When  one  of  these  structures  was  entirely  complete,  its  muster- 
in-roll  or  personnel-list  was  sent  to  the  War  Department.  The 
Surgeon  General  then  orderc^l  the  nurses  into  active  service; 
travel  orders  were  issued  to  each  nurse.  The  procedure  by 
which  the  majority  of  nurses  serving  in  the  European  War 
were  mustered  into  military  duty  is  well  illustrated  by  the  de- 
tailed steps  taken  in  the  case  of  a  member  of  an  emergency 
detachment. 

"JMary  Brown,"  a  nurse  engaged  in  private  duty  nursing  at 
Cascade,  Iowa,  desired  military  service.  She  had  previously 
learned  that  the  Red  Cross  Nursing  Service  was  the  reserve  of 
the  Army  Nurse  Corps,  so  she  wrote  to  the  nearest  Local  Com- 
mittee on  Red  Cross  Nursing  Service.  The  chairman  of  this 
Local  Committee  opened  correspondence  with  Mary  Brown, 
or  in  a  personal  interview,  required  by  the  National  Commit- 
tee if  possible,  gave  her  the  necessary  application  papers,  told 
her  that  an  emergency  detachment  was  then  under  process  of 
organization  in  her  locality  and  advised  her  to  join  it.  Mary 
Brown  expressed  her  willingness,  filled  out  her  application 
papers  and  in  due  time  underwent  a  complete  physical  exam- 
ination and  immunization  for  typhoid  and  paratyphoid.  (This 
inoculation  was  later  given  at  cantonment  hospitals.)  The 
chairman  of  the  Local  Committee  in  the  city  near  Cascade 
entered  Mary  Brown's  name  on  the  lists  of  one  of  the  emer- 
gency detachments  for  which  the  committee  was  responsible, 
secured  her  training  school  credentials,  her  certificates  of  exam- 
ination and  inoculation,  her  latest  address  and  her  date  of 
availability  and  sent  them  all  to  tlu^  director  of  the  Depart- 
ment of  Nursing,  (Ventral  Division,  who  passed  upon  them 
and  forwarded  them  to  National  Ileadqiiartc^vs.  Miss  Noyes 
then  wired  ^farv  JJrown  and  in  a  telegraphed  answer  received 
confirmation  of  tlH>  statement  in  her  enrolhnent  pajDers  that 
she  would  ho  availal>l(>  for  assignment  on  June  5  at  Cascade, 
Iowa,  ^liss  Noyes  then  s(>nt  this  Inst  yellow  telegi'am,  together 
with  the  other  papers,  to  ^liss  Thompson.  The  Surgeon  Gen- 
eral's oi'der  followed  within  a  few  davs: 


322  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Mary  Brown,  Reserve  ISTurse,  Army  Nurse  Corps,  now  at 
Cascade,  Iowa,  will  proceed  without  delay  not  later  than 
June  6,  after  having  taken  the  oath  of  office,  to  Camp  Dodge, 
Des  Moines,  Iowa,  and  will  report  to  the  Commanding 
Officer,  United  States  Army  Base  Hospital,  for  assignment 
to  duty. 

Travel  is  necessary  in  the  Military  Establishment.^ 

This  task  of  locating  and  stabilizing  nurses  which  devolved 
upon  Miss  Noyes  and  her  associates  was  fraught  with  tedious 
and  troublesome  detail.  In  addition  to  professional  creden- 
tials, immunization  and  physical  examination  certifications, 
it  was  necessary  that  the  enrollment  papers  of  every  nurse  show 
the  address  at  which  she  might  be  reached  within  a  certain 
period  of  time.  To  this  location,  within  a  prescribed  number 
of  days,  the  Surgeon  General  sent  instructions,  as  has  been 
shown  before,  bidding  the  nurse  take  oath  of  office  and  proceed 
to  her  post  of  duty.  If  the  nurse  was  not  at  this  given  place 
at  the  time  specified  in  her  papers,  the  order  for  her  oath  of 
office  and  her  transportation  had  to  be  revoked  and  a  corrected 
one  issued.  ISTurses  often  could  not  understand  why  travel 
orders  could  not  be  forwarded  to  another  town  like  personal 
mail.  The  War  Department,  overburdened  with  clerical  de- 
tail, for  its  part  failed  to  see  in  the  call  for  an  issuance  of  new 
orders  anything  but  carelessness  and  inefficiency  on  the  part 

*  In  addition  to  the  requirements  for  enrollment  in  the  Red  Cross 
Nursing  Service,  the  Surgeon  General  set  up  the  following  regulations: 
"Citizens  of  the  United  States,  native  or  naturalized,  are  alike  liable  to 
service  and  no  discrimination  should  be  made  as  far  as  the  manner  in 
which  the  citizenship  was  acquired  is  concerned,  if  the  loyalty  and  fidelity 
of  the  individual  is  unquestioned. 

In  case  of  medical  imits  or  individuals  intended  for  service  directly 
with  or  under  tlie  forces  of  our  allies,  care  sliould  be  taken  not  to  assign 
to  such  units  or  detail  for  such  service  persons  wlio  are  naturalized  citi- 
zens of  alien  enemy  origin." 

Married  nurses  were  not  eligible  for  service  with  the  Army  Nurse  Corps. 

The  length  of  service  was  covered  in  the  following  regulation:  "Re- 
serve nurses  assigned  to  active  service  during  war  will  be  expected  to 
serve  as  long  as  they  may  l)e  needed.  A  nurse  who  desires  relief  from 
active  service  may  apply  therefor  by  letter  to  the  Surgeon  General, 
through  tlie  proper  channels,  stating  her  reasons  in  full.  If  the  reasons 
are  sufficient  in  the  judgment  of  tlie  Surgeon  General  her  request  may  be 
granted.  Return  transportation  will  not  be  authorized  to  nurses  who  have 
served  less  than  on'e  year,  unless  the  need  for  their  services  ceases  to  exist, 
or  to  those  who  are  discharged  for  misconduct.  A  nurse  who  is  found 
to  be  unsuited  for  the  service  physically,  professionally  or  temperamentally, 
will  be  furnished  transportation  to  lier  home  for  relief  from  active  service, 
without  regard  to   length   of  service." 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  323 

of  the  Ked  Cross  in  giving  an  inaccurate  address  in  the  first 
pLace.  Hence  arose  the  necessity  for  establishing  the  rule  that 
a  confirmation  telegram  be  received  from  the  nurse  before  her 
papers  were  sent  to  the  War  Department.  An  idea  of  the 
correspondence  which  was  carried  on  between  National  Head- 
quarters, Division  offices,  State  and  Local  Committees  and  in- 
dividuals before  a  nurse  could  be  assigned  to  active  service, 
may  be  gained  from  the  following  letter  written  October  12, 
1017,  by  Miss  Noyes  to  all  nurses  organizing  units  for  the 
Army: 

Organizing  nurses  will  please  bear  in  mind  the  following 
points  to  make  the  Service  more  efficient: 

First :  Do  not  report  to  lied  Cross  Headquarters  a  nurse 
as  "ready  for  duty"  before  communicating  with  her  in  order 
to  determine  this  fact.  Information  upon  this  point  two 
or  three  weeks  old  is  many  times  found  to  be  inaccurate. 

Second :  Please  determine  from  each  nurse  her  latest  ac- 
curate address. 

Third:  Communicate  with  each  individual  nurse  imme- 
diately before  sending  her  name  to  this  office  in  order  to 
make  definitely  certain  her  date  of  availability  and  her 
accurate  address. 

Fourth :  Impress  upon  the  nurse  that  except  in  case  of 
grave  illness  it  is  impossible  to  release  her  from  her  promise 
to  answer  a  call  wlien  once  her  name  has  been  sent  to  the 
War  Department. 

Fifth :  When  a  nurse  is  reported  to  the  Surgeon  General's 
office  as  "ready."'  assignment  to  duty,  oath  of  offiice  and 
transportation  will  be  forwarded  by  that  Department.  If, 
by  any  chance,  this  is  forwarded  to  an  incorrect  address,  it 
is  not  only  a  very  serious  inconvenience  to  the  War  Depart- 
ment to  revoke  tliesc  orders,  but  a  reflection  on  the  efficiency 
of  the  Ped  Cross  Xursing  Service. 

Sixth:  In  all  cases  when  the  nurses  live  in  an  adjacent 
town,  it  is  advisable  to  have  them  assemble  at  their  own 
expense  at  the  larger  point  where  the  detachment  has  been 
organized.  In  tliis  way,  tliey  can  proceed  together  to  their 
point  of  destination.  If  this  is  not  possible,  individual  trans- 
})()rtation  orders  may  be  issued  to  each  nurse  from  her  own 
home. 

E(iuipment  occupied  the  last  phase  of  the  manifold  duties 
devolving  upon  ^liss  Xoyes  and  her  associates.  After  ^Tary 
I'jrown  had  served  her  apprenticeship  at  Camp  l)()di:o,  the  long- 


324   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

coveted  orders  for  foreign  assignment  were  forwarded  her 
through  her  chief  mirse  and  off  she  went  to  Ellis  Island  with 
instructions  to  report  as  soon  as  possible  to  the  director  of 
JSTnrsing  Service,  Atlantic  Division,  American  Red  Cross,  re- 
garding equipment.  In  New  York  City,  the  Bureau  of  Nurses' 
Equipment  supplied  uniforms,  blankets,  sou'westers,  boots  and 
other  comforts  to  soften  the  harsh  living  conditions  of  these 
nurses  of  the  American  Expeditionary  Forces. 

The  middle  span  of  cantonment  service  was  omitted  for  the 
members  of  the  iirst  base  hospital  units.  Their  orders  read  for 
them  to  proceed  direct  to  the  port  of  embarkation  and  Europe. 
As  was  often  the  case  with  the  soldiers,  many  nurses  waiting 
patiently  in  cantonment  wards  never  received  foreign  assign- 
ment. 

These  units  through  which  nurses  were  mobilized  by  the 
American  Red  Cross  were  not  only  complex  in  detail,  but  dis- 
similar in  purpose.  Consequently,  each  form  of  organization 
would  be  treated  separately. 

In  modern  warfare,  with  its  enormous  armies  in  the  field, 
its  fleets  of  capital  ships  at  sea  and  its  instruments  highly  per- 
fected in  the  science  of  killing,  it  is  imperative  that  the  Army 
and  Navy  be  supplemented  by  organized  volunteer  aid.  Sir 
Frederick  Treves  summarized  this  need : 

In  time  of  peace,  no  army  medical  service  can  be  main- 
tained on  a  war  footing.  There  is  involved  at  such  times 
an  elaborate  scheme  for  expansion  in  war;  but  one  promi- 
nent and  inevitable  feature  of  that  scheme  is  the  enrohment 
of  a  vast  body  of  doctors,  nurses,  orderlies,  motor  drivers, 
clerks,  cooks,  dispensers  and  the  like.  In  such  a  work,  a 
civilian  society  can  act  with  greater  ease  and  promptness 
than  can  a  huge  organization  like  the  AVar  Office,  and  thus 
it  is  that  in  the  supply  of  personnel,  the  Red  Cross  societies 
have  undoubtedly   rendered   sterling  service. ° 

Tn  the  Red  Cross  Annual  Report  for  1916, ^"^  Colonel  Ivean 
outlined  the  zones  into  which  the  military  service  for  the  rescue 
of  the  wounded  of  armies  in  the  field  were  divided : 

'The  Medical  Record.  Vol.  90,  page  4GC. 

"*  nie  Annual  Iicport  of  tlio  Anu'rican  National  Rod  Cross  is  published 
yearly  in  two  fornis,  tlic  first  a  full  report  pnblislied  by  the  chairman 
of  the  Central  Conuiiittee,  tlie  secfjnd  a  somewhat  ablireviat(>d  report 
published  as  a  Document  of  Record  of  the  House  of  Representatives.  The 
quotations  and  jtage  references  which  are  used  in  this  history  are  taken 
from  the  full  Annual  Report  published  by  the  American  Red  Cross, 
the  so-called   "unofhcial   report,"  ratlier  tlian  the  Congressional   Document. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  325 

The  medical  service  of  the  zone  of  the  front  is  one  of  first 
aid,  temporary  shelter  and  transportation  of  tiie  wounded 
to  the  rear.  It  is  manned  by  trained  sanitary  soldiers  of 
the  Army  and  requires  for  its  service  nearly  the  entire  per- 
sonnel of  the  peace  establishment.  The  Ked  Cross  units  and 
personnel  are  not  admitted  to  this  zone. 

The  medical  service  of  the  second  zone,  tlie  militiiry  l)ase, 
consists  of  sick  transport  trains  and  base  hospitals  and  is 
largely  manned  by  a  personnel  from  civil  life,  recruited 
either  by  the  Red  Cross  or  the  Medical  Department  of  the 
Army.  Its  base  hospitals  are  the  first  true  hospitals  en- 
countered by  the  wounded  man  in  his  Journey  to  the  rear. 
Here  for  the  first  time  he  finds  a  good  bed  with  a  mattress, 
instead  of  a  cot;  trained  nurses  instead  of  sanitary  soldiers; 
and  the  highly  trained  and  specialized  practitioners  from 
civil  life.  Here  he  finds  quiet  and  rest  and  the  conditions 
suitable  for  recovery. 

The  third  zone,  that  of  the  home  country,  receives  the 
overflow  and  the  convalescents  from  the  base  hospitals  near 
the  theater  of  war.  In  it  the  civil  hospitals  of  the  country 
are  called  into  use  in  addition  to  such  general  hospitals  as 
the  medical  department  may  establish.  Its  medical  staff  are, 
with  the  exception  of  a  few  trained  administrative  officers, 
physicians  and  nurses  drawn  from  civil  life. 

Of  this  structure,  the  base  hospital  is  the  central  span 
and  the  most  imjiortant  contribution  which  the  Ked  Cross 
can  make  for  the  safety  and  comfort  of  the  wounded.  It 
is  immediately  and  urgently  needed  as  soon  as  war  is  de- 
clared, yet  because  of  its  numerous  personnel  and  massive 
and  costly  equipment,  it  has  never  heretofore  been  provided 
in  time  of  peace.  Yet  so  large  and  complex  an  organization 
cannot  be  improvised.  Its  varied  and  specialized  personnel 
when  brought  together,  require  time  and  training  to  fail 
into  orderly  adjustment  and  eillcient  operation.  A  chance 
aggregation  of  doctors  and  nurses  can  no  more  claim  at  first 
to  be  an  efficient  hospital  tiian  a  thousand  men  collected  from 
the  streets  can  be  regarded  as  an  eifective  regiment.  Like- 
wise, its  elaborate  equipment  cannot  be  ])urcha>e(l  in  a  day, 
or  a  week,  nor  yet  in  a  month,  especially  in  time  of  war. 

It  has  already  been  shown  that  by  Presidential  Proclama- 
tion, dated  August  22,  1!)11,  and  Act  of  Congress  of  April 
24,  1912,  the  Ked  Cross  personnel  constituted  in  time  of  war 
a  part  of  the  sanitary  services  of  the  (JovernuKMit.  In  con- 
formity with   this  edict   and  these   statutes,   the   War   Depart- 


326   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ment,  upon  the  recommondation  of  George  A.  Torney,  Surgeon 
General  of  the  United  States  Army,  issued  on  September  10, 
1912,  Circular  No.  8,  which  contained  the  following  regula- 
tions : 

2.  When  the  War  Department  desires  the  use  of  the  serv- 
ices of  the  Ked  Cross  in  time  of  war,  or  when  war  is  im- 
minent, the  Secretary  of  War  will  commimicate  with  the 
president  of  the  society,  specifying  the  character  of  the  serv- 
ices required,  and  designating  the  place  or  places  where  the 
personnel  and  material  will  be  assembled. 

3.  When  any  member  of  the  Ked  Cross  reports  for  duty 
with  the  land  forces  of  the  United  States  pursuant  to  a 
proper  call,  he  will  therefore  be  subject  to  military  laws 
and  regulations  as  provided  in  Article  Ten  of  the  Interna- 
tional Red  Cross  Convention  of  1906,  and  will  be  provided 
with  the  necessary  brassard  and  certificate  of  identity. 

4.  Except  in  cases  of  great  emergency,  Eed  Cross  per- 
sonnel serving  with  the  land  forces  will  not  be  assigned  to 
duty  at  the  front,  but  will  be  employed  in  hospitals  in  the 
home  country,  at  the  base  of  operations,  on  hospital  ships 
and  along  lines  of  communications  of  the  military  forces 
in  the  United  States. 

5.  Red  Cross  organizations  will  not  establish  independent 
hospitals  or  other  institutions,  but  will  assist  military  sani- 
tary formations  at  the  places  above  indicated. 

6.  Before  military  patients  are  assigned  thereto,  separate 
establishments  maintained  by  the  Red  Cross  Society  will  be 
placed  under  the  immediate  direction  of  a  medical  officer 
of  the  Army.  Such  officer  will  be  held  responsible  for  the 
management,  discipline  and  records  of  the  institution;  he 
will  regulate  admissions  and  discharges  and  see  that  the 
interests  of  both  the  Government  and  the  patients  are 
conserved. 

7.  Xo  columns,  sections  or  individuals  of  the  Red  Cross 
Society  will  be  accepted  for  service  by  the  War  Department 
unless  previously  inspected  by  a  medical  officer  of  the  Army 
and  found  qualified  for  the  service  expected  of  them. 

8.  Tlie  Red  Cross  Society  may  be  called  upon  in  time  of 
war,  or  when  war  is  pending,  for  the  following  columns  of 
personnel:  (1)  physicians  and  surgeons;  (2)  dentists;  (3) 
pharmacists;  (1)  nurses;  (."))  clerks;  (0)  cooks;  (7)  litter 
bearers,  dri\ci-s  and  oilier  transport  personnel;   (<S)   laborers. 

9.  To  facilitate  ilio  training  of  Red  Cross  personnel  for 
the  duties  it  may  he  called  upon  to  perform  in  time  of  war, 
it   is  divided  into  throe  classes:  Class    (a)    those  willing  to 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  32T 

serve  when  needed;  (b)  those  willing  to  serve  in  home  coun- 
try only;  (c)  those  willing  to  serve  at  place  of  residence 
only,  etc.,  etc, 

10.  The  l?ed  Cross  service  at  the  base,  along  the  line  of 
communications  or  in  a  military  district,  will  be  under  the 
supervision  of  a  director  general  who  will  conduct  the  serv- 
ice under  the  direction  of  the  chief  surgeon  of  the  field 
army  or  expeditionary  force. 

11.  For  service  at  the  base  and  along  lines  of  communi- 
cations l?ed  Cross  personnel  shall  be  organized  into  (1)  field 
columns;  (2)  hospital  columns;  (3)  supply  columns;  (4) 
information  bureau  sections,  etc.,  etc.  .  .  . 

The  greatest  single  contribution  of  the  American  Red  Cross 
to  the  welfare  of  the  sick  and  wounded  American  soldier  lay 
in  its  organization  and  equipment  of  fifty  base  hospitals  for 
the  United  States  Army.  The  germ  idea  of  a  medical  unit 
organized  from  the  staff  of  a  large  civilian  hospital  for  war 
service  in  the  zone  of  the  base  had  been  conceived  in  1914 
by  Dr.  George  W.  Crile,  of  Lakeside  Hospital,  Cleveland, 
Ohio.  The  project  of  organizing  such  units  for  the  Army  was 
brought  forward  for  discussion  by  Dr.  Crile  as  follows  on  Oc- 
tober 25,  1915,  at  the  symposium  on  military  surgery,  Clini- 
cal Congress  of  Surgeons  of  North  America: 

When  our  distinguished  American  Ambassador,  the 
Honorable  ^lyron  T.  Herrick,  asked  me  to  take  a  service  in 
the  American  Ambulance,  I  suggested  that  it  might  be  bet- 
ter to  form  a  unit  among  the  men  at  Lakeside  Hospital  and 
take  complete  charge  of  a  given  number  of  patients.  This 
proposal  was  cabled  to  the  American  Ambulance  and  a 
favorable  re])ly  returned.  This  was  the  beginning  of  the 
university  unit  plan  of  organization  for  service  at  the 
American  Ambulance. 

This  plan  worked  out  so  excellently  in  France  that  it  has 
occurred  to  mo  tliat.  at  least  for  the  base  hospitals,  it  would 
be  a  workable  ])laii  for  our  American  ^ledical  l^eserve  Corps. 
After  an  informal  discussion  with  the  Surgeon  General  of 
the  Army,  be  suggested  that  to  stimulate  further  discussion, 
I  should  outline  a  plan  for  a  unit  to  take  charge  of  a  five 
hundred  bed  base  hospital.  .  .  . 

These  units  will  \)o  more  efTicieut  if  they  are  made  up  of 
men  who  have  liad  similar  trniniiig  and  who  know  each  other 
well,  and  if  tliey  lia\(^  associated  with  them  a  nursing  staff 
familiar  with   tlieir   methods.      This   suiiu'ests   that    the   tirst 


328  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

units  be  made  up  from  the  staffs  of  large  well-organized 
hospitals,  especially  teaching  hospitals,  and  that  they  be  dis- 
tributed according  to  population  among  the  states  of  the  Union. 
In  making  such  an  organization  of  the  Medical  Reserve 
Corps  we  must  be  guided  by  three  fundamental  principles. 
First:  each  man  should  be  assigned  to  the  service  for  which  he 
is  best  qualified.  Second:  the  mobilization  of  the  Reserve 
Corps  should  be  country-wide.  Third:  standard  materials 
should  be  stored  so  that  we  may  not  be  caught  by  a  shortage  at 
a  time  when  industries  are  paralyzed.   .    .    .  ^^ 

A  few  days  previous  to  this  meeting,  the  Red  Cross  had 
taken  up  with  Dr.  Crile  the  question  of  the  organization  of 
such  units.  Adelaide  llcKee,  chairman  of  the  Cleveland 
Local  Committee  on  Red  Cross  Nursing  Service,  wrote  on 
October  16,  1915,  to  Miss  Delano  that  "circulars  and  applica- 
tions have  been  sent  to  graduate  nurses  in  this  city  by  Miss 
Allison,  the  superintendent  of  nurses  of  the  Lakeside  Hos- 
pital, asking  them  to  join  an  organization  composed  of  a  body 
of  nurses  and  doctors  for  service  at  home  and  abroad.  This 
circular  states  that  Dr.  Crile  has  been  asked  by  the  United 
States  Government  to  organize  a  society,  salary  to  be  the  same 
as  that  of  the  Rod  Cross  Nursing  Service,  and  that  the  Gov- 
ernment has  promised  to  equip  a  hospital  of  five  hundred  beds 
for  Dr.  Crile  in  case  of  emergency." 

Miss  Boardman  telegraphed  Dr.  Crile  on  October  18,  in- 
forming him  that  according  to  Regulations  issued  by  the  War 
Department  and  by  Presidential  Proclamation,  all  volunteer 
aid  must  go  through  the  American  Red  Cross,  and  requesting 
further  information  regarding  his  plans.  "Great  confusion 
now  exists,"  she  concluded. 

Dr.  Crile  in  a  letter  written  October  31  explained  that  in 
view  of  the  uupreparcdness  in  offering  organized  aid  to 
wounded  soldiers  which  had  been  experienced  by  France  and 
England  and  which  many  American  surgeons  had  witnessed 
when  in  foreign  service  in  1014  and  1915,  it  was  felt  that 
"the  preparation  of  our  country  for  offensive  and  defensive 
maneuvers  in  time  of  war  should  include  pre-organized  plans 
for  medical  and  surgical  service.  This  is  a  work,"  he  added, 
"which  belongs  primarily  to  the  Government.  With  this  under- 
standing, at  the  suggestion  of  General  Gorgas,  a  tentative  plan 
is  now  in  progress  of  formation.   .  .  ." 

'^  Surgery,   (hjnecology  (Did  Obstetrics,  January,   1910,  pp.   68-69. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  329 

In  her  reply  addressed  to  T)r.  Crile  October  23,  Miss  Board- 
man  explained  that  so  much  confusion  already  existed  among 
the  nurses  that  unless  it  could  be  cleared  up  Miss  Delano 
might  dissolve  the  Red  Cross  Nursing  Service,  in  which  she 
had  enrolled  between  six  and  seven  thousand  of  the  best  trained ' 
nurses  in  the  country.  There  could  not  be  two  organizations 
undertaking  the  same  enterprise  independently  of  each  other 
without  leading  to  great  confusion. 

The  Regulations  of  the  War  Department,  Miss  Boardman 
argued  in  this  letter  of  October  23,  provided  that  the  Red 
Cross  should  form  exactly  the  same  type  of  unit  as  that  under 
organization  by  Dr.  Crile.  A  National  Medical  Committee 
was  already  appointed  to  take  up  this  work.  Dr.  Crile's  name, 
as  well  as  that  of  Dr.  Harvey  Gushing,  Dr.  Lambert  and  Dr. 
George  Brewer,  was  among  the  list  of  members.  Should  any 
or  every  hospital  in  the  country  that  desired  to  do  so  under- 
take the  organization  of  hospital  units  independently  of  the 
Red  Cross,  which  under  its  charter  was  the  official  volunteer 
agency  of  the  Government  for  the  relief  of  sick  and  wounded 
in  war,  then  the  Red  Cross  would  go  out  of  existence. 

When  in  time  of  war,  continued  Miss  Boardman,  the  War 
Department  asked  of  the  Red  Cross  hospital  formations,  they 
were  to  be  turned  over  to  the  office  of  the  Surgeon  General  just 
as  it  was  now  proposed  to  turn  over  these  surgical  units.  There- 
fore, there  appeared  to  be  no  valid  reason  why  the  organization 
of  these  units  should  not  be  undertaken  through  the  medium 
of  the  Red  Cross,  in  the  place  of  these  proposed  units.  INIiss 
Delano  was  ready  to  issue  regulations  that  would  make  the 
nurses  of  these  units  al)le  to  enroll  as  Red  Cross  nurses,  pro- 
vided that  they  came  up  to  the  recpiiroments  of  the  Army  Nurse 
Corps  and  of  the  Rod  Cross. 

Dr.  Crile  replied  on  October  30  to  Miss  Boardman  that  ''this 
is  a  matter  which  pertains  to  the  ^Medical  Reserve  Corps  of  the 
Army,  of  which  I  am  a  member  .  .  ."  and  that  "I  have  reread 
with  care  Circular  No.  S  of  the  War  Department  and  find 
nothing  therein  to  indicate  any  conilict  between  the  Red  Cross 
Association  and  the  organization  of  hospital  units."  He  went 
on  to  say  that  "the  Red  Cross  may  be  called  upon  in  time  of 
war  for  certain  services  at  the  discretion  of  the  War  Depart- 
ment. The  ^[(^dical  Keserve  (^orps  is  a  part  of  the  Army  and 
therefore  is,  of  course,  subject  to  its  call.'' 

On  November  2,  1915,  Miss  Boardman  wrote  Dr.  Crile; 


330  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  number  of  years  ago,  the  Surgeon  General's  office  started 
an  Army  nursing  reserve.  At  first,  there  were  some  two 
or  three  hundred  enrolled,  but  in  time  the  interest  died 
out  and  finally  it  was  reduced  to  less  than  twenty  nurses  who 
reported  yearly.  In  the  meantime,  the  American  Eed  Cross 
had  initiated  its  enrollment  of  nurses,  under  Miss  Delano's 
remarkably  able  executive  management.  I  will  not  go  into 
details  of  development,  but  after  three  or  four  years,  the 
Army  decided  to  give  up  its  nursing  reserve  and  to  take 
the  American  I?ed  Cross  nurses  as  a  reserve.  The  plan  is 
working  very  satisfactorily.  We  have  between  six  and  seven 
thousand  of  tlie  best  trained  nurses  of  the  profession  en- 
rolled; between  seven  and  eight  hundred  of  the  most  repre- 
sentative nurses  in  the  country  are  serving  as  members  of 
Local  Committees.  We  can  and  have  mobilized  our  nurses 
on  short  notice.  We  have  spent  thousands  of  dollars  on  this 
work  and  it  would  have  cost  several  thousands  more,  if  Miss 
Delano  had  not  given  her  services  without  remuneration.  I 
have  spoken  at  many  nurses'  meetings  to  arouse  their  in- 
terest. Xext  year  (the  work  has  grown  so),  we  will  prob- 
ably give  Miss  Delano  an  assistant.  She  also  has  an  Army 
nurse  detailed  to  her  office  and  two  or  three  stenographers 
to  assist  her  to  maintain  this  efficient  enrollment. 

Suddenly  without  any  word  to  the  Eed  Cross,  various 
doctors  are  communicated  with  and  the  request  is  made  that 
they  form  hospital  units  and  enroll  nurses  in  a  reserve  corps. 
In  several  cases  our  own  nurses  have  been  applied  to,  not 
only  to  enroll  but  to  secure  nurses  for  this  Army  nurse 
reserve.  This,  of  course,  is  leading  to  great  confusion.  It 
is  breaking  up  our  nursing  reserve.  The  plan  of  the  Sur- 
geon General's  office  cannot  be  kept  up  except  by  an  or- 
ganization such  as  the  Red  Cross,  as  was  evident  from  past 
experience. 

Miss  Delano  has  already  been  to  Xew  York,  has  seen  the 
superintendents  of  some  of  the  large  hospitals  there  and  a 
plan  is  being  worked  out  to  form  units  or  hospital  columns, 
for  hospitals  of  five  hundred  bods,  securing  the  nurses  from 
each  hospital  for  a  hospital  unit  or  column.  The  head  of 
such  a  column  Avould  be  a  mem])er  of  the  Army  ^ledical 
Reserve  Corps  and  the  nurses  would  be  from  the  same  hos- 
pital and  those  with  whom  he  was  accustomed  to  work.  In 
this  way,  the  Red  Cross  will  be  able  to  build  up  around 
various  members  of  the  Medical  Reserve  Corps  complete 
nospital  columus  or  units.  It  is,  furthermore,  making  ar- 
rangements for  special  instruction  for  other  personnel,  such 
as  women  to  run  linen  rooms  and  other  hospital  work  and 


RELATION  OF  M  RSIXG  SERVICE  TO  THE  ARMY  331 

plans  to  enroll  cooks,  etc.,  so  as  to  have  a  whole  unit  and  a 
complete  one. 

Many  other  points  I  will  not  now  attempt  to  discuss.  I 
have  explained  the  situation,  trusting  that  the  matter  can 
he  worked  out  in  fairness  to  the  Red  Cross. 


Miss  Boardman  and  Miss  Delano  then  interviewed  the  Sur- 
geon General  of  the  Army,  only  to  find  that  it  was  the  opinion 
of  General  Gorgas  and  Alajor  Robert  E.  Noble  that  the  or- 
ganization of  base  hospital  units  was  an  undertaking  for  the 
Medical  Reserve  Corps  rather  than  for  the  Red  Cross.  This 
interview  resulted  in  the  deadlock  which  Colonel  Jefferson  R. 
Kean  of  the  United  States  Army  found  upon  his  arrival,  Jan- 
uary 6,  191G,  at  National  Headquarters. 

At  the  request  of  the  Red  Cross  Executive  Committee,  Col- 
onel Kean  had  been  detailed  by  the  War  Department  to  act 
as  Director  General  of  the  newly-created  Department  of  Mili- 
tary Relief  of  the  American  Red  Cross.  A  former  president 
of  the  Association  of  ]\Iilitary  Surgeons,  Colonel  Kean  was  an 
early^  and  enthusiastic  sponsor  of  the  Medical  Reserve  Corps. 
He  was  an  alumnus  of  the  University  of  Virginia.  His  Army 
record  included  thirty  years'  active  service  at  Fort  Sill,  Fort 
Robinson,  St.  Augustine,  Key  West,  Fort  Warren,  Cuba,  Wash- 
ington, D.  C,  and  Fort  Leavenworth.  He  had  received  the 
Campaign  Modal  for  service  in  the  Indian  wars  and  was  chief 
surgeon  of  an  Army  Corps  during  the  Spanish- American  War. 
He  brought  to  the  Red  Cross  a  thorough-going  knowledge  of 
Army  personnel  and  methods  of  procedure,  also  tact  and  a 
tremendous  faith  in  the  opportunities  for  Red  Cross  service. 
His  ability,  his  lively  humor,  his  keen  vision  brought  him  many 
friends,  both  within  the  Army  and  the  Red  Cross. 

Colonel  Kean's  lirst  constructive  work  resulted  immediately 
in  a  more  complete  understanding  of  the  relation  of  the  Red 
Cross  to  the  Army.  On  January  24,  191 G,  eight  days  after 
his  arrival,  he  wrote  to  Colonel  Merritte  W.  Ireland,  ^ledical 
Corps,  then  stationed  at  Fort  Sam  Houston,  Texas.  Colonel 
Ireland,  like  Colonel  Kean  and  Colonel  Francis  Winter,  was 
one  of  that  brilliant  group  of  young  officers,  since  risen  to 
generalship  in  tlie  Medical  Corps,  who  had  known  and  esteemed 
Miss  Delano  when  she  had  shared  with  them  in  li)10  the 
limited  desk-space  of  the  Surgeon  General's  office.  In  his  letter 
to  Colonel  Ireland,  Colonel  Kean  stated: 


332   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  military  preparedness  side  of  Red  Cross  organization 
has  never  been  developed  and  the  consequence  is  that  I  have 
a  new  and  untilled  field  in  which  nothing  has  yet  been  done 
except  in  the  two  bureaus — the  First  Aid  which  [Colonel 
Charles]  Lynch  developed,  and  Miss  Delano's  reserve  nurses 
with  which  you  are  entirely  familiar.  Miss  Delano  has  at 
present  between  six  and  seven  thousand  of  these  and  you 
know  her  well  enough  to  know  how  well  she  has  them  in 
hand. 

The  first  thing  I  had  to  do  was  with  reference  to  the 
proposed  organization  by  the  Surgeon  General  of  surgical 
units.  ...  1  discussed  the  matter  with  the  Surgeon  General 
and  his  associates.  I  admitted  that  he  had  the  right  to  go 
outside  of  the  Red  Cross  reserve  to  employ  nurses  if  he 
chose  to  do  so,  and  that  he  also  had  the  right  to  let  his 
Reserve  Corps  officers  undertake  to  get  up  units,  although 
these  would  have  no  official  existence.  But  I  pointed  out  that 
while  this  was  an  abstract  right,  ...  it  would  much  dis- 
courage the  nurses'  reserve  and  the  Red  Cross  would  be  very 
nearly  inhibited  from  any  successful  effort  to  carry  out  the 
provisions  of  Circular  'No.  8,  1913,  in  organizing  sanitary 
units.  I  proposed  that  the  units  wdiich  he  had  already 
authorized  should  be  enrolled  and  inspected  by  me,  both  as 
a  representative  of  the  Red  Cross  and  as  his  assistant  under 
a  letter  of  instructions  from  him.  The  three  so  authorized 
are  Crile  in 'Cleveland,  Swan  in  Rochester,  and  Gushing  in 
Boston. 

]My  proposition  would  enable  the  Surgeon  General  to  make 
use  of  the  assistance  of  the  Red  Cross,  whereas  if  he  re- 
jected it,  he  would  have  no  place  in  time  of  peace  to  get  the 
pecuniary  assistance  which  the  Red  Cross  stood  ready  to 
offer.  p]xisting  orders  already  provided  that  when  these  units 
were  called  into  active  service,  they  came  under  the  orders  of 
the  War  De])artment,  and  by  placing  a  regular  medical 
officer  in  command  of  each  hospital,  it  became  absolutely 
under  tlie  control  of  the  Surgeon  General. 

On  Fobrnary  7,  1910,  Colonel  Kean  wrote  Dr.  Crile  that 
"with  reference  to  tlie  base  hospital  which  you  were  authorized 
by  the  Surgeon  (leneral  to  enroll  for  service  in  war,  it  has  been 
decided  after  conference  between  the  Surgeon  General  and  the 
National  Red  Ci-oss  that  the  enrollment  will  be  made  through 
the  agency  of  the  latter,  as  is  <'ontenij)late(l  by  the  cbai'ter  of 
the  American  National  Red  Cross  and  existing  War  Depart- 
ment orders." 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  333 

In  a  second  letter  written  February  10  to  Colonel  Ireland, 
Colonel  Kean  reported  further  details  of  the  new  project: 

I  am  starting  out  now  in  a  few  minutes  to  Xew  York, 
Boston,  Koehester  and  Cleveland,  to  organize  base  hospitals. 
We  have  three  already  in  process  of  organization  in  Xew 
York,  one  in  each  of  the  other  cities.  There  is  so  much 
enthusiasm  abroad  that  I  believe  we  can  organize  one  in 
connection  with  every  big  hospital  in  the  country.  My  pres- 
ent scheme  is  to  have  Ked  Cross  Chapters  accumulate  the 
money  to  buy  the  equipment  for  each  hospital  and  store  it 
•when  at  hand.  It  will  cost  over  $20,000  for  each  hospital, 
so  you  see  there  is  nothing  small  about  my  scheme ! 

With  characteristic  briskness  and  zeal,  Colonel  Kean  and 
l\riss  Delano  set  about  their  gigantic  task  in  the  early  spring 
of  191 C.  By  personal  intervnew  or  letter,  Colonel  Kean  placed 
his  project  before  the  president  of  the  Board  of  Directors,  or 
the  Trustees  of  each  hospital.  After  they  had  signified  their 
willingness  to  undertake  the  organization  of  a  base  hospital 
composed  of  the  personnel  within  their  institution,  a  director 
and  chief  nurse  were  immediately  appointed  to  undertake 
the  enrollment  of  the  other  members  of  the  unit.  While  these 
busy  individuals  were  interviewing  their  candidates  and  look- 
ing into  past  records,  Colonel  Kean  took  up  with  the  local  Red 
Cross  Chapter  the  problem  of  equipment.  This  meant  buying, 
storing  and  having  "ready  for  instant  transportation  every- 
thing necessary  for  the  surgical,  medical  and  nursing  care  of 
five  hundred  sick  and  wounded  soldiers,  from  the  beds  they  lie 
upon  to  every  kind  of  bandage  and  operating  instrument."  ^^ 
This  non-perishable  equipment,  the  finest  w'hich  could  be  pur- 
chased, was  estimated  to  cost  approximately  $25,000.00  per 
unit ;  this  equipment  was  "found  to  cost  upwards  of  $75,- 
000"'  for  each  unit  before  the  work  was  completed. ^^  Tlie 
Comptroller's  Iveport  for  the  period  July  1,  1017,  to  February 
28,  1010,  the  months  during  which  the  operations  of  the  Ameri- 
can Bed  Cross  were  directed  by  the  War  Council,  stated  that 
"the  Chapters  of  tlie  B(>d  Cross  spent,  in  round  figures,  $."),- 
000,000  in  equipping  base  hospitals.  In  addition,  Xational 
Headquarters  made  a  number  of  appropriations  to  meet  spe- 
cial needs."  ^^     Tlie  equipment  of  each  unit  required  the  use 

"The  Purvey,  rd)nmry  7,  1917,  Vol.  37,  p.  .'^87. 

"Annual  Report.  Anu'ikan  Rod  Cross,  1917.  ]).  22. 

"'"Tlie  Work  of  the  American  Red  Cross  during  the  War,"  p.  41. 


334   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  seven  freight  ears  to  transport  its  beds,  bedding,  ward  furni- 
ture, drugs,  dental  and  surgical  instruments,  laboratory  supplies 
and  equipment,  mess  gear,  sterilizers,  ambulances,  touring  cars, 
motor  trucks,  motorcycles,  complete  X-ray  plant,  kitchen  and 
disinfectors.  The  initial  supply  of  surgical  dressings  and  hos- 
pital garments  was  at  first  furnished  through  committees  of 
Women's  Auxiliaries  of  the  parent  hospital  and  the  cost 
amounted  to  $8000  for  each  base  hospital  unit.  After 
^National  Headquarters  had  built  up  its  surgical  dressings 
department,  the  Red  Cross  assumed  entire  responsibility  for 
these  articles. 

The  relation  between  the  local  Red  Cross  Chapter  which 
furnished  the  funds  for  equipment  and  the  base  hospital  unit 
was,  in  Colonel  Kean's  words,  ''that  of  a  big  sister,  close  and 
cordial,  but  without  parental  authority."  ^^  In  view  of  the 
great  pecuniary  assistance  which  was  expected  of  the  Chap- 
ters, the  question  of  whether  they  should  not  have  a  controlling 
voice  in  the  selection  of  officers  and  in  other  details  of  organiza- 
tion, had  naturally  arisen,  but  National  Headquarters  had  not 
felt  it  wise  to  authorize  this  because  the  military  and  profes- 
sional personnel  of  the  units  would  naturally  demand  that 
direct  control  be  of  a  military  and  professional  character. 

A  base  hospital  first  included  a  personnel  of  265  souls,  with 
"such  subordinate  administrative  personnel  as  may  be  neces- 
sary" and  "such  Red  Cross  volunteers  as  may  be  authorized  by 
the  Director  General  of  Military  Relief,  upon  the  approval  of 
the  Secretary  of  War."  ^^  The  original  number  of  nurses 
was  placed  at  fifty,  but  was  later  increased  to  sixty-five  and  then 
to  one  hundred  and  the  rest  of  the  personnel  raised  propor- 
tionately. The  personnel  of  a  base  hospital  as  originally  au- 
thorized included  twenty-throe  doctors  (later  raised  to  fifty)  ; 
fifty  nurses  (later  raised  to  one  hundred)  ;  twenty-five  nurses' 
aides  (never  called  out)  ;  fifteen  reserve  nurses  (later  raised  to 
twenty-five)  ;  and  twenty-five  reserve  nurses'  aides  (lun'cr 
called  out)  ;  and  other  personnel  necessary  to  care  for  a  five- 
hundred-bed  hospital   (later  raised  to  one  thousand  beds). 

In  the  Regulations  Governing  the  Employment  of  the 
American  Red  Cross  in  Time  of  War,  authorization  for  the 
nursing  staff  was  contained  in  paragraph  twelve,  viz.,  that  "the 

"See  Annual  Report,  American  Red  Cross,  1916,  p.  41. 
"  Regulations   Ooverninj^  the   Kmployment   of   the   American   Red   Cross 
in   Time  of   War,   December   IS,    1910.  ' 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  335 

organization  of  a  base  hospital  will  be  .  .  .  fifty  nurses,  mem- 
bers of  the  Ked  Cross  JS'iirsing  Service,  one  of  whom  shall  be 
chief  nurse  and  one  of  whom  may  be  a  dietitian.  Twenty-five 
volunteer  nurses'  aides." 

To  the  chief  nurse,  in  consultation  with  the  director  of 
each  base  hospital  was  delegated  the  selection  of  the  nurses, 
the  dietitian  and  the  nurses'  aides.  All  members  of  the  nurs- 
ing staff  thus  selected  were  required  to  be  enrolled  in  the  Red 
Cross  Xursing  Service.  To  save  unnecessary  correspondence 
and  to  hasten  appointments,  Red  Cross  application  blanks  were 
sent  to  chief  nurses,  who  secured  the  training  school 
credentials  of  each  nurse  not  already  enrolled.  The  blanks 
were  then  sent  to  the  Secretary  of  the  Local  Committee 
on  Red  Cross  Xursing  Service.  The  nursing  staff  consisted 
of  one  chief  nurse ;  one  assistant  chief  nurse ;  one  night  chief 
nurse ;  one  charge  nurse,  operating-room ;  five  assistant  nurses, 
operating-room;  one  charge  nurse  or  dietitian;  ^'^  one  assistant 
uurse  or  dietitian ;  one  charge  nurse,  linen  room ;  thirty-eight 
nurses  for  medical  and  surgical  wards ;  fifteen  reserve  nurses 
not  on  the  muster-roll.  It  was  suggested  that  at  least  three  of 
the  nurses  should  have  had  some  practical  experience  in  the 
care   of   contagious   diseases. 

As  muster-rolls  of  the  base  hospitals  lengthened  and  as  the 
Chapters  purchased  and  stored  the  equipment  for  each  unit, 
the  eagerness  of  laywomen  to  share  in  this  type  of  war  service 
grew  to  such  dimensions  that  the  Surgean  General  and  the 
Red  Cross  decided  to  include  among  the  personnel  of  the  base 
hospitals  twenty-five  nurses'  aides,  with  a  reserve  of  the  same 
number.  This  group  included  for  each  hospital  four  diet 
kitchen  aides,  four  aides  to  be  assigned  to  the  linen  room,  two 
aides  to  the  nurses'  quarters  and  fifteen  to  the  wards.  Like 
the  nurses,  these  aid(>s  were  required  to  enroll  in  the  Red  Cross 
and  to  undergo  a  thorough  physical  examination.  Their  in- 
struction in  the  care  of  the  sick  has  already  been  set  forth  in 
a  preceding  section. 

Throughout  the  strained  summer  of  lOlG  the  organization 
of  base  hospitals  proc(Hxled.  A  vivid  picture  of  !Miss  Delano 
remained  in  the  meninrv  of  one  of  h(»r  secretaries  at  Xational 
Ilc^adtpiarters.     At  the  close  of  an  oppressively  warm  Sunday's 

''  Full  iuforination  ('(mceruing  requirements  for  service  ns  Red  Crciss 
(lictiliiuis  may  l)e  found  in  tlie  cliaptcr  relating  to  the  Ked  Cross  Nutri- 
tion  Service. 


336   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

work,  the  chairman  of  the  National  Committee  was  on  her 
knees  on  the  floor  sorting  out  nurses'  papers.  Her  secretary 
reached  over  to  a  file-case  and  the  string  of  beads  which  she 
wore  caught  on  a  corner  of  the  drawer,  broke  and  scattered 
about  the  floor.  With  a  sigh  of  relief,  Miss  Delano  said: 
''You  go  on  wi^h  the  papers  and  I'll  gather  up  the  beads.  I'm 
so  tired  I  can't  keep  my  mind  on  the  work." 

After  the  personnel  of  a  base  hospital  unit  had  been  en- 
rolled, the  nurses  and  enlisted  men  were  required  to  sign  in 
duplicate  the  muster-roll  of  the  unit.  This  early  system  of  re- 
quiring nurses  to  aflix  their  signature  to  the  muster-roll  was 
later  discontinued.  Since  nurses  were  members  of  the  pro- 
fessional staff,  the  Surgeon  General  decided  in  1917  that  this 
troublesome  detail  might  well  be  eliminated. 

The  American  Red  Cross  entered  into  a  definite  contract 
with  every  parent  institution  which  had  undertaken  the  or- 
ganization of  a  base  hospital  unit.  The  following  contract  illus- 
trated this  relation: 

The  parties  in  this  agreement  hereinafter  referred  to  as 
the  EED  CROSS  and  as  THE  HOSPITAL  shall  refer  to 
the  American  Red  Cross  and  to  the  Lakeside  Hospital, 
Cleveland,  Ohio. 

The  Hospital  does  hereby  agree  to  assemble  from  its  staff 
graduates,  nurses,  employes  and  friends,  a  trained  personnel 
for  a  five-hundred  bed  Army  base  hospital,  and  to  keep 
the  specified  posts  of  such  a  personnel  filled,  in  accordance 
with  the  specifications  as  made  and  from  time  to  time  re- 
vised, by  the  Surgeon  General  of  the  United  States  Army. 
It  also  agrees  to  keep  in  the  official  muster-roll  and  ready 
for  service,  this  personnel  and  at  the  call  of  the  Red  Cross, 
immediately  assemble  such  persons  for  transportation  under 
the  Government  orders.  From  time  to  time  as  vacancies 
occur,  they  shall  be  filled  by  persons  nominated  by  the  Hos- 
pital Trustees  and  the  Director,  and  those  so  nominated 
shall  be  ap])ointed  to  such  vacant  posts,  provided  they  con- 
form to  the  prescribed  regulations.  At  a  call  from  the  Red 
Cross  for  the  services  of  this  unit,  the  superintendent  of 
the  Hospital  is  hereby  authorized  and  is  instructed  by  the 
Trustees  of  the  Hospital  to  release  and  send,  wherever  and 
whenever  ordered,  the  enlisted  personnel  of  this  unit,  and 
with  the  Director,  to  select  substitutes  for  any  who  are  un- 
able to  go. 

The  employees  sent  with  the  Hospital  unit  shall  not  re- 
main on  the  Hospital  pay-roll  during  absence,  but  no  em- 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  337 

ployee  of  the  Hospital  shall  be  dismissed  from  the  Hospital 
service,  or  fail  in  reinst^itement  at  the  close  of  such  service, 
because  of  absence  on  account  of  the  call  of  the  unit  to  active 
service. 

In  consideration  of  the  maintenance  of  the  above  personnel 
by  the  Hospital,  the  Hod  (Jross  agrees  that  the  above  men- 
tioned unit  shall  (constitute  a  part  of  its  reserve  medical 
organization  and  be  known  by  the  name  of  the  Hospital  as 
well  as  by  its  ofllicial  number.  It  is  understood  tliat  after 
the  calling  of  this  unit  it  will  be  out  of  the  Ked  Cross  re- 
serve organization  and  controlled  entirely  by  the  Govern- 
ment. It  is  also  understood  that,  whenever  this  Hospital 
Unit  is  called  out  by  the  Ked  Cross  or  Government,  that  its 
entire  expenses,  including  transportation  from  Cleveland, 
are  to  be  paid  either  by  the  Eed  Cross  or  the  Government. 

Eliot  Wads  worth. 
Acting  Chairman,  American  .Ked  Cross. 
Samuel  Mather, 
President,   Lakeside   Hospital. 

To  the  Lakeside  Unit  belongs  the  honor  of  being  the  first  base 
hospital  to  complete  its  muster-roll,  and  also  to  be  mobilized 
into  active  service.  Colonel  Kean  in  a  letter  written  Dr.  Crile 
on  July  31,  1910,  gave  the  Lakeside  Unit  the  designation  of 
Red  Cross  Base  Hospital  Xo.  4.  lie  stated  that  while  Xational 
Headquarters  had  originally  intended  to  give  numerical  desig- 
nations to  base  hospital  units  in  the  order  in  which  the  com- 
pleted muster-rolls  had  been  received,  this  plan  had  not  been 
possible  on  account  of  unexpected  delays  encountered  in  com- 
pleting the  muster-rolls,  especially  in  the  column  of  male 
administrative  personnel.  "The  purchase  of  equipment,"  con- 
cluded Colonel  Kean,  "therefore  began  before  the  rolls  were 
completed  and  it  became  necessary  to  give  numbers  to  the  base 
hospitals  in  order  that  accounts  might  be  opened  with  them 
in  this  office  for  the  purchased  property  and  in  order  that  the 
equipment  so  purchased  might  be  duly  marked." 

On  August  1,  1!>1G,  Colonel  Kean  transmitted  to  the  chair- 
man of  the  Red  Cross  Central  Committee  the  completed  muster- 
roll  of  American  Red  Cross  Base  Hospital  Xo.  -1  (Lakeside) 
with  the  recommendation  that  "this  unit  be  enrolled  in  the 
office  of  the  Surgeon  General,  U.  8.  A.,  under  Paragraph  IG, 
Circular  l^o.  8,  S.  G.  O.  September  10,  1912."  On'the  same 
day,  ]\rajor  General  Arthur  ^Murray,  L^.  S.  A.  Retired,  then 
chairman  of  the   Central   Committee,   forwarded   the   muster- 


338   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

roll  and  Colonel  Kean's  letter  to  the  Adjutant  General,  for 
transmittal  to  General  Gorgas.  On  August  5,  the  Surgeon 
General  informed  the  Red  Cross  that  "the  receipt  of  muster-in 
roll  of  Base  Hospital  'No.  4  (Lakeside)  Cleveland,  Ohio,  Dr. 
George  W.  Crile,  Director,  is  acknowledged.  The  same  has 
been  placed  upon  the  records  for  future  reference."  Thus  in 
complete  readiness  for  immediate  mobilization  upon  future 
need,  the  first  one  of  that  subsequently  long  list  of  Red  Cross 
base  hospitals  was  entered  among  the  reserve  personnel  of  the 
United  States  War  Department.  A  list  of  these  units  may  be 
found  in  the  Appendix. 

In  addition  to  these  first  fifty  base  hospital  units,  the  Curs- 
ing Service  supplied  twenty  nurses  to  serve  on  the  staff  of 
Base  Hospital  No.  55  which  was  organized  by  Dr.  Balch,  of 
Boston,  Mass.  Jessie  Grant  was  chief  nurse  of  this  unit. 
Two  other  units,  which  were  designated  as  Supplementary 
and  as  Replacement  Hospitals,  each  had  their  full  complement 
of  one  hundred  nurses  furnished  by  the  Red  Cross,  but  these 
units  acted  as  a  reserve  in  furnishing  nurses  for  other  hospitals 
and  so  were  not  regularly  organized  as  Red  Cross  base  hos- 
pitals. Another  unit,  called  the  British  Base  Hospital,  had  its 
nurses  furnished  by  the  American  Red  Cross  with  the  definite 
destination  of  service  in  England  in  view. 

After  the  completed  muster-rolls  of  several  base  hospitals 
had  been  filed  in  the  War  Department  and  the  equipment  for 
each  had  been  stored  in  warehouses  provided  by  the  Govern- 
ment and  the  Red  Cross,  Is^ational  Headquarters  desired  to 
see  how  these  "canned  hospitals"  would  meet  the  test  of  actual 
mobilization.  The  Xational  Committee  on  Red  Cross  Medi- 
cal Service  at  a  meeting  held  June  15,  1916,  requested  the 
American  Red  Cross  to  order  out  on  October  28  one  of  its 
base  hospital  units  in  Philadelphia.  Colonel  Kean  stated  that 
"the  purpose  of  this  mobilization  was  primarily  to  demonstrate 
that  the  organization  existing  on  paper  was  a  practical  and 
serviceable  one ;  secondly,  to  ascertain  what  difiieulties  would 
stand  in  the  way  of  such  a  mobilization;  and  thirdly,  for  the 
instruction  in  medical  preparedness  of  the  great  body  of  sur- 
geons who  would  be  in  Philadelphia  at  that  time,  in  attendance 
upon  the  Clinical  Congress  of  Surgeons  and  the  American 
College  of  Surgeons."  ^^ 

Base  Hospital  Xo.  4  was  selected  for  trial  mobilization.     On 

"American  Red  Cross  Annual  Report,  191G,  p.  30. 


RELATION  OP^  NURSING  SERVICE  TO  THE  ARMY  339 

the  brow  of  pictiircsquo  Belmont  Plateau,  Fairmont  Park,  Phil- 
adelphia, Pa.,  Base  Hospital  Xo.  4  mobilized  on  October  28, 
191(j,  under  eighty-five  dun-colored  Army  tents.  Twenty- 
five  nurses,  with  (irace  Allison  as  chief  nurse,  reported,  but 
no  nurses'  aides  were  present,  owing  to  a  decision  not  to  call 
them  out.  The  camp,  covering  twelve  acres,  had  been  erected 
by  a  detachment  of  the  Medical  Department  sent  over  from 
Washington,  U.  C,  under  the  command  of  Major  Harold  W. 
Jones.  Twenty-four  hours  after  the  arrival  of  the  nurses,  all 
wards  were  in  readiness  for  patients. 

Tents  are  not  the  most  satisfactory  housing  equipment  for 
"so  large  and  sedentary  an  organization  as  a  base  hospital." 
On  exhibition  at  Fairmont  Park  was  a  splendid  model  showing 
the  arrangement  and  materials  of  an  ideal  base  hospital,  created 
under  the  supervision  of  Dr.  George  E.  Brewer,  of  ISTew  York, 
and  his  assistant,  Dr.  Sidney  K.  Burnap. 

Colonel  Kean  summarized  the  benefits  derived  from  the  trial 
mobilization  of  Base  Hospital  No.  4: 

The  mobilization  of  this  hospital  marks  an  epoch  in  Red 
Cross  develoi)mcnt  as  concerns  its  obligations  to  assist  the 
medical  service  of  the  armed  forces  in  time  of  war.  It  is 
the  first  practical  and  concrete  demonstration  of  the  ability 
of  the  Eed  Cross  to  do  this.  It  takes  the  scheme  of  Eed 
Cross  military  units  as  a  part  of  the  Medical  Service  out 
of  the  domain  of  theory  into  that  of  accomplished  fact.  The 
cost  of  this  mobilization  was  in  all  $5035.75.  The  freight 
on  equipment  and  incidentals,  $355.15,  was  paid  for  by  the 
Xew  York  County  Chapter.^" 

During  the  fall  of  19 IG  and  throughout  the  year  1917,  Miss 
Novcs  carried  practically  alone  the  work  of  orijanizinir  the 
nursing  staffs  of  the  first  fifty  base  hospitals,  a  task  fraught 
with  extensive  detail. 

In  the  organization  and  equipment  of  its  base  hospitals  for 
the  Army,  including  a  total  personnel  of  4397  nurses,  the  Red 
Cross  accomplished  the  greatest  single  project  of  medical  and 
nursing  preparedness  in  history.  The  amount  of  time  required 
to  purchase  the  ecjuipment  of  Base  Hospitals  Xos.  1  and  2 
in  Xew  York  in  fl)n('  of  pence,  without  any  restrictions  of  funds 
or  military  "red  tape"  amounted  to  four  months.  Advocates 
of   preparedness   felt  that  economic   conditions   existing   in   a 

"AiiuTican  Rod  Cms?  Annual  Report.  1016,  p.  30. 


340   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nation  at  war  would  greatly  increase  the  period  necessary  for 
these  mechanical  arrangements.  "Therefore,"  argued  Colonel 
Kean,  "if  we  are  to  have  base  hospitals  ready  to  take  care  of 
our  soldiers  when  war  comes,  we  must  equip  them  in  time  of 
peace."  Theoretically,  it  was  undoubtedly  the  duty  of  the 
Government  to  provide  base  hospitals.  The  fighting  branch 
of  the  Army  had  always  lacked  many  things,  however,  which 
perforce  had  to  be  asked  for  in  preference  to  base  hospital 
equipment.  "Rifles,  cannon,  munitions,  tentage,  clothing, 
transport  service  have  to  be  provided  before  we  can  have  an 
army  and  naturally  take  precedence  over  provision  for  the  care 
of  the  sick  and  wounded."  ^°  Here  lay  a  supreme  opportunity 
for  the  American  Red  Cross,  unhampered  by  lack  of  funds, 
possessed  of  flexibility  of  organization,  blessed  with  popular 
appeal. 

Only  the  larger  civil  hospitals  in  the  principal  cities  of  the 
United  States  maintained  stafi^s  of  sufficient  size  and  specializa- 
tion to  permit  the  organization  of  a  base  hospital.  Many  small 
institutions,  however,  were  also  eager  to  organize  Red  Cross 
units.  To  accept  their  offers  of  assistance  which  came  di- 
rectly to  the  Red  Cross  or  were  referred  thereto  by  the  War 
Department,  and  to  utilize  the  hospital  facilities  of  the  entire 
country,  the  War  Department  authorized  the  organization  of 
smaller  units  of  about  one-half  the  size  of  a  base  hospital,  to 
be  known  as  hospital  units.  The  Regulations  Governing  the 
Employment  of  the  American  Red  Cross  in  Time  of  War  (De- 
cember 18,  1916)  stated  in  Paragraph  Thirteen  that  "hospital 
units  are  intended  to  supplement  and  assist  established  mili- 
tary hospitals.  Sections  of  hospital  units  may  also  be  assigned 
to  duty  on  hospital  trains  and  ships  and  to  other  military  sani- 
tary organizations." 

The  staff  of  a  hospital  unit  was  made  up  of  "a  director ;  an 
adjutant ;  two  chiefs  of  service ;  four  staff  physicians ;  one  head 
nurse ;  twenty  nurses ;  three  clerks,  who  may  be  women ;  and 
such  numbers  of  orderlies  as  may  be  necessary." 

The  method  by  which  hospital  units  were  organized  was  simi- 
lar to  that  used  for  their  bigger  brother,  the  base  hospital.  The 
equipment  of  hospital  units  included  only  instruments,  medical 
and  surgical  supplies,  basins,  cushions,  brushes,  buckets,  frac- 
ture apparatus,  splints,  and  similar  articles.  As  the  purpose 
of  these  units  was  to  supplement  established  institutions,  all 

'"Soe  A.  R.  C.  Annual  Report,  191G,  p.  31. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  341 

permanent  articles  sneli  as  furniture,  refrigerating-  and  delous- 
ing  plants  and  X-ray  apparatus  were  omitted,  lied  Cross 
Chapters  in  the  cities  where  hospital  units  were  organized,  pro- 
vided and  stored  their  e(iuipment  and  prepared  their  quotas  of 
surgical  dressings.  Perishable  supplies  were  often  purchased 
from  the  stock  of  the  parent  institution  when  the  hospital  unit 
was  ordered  into  active  service.  Complete  equipment  for  a 
hospital  unit  was  estimated  to  cost  approximately  $2r)()(). 

iS'ational  Headcjuarters  organized  nineteen  hospital  units 
which  were  assigned  to  active  service  with  the  United  States 
Army  during  the  European  War.  The  nursing  staffs  of  these 
units  were  composed  of  .'}*,)9  American  Red  Cross  nurses,  who 
served  as  reserves  of  the  Army  Nurse  Corps.  A  complete  list 
of  these  units  may  be  found  in  the  Appendix. 

Although  surgical  sections  were  a  type  of  unit  which  Secre- 
tary Baker  authorized  the  Red  Cross  to  organize  in  the  Regula- 
tions Governing  the  Employment  of  the  American  Red  Cross 
in  Time  of  War  (December  18,  1916)  only  one  such  unit  was 
organized  by  National  Headquarters.  It  was  designated  as 
Surgical  Section  No.  1  and  was  organized  under  Dr.  E.  M. 
Quain,  of  Bismarck,  North  Dakota. 

Emergency  detachments,  made  up  solely  of  nurses,  were  the 
smallest  and  the  most  numerous  of  the  three  early  Red  Cross 
units.  As  early  as  .lune  22,  1916,  Miss  Delano  wrote  to  all 
State  and  Local  Committees  on  Red  Cross  Nursing  Service, 
explaining  the  purpose  of  emergency  detachments  and  charg- 
ing the  State  and  Local  Committee  members  with  the  responsi- 
bility of  developing  one  or  more  of  these  units.  The  Regu- 
lations Governing  the  Employment  of  the  American  Red  Cross 
in  Time  of  War  (December  18,  1916)  stated  in  Paragraph 
Eiftecn  that  "emergency  detachments  of  nurses  arc  organized 
to  meet  sudden  calls  from  the  sanitary  service  of  the  Army, 
or  other  emergencies.  They  will  be  used  to  supplement  the 
nursing  servi^ce  of  military  hospitals  already  established,  or 
be  assigned  to  duty  on  hospital  ships,  hospital  trains,  or  any 
service  where  groups  of  nurses  may  be  needed.  .  .  .  Each 
detachment,"  conclu(l(>d  the  paragraph,  "consists  of  ten  nurses, 
one  of  whom  niav  ho  designiated  as  head  nurse  and  acts  as  such 
until  the  group  is  assigned  to  duty  under  the  supervision  of  an 
Army  chief  luirse,  when  her  duties  will  be  the  same  as  those 
of  other  members  of  tlie  detachment.'' 

Oriiani/.atioii  of  ciiici'iiciu'v  detnclnnents  was  llrst  carried  on 


842   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

by  direct  correspondence  between  the  Bureau  of  Nursing  at 
National  Headquarters  and  Local  Committees  on  Red  Cross 
Nursing  Service.  This  procedure  continued  until  the  fall  of 
1917,  when  the  thirteen  lied  Cross  Division  offices  were 
created ;  the  Divison  Directors  of  Nursing  then  took  over  the 
details  of  recruiting  which  had  previously  been  handled  by 
Miss  Noyes  and  her  assistants.-^ 

With  its  absence  of  equipment,  its  ease  of  mobilization,  its 
ability  to  respond  immediately  to  duty  upon  the  receipt  of  its 
orders  into  active  service,  the  emergency  detachment  proved  one 
of  the  most  valuable  methods  through  which  nurses  were  se- 
cured. The  first  of  these  groups  was  ordered  into  duty  on 
the  Mexican  border  in  July,  1916.  Many  others  were  assigned 
during  1917  and  the  early  months  of  1918  directly  to  the 
British  and  American  Expeditionary  Forces.  Later,  however, 
nurses  from  these  units  were  sent  to  cantonments  where  they 
were  prepared  for  overseas  duty.  Red  Cross  emergency  de- 
tachments supplied  11,470  nurses  to  the  War  Department,  half 
the  entire  strength  of  the  Army  Nurse  Corps.  No  more  bril- 
liant proof  than  this  can  be  found  of  the  soundness  of  the  Red 
Cross  Nursing  Service  committee  system,  nor  of  the  untiring 
patriotism  of  these  nurse-members,  who,  although  already  over- 
burdened with  tasks  of  maintaining  with  inadequate  personnel 
hospitals  and  training  schools  and  other  types  of  work,  served 
as  volunteers  during  every  available  moment  on  the  Local 
Committees  which  brought  these  eleven  thousand  nurses  into 
the  military  service. 

The  youngest  members  of  the  nursing  profession  to  serve 
with  the  American  Army  during  the  European  War  entered 
the  Army  Nurse  Corps  by  joining  training  school  units  which 
the  Red  Cross  organized  within  the  senior  classes  of  hospital 
schools  of  nursing.  An  unusually  attractive  group  they  were, 
young,  adventure-loving,  a  brave  and  eager  company  of  whom 
almost  all  were  of  recognized  dependability  and  skill. 

Red  Cross  base  hospitals  and  hospital  units,  made  up  of  the 
members  of  staifs  of  major  civilian  institutions  in  all  parts  of 
the  country,  had  drawn,  during  1917,  hundreds  of  nurses  of 
distinguished  positions  from  the  institutional  field.  Local 
Committees  on  lied  Cross  Nursing  Service  were  combing  grad- 
uate nurses'  associations,  clubs,  registries  and  other  agencies 

^' Sco  letter  written  Xoveiiiber  1.  1017.  Iiy  C.  D.  Xoyes  to  all  State  ami 
Local   Coimiiittees   and   ori^aniziii''   muses. 


RELATION  OF  NURSIxXG  SERVICE  TO  THE  ARMY  343 

for  private  duty  nurses  to  serve  especially  in  emergency  de- 
tachments. With  these  fields  of  supply  almost  exhausted  in 
the  spring  of  1918,  ^liss  Delano  and  Miss  Noyos  appealed  to 
members  of  the  June  gradiuiting  classes  of  hospital  schools  of 
nursing,  urging  these  young  women  also  to  join  that  continuous 
procession  of  reserve  nurses  filing  into  the  Army  Nurse  Corps 
through  the  American  Red  Cross. 

Miss  Delano  presented  in  a  letter  written  March  12,  1918,  to 
all  superintendents  of  schools  of  nursing,  the  first  step  of 
the  Red  Cross  plan  to  utilize  the  services  of  young  graduates 
for  the  Army : 

We  have  been  definitely  asked  by  the  Surgeon  General  to 
supply  five  thousand  nurses  by  June  1,  1918,  for  the  Army 
alone,  and  it  is  estimated  that  probably  not  far  from  thirty 
thousand  additional  ones  will  be  needed  by  January  1,  1919. 
...  It  seems  evident  from  the  recent  surveys  which  have 
been  made  of  the  nursing  resources  of  the  country  that  there 
are  not  more  than  sixty-five  thousand  registered  nurses  in 
the  United  States.  .  .  . 

We  believe  that  training  school  superintendents  are  most 
anxious  to  aid  in  every  possible  way  to  secure  the  number 
of  nurses  needed.  One  of  the  most  practical  methods  of 
increasing  the  available  supply  of  nurses  is  to  advance  some- 
wliat  the  date  of  graduation  in  training  scliools  giving  a 
three  years'  course  of  training,  provided  of  course  that  only 
such  nurses  slioidd  be  graduated  as  are  willing  to  enroll 
promptly  with  tlie  l?ed  Cross  and  accept  service  at  once 
with  the  Army  or  with  the  Xavy.  .  .  . 

I  should  not  feel  justified  in  urging  this  shortening  of 
the  regular  three  years'  course,  if  I  did  not  believe  that  the 
experience  in  military  hospitals  would  supplement  their 
regular  training  and  give  them  not  only  ex{)ericnce  which 
will  be  of  value  to  them  in  their  career  as  nurses,  but  would 
give  them  as  well  the  satisfaction  of  having  served  their 
country  in  time  of  need. 

On  !\rarch  13,  1918,  ^^Fiss  Xoycs  followed  up  Miss  Delano's 
letter  with  a  personal  communication  addressed  to  all  superin- 
tendents, in  which  she  urged  them  to  undertake  the  organiza- 
tion of  at  least  one  training  school  unit. 

The  undcrlyiug  principle  of  organizing  such  units  was  a 
recognition  of  the  chin  instinct.  AVar  seemed  less  formidable 
when  a  nurse  could  go  out  with  a  former  room-mate  or  a  friend 
who  had  been  trained  in  the  same  wards. 


344    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Each  training  school  unit  was  numbered,  the  designation 
beginning  with  a  high  number  to  avoid  confusion  with  base 
hospitals  and  hospital  units.  The  first  training  school  unit 
was  formed  at  Sara  Elizabeth  Hospital,  Henderson,  North  Car- 
olina, and  was  designated  T.  S.  Unit  No.  500 ;  the  second,  from 
the  Methodist  Episcopal  Hospital,  Brooklyn,  New  York,  as 
T.  S.  Unit  No.  501.  Nurses  other  than  the  graduates  of  a  given 
school  which  had  formed  a  unit  might  join  the  unit  of  that 
institution  if  none  existed  in  their  own  school,  or  if  satis- 
factory reasons  were  presented,  but  this  was  seldom  done. 

During  the  spring  and  summer  of  1918,  1362  nurses  volun- 
teered for  war  service  in  307  training  school  units.  A  list  of 
the  units  is  given  in  the  Appendix. 

Immediately  following  the  declaration  of  war  by  the  United 
States,  General  Gorgas  organized  within  the  Medical  Corps  of 
the  Army,  divisions  of  Mental  Diseases,  Internal  Medicine, 
Orthopedics  and  Opthalmology,  the  directors  of  which  were 
experts  in  these  different  branches  of  medical  practice.  These 
directors  were  charged  with  the  responsibility  of  organizing 
such  base  hospitals  for  service  in  the  United  States  and  abroad 
as  the  treatment  of  such  cases  as  might  fall  under  the  above 
classifications,    required. 

The  medical  and  enlisted  personnel  of  these  units  was  or- 
ganized entirely  within  the  Surgeon  General's  office  and  the 
equipment  was  supplied  by  the  Government,  but  the  Army 
Nurse  Corps  called  upon  the  Red  Cross  to  supply  the  nurses. 
The  first  stop  in  securing  nurses  qualified  for  this  service  lay 
in  the  establishment  of  a  classified  list  of  nurses  specially 
trained  in  pediatric,  psychopathic  and  orthopedic  nursing  and 
in  nursing  mental  diseases,  contagious  diseases,  head  and  neck 
surgery  and  eye  and  ear  work.  After  the  establishment  of  this 
list,  the  procedure  was  comparatively  simple.  From  time  to 
time.  Miss  Tliompson  notified  Miss  Noycs  of  the  formation  of 
special  hospitals  and  she  secured  the  nurses  through  corre- 
spondence with  those  whose  names  appeared  on  the  classified 
lists. 

The  development  of  physio-therapy,  one  of  the  signal  de- 
velopments which  the  war  indirectly  brought  to  medical 
science,  created  a  demand  for  expert  masseuses.  Miss  Noyes 
prepared  a  form  letter  in  Novemlx'r,  1917,  to  be  sent  to  nurses 
wlio  requested  information  of  tliis  type  from  National  Head- 
(juartcrs,  or  to  nurses  whose  enrollment  showed  special  training. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  345 

Regulations  conccriiiiig  enrollment  as  an  expert  masseuse  were 
as  follows : 

Applicants  should  be  graduates  of  a  recognized  school  of 
massage. 

The  service  is  entered  for  tlie  period  of  the  war.  It  is  to 
be  performed  in  the  wards  of  the  reconstruction  hospitals 
under  the  supervision  of  the  head  nurse  of  the  ward. 

Applicants  should  be  preferably  between  tlie  ages  of 
twenty-five  and  forty-five. 

Applicants  should  be  endorsed  by  the  principal  of  the 
school  of  massage  from  whicli  she  received  her  di])loma. 

Members  of  tbe  service  are  expected  to  respond  promptly 
to  a  call  for  service  coming  from  the  Bureau  of  Nursing  of 
the  Red  Cross. 

A  masseii.se  will  be  paid  $50.00  a  month,  with  mainte- 
nance and  transportation. 

[Here  follow  the  same  passport  and  physical  examination 
instructions  as  apply  to  the  Eed  Cross  iSTursing  Service.] 

The  Nursing  Service  assigned  193  nurses  expert  in  the  care 
of  special  diseases  to  the  Armv  Xurse  Corps  for  service  in  the 
following  special  base  hospitals  of  the  Medical  Department : 
Xo.  114,  Orthopedic  (assigned  to  service  in  the  United  States 
and  later  to  foreign  duty)  ;  No.  115,  Eye  and  Ear  (assigned 
to  service  in  the  United  States  and  later  to  foreign  duty)  ; 
No.  116,  Fracture  (assigned  to  service  abroad)  ;  No.  117,  Psy- 
chiatric (assigned  to  service  abroad)  ;  a  mobile  operating  unit 
under  [Major  P.  P.  Turnure,  M.  P.  C.  of  New  York  City. 

As  the  Selective  Draft  brought  thousands  of  recruits  to  the 
cantonments,  which  had  sprung  up  overnight  in  rows  of  un- 
painted  barracks  like  clusters  of  enormous  gray  mushrooms, 
a  problem  in  sanitation  arose  which  presented  an  opportunity 
to  the  Ped  Cross  for  vital  service  to  the  enlisted  man.  Within 
the  military  boundaries  of  each  cantonment,  sanitary  measures 
were  directly  under  the  charge  of  Army  ^Fedical  officers.  In 
the  regions  immediately  surrounding  the  military  district,  this 
responsibility  was  divided  between  State,  county  and  uiunicii)al 
health  departments.  Tlie  ])liysical  well-being  of  the  new 
armies  was  intimately  related,  however,  to  these  extra-canton- 
ment zones.  Through  the  C()<")p('rati()n  of  the  War  and  Treasury 
Departments,  the  United  States  Public  Health  Service  had 
agreed  to  assigii  an  expei-ienced  sanitarian  of  its  stall'  to  super- 
vise health  nu'asures  about  each  cantonment.     This  olHcer  was 


346   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

duly  invested  with  such  powers  as  the  State  and  Local  Boards 
of  Health  would  transfer. 

Neither  the  Federal  Public  Health  Service,  nor  local  agencies 
possessed,  however,  sufficient  funds  to  employ  an  adequate 
personnel  to  help  this  officer.  Legislative  action  would  have 
consumed  valuable  time.  The  Red  Cross  accordingly  set  aside 
an  initial  appropriation  of  over  $10,000  to  organize  a 
Bureau  of  Sanitary  Service  under  the  Department  of  Military 
Relief  and  supplemented  this  appropriation  from  time  to  time 
to  the   amount  of  approximately   $750,000   in  the  aggregate. 

Dr.  Taliaferro  Clark,  Surgeon,  United  States  Health  Service, 
and  one-time  director  of  the  Red  Cross  Bureau  of  Sanitary 
Service,  stated  in  the  Annual  Report  of  1917,  the  method 
under  which  this  bureau  operated : 

Assistance  is  given  only  on  request  from  a  State  and  on 
recommendation  of  the  Surgeon  General  of  the  United 
States  Public  Health  Service,  under  wliose  direction  a  sani- 
tary survey  is  being  made  in  the  vicinity  of  each  canton- 
ment. 

l^pon  receipt  of  a  report  from  the  Public  Health  Service 
stating  the  conditions  in  a  district  and  establishing  the  need 
for  aid,  the  Red  Cross  promptly  furnishes  this  supplemen- 
tary assistance  by  assigning  to  the  district  bacteriologists, 
sanitary  inspectors  and  Rod  Cross  public  health  nurses,  with 
an  appropriation  sufficient  to  provide  equipment,  transporta- 
tion and  maintenance. 

Miss  Xoycs  wrote  on  August  G,  1917,  to  chief  nurses  of  all 
units  and  detachments,  stating  that  the  Xational  Connnittee  on 
Red  Cross  Xursing  Service  had  voted  the  week  before  in  favor 
of  a  special  enrollment  for  public  health  nurses,  exempting 
them  from  active  military  service,  if  they  desired,  so  that  they 
might  undertake  cantonment  zone  work.  ]\liss  i^oyes  suggested 
that  all  nurses  who  were  enrolled  in  base  hospital  and  other 
units,  yet  who  by  training  and  experience  were  fitted  for  can- 
tonment zone  service,  should  be  withdrawn  from  the  units  then 
being  organized  for  the  Army  and  should  be  transferred  to 
cantonment    zone    service. 

This  particular  phase  of  war  nursing  surrounding  the  can- 
tonments consisted  in  sanitary  work  in  C(uinection  with  the 
public  and  private  water  sup})ly;  the  disposal  of  sewage  and 
garbage;    the   drainage   of   mos(iuito-infested   swamps;    the    in- 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  347 

spection  of  food  supplies;  and  the  control  of  communicable 
diseases.  Miss  Klla  Tliillips  Crandall,  executive  secretary  of 
the  National  Organization  for  Public  Health  Nursing,  assisted 
the  Red  Cross  in  the  selection  of  public  health  nurses  for  this 
service,  one  hundred  and  fifty-four  of  whom  were  assigned 
to  twenty-nine  sanitary  zones  at  the  following  localities : 
Alexandria,  La. ;  American  Lake,  Wash. ;  Anniston,  Ala. ;  At- 
lanta, Ga. ;  Augusta,  Ga. ;  Ayer,  Mass. ;  Charlotte,  N.  C. ;  Chat- 
tanooga, Tenn, ;  Chillicothe,  Ohio;  Columbia,  S.  C. ;  Des 
Moines,  Iowa ;  ]\ranhattan,  Kansas ;  Fort  Worth,  Texas ;  Green- 
ville, S.  C. ;  Hattiesburg,  Miss.;  Houston,  Texas;  Jacksonville, 
Fla. ;  Leavenworth,  Kansas;  Little  Rock,  Ark. ;  Louisville,  Ky. ; 
]\Iacon,  Ga. ;  Montgomery,  Ala. ;  Newport  News,  Va. ;  Peters- 
burg, Va. ;  Portsmouth  and  Norfolk,  Va. ;  San  Antonio,  Texas ; 
Spartanburg,  S.  C. ;  Waco,  Texas ;  Wrightstown,  N.  J. 

By  vote  of  the  National  Committee  on  Red  Cross  Nursing 
Service  in  ]\ray,  1918,  the  name  of  the  Red  Cross  Town  and 
Country  Nursing  Seiwice  was  changed  to  that  of  the  Bureau 
of  Public  Health  Nursing  Service.  To  it  were  delegated  during 
the  summer  of  1918  the  responsibility  for  public  health  nurses 
assigned  to  extra-cantonment  zones. 

Second  in  military  importance  to  American  combat  troops 
in  France  were  the  essential  war  industries  in  the  L^nited 
States,  which  furnished  supplies  to  the  American  Expeditionary 
i'orces  and  to  the  Allies.  For  ten  miles  along  tlie  Ohio  River, 
in  whose  dark,  swiftly-flowing  waters  Vv-cre  reflected  at  night 
the  glaring  throats  of  a  thousand  furmues,  atreLched  ihe  L^nited 
States  Ammunition  Plant  at  Nitro,  iu  \aq  West  Virginia  hills. 
From  ]\[uscle  Shoals,  Alabama,  came  the  nitrate  for  high  ex- 
plosives. Various  other  centers  for  manufacturing  essential 
war  supplies  were  located  in  diflerent  parts  of  the  country 
and  employed  many  thousands  of  workers.  The  health  of 
these  men  and  of  their  families  was  of  paramount  importance, 
— for  upon  their  labor  depended  the  output  of  these  manufac- 
turing centers — so  the  Government  established  base  hospitals 
to  care  for  accident  cases  and  illness  which  occurred  there. 

The  Surgeon  (!(Miera]  of  the  L^nited  States  Public  Health 
Service,  undiM-  wh(»s(>  departmtnit  these  hospitals  were  main- 
tained, agreed  to  utilize  for  tliis  s(>rvi('(>  nurses  who  had  been 
slightly  below  the  physical  re(|uirenH'nts  of  the  Army  and  Navy, 
(ir  those  slightly  above  the  miiximnm  age  limit,  or  married 
nurs(\s  whose  husbands  were  in  military  service,  a  group  which 


348   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  barred  from  joining  the  Army  ITurse  Corps.    Eighty-eight 
nurses  were  assigned  to  this  service. 

To  Marine  Hospitals  and  to  special  institutions  maintained 
by  the  United  States  Public  Health  Service  for  the  care  of 
pellagra,  trachoma  and  other  contagious  diseases,  fifty-four  Red 
Cross  nurses  were  assigned  before  the  Armistice.  The  develop- 
ment of  the  Nurse  Corps  of  the  Public  Health  Service  is  treated 
more  fully  in  a  later  chapter. 

The  first  field  service  which  American  Red  Cross  nurses 
experienced  as  reserve  members  of  the  Army  Nurse  Corps  was 
on  the  Mexican  border.  This  type  of  duty  began  in  1911. 
In  the  spring  of  1914,  the  Punitive  Expedition  was  dispatched 
to  Vera  Cruz  and  occupied  the  city.  Army  nurses  accompanied 
the  military  forces.  Early  in  1916,  the  Villesta  forces  killed 
several  American  miners  and  the  United  States  Government 
demanded  reparation.  On  March  9,  1916,  Villa  invaded 
Columbus,  New  ]\Iexico,  killed  seven  troopers  and  several 
civilians  and  fired  many  buildings.  President  Wilson  then 
ordered  a  punitive  expedition  under  "Black  Jack"  Pershing 
to  cross  the  border  in  pursuit  of  Villa,  but  to  respect  scrupu- 
lously the  sovereignity  of  the  Mexican  Republic.  Pershing, 
with  the  aid  of  Carranza's  troops,  drove  Villa  into  the  hills, 
but  the  chaotic  state  of  anarchy  existing  in  Mexico  continued. 

In  June,  President  Wilson  changed  his  policy  of  "watchful 
waiting"  to  one  of  border  defense ;  in  a  note  of  June  2,  1916, 
sent  to  all  factions,  he  warned  them  that  they  must  adjust 
their  differences  and  "act  promptly  for  the  relief  and  redemp- 
tion of  their  prostrate  country"  or  else  the  United  States  would 
be  "constrained  to  decide  what  means  should  be  employed  to 
help  Mexico  save  herself."  On  June  12,  two  troops  of  U.  S. 
cavalry  (colored)  approached  the  town  of  Carrizal,  requested 
permission  of  General  Gomez  to  pass,  stopped  at  his  suggestion 
to  confer  and  were  fired  upon  by  the  Mexican  forces.  A  immber 
of  soldiers,  including  the  officer  in  command,  were  killed  and 
twenty-four  were  taken  prisoners.  President  Wilson  imme- 
diately demanded  that  Carranza  define  his  attitude  and  sur- 
render the  prisoners.  On  June  18,  he  called  out  every  militia- 
man in  the  United  States  to  strengthen  Pershing's  line  of  12,000 
Regulars  which  extended  280  miles  directly  south  to  Nami- 
quipa.  Sixteen  battleships  steamed  to  the  Mexican  coast. 
Congress  officially  authorized  the  President  to  draft  the  Na- 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  349 

tional  Guard  into  Federal  service  and  voted  $26,000,000  for 
the  emergency.  Carranza  then  yielded  and  returned  the  pris- 
oners. Notes  proposing  diplomatic  settlement  of  the  differ- 
ences between  Mexico  and  the  United  States  were  exchanged 
in  July.  At  this  juncture,  Villa  emerged  from  among  the 
hills  and  the  "cat  and  mouse"  warfare  that  had  been  going  on 
before  began  again. 

With  over  200,000  Regulars  and  Militiamen  in  the  field  in 
August,  1916,  the  United  States  Army  established  during  the 
summer  five  base  hospitals,  five  camp  hospitals  and  one  can- 
tonment hospital  along  the  ^Mexican  border.--  Kathrinc  Don- 
nelly, Lulu  T.  Lloyd,  Alice  B.  Harvey  and  Nannie  B.  Hardy, 
reserve  members  of  the  Army  Nurse  Corps,  had  been  in 
service  with  the  border  troops  since  1914.  When  the  rela- 
tions between  Mexico  and  the  United  States  became  strained 
in  the  spring  of  1916,  Colonel  Kean,  then  acting  chairman 
of  the  Central  Committee  of  the  American  Red  Cross,  wrote 
May  15  to  the  Surgeon  General,  offering  the  services  of  "such 
a  number  of  nurses,  not  exceeding  forty,  as  may  be  needed." 
The  Red  Cross  at  the  same  time  offered  to  pay  the  salaries  of 
these  nurses  and  to  furnish  transportation  for  them  to  the 
place  of  service,  but  the  Arnr\'  to  furnish  maintenance.  "It 
is  presumed,"  concluded  Colonel  Kean,  "that  after  July  1  these 
nurses  can  be  paid  from  the  Army  appropriation  if  their  ser- 
vices are  still  needed."  Red  Cross  records  show  no  evidence 
of  a  written  reply  to  this  offer. 

Colonel  Kean  took  up  the  question  again  in  a  letter  ad- 
dressed July  28  to  Colonel  Birmingham,  then  Acting  Surgeon 
General.  This  letter  contained  interesting  arguments  of  the 
three  ways  in  "which  the  number  of  nurses  available  for  the 
^ledical  Corps  might  be  increased.  The  first  way  was  to  in- 
crease the  number  of  nurses  in  the  Regular  Xurse  Corps.  The 
second  way  was  to  call  reserve  nurses,  namely,  American  Red 
Cross  nurses,  into  active  service  in  the  Army  Xurse  Corps. 
The  third  way  was  to  employ  contract  nurses  "who  may  or 
may  not  be  enrolled  Red  Cross  nurses,"  stated  Colonel  Kean, 
"but  who  are  paid  out  of  the  Medical  and  Hospital  Appropria- 
tion." 

Tlie  first  method,  that  of  increasing  the  number  of  nurses 
in  the  Regular  Xurse  (^orps,  was  then  being  used  to  secure 
nurses  for  the  Army  base  hospitals  on  the  Mexican  border. 
=^  Report  of  tlio  Sur<,'eoii  General.  V.  S.  A..  1917.  p.  23. 


350    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"I  do  not  know,"  argued  Colonel  Kean  in  his  letter  of  July  28, 
"what  advantages  it  has  which  have  led  to  its  adoption  in 
preference  to  the  second  method,  in  an  emergency  which  is 
of  a  more  or  less  temporary  nature,  but  I  think  it  is  clear  that 
it  has  the  disadvantage  of  being  much  slower  than  calling  out 
the  reserve  nurses.  I  understand  that  only  190  out  of  the 
more  than  400  which  are  now  authorized,  have  been  obtained 
during  the  number  of  weeks  since  an  increase  was  authorized. 
Also,  I  do  not  believe,"  he  continued  further,  "that  the  best 
nurses  in  the  country  are  as  easily  secured  for  a  permanent 
engagement  in  the  Army  Nursing  Service  as  can  be  secured 
by  the  selection  from  the  Reserve.  In  the  latter,  as  you  know, 
a  very  large  number  is  available  from  which  to  select,  and  there 
is  the  appeal  of  patriotic  service  which  is  not  so  much  in 
evidence  in  the  Army." 

Colonel  Kean's  argument  next  dealt  with  the  third  method, 
the  employment  of  nurses  by  contract.  In  his  opinion,  it  had 
several  disadvantages.  "In  the  first  place,"  he  stated,  "the  term 
'contract  nvirse'  is  one  which  was  brought  into  discredit  during 
the  Spanish-American  War  by  the  employment  in  this  way  of 
untrained  nurses  and  of  women  for  matrons  and  other  purposes 
than  special  nursing,  and  the  term  'contract  nurse,'  like  'con- 
tract doctor,'  is  itself  not  an  attractive  one.  Also,  the  fact 
that  these  nurses  are  paid  out  of  the  Medical  and  Hospital 
Appropriation,  which  is  never  too  large,  rather  than  from  the 
appropriation  for  pay  of  the  Army,  is  a  serious  disadvantage. 
I  think,  therefore,"  he  declared,  "that  this  method  of  securing 
nurses  should  not  be  considered." 

After  a  discussion  of  the  probable  number  of  nurses  needed, 
which  Colonel  Kean  estimated  would  ultimately  be  one  thou- 
sand, he  proceeded  with  directness  to  his  conclusion :  "I  am 
writing  to  suggest  that  the  additional  nurses  needed  in  the 
present  emergency,  due  to  the  calling  out  of  the  National  Guard 
and  the  mobilization  of  the  Army  on  the  border,  be  furnished 
from  the  nurses'  Reserve,  as  is  contemplated  by  the  Regulations, 
and  that  this  office  be  taken  into  the  confidence  of  the  Surgeon 
General's  office  as  far  as  possible  and  notified  as  much  in 
advance  as  may  be  practicable  of  the  calls  which  may  bo  made 
upon   it   for   nurses." 

On  July  2!),  IDK),  the  Surgeon  General  replied  to  Colonel 
Koan,  requesting  that  "this  office  be  furnished  with  the  names 
of  forty  reserve  nurses  in  groups  of  about  ten,  who  are  willing 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  351 

to  be  assigned  to  active  duty  in  the  Military  EstaLlisliment  and 
who  can  respond  to  an  innnediate  call."  In  this  letter,  the 
Surgeon  General  also  stated  that  the  physical  examination 
required  by  the  lied  Cross  for  enrollment  would  be  satisfactory, 
but  he  re(iuested  that  the  credentials  of  each  nurse  assigned 
to  meet  this  call  should  be  sent  to  his  office. 

Insight  into  the  reasons  why  the  War  Department  did  not 
accept  earlier  the  offer  of  Ked  Cross  assistance  was  contained 
in  a  letter  written  by  Miss  Delano  August  10  to  Mrs.  William 
K.  Draper: 

.  .  .  The  Red  Cross  offer,  to  send  forty  or  fiftj  nurses  to 
the  border,  went  to  the  War  Department  and  after  much 
discussion  it  was  decided  by  the  Secretary  of  War,  I  believe, 
that  the  xVrmy  could  not  accept  this  contribution  from  the 
Red  Cross  except  when  war  was  actually  declared.  Their 
appropriation  for  additional  nurses  is  now  available  and  we 
have  again  offered  to  send  nurses  as  they  are  needed. 

I  believe  that  at  present  there  is  some  question  concerning 
quarters,  but  at  any  rate  the  nurses  are  ready.  I  began  some 
time  ago  the  development  of  what  we  call  emergency  de- 
tacliments  of  wliich  we  now  have  a  good  many  available. 
Our  base  hospitals  are  well  developed,  nearly  ready  for  serv- 
ice. 1  thank  Heaven  every  day  that  we  were  fortunate 
enough  in  beginning  the  organization  of  the  Nursing  Service 
so  long  ago  that  now  there  need  be  no  delay  as  far  as  the 
nurses  are  concerned. 

Four  days  later,  August  14,  the  Surgeon  General  called  upon 
the  lied  Cross  for  one  hundred  nurses,  instead  of  forty,  for 
l)or(ler  service.  As  this  was  the  first  call  of  sizable  dimensions 
which  the  Ived  Cross  Xursing  Service  had  received,  the  rules 
and  regulations  handed  down  by  the  Surgeon  General  are  of 
importance,  in  that  they  constituted  the  precedent  which  later 
governed  the  assignment  of  American  lied  Cross  nurses  to 
tli(!  Army  Xurse  Corps  during  the  participation  of  the  United 
States  in  the  European  War.  In  his  letter  of  August  14,  the 
Surgeon  (Jeneral  stated  that  reserve  inirses  m\ist  be  citizens  of 
the  United  States.  Colonel  Kean  in  his  reply  of  August  IG 
wrote : 

2.  The  reciuiroment  mentioned  in  your  letter,  wliich  is  a 
new  one  as  far  as  reserve  nurses  are  concerned, — tliat  rcs('r\e 
nurses   must    be   citizens. — may   delay   soniewbat    tbe   calling 
out  of  tbe  emergency  detachments,  as  llie  question  of  citizen- 


352   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ship  has  to  be  put  to  each  individual  nurse.  The  War  Relief 
Board,  of  which  the  Surgeon  General  of  the  Army  and  the 
Surgeon  General  of  the  Navy  are  members,  have  considered 
the  regulations  for  enrollment  in  the  Red  Cross  Eeserve  and 
have  not  considered  this  requirement  necessary  for  reserve 
nurses,  whose  service  is  of  a  more  or  less  temporary  char- 
acter, although  it  is  required  of  members  of  the  Army  Nurse 
Corps.  They  have  always,  of  course,  been  required  to  take 
the  oath  of  allegiance.  This  requirement  seems  somewhat 
at  variance  with  the  neutral  and  international  character  of 
the  Red  Cross. 

In  his  letter  of  August  16,  Colonel  Kean  next  dealt  with 
two  questions  of  only  temporal  importance.  He  suggested  that 
nurses  assigned  to  border  duty  be  permitted  to  serve  for  a 
period  of  only  six  months,  if  necessary,  so  that  they  might 
return  to  positions  which  were  being  held  open  for  them.  He 
also  requested  that  several  reserve  nurses  from  various  base 
hospital  units  be  assigned  to  the  border,  so  that  they  might 
become  familiar  with  Army  paper  work  and  other  conditions 
peculiar  to  Army  nursing.  The  last  point  made  in  this  letter 
was  one  of  vital  importance.     Colonel  Kean  wrote: 

5.  As  the  question  of  insignia  for  Red  Cross  nurses  when 
on  active  duty  has  not  been  authoritatively  settled,  it  is  re- 
quested that  a  ruling  be  made  that  they  shall  wear  the  Re- 
serve cap  with  the  Red  Cross  on  the  front  and  the  Red  Cross 
cape  which  is  issued  to  them  gratis.  This  is  considered  of 
importance  on  account  of  the  international  and  well-accepted 
character  of  this  insignia  and  its  value  in  maintaining  esprit 
de  corps. 

In  a  letter  written  August  18,  the  Acting  Surgeon  General, 
Colonel  Birmingham,  answered  these  points  in  the  following 
order  and  manner: 

1.  Your  letter  of  August  16  is  herewith  acknowledged. 

2.  As  there  appears  to  be  no  law  requiring  the  reserve 
nurses  assigned  to  active  duty  in  the  Military  Establishment 
to  be  citizens  of  the  United  States,  so  much  of  letter  dated 
August  14  as  pertains  to  this  need  not  be  regarded,  though 
citizens,  or  tliose  wlio  have  made  declaration  of  intention  to 
become  such,  will  be  given  precedence. 

3.  You  are  authorized  to  inform  reserve  nurses  volunteer- 
ing for  active  service  that  they  may  on  request,  be  relieved 
from  active  duty  and  given  transportation,  to  the  place  from 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  353 

which  they  started,  at  the  end  of  six  months'  service,  unless 
in  the  meantime,  the  need  for  their  service  ceases  to  exist  or 
in  case  of  misconduct. 

4.  In  the  case  of  nurses  assigned  to  active  duty,  and  who 
are  enrolled  for  base  hospital  units,  every  effort  will  be  made 
to  transfer  them  to  the  unit  of  which  they  are  a  part,  should 
the  unit  be  called  out,  provided  the  Eed  Cross  will  nominate 
other  nurses  to  replace  them. 

5.  There  is  no  objection  in  this  office  to  the  use  of  the 
Red  Cross  cape  and  cap  by  reserve  nurses. 

Immediately  upon  receipt  of  Col.  Birmingham's  answer, 
]\Iiss  Delano  called  out  emergency  detachments  which  had  been 
organized  by  Local  Committees  in  Alabama,  Colorado,  Georgia, 
Nebraska,  Iowa,  Louisiana,  Maryland,  Minnesota,  New  Jersey, 
New  York,  Ohio,  Pennsylvania,  Texas,  Virginia  and  Wash- 
ington, D,  C,  One  hundred  and  forty-four  nurses  were  first 
assigned  to  Camp  jMcAllen,  Fort  Sam  Houston,  Eagle  Pass, 
Laredo,  Llano  Grande,  Brownsville  and  Fort  Bliss  in  Texas; 
to  Nogales  and  Douglas,  Arizona ;  and  to  Doming,  New  Mexico. 

Nurses  w^ere  also  assigned  to  United  States  Army  base  hos- 
pitals from  the  base  hospital  units  organized  at  Bellevue,  the 
Presbyterian,  the  New  York  City,  the  Post  Graduate,  Mt. 
Sinai  and  the  German  Hospital,  of  New  York  City;  at  the 
Boston  City,  the  Massachusetts  General  and  the  Peter  Bent 
Brigham,  of  Boston ;  at  the  Lakeside,  of  Cleveland ;  at  the 
Rochester  Hospital,  of  Rochester,  New  York ;  at  the  Harper 
Hospital,  of  Detroit,  Michigan ;  and  at  the  Washington  Uni- 
versity Medical  School,  of  St.  Louis,  Missouri. 

Reserve  nurses  who  went  to  the  border  were  almost  unani- 
mous in  their  expression  of  enjoyment  of  the  service.  The 
chief  nurses  were  R(\gulars  of  the  Army  Nurse  Corps.  An 
eight-hour  day  gave  the  nurses  ample  leisure.  The  work  in 
itself  was  light,  but  the  Reserves  found  unending  iiit(>rest  in  the 
routine  of  an  Army  General  Hospital.  ''The  Military  is  so 
different!"  they  wrote  ]\riss  Delano. 

At  Fort  Sam  Houston,  Sau  Antonio,  Texas,  the  base  lios- 
pital  of  ouc  tliousand  beds  was  always  full.  "The  patients  are 
mostly  typhoid  and  operative  cases  and  soldiers  suffering  from 
exhaustion  due  to  the  hot  sun,"  wrote  Ada  Hayton,  of  the 
Washington,  1).  C,  emergency  detachment,  to  !Miss  Delano. 
Klizabeth  K.  O'Keefe,  another  r(^serve  nurse,  wrote  of  tlu^ 
attitude  with  which  visitors  and  patients  regarded  the  Reserve: 


354  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  are  quite  amused  at  the  terms  applied  to  us  by  the 
soldiers  and  their  visitors  to  designate  us  from  the  Army 
nurses.  A  young  woman  visiting  one  of  the  wards,  stopped 
me  to  say  "I  want  to  ask  you  a  question,  and  if  you  are  not 
allowed  to  answer  it,  why  just  say  so,  won't  you?"  I  nodded. 
Imagine  my  surprise  when  she  drew  a  long  breath,  screwed 
up  her  courage  and  whispered  confidentially:  "You  Eed 
Cross  nurses  aren't  really  all  graduate  nurses,  now,  are  you?" 

A  patient  said  to  one  of  the  Eeserves,  as  she  was  giving 
him  a  bath:  "Do  you  find  this  work  very  hard  to  learn?" 
"What  do  you  mean  ?"  she  asked.  "Why,"  he  replied, 
"aren't  you  one  of  those  society  women  who  are  doing  this 
for  fun  and  the  good  of  humanity?" 

At  Fort  Bliss,  Texas,  the  Army  base  hospital  cared  for  an 
average  of  five  hundred  patients,  the  majority  of  them  accident 
cases.  Here  as  in  other  bases,  the  nurses  were  at  first  somewhat 
uncertain  as  to  their  exact  dutiefs.  "After  we  get  better 
acquainted  with  the  Army,"  wrote  Ellen  Thomas  to  Miss  Delano 
on  September  12,  1916,  "I  think  we  will  be  busier.  The  Corps 
men  have  done  all  the  work  until  June  of  this  year  and  it  is 
now  rather  difiicult  to  know  where  their  work  stops  and  ours 
begins." 

Overlooking  the  low  brush  and  cacti  of  the  ]\rexican  shore, 
directly  on  the  bank  of  the  Rio  Grande,  stood  the  Brownsville 
Hospital.  In  a  letter  written  September  28,  1916,  to  Miss 
Delano,  Edith  L.  Wood,  reserve  nurse,  described  their 
"quarters" : 

We  are  fairly  comfortably  situated  here  in  a  low  frame 
building,  just  boards,  with  two  of  us  in  each  room.  Every- 
thing is  screened  against  mosquitoes  and  we  sleep  under  nets. 
Though  the  heat  is  intense  during  the  day,  the  wind  off  the 
Gulf  of  Mexico,  twenty  miles  away,  makes  our  nights  very 
comfortable. 

All  the  buildings  are  of  the  same  construction.  The  wards 
accommodate  about  fifty  patients  each.  They  are  so  quickly 
and  easily  assembled  that  tliey  seem  to  spring  up  overnight 
like  mushrooms.  A  month  ago  there  was  nothing  here  but 
dust,  sandfleas,  cacti  and  heat.  Xow  it  looks  lilve  a  small 
village. 

No  special  disease  prevails.  We  have  something  of  every- 
thing, quite  a  bit  of  malaria,  and  a  fever  called  "dengue," 
which  the  merry  mosquitoes  give  us. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY   355 

One  of  the  five  camp  hospitals  which  the  Medical  Corps 
maintained  on  the  border  was  located  at  Llano  Grande,  Texas. 
A  reserve  nurse  who  had  seen  service  with  the  British  Expedi- 
tionary Forces  during  the  early  years  of  the  European  War 
wrote  of  the  work  at  Llano  Grande: 

Our  experiences  are  quite  different  from  those  in  an  Eng- 
lish camp  hospital  in  France.  We  were  much  disappointed 
at  first  to  find  our  liospital  so  poorly  equipped.  Camp  life 
in  France  was  so  very  fascinating  and  the  nurses  were 
treated  with  great  respect  by  the  British  Tommies.  .  .  . 

We  were  later  transferred  to  Fort  Sam  Houston,  where 
everything  is  well  systematized,  with  supplies  in  abundance. 
Here  we  found  our  boys  quite  as  appreciative  as  the  English 
and  French  and  so  full  of  fun ! 

The  camp  hospital  at  Douglas,  Arizona,  consisted  of  tents 
and  wooden  barracks.  "Xurses'  quarters,"  wrote  Harriet  Han- 
kins  to  Miss  Delano  on  August  27,  1916,  "are  separate  and 
are  built  of  wood,  with  excellent  floors,  plenty  of  screened 
windows,  running  water,  in  fact  are  wonderfully  comfortable. 
Each  inirsc  has  a  bed,  a  bureau  and  a  built-in  wardrobe."  Miss 
Delano's  reply  was  reminiscent  of  her  own  early  experiences 
in  the  West :  "Soon  after  my  graduation,"  she  wrote,  "and 
almost  my  first  work  was  in  the  mining  camp  at  Bisbec,  Arizona, 
not  far  from  your  present  assignment.  In  those  days,  the 
Apache  Indians  were  usually  on  the  war-path  and  we  never 
dared  stir  out  without  a  revolver.  I  imagine  things  are  more 
civilized  no\y." 

The  wooden  buildings  and  tents  at  Douglas,  which  were 
comfortable  enough  during  the  summer  of  10 10,  were  meager 
protection  against  the  raw  fall  rains  and  the  bitterly  cold 
winters.  The  nurses  stationed  there  then  experienced  more 
of  tli(>  rigors  of  open  camp  life,  for  a  letter  written  by  a  member 
of  a  Local  Committee  on  Bed  Cross  Xursing  Service  to  Miss 
Delano  gave  a  different  picture: 

Their  quarters  were  a  small  tent  shared  by  five  nurses. 
There  Mas  no  way  of  heating  it ;  the  weather  was  very  cold. 
The  nurses  in  the  shacks  had  four  blankets  and  a  stove. 
When  it  rained,  the  water  would  run  under  the  eots.  The 
flooring  of  the  tents  was  earth.  One  very  cold  night  the  wind 
blew  uj)  the  top  of  the  tent  and  the  nurses  gathered  \ij)  their 
hlaiikcts  and  clotlu's  and  si)eiit  the  rest  of  the  night  on  the 


356  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

floor  of  the  dining-room.  They  used  to  stand  on  their  cots  to 
dress  so  they  would  not  have  to  put  their  feet  on  the  cold 
earth.^^ 

This  first  field  service  with  the  Army  which  reserve  nurses 
experienced  on  the  Mexican  border  was  of  great  value  in 
acquainting  American  Red  Cross  nurses  with  military  disci- 
pline. In  her  letters  in  reply  to  complaints  which  the  nurses 
sent  to  National  Headquarters,  Miss  Delano  emphasized  again 
and  again  the  unofiicial  connection  which  she  held  to  Red  Cross 
nurses  after  they  had  once  been  assigned  to  the  Army  Nurse 
Corps.  The  Red  Cross  could  in  no  way  interfere  with  the 
discipline  of  the  Army  and  Navy  and  no  one  appreciated  this 
fact  more  than  did  Miss  Delano.  To  complaints,  her  answers 
were  almost  invariably  as  follows: 

In  the  first  place,  Red  Cross  nurses  when  assigned  to  duty 
in  a  military  hospital  become  temporarily  members  of  the 
Army  Nurse  Corps,  subject  to  all  rules  governing  that  service. 
It  is  impossible  for  me  to  take  up  this  situation  officially. 
Any  statement  should  be  sent  through  the  chief  nurse  and 
the  regular  military  channels. 

May  I  urge,  however,  that  you  keep  the  nurses  from  dis- 
cussing this  matter  and  ask  them  to  accept  without  question 
any  decision  of  the  chief  nurse?  Be  patient  for  a  little  while. 
You  know  how  deeply  interested  I  am  in  everything  concern- 
ing Eed  Cross  nurses,  but  when  it  comes  to  a  question  of 
military  authority,  I  am  quite  helpless.  I  can  only  count  on 
you  to  do  your  best  to  keep  things  running  smoothly. 

Though  only  a  minor  skirmish  in  comparison  with  the  titanic 
struggle  to  come,  the  ^lexican  border  service  of  257  reserve 
nurses  remained  an  illuminating  and,  for  most  of  them,  a 
worth-while  memory. 

Both  from  a  utilitarian  and  from  an  aesthetic  point  of  view, 
the  uniform  of  the  American  Army  nurse  on  active  duty  during 
the  European  War  diifcred  greatly  from  the  costumes  worn 
by  nurses  in  previous  wars.  Volunteer  and  professional  nurses 
of  the  Spanish-American  War  had  gone  to  their  posts  of  duty 
garbed  in  civilian  dross  or  in  the  uniform  of  their  school  of 
nursing.  The  appearance  of  the  Civil  War  nurses,  in  crinoline 
and  shawl,  is  familiar  to  students  of  American  military  history. 

"  Red  Cross  Archives.  X;itional   TTeadquarters,  Wash.,   D.   C. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  357 

The  description  of  the  "grey  tweed  wrapper,  worsted  jacket 
with  cap,  a  short  woolen  cloak  and  frightful  scarf  of  brown 
holland"  ^'*  of  Miss  Nightingale's  nurses  calls  up  an  awesome 
image. 

The  uniform  of  the  American  Army  nurse  was  both  useful 
and  attractive.  It  consisted  of  blue  norfolk  coat  with  the  bronze 
letters  U.  S.  and  the  caduceus  of  the  Army  Medical  Corps  with 
the  initials  of  the  Army  Nurse  Corps  superimposed  upon  them, 
the  short  blue  skirt  above  brown  shoes,  and  trim  sailor  hat,  or 
the  white,  one-piece  dress  worn  with  the  scarlet-lined  blue 
Red  Cross  cape  and  the  winged  white  cap.  A  war  correspondent 
once  asked  a  doughboy  from  a  Pennsylvania  mining  town,  who 
had  been  brought  into  an  American  base  hospital  with  a  shat- 
tered leg,  what  he  thought  of  the  reserve  Anny  nurses  there. 
''It  gives  me,"  replied  the  Pennsylvanian,  "bcneficient  shell- 
shock  to  look  at  'em !" 

The  distinctive  uniform  of  the  American  nurse  was,  however, 
a  gradual  evolution.  The  Manual  of  the  Medical  Department, 
190G,  the  edition  in  which  first  appear  regulations  regarding 
the  uniform  of  Army  nurses,  stated  that  "the  uniform  of  the 
Army  Nurse  Corps  shall  consist  of  a  waist  and  skirt  of  suitable 
white  material,  adjustable  white  cuffs,  bishop  collar  and  white 
cap,  according  to  patterns  and  specifications  in  the  office  of  the 
Surgeon  General."  ~^ 

At  the  first  meeting  of  the  National  Committee  on  Red  Cross 
Nursing  Service,  which  was  held  in  New  York  on  January  20, 
1910,  a  committee  which  consisted  of  Miss  Delano,  Miss  Board- 
man,  Miss  Nevins  and  ]\Iajor  Lynch  (then  in  charge  of  Red 
Cross  First  Aid  instruction)  was  appointed  to  draw  up  a  cir- 
cular of  information  regarding  enrollment  in  the  Nursing 
Service.  This  circular  was  printed  by  the  National  Head- 
quarters on  April  1,  1910,  and  contained  the  following  regula- 
tions : 

Uniform  and  Badge 
Unless  otherwise  authorized,  nurses  called  upon  for  service 
under  the  IJed  Cross  will  wear  plain  wliite  uniforms  with 
bishop  collars  and  caps,  the  ])atterns  of  which  will  he  provided 
by  the  American  l\ed  Cross  on  application  to  the  chairman  of 
the  National  Committee  on  b'ed  Cross  Nursing  Service.  .  .  . 
[Address  follows.  | 

"  "'^fcniorics  of  the  Crini(>a."  Sister  ^fary  Alovsius,  p.  17. 
*> Manual  of  the  .Medical  Department,  l!tO(i,  p.  31. 


358  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  the  time  of  appointment  each  nurse  will  receive  a  badge 
with  her  name  and  the  number  of  the  badge  engraved  on  the 
back  and  a  record  of  the  same  will  be  kept  in  the  National 
office  of  the  lied  Cross  in  Washington. 

Under  the  Act  of  Congress  incorporating  the  Eed  Cross, 
this  badge  cannot  be  legally  worn  by  any  other  than  the 
person  to  whom  it  is  issued,  and  is  owned  by  the  American 
Eed  Cross.  It  should  be  worn  on  the  front  left-hand  side  of 
the  collar.  In  case  of  withdrawal  from  enrollment,  the 
badge  and  certificate  of  appointment  must  be  returned  to  the 
chairman  of  the  Xational  Committee  on  Eed  Cross  Nursing 
Service.  .  .  .   [Address  follows.] 

In  the  event  of  war,  the  Eed  Cross  will  provide  all  nurses 
called  upon  for  active  service  with  blue  capes — bearing  the 
insignia  of  the  Eed  Cross. 

Miss  Delano,  with  a  rare  sense  of  the  dramatic  and  an  ap- 
preciation of  the  power  of  sentiment,  designed  the  cape  referred 
to,  which  has  since  become  perhaps  the  most  distinguishing 
mark  of  the  American  nurse  on  active  service  during  the 
European  War.  It  was  a  circular  garment  of  medium  length, 
made  of  navy  blue  flannel  and  lined  with  scarlet,  and  it  was 
usually  worn  flung  back  over  the  left  shoulder.  On  the  left 
side  was  a  Red  Cross  and  by  reason  of  the  high  ideal  of  conduct 
which  Miss  Delano  set  for  the  enrolled  nurses  and  the  vivid 
appearance  of  the  garment  itself,  nurses  grew  to  honor  and 
love  the  cape  and  to  wear  it  with  soldierly  pride.  It  symbolized 
for  them  the  romance  and  the  sacrifice  of  war  nursing. 

The  use  of  the  Ked  Cross  brassard  was  outlined  in  the  original 
Treaty  of  Geneva  and  was  defined  in  the  revised  Treaty  of 
Geneva,  which  was  signed  July  6,  1900: 

Article  20.  The  personnel  protected  in  virtue  of  the  first 
paragraph  of  article  nine  and  articles  ten  and  eleven,  will 
wear  attached  to  the  left  arm  a  brassard  bearing  a  red  cross 
on  a  wliite  ground,  which  will  be  issued  and  stamped  by 
competent  military  authority,  and  accompanied  by  a  certificate 
of  ideiitity  in  tlie  case  of  persons  attaclied  to  the  sanitary 
service  of  armies  who  do  not  have  military  uniform. 

In  the  Kogulations  concerning  the  American  Red  Cross 
Xursing  ScTvicc,  as  adopted  by  the  Executive  Committee  De- 
cember 20,  1012,  which  superseded  the  Circular  of  Informa- 
tion issued  April  1,  1010,  the  following  sentence  was  incor- 


Outdoor  miifonn  of  an  Aincricaii  \lvd  Cross  inirsc.  Tliis  uniform  was 
also  \vt)rn  during;  tin'  Kuropcan  War  liy  all  nifniin'rs  t)f  ihe  Army  Nurse 
Corps,  with    the   insiiinia   of  that    Corps. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  359 

porated  into  the  section  defining  the  Red  Cross  nurse's  uniform : 
"Nurses  are  not  at  any  time  allowed  to  wear  Red  Cross  bras- 
sards without  special  authority  from  the  American  National 
Red  Cross." 

The  next  mention  of  uniforms  is  to  be  found  in  the  Minutes 
of  a  meeting  of  the  National  Committee  on  Red  Cross  Nursing 
Service,  held  December  9,  1913,  at  which  "it  was  decided  to 
adopt  a  nurse's  uniform  for  the  Red  Cross  Nursing  Service  if 
a  suitable  material  could  be  found.  .  .  .  Miss  Delano  was  asked 
to  get  information  about  gray  cotton  crepe  material,  the  cost, 
width,  etc.  and  to  send  this  information  to  all  Local  Com- 
mittees." 

At  a  meeting  held  at  the  Planters'  Hotel,  St.  Louis,  Mo., 
on  April  24,  1914,  the  National  Committee  again  discussed 
the  question  of  equipment  and  uniforms  and  "it  was  suggested 
that  patterns  be  distributed  by  Local  Committees  and  that  Local 
Committees  be  ready  to  help  watli  details  in  any  way  in  order 
to  relieve  the  Washington  office.  Samples  of  the  uniform 
material  were  distributed,  so  that  the  nurses  might  begin  their 
preparation.  .  .  .  The  meeting  was  crowded  with  earnest, 
dignified,  enthusiastic  nurses  ready  to  prepare  for  w^ork  which 
might  come."  ~*^  When  within  four  months,  the  first  call  for 
the  mobilization  of  Red  Cross  nurses  on  a  large  scale  sounded 
in  the  organization  of  the  !Mercy  Ship  Expedition  of  1914,  the 
uniform  was  thus  practically  agreed  upon.  The  nurses  of  the 
Mercy  Ship,  as  it  has  been  explained  in  Chapter  IV,  wore  the 
gray  cotton  crepe  uniform,  with  white  collars  and  cuifs,  a  navy 
blue  ulster  and  the  Red  Cross  cap  and  cape.  National  Head- 
quarters allowed  them  to  wear  also  the  Red  Cross  brassard. 

In  the  meantime,  certain  small  changes  had  occurred  in  the 
uniform  of  the  Army  Nurse  Corps.  In  1912,  the  Surgeon 
General  had  authorized  nurses  on  duty  in  the  Philippines  and 
in  the  Hawaiian  Department  to  wear  low  collars.  In  191.'>, 
he  issued  regulations  changing  the  "waist  and  skirt"  to  a  one- 
piece  dress  similar  to  that  worn  by  Army  nurses  during  the 
European  War.  When  Army  nurses  were  ordered  with  the 
Punitive  Expedition  to  Vera  Cruz,  Mexico,  the  question  of 
laundry  arose  and  Miss  ^Mc Isaac,  then  superintendent  of  the 
Army  Nurse  Corps,  decided  that  gray  crepe  uniforms  would 
solve  the  problem.  One  of  the  nurses  ordered  there  was  Sayres 
L.  ^lilliken,  who  later  became  assistant  superintendent  of  the 

^'' Miiuitos  of  the  National  Coniniitti'e,  Vol.  I,  pp.  83-S5. 


360   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Army  l^urse  Corps;  she  wrote,  "I  supplied  myself  at  my  own 
expense  with  gray  crepe  uniforms,  made  exactly  like  our  white 
ones,  touched  off  by  white  collars,  cuffs  and  aprons.  This  uni- 
form, however,  was  so  unbecoming  and  washed  so  poorly  that 
the  nurses  wore  them  only  a  few  weeks  and  then,  by  special 
permission  from  Miss  Mclsaac,  went  back  to  the  white  uniform." 

As  for  the  Red  Cross  nurses,  the  gray  uniform  for  ward  duty 
and  the  white  uniform  for  dress  wear,  which  were  both  worn 
with  the  Red  Cross  cape,  remained  the  only  distinctive  uni- 
form of  the  Red  Cross  nurse  until  1916.  Then  i^ational  Head- 
quarters undertook  the  organization  of  base  hospitals  and  other 
units  for  the  Army  and  the  question  of  uniforms  arose  again. 
Miss  Delano  was  strongly  in  favor  of  using  the  gray  uniform, 
because  she  thought  it  was  highly  practicable,  but  the  Surgeon 
General's  office  did  not  share  this  opinion  and  Miss  Delano 
was  forced  to  coincide  with  their  decision  to  continue  the  use 
of  the  white  uniform,  since  nurses  of  base  hospitals  and  other 
units,  when  turned  over  to  the  War  Department,  became  mem- 
bers of  the  Army  ISTurse  Corps  and  as  such  would  be  required 
to  wear  the  uniform  of  that  Corps. 

On  June  20,  1917,  Miss  Delano  telegraphed  Miss  Koyes, 
then  chief  nurse  of  Base  Hospital  No.  1,  that  "to  save  pur- 
chase of  additional  uniforms,  it  has  been  decided  that  members 
of  base  hospital  units  may  wear  the  uniform  of  their  school, 
except  caps.  Brassards,  capes  and  caps  will  be  supplied  with- 
out cost  by  the  Red  Cross  upon  assignment  to  duty."  Formal 
authorization  of  the  change  from  the  gray  to  the  white  uniform 
was  requested  by  Miss  Delano  in  a  letter  written  July  IT,  1910, 
and  addressed  to  General  IMurray,  then  acting-chairman  of  the 
Central  Committee ;  this  letter  was  returned  approved  by  Gen- 
eral Murray,  Colonel  Kean  and  Mr.  Bicknell  under  the  same 
date. 

While  the  American  ^Nurses'  Association  was  holding  its 
Twentieth  Annual  Convention  in  Philadelphia,  ISTational  Head- 
quarters wired  ]\liss  N'oyes  April  29,  1917,  of  the  impending 
mobilization  of  six  base  hospitals  for  service  with  the  British 
Expeditionary  Forces.  ]\Iiss  I^oyes  returned  post-haste  to  Wash- 
ington to  look  into  the  question  of  an  outdoor  uniform.  The 
Army  had  not  standardized  an  outdoor  uniform  for  its  Xurse 
Corps,  but  the  Surgeon  General's  office  concurred  in  the  opinion 
of  the  Red  Cross  War  Council  that  nurses  of  the  units  assigned 
to   the   British    Expeditionary   Forces   should   bo    distinctively 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  361 

garbed  as  United  States  military  personnel.  Miss  Noyes  tele- 
graphed Miss  Van  Blarconi,  then  the  representative  of  the 
Nursing  Service  in  the  Atlantic  Division  headquarters,  New 
York  City,  to  call  together  a  committee  composed  of  the  chief 
nurses  of  base  hospital  units  organized  in  the  larger  civilian 
hospitals  of  New  York  City,  to  consider  the  selection  of  a  suit- 
able outdoor  uniform.  ]\liss  Maxwell,  of  the  Presbyterian 
Hospital,  and  the  other  members  of  this  group  had  sample 
garments  and  prices  ready  to  submit  to  the  committee  by  the 
time  ]\Iiss  Noycs  got  over  to  New  York.  The  committee  selected 
an  outdoor  uniform  consisting  of  a  one-piece  blue  serge  dress 
of  distinctive  military  cut,  a  heavy  blue  ulster  and  a  blue  velour 
hat  of  campaign  style  and  !Miss  Noyes  immediately  placed  or- 
ders for  a  large  inimber  of  these  uniforms  with  a  New  York 
manufacturing  clothier. 

Base  Hospital  No.  4  (Lakeside)  arrived  at  the  port  of  em- 
barkation, however,  before  the  uniforms  were  ready.  The  nurses 
of  the  unit  sailed  in  civilian  clothes,  with  only  such  accessories 
as  capes,  blankets,  caps  and  other  articles  then  in  Red  Cross 
supply  rooms,  but  their  measurements  were  taken  so  that  the 
next  unit  scheduled  to  sail  a  few  days  later  might  take  over 
their  equipment.  The  Peter  Bent  Brigham  Unit  (Base  Hos- 
pital No.  5)  also  embarked  without  uniforms.  The  third 
column  to  be  ordered  out  was  the  Presbyterian  Unit,  and  the 
nursing  staff  not  only  went  completely  uniformed  but  took  with 
them  equipment  for  the  Lakeside  and  Peter  Bent  Brigham 
units.  So  hurried  had  been  the  embarkation  of  these  three 
pioneer  columns  that  many  of  the  nurses,  especially  those  who 
lived  at  a  considerable  distance  from  New  York  City,  went  di- 
rectly from  the  trains  to  the  docks  and  ]\[iss  Noycs,  ]\[iss  Van 
Blarcom,  members  of  the  New  York  County  Chapter  and  the 
tailors'  assistants,  followed  them  in  taxis  and  private  limousines 
piled  high  with  boxes  of  dresses,  hats  and  other  articles. 

The  New  York  County  Chapter,  which  had  equipped  the 
nurses  of  the  Mercy  Ship,  acted  as  agents  for  National  Head- 
quarters. Mrs.  John  S,  Thatcher,  Frances  Anderson  and  Mary 
Magoun  Lrown  volniiteered  their  s(n'vi(*es.  The  Chapter  as- 
sumed the  immediate  responsibility  for  the  payment  of  tli(> 
clothiers'  bills  until  National  Hc^uhjuarters  could  secure  a  de- 
cision from  the  War  l){^partnn'nt  that  the  Government  would 
furnish  nurses'  e(pii])nient,  or  until  the  Ked  Cross  War  Council 
(■(»ul(l  appropriate  funds  for  tliis  purpose. 


362   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Kojes  notified  the  manufacturing  tailor  on  June  1, 
1917,  to  prepare  to  equip  Base  Hospital  No.  17,  of  Detroit,  and 
four  additional  Army  base  hospitals.  Her  letter  also  gave  an 
important  change  in  procedure ;  Miss  Thompson  had  consented 
to  issue  nurses'  sailing  orders  several  days  in  advance  so  that 
the  nurses  might  have  opportunity  to  be  measured  and  fitted 
for  uniforms  after  their  arrival  in  New  York.  This  was  a 
great  advantage  over  the  former  system  by  which  the  chief 
nurse  had  endeavored  to  secure  and  forward  the  nurses'  meas- 
urements to  the  manufacturing  tailor  before  the  unit  had  left 
its  home  city. 

The  ]\Iinutes  of  the  National  Committee  on  Red  Cross  Nurs- 
ing Service,  which  met  June  16  at  National  Headquarters, 
recorded  this  action : 

The  chairman  stated  that  in  order  to  equip  Red  Cross 
nurses  assigned  to  duty  as  expeditiously  as  possible,  it  was 
necessary  to  appoint  a  special  committee  on  uniforms,  who 
would  be  responsible  for  selecting  the  uniform  and  issuing 
the  equipment.  As  the  time  was  limited,  the  chairman 
appointed  this  committee  as  follows :  ]\[rs.  John  S.  Thatcher, 
chairman;  Miss  Charlotte  Stillman;  ]\Iiss  Frances  Anderson; 
Miss  Anna  C.  Maxwell ;  ]\riss  ]\rary  M.  Brown. 

The  chairman  asked  that  this  action  be  ratified,  as  this 
Committee  should  be  appointed  by  the  National  Committee 
rather  than  by  the  chairman.  [Motion  to  this  effect  made 
and  carried.] 

]\rrs.  Thatcher  immediately  began  to  look  about  for  a  suitable 
place  in  which  to  establish  headquarters  for  the  equipment  di- 
vision. She  visited  the  newly-established  headquarters  of  the 
Atlantic  Division,  then  located  at  No.  One,  Madison  Avenue, 
and  conferred  with  ]\Iiss  Van  Blarcom,  who  as  the  representa- 
tive of  the  Nursing  Service  in  the  Atlantic  Division  was  an  ex- 
ofhcio  mendjcr  of  the  Committee  on  Equipment.  It  was  then 
decided  to  locate  tlie  equipment  work  there.  Miss  Van  Blarcom 
at  the  same  time  secured  the  services  of  !Maude  G.  bloody  to 
assist  ]Mrs.  Thatclier  in  the  business  details  of  the  work.  ''^frs. 
]\roody  has  been  recommended  to  us,"  wrote  ]\rrs.  Thatcher  to 
]\Iiss  Noyes  on  June  14,  "as  an  unusually  capable  woman,  of 
good  executive  mind,  tactful  and  of  pleasing  personality." 

]\rrs.  ^foody  MTote  of  the  expansion  of  the  early  division  of 
nurses'  equijmient: 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  3G3 

In  June,  1917,  the  Atlantic  Division  took  oflices  on  the 
thirty-second  floor  of  the  ^letropolitan  Tower,  and  the  Bureau 
of  Xurses'  Equipment  was  soon  in  actual  operation  there.  On 
the  twenty-eighth  floor  we  had  a  little  storeroom  where  our 
stock  of  all  articles,  excepting  the  ulsters  and  dresses,  was 
kept.  We  carried  tan  gloves,  aprons,  etc.,  for  the  nurses  to 
purchase  at  cost. 

Army  Base  Hospital  No.  15  (Roosevelt  Hospital)  was  the 
first  unit  equipped  hy  the  hureau.  As  we  had  no  assemhly 
room  to  which  the  nurses  could  come,  we  conveyed  the  equip- 
ment to  them  at  the  hospital.  To  transport  those  many 
packages,  Mr.  John  Nieser  of  the  Manhattan  Storage  and 
Warehouse  Company  offered  us  the  use  of  his  vans.  Ellis 
Island  in  the  meantime  had  hecn  designated  as  the  nurses' 
mohilization  station,  and  it  was  not  unusual  to  see  the  vans 
backing  up  at  the  ferry-house  discharging  their  cargo  of 
hundreds  of  boxes  of  all  sizes,  to  be  transferred  to  the  waiting 
baggage  trucks  which  husky  corpsmen  hustled  aboard  the 
ferry.  Perilous  indeed  were  those  trips  from  Island  Xo.  One 
to  Island  Xo.  Three,  when  we  dashed  from  one  truck  to 
another  trying  to  keep  that  precious  equipment  from  falling 
under  the  wheels !  Once  safe  in  the  large  many-windowed 
assembly  room  of  Island  Xo.  Three,  the  hold-alls  and  boxes 
were  arranged  alphabetically  and  given  out  to  the  long  line  of 
waiting  nurses,  who  signed  their  cards,  had  their  hats  fitted 
and  went  off  laden  with  burdens  almost  too  great  to  carry. 

Following  the  establishment  of  the  Bnreau  of  iSTurses'  Equip- 
ment at  Atlantic  Division  headquarters,  the  next  step  in  build- 
ing up  efficient  organization  was  the  transfer  of  all  responsibility 
for  e(piipping  nurses  from  the  Xew  York  County  Chapter  to 
Division  and  Xational  Headquarters.  !Mr.  Leo  Arnstein  was 
then  Director  of  Military  Kelief  of  the  Xew  York  County 
Chapter  and  he  was  loath  to  surrender  responsibility  which  he 
felt  belonged  in  his  department.  jMiss  Noyes  announced  this 
transfer  in  a  letter  written  June  15  to  jMr.  Harvey  D.  Gibson, 
then  chairman  of  the  Executive  Committee  of  i\w  Xew  York 
County  Chapter.  "This  arrangement,"  connuented  ]\Iiss  Xoyes, 
"will  centralize  all  nursing  affairs  at  a  given  point,  an  arrange- 
ment never  before  possible  owing  to  the  fact  that  we  have  not 
had  a  direct  representative  in  New  York  until  ^liss  Yan  Llar- 
com's  assignment  there.  I  cannot  l)egin  to  tell  you,''  slu>  con- 
cluded, "how  grateful  we  are  to  the  Chapter  for  the  services 
which  they  have  rendered  in  the  past.  We  must  have  been  a 
verv  great  trial  at  times." 


364   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  cost  of  equipping  these  first  units  of  nurses  was  increas- 
ing by  leaps  and  bounds  and  iNTational  Headquarters  had  already 
foreseen  that  financial  responsibility  for  this  work  would  far 
exceed  the  resources  of  the  !New  York  County  Chapter  and 
would  soon  become  a  matter  for  decision  between  the  War  De- 
partment and  National  Headquarters.  Miss  ISToyes  submitted 
a  memorandum  to  the  War  Council  in  July,  1917,  which  recom- 
mended outdoor  uniforms  for  nurses  at  an  estimated  cost  of 
$35,580  per  thousand  nurses.  "The  War  Council,"  stated 
the  minute  covering  a  meeting  of  the  War  Council  held  July  4, 
1917,  "decided  to  refer  the  matter  to  Colonel  Kean,  with  in- 
structions to  present  it  formally  to  the  War  Department.  As 
the  nurses,  on  going  into  service,  come  immediately  under  the 
War  Department,  it  would  seem  that  the  War  Department 
should  decide  upon  the  uniform  and  pay  for  same." 

At  a  meeting  held  July  10,  Mr.  Wadsworth  again  brought 
up  the  question  of  nurses'  equipment.  Mr.  Davison  stated  that 
it  was  the  policy  of  the  War  Council  that  Red  Cross  nurses 
assigned  to  service  in  Allied  countries  should  always  be  uni- 
formed. The  War  Council  accordingly  voted  that  the  "Chapters 
sending  Red  Cross  units  shall  provide  uniforms  for  nurses, 
that  nurses  whom  Chapters  are  unable  to  uniform  shall  be 
uniformed  by  Xational  Headquarters,  and  Mr.  Wadsworth  is 
directed  to  make  arrangements  accordingly  with  each  Chapter." 

Early  in  July,  Colonel  Kean  was  placed  in  charge  of  the 
Ambulance  Service  of  the  American  Expeditionary  Forces 
and  was  sent  immediately  to  Erance.  John  D.  Ryan,  of  'New 
York  City,  was  elected  Director  General  of  Military  Relief. 
Colonel  Winford  Smith,  late  superintendent  of  Jolms  Hopkins 
Hospital,  was  detailed  on  July  18,  1917,  to  represent  the  Sur- 
geon General  at  Xational  Headquarters  and  on  August  31, 
he  was  elected  Director  General  of  Military  Relief,  following 
the  appointment  of  Mr.  Ryan  to  membership  on  tlie  War 
Council. 

While  the  War  Department,  Xational  Red  Cross  Headquar- 
ters and  Local  Red  Cross  Chapters  were  considering  who  should 
pay  the  bills  for  nurses'  equipment,  the  fortunes  of  war  took  a 
hand  in  the  matter.  The  S.  S.  Saratoga,  on  which  Base  Hos- 
pital Xo.  8  had  ciiibarkod  for  Erance,  collided  on  July  30  in 
Xew  York  Harbor  with  the  Ciijj  of  Panama.  The  nurses  had 
gone  to  their  staterooms,  had  removed  their  heavy  uniforms  on 
account  of  the  intense  heat  and   in  kimonos  and  niffht  ffowns 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  365 

were  resting  or  sleeping.  Following  the  collision,  all  hands 
were  ordered  immediately  to  the  life-boats.  The  nurses  caught 
up  capes  and  coats,  flung  them  over  their  scant  garments  and, 
with  admirable  savoir  fairc,  took  their  places  in  the  lx)ats,  aban- 
doning not  only  their  uniforms  but  other  articles  of  clothing 
and  their  money  as  well. 

The  Saratoga  sank  eighteen  minutes  after  she  had  been  struck. 
The  life-boats  containing  the  nurses  were  rowed  some  distance 
from  the  accident  and  held  there  for  further  orders.  The  men 
of  the  rescuing  crews  spread  their  coats  over  the  shoulders 
of  the  nurses  to  protect  them  from  the  glare  of  the  July  sun. 
After  a  tedious  cielay,  the  nurses  were  rowed  to  Ellis  Island. 
The  interned  Germans  and  agents  detained  on  the  Island 
crowded  to  the  wire  fences  to  watch  the  American  women  come 
ashore.  Wet  and  insufficiently  clad,  with  their  arms  and  faces 
burned  and  their  nerves  taut  from  a  harrowing  experience, 
the  nurses,  when  they  heard  the  jeering  words  of  the  enemy, 
conducted  themselves^  according  to  the  best  traditions  of  Ameri- 
can womanhood.  Up  went  their  heads  and  they  marched 
proudly  to  their  dormitories  with  laughter  on  their  lips. 

On  August  1,  Miss  Van  Blarcom  telephoned  Miss  Xoyes 
that  the  nurses  of  the  unit  were  stationed  on  Ellis  Island  with- 
out adequate  clothing.  ^liss  Koyes  went  immediately  to  the 
offices  of  the  War  Council ;  the  members  were  holding  one  of 
their  customary  morning  meetings.  ]\[iss  Xoyes  presented 
the  facts  of  the  case  and  asked  the  War  Council  to  appropriate 
funds  sufficient  to  ree(;[uip  the  nurses, — an  appropriation  which 
she  estimated  roughly  at  $14,000  or  $200  per  nurse.  A 
member  of  the  War  Council  suggested  that  !^Iiss  ISToyes  call 
the  War  Department  to  ascertain  whether  any  Government  fund 
was  available  for  such  purposes. 

!Miss  Xoyes  was  referred  to  Colonel  Birmingham,  then 
Acting  Surgeon  General  of  the  Army.  He  stated  that  the 
only  possible  way  in  which  the  War  Department  could  reequip 
these  nurses  was  by  special  Act  of  Congress ! 

]\lis3  Xoyes  again  went  to  the  War  Council  and  within  two 
hours  after  the  time  when  ^liss  Van  Blarcom  had  first  tele- 
phoned, Xational  lI('ad(|uart(M's  had  appropriated  $14. (>()(» 
for  the  complete  rc('(inipment  of  the  destitute  nurses  at  Ellis 
Island  and  Miss  Xoyes  had  instructed  ]Miss  Van  Blarcom  by 
telephone  to  begin  the  selection  and  purchase  of  the  various 
articles. 


366   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

When  the  nursing  representatives  of  the  Atlantic  Division 
went  over  to  Ellis  Island  to  confer  with  the  nurses  regarding 
their  needs,  they  found  a  chaotic  condition.  Mrs.  Moody  de- 
scribed it: 

Ellis  Island  showed  us  "stay-at-homes"  to  a  small  degree  at 
least  what  war  meant.  Island  No.  3  looked  like  a  refugee 
camp  in  a  war-ridden  country.  Spread  over  the  lawn  Avere 
water-soaked  army  lockers,  stained  and  muddy  clothing,  here 
a  white  uniform  streaked  with  the  red  of  a  cape  which  had 
lain  near  it,  there  a  pathetic-looking  shoe  ruined  beyond  re- 
pair. Too  much  cannot  be  said  in  praise  of  the  courage 
displayed  by  these  women  who  after  a  harrowing  ordeal  during 
those  torrid  summer  days  met  us  with  a  joke  and  a  smile. 

In  the  meantime,  the  six  American  base  hospitals  assigned 
to  the  British  Expeditionary  Forces  had  arrived  in  France. 
Xone  of  the  British  General  Hospitals  where  they  were  detailed 
for  duty  were  equipped  with  laundries  and  the  nurses  soon 
discovered  that  they  would  have  to  wash  out  the  white  uni- 
forms after  they  came  off  duty  if  they  were  to  present  a  neat 
and  professional  appearance.  Members  of  several  base  hos- 
pital units  even  joinec^  groups  of  French  women  who  were 
pounding  their  clothes  clean  in  convenient  brooks !  "The  white 
uniform  is  most  unpractical,"  wrote  Miss  Stimson  at  Rouen, 
France,  to  Miss  Xoyes.  "The  night  nurses  put  them  on  with 
aprons  and  caps,  then  don  raincoats  and  rubbers,  carry  an 
umbrella  in  one  hand  and  a  lantern  in  the  other  and  start  on 
their  rounds  from  one  tent  or  hut  to  another.  By  morning 
you  should  see  the  caps  of  those  wdio  have  not  brought  rubber 
hats,  after  they  have  ducked  in  and  out  of  the  tents,  and  their 
white  skirts,  after  they  have  gone  splashing  through  the  sticky 
yellow  mud !" 

Dr.  Richard  H.  Harte,  director  of  Base  Hospital  Xo.  10, 
which  was  stationed  with  the  British  at  Etretat,  stated  in  a 
letter  written  to  Miss  Delano  on  June  17  that  in  addition  to 
the  impracticality  of  the  white  uniform,  the  nurses'  equipment 
was  sadly  inadequate.  "Each  nurse,"  he  declared,  "should  have 
a  good  pair  of  rubber  boots,  a  mackintosh,  and  a  rubber  hat, 
preferably  the  ordinary  sou'wester  worn  by  sailors.  Anything 
less  will  be  blown  off  by  the  terrific  winds  prevailing  here. 
It  is  also  terrifically  cold." 

Colonel  Robert  E.  Xoble  transmitted  Aujnist  9  to  the  Di- 


fA 


a 


K 


P.O 


RELATION  OF  NURSLNG  SERVICE  TO  THE  ARMY  3G7 

rector  General  of  Military  Relief  a  copy  of  the  following  regu- 
lation : 

Referring  to  information  received  in  this  ofTicc  that  the 
white  uniform  now  used  by  members  of  the  Army  Xursc 
Corps  is  not  practicable  for  service  in  Europe,  1  am  directed 
by  the  Surgeon  General  to  inform  you  that  the  use  of  a 
medium  gray  uniform  and  white  apron  has  been  authorized  to 
be  made  in  accordance  with  specifications  enclosed  herewith. 
This  information  is  furnished  so  that  reserve  nurses  going  to 
Europe  may  have  their  uniforms  made  to  conform  with  these 
instructions.  This  authority  has  been  forwarded  this  date  to 
the  commanding  olhcers  of  the  United  States  Army  hospitals 
now  in  Europe. 

A  certain  amount  of  well-behaved  humor  appeared  in  the  Min- 
utes of  the  War  Council  for  August  8,  1917: 

The  chairman  stated  that  in  preparing  Eed  Cross  base 
hospitals  for  service  abroad,  the  white  uniform  for  nurses  was 
insisted  upon  l)y  the  ^ledical  Department  of  the  Army;  that  it 
now  appeared  that  owing  to  lack  of  laundry  facilities,  white 
uniforms  are  impracticable  in  France  and  the  Surgeon  Gen- 
eral's ottice  has  decided  to  adopt  the  gray  uniform ;  that  there 
are  sixty-five  nurses  iu  each  of  the  six  base  hospitals  with  the 
British  forces  in  France,  all  equipped  with  white  uniforms 
purchased  at  the  expense  of  the  individual  nurses,  the  same 
being  true  of  the  nurses  in  the  six  hospitals  with  the  American 
trooj)s  in  France;  and  that  no  doubt  many  nurses  of  the 
hospitals  not  yet  called  have  supplied  themselves  with  the 
white  uniforms  formerly  required. 

The  chairman  further  stated  that  these  nurses  could  not  be 
expected  to  go  to  additional  expense  in  buying  more  uniforms  ; 
that  the  estimated  cost  of  the  gray  uniform  being  about  $1<) 
it  would  require  about  $1040  to  equip  the  sixty-five  nurses 
of  each  unit;  and  on  the  recommendation  of  the  Department 
of  ^Military  Relief,  he  advised  this  appropriation.  Wliereupon 
it  was,  on  motion 

Voted  :  That  from  the  Red  Cross  War  Fund  the  sum  of 
$14,000  be  and  is  hereby  aijipropriated  for  furiiishing  iiray 
uniforms  to  the  nurses  of  the  twelve  base  hospitals  serving 
with  the  British  and  American  troops  in  France. 

]\riss  Xoyos  then  sot  about  furnishing  tlu^  gray  dross  to  nil 
nurses  of  base  hos])itals  and  other  units,  both  in  this  country 
and  overseas,  tlnvuiuh  the  Xcw  York  Bureau  (^f  Xurs(\s'  E<piip- 
ment  and  throua-h  the  office  located  in  Paris  of  the  chief  nurse. 


368   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

American  Red  Cross  in  France.  The  difficulties  of  sending 
the  gray  uniform  to  all  members  of  base  hospital  units  then 
with  the  British  and  American  Expeditionary  Forces  was 
greatly  heightened  by  submarine  warfare.  Twice  the  enemy 
sunk  merchant  steamers  in  which  gray  uniforms  had  been  sent. 
The  following  quaint  description  of  the  Soeurs  Americaines, 
appearing  in  a  French  newspaper,  recorded  their  iinal  meta- 
morphosis : 

The  American  nurses,  notres  dames  grises,  we  see  leaving 
the  hotel  where  they  are  lodged  and  note  that  almost  every  one 
is  tall  and  stately  in  stature,  wearing  short  gray  skirts  and 
laced  brown  boots.  The  waist  has  a  large  white  collar  and  the 
white  apron  is  worn  in  a  crosswise  fashion  in  the  back.  The 
head  is  coquettishly  crowned  with  a  little  white  cap,  which 
rests  softly  on  the  knot  of  hair,  dressed  in  a  style  much  like 
the  arrangement  used  by  our  own  women.  ]\[any  of  them 
wear  large  round  eye-glasses,  which  make  them  retain  their 
youthful  appearance  and  look  as  if  they  were  school  girls 
going  to  their  class. 

The  question  of  tlie  insignia  to  be  worn  by  reserve  members 
of  the  Army  Nurse  Corps,  the  cause  of  patient  and  prolonged 
discussion  between  the  Surgeon  General's  office  and  the  Red 
Cross,  had  first  arisen  in  August,  1016,  following  the  assign- 
ment of  Red  Cross  nurses  to  United  States  base  hospitals  on 
the  Mexican  border.  One  year  later,  on  August  '27,  1917,  the 
War  Department  made  its  first  move  toward  the  militarization 
of  Red  Cross  nurses ;  Acting  Surgeon  General  Birmingham 
then  wrote  to  the  Director  General  of  Military  Relief: 

In  reply  to  your  letter  of  August  18,  relative  to  the  wearing 
of  the  brassard  by  the  reserve  nurses,  Army  Xurse  Corps, 
unless  the  use  of  the  brassard  by  members  of  the  regular 
Military  Establishment  is  indicated,  its  use  by  members  of  the 
Reserve  is  not  considered  necessary.  Also,  the  wisdom  of 
wearing  the  brassard  in  Europe  has  been  qnestioiu^d  on  ac- 
count of  its  conspicuousncss. 

It  is  requested  that  liereafter  the  outdoor  uniform  of  tlie 
reserve  nurses,  wliicli  is  furnished  by  the  l\ed  Cross,  be  made 
to  conform  in  all  respects  to  that  which  lias  been  ap])rovcd  by 
the  Secretary  of  War  for  the  Army  Xnrse  Corps  (diagram  and 
information  eiu-losed).  Owing  to  the  confusion  wbicli  has 
been  created  in  the  minds  of  tbe  nurses  by  tlie  use  of  the 
Red  Cross  on  the  cap  and  cape,  the  authority  given  in  letter 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  369 

from  this  office  dated  August  18,  1916,  for  the  use  of  this 
emblem  on  these  articles  is  hereby  revoked. 

With  this  letter,  specifications  were  sent  for  an  outdoor  uni- 
form, Army  Nurse  Corps,  consisting  of  blue  serge  norfolk  coat 
and  skirt.  This  uniform  replaced  the  Red  Cross  serge  dress 
and  was  to  be  worn  by  all  Army  nurses  in  foreign  service.  At 
the  same  time,  the  Surgeon  General's  office  adopted  a  new 
white  uniform  of  distinctive  type,  to  be  worn  by  nurses  while 
on  indoor  duty  in  military  hospitals  in  the  United  States  and 
wherever  practicable  in  foreign  service ;  the  use  of  the  gray 
uniform  was  retained,  however,  for  general  ward  duty  over- 
seas. 

For  nurses  volunteering  for  foreign  service,  this  ruling  made 
necessary  the  purchase  of  entirely  new  indoor  and  outdoor 
uniforms.  For  the  Red  Cross  Nursing  Service,  these  regula- 
tions meant  the  banishment  of  the  cap  and  cape,  beloved  symbols 
of  an  ideal  of  pure  altruism.  Following  protracted  conferences 
between  the  Red  Cross  and  the  Surgeon  General's  office.  Colonel 
Birmingham  wrote  September  11,  1917,  to  the  Director  General 
of  ]\[ilitary  Relief:  "Referring  to  letter  from  this  office  dated 
August  27,  relative  to  the  uniform  of  the  reserve  nurses,  Army 
Nurse  Corps,  upon  further  consideration  the  use  of  the  Red 
Cross  cap  is  hereby  authorized.  The  nurses  may  also  continue 
to  use  the  present  cape,  but  without  the  Red  Cross  upon  it." 

Banishment  of  the  well-loved  Red  Cross  badge  was  con- 
firmed on  October  10,  1917,  in  a  letter  addressed  by  ]\riss 
Thompson  to  ]\Iiss  Delano:  "In  regard  to  the  ruling  of  the  Red 
Cross  pin,  it  was  decided  some  time  ago  that  the  Red  Cross 
on  the  cap  was  to  be  used  to  indicate  that  the  wearer  was  an 
enrolled  Red  Cross  nurse  and  that  the  pin  was  not  to  be  worn 
with  the  uniforms." 

Following  the  authorization  of  the  new  indoor  and  outdoor 
uniform  for  members  of  the  Army  Nurse  Corps  assigned  to 
foreigii  service,  the  Red  Cross  felt  even  more  strongly  than 
they  had  at  the  time  of  the  embarkation  of  the  Red  Cross  base 
hospitals,  that  the  Governmcnit  should  furnish  uniforms  and 
equipment  for  nurses  assigned  to  military  service.  The  Di- 
rector General  of  ^Military  Relief  brought  this  (pu^stion  to  the 
attention  of  the  Surgeon  General  on  August  *30  ;  he  in  turn  re- 
ferred it  to  the  S(H'retarv  of  War,  but  Mr.  Baker  did  not  share 
the  opinion  of  the  Red  Cross.     (\)lonel  George   E.  Bushnell, 


370   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Acting  Surgeon  General,  Medical  Corps,  wrote  on  September 
26,  1917,  to  the  Director  General  of  Military  Relief,  National 
Headquarters : 

Eelative  to  the  clothing  allowance  for  nurses  ordered  to 
Europe,  this  question  was  taken  up  with  the  Secretary  of  War 
and  a  letter  sent  from  this  office  recommending  an  appropria- 
tion be  made  for  this  purpose. 

The  recommendation  was  returned  disapproved,  with  the 
remark  that  it  was  not  the  policy  of  the  War  Department  to 
make  clothing  allowance  during  war. 

In  view  of  the  expense  of  this  equipment,  which  in  the 
opinion  of  this  office  is  too  heavy  to  be  borne  by  the  indi- 
vidual nurse,  it  is  requested  that  the  War  Council  of  the 
Americaii  Red  Cross  make  some  provision  for  the  nurses 
ordered  to  Europe. 

It  is  also  requested  that  the  allowance  be  made  to  members 
of  the  permament  Corps  as  well  as  to  the  reserve  nurses  who 
may  be  ordered  abroad  for  duty. 

The  War  Council  was  at  this  time  considering  the  equipment 
and  uniforms  of  members  of  the  Red  Cross  foreign  commissions. 
On  September  20  thoy  had  appropriated  an  allowance  not  to 
exceed  two  hundred  dollars  ($200)  for  each  member  of  such 
units.  Following  the  receipt  of  Colonel  Bushnell's  letter,  they 
authorized  the  Nursing  Service  to  recommend  a  list  of  equip- 
ment necessary  for  all  nurses  assigned  to  foreign  service. 
Chosen  with  care  and  economy  as  befitted  the  expenditure  of 
Red  Cross  funds,  yet  with  full  insight  to  future  needs,  and 
given  with  the  same  generosity  of  spirit  which  had  led  !Miss 
Delano  to  buy  and  pack  boxes  of  comfort  for  her  ''lambs"  of 
the  [Mercy  Ship,  the  list  of  articles  as  finally  worked  out  by 
]\Iiss  Xoyes  comprised:  hat;  outdoor  uniform;  coat  or  heavy 
ulster;  cape;  gloves;  shirtwaists,  two,  white;  shirtwaists,  colored 
flannel  (two  if  suit  is  used)  ;  gray  wash  uniforms,  four;  aprons, 
six  or  eight ;  cuffs  and  collars,  six  sets ;  caps ;  sleeve  links,  2 
pairs ;  caduceii,  one  set ;  U.  S.  letters,  one  set ;  black  woolen 
tights,  2  pairs  ;  steamer  blanket,  one  ;  sleeping  bag,  one  ;  sweater, 
gray,  one ;  poncho,  or  rubber  sheet,  one ;  blanket  roll,  one ;  rain- 
coat, one;  rain  hat,  one;  rubber  boots,  one  pair;  moccasins,  one 
pair;  shoes-";  stockings"^;  heavy  underwear'-";  pajamas.-" 

^  Shoes,  stockinirs.  heavy  iui(h>r\vear  and  pajamas  were  not  in  tlio  first 
list  of  e(juipnieiit  furnished  by  tlie  Ked  Cross  witliont  cost.  These  articles 
had  to  be  supplied  bv  the  nurses  themselves  (A.  R.  C.  702,  December  31, 
19171.     Later.  howevt^T,  tliev  were  all  added    ( Septeml)er   IS.   1918). 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  371 

The  Bureau  of  Equipment  at  the  Atlantic  Division  now  set- 
tled down  to  the  long  pull  ahead.  Mrs.  Thatcher  had  resigned  in 
September,  1917,  the  chairmanship  of  the  Uniform  Committee. 
The  efficiency  of  the  organization  of  the  bureau  luider  J\Iiss 
Van  Blarcom  and  Mrs.  Moody  had  relieved  Mrs.  Thatcher  and 
^liss  Brown,  the  two  most  active  members  of  the  committee, 
of  the  heavy  responsibilities  which  they  had  bravely  borne 
since  May,  1917.  Mrs.  Thatcher  wished  to  turn  her  enthu- 
siasm and  energy  to  more  active  expression  than  the  chairman- 
ship of  an  Advisory  Committee  on  Uniforms  permitted.  Xurses 
will  long  remember  w'ith  gratitude,  however,  her  courteous, 
faithful  assistance  during  the  strenuous  spring  and  summer 
when  the  base  hospitals  were  embarking  for  France. 

Miss  Xoycs  wrote  on  October  16  to  Mr.  Harvey  D.  Gibson, 
by  this  time  general  manager  at  National  Headquarters  of 
the  Red  Cross,-'**  requesting  the  first  of  the  several  extensive 
appropriations  made  from  time  to  time  by  the  War  Council 
to  sustain  the  Bureau  of  Equipment :  'T  should  be  grateful," 
she  stated,  ''if  the  War  Council  would  vote  an  appropriation 
sufficiently  large  to  enable  us  to  carry  an  adequate  supply  in 
our  store-room,  viz.,  five  hundred  sets  at  two  hundred  dollars  a 
set.  We  find  it  exceedingly  difficult  to  secure  sleeping  bags, 
steamer  rugs,  rubber  boots  and  slickers  on  short  notice.  We 
now  have  four  units  waiting  in  New  York  for  sleeping  bags. 
All  their  other  equipment  was  given  by  Local  Chapters  before 
they  left  home.  To  avoid  such  situations  as  this,  it  seems  highly 
important  that  an  adequate  supply  be  kept  on  hand."  The  War 
Council  appropriated  on  October  30,  1917,  one  hundred  thou- 
sand dollars  "for  the  purchase  of  equipment  for  xVrmy  and  Navy 
nurses,  it  being  understood  that  in  the  case  of  hospital  units, 
etc.,  which  would  ordinarily  be  outfitted  by  Chapters,  the  amount 
so  spent  shall  be  collected  from  the  Chapter  wherever  possible." 
Tliis  attempt  to  have  the  local  Chapter  include  nurses'  equip- 
ment in  its  appropriation  for  base  hospitals  was  never  satis- 
factorily worked  out  and  was  later  completely  given  up. 

In  order  that  Red  Cross  public  health  nurses  working  in  the 
sanitary  zones  which  the  United  States  Public  Health  Service 
had  drawn  about  the  cantonments,  might  be  properly  uniformed, 

^^  Tlic  oflic'c  of  fU'iicral   MaTiajror,  National    Headquarters.  AmerieaTi   Ixed 
Cross,  was  created  liy  the  W'nv  Coiiiicil  on  July  11,    1917.  and  Mr.   Harvey 
D.    (Jihson,    late   cliairTnan    of   tlu'    Kxecutive   Committee   of   tlie   New    York 
C'nunty   Chapter,   \Aas  appointed    to   tiie   ])osition. 


372   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  War  Council  also  appropriated  funds  to  furnish  uniforms 
and  equipment  to  them.  The  following  statement  appears  in 
the  pamphlet,  Information  for  jSTurses  Called  Upon  for  Active 
Service  (A.  R.  C.  702,  December  31,  1917)  : 

Xurses  assigned  to  sanitary  zones  under  the  Eed  Cross  for 
public  health  or  other  forms  of  service  will  be  provided,  free 
of  cost,  with  the  following  articles:  one  or  more  outdoor  uni- 
forms of  dark  blue  serge ;  detached  waist  with  high  collar ;  one 
blue  ulster;  one  cape,  dark  blue,  lined  with  red,  insignia  on 
left  side ;  one  hat,  dark  blue  velour ;  caps ;  three  gray  uniforms. 
These  articles  will  be  issued  upon  the  arrival  of  the  nurse  at 
her  destination. 

When  the  Army  was  mobilizing  its  Psychiatric  and  Ortho- 
pedic Base  Hospital  Units,  No.  117  and  No.  114,  Miss  Thomp- 
son in  a  letter  addressed  on  March  4,  1918,  to  Miss  Delano, 
asked  if  the  Red  Cross  would  supply  equipment  to  the  civilian 
employees  and  the  reconstruction  aides  of  these  units.  National 
Headquarters  ultimately  shouldered  the  responsibility  for  equip- 
ping, through  the  Bureau  of  Nurses'  Equipment  in  New  York 
City,  all  nurses,  dietitians,  clerical  workers  and  aides  for  all 
types  of  foreign  service  in  the  Army,  the  Navy  and  American 
Red  Cross  commissions. 

On  January  15,  1918,  Caroline  Van  Blarcom,  who  had  rep- 
resented the  Nursing  Service  at  the  Atlantic  Division  since  the 
early  summer  of  1917,  resigned  and  Florence  Mcrriam  Johnson 
w^as  appointed  as  director  of  the  Department  of  Nursing  there. 
The  Bureau  of  Nurses'  Equipment  w'as  maintained  as  a  branch 
office  of  National  Headquarters,  but  Miss  Johnson,  representing 
Miss  Delano  and  Miss  Noyes,  had  general  supervision  of  its 
activities. 

Now  in  March,  1918,  began  that  long  procession  of  women, 
which  day  after  day  passed  in  ever-increasing  numbers  through 
the  port  of  embarkation  for  Europe.  Mrs.  Moody  described 
the  expansion  that  had  been  going  on  of  the  Bureau  of  Equip- 
ment; 

In  October,  1917,  the  Atlantic  Division  moved  across  the 
street  from  its  former  home  and  our  new  storeroom  seemed 
enormous.  Only  too  soon  did  we  outgrow  it  and  packing  cases 
lined  the  corridors.  The  overseas  units  began  mobilizing 
thick  and   fast   and  we   found   it   necessary  to   secure  more 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  373 

trucks.  The  Peter  Doelf^or  Brewing  Company  came  to  our 
rescue  and  many  were  the  smiles  of  amusement  from  by- 
standers when  those  bri<ijht  yellow  brewery  wagons  would 
begin  to  disgorge  their  IJed  Cross  boxes. 

It  became  necessary  now  to  revise  our  previous  method  of 
issuing  equipment,  both  l)ecause  of  the  many  articles  and  also 
because  of  the  great  numbers  of  personnel  sailing  each  week. 

When  a  base  hos])ital  or  unit  arrived  in  New  York,  Miss 
Johnson  appointed  a  day  when  that  group  should  report  to 
her  at  the  Atlantic  Division  headquarters.  After  her  graphic 
and  inspiring  talk,  the  nurses  came  to  the  Bureau  of  Nurses' 
Equipment  (we  had  moved  to  the  New  York  Branch  of 
National  Headquarters  at  2"-^2  Fourth  Avenue  and  now  had 
half  an  ofhce  floor,  none  too  much  space).  Here  cards  were 
distributed  to  each  nurse.  On  these  cards  were  listed  all  the 
articles  to  be  issued  and  the  nurse,  after  filling  in  her  name, 
unit  and  badge  number,  designated  on  the  card  the  sizes  of  the 
garments  which  she  needed.  Perhaps  here  she  first  appreci- 
ated the  hardships  of  war.  She  was  destined  to  have  her 
uniform  hats  tried  on  without  being  allowed  even  a  peep  at  a 
mirror. 

To  every  member  of  the  group  we  gave  an  order  for  shoes 
and  rubber  boots  and  the  next  day  the  unit  went  en  masse  to 
the  one  tailor  to  be  fitted  for  suits  and  coats,  then  to  the  other 
for  gray  service  uniforms  and  raincoats  and  then  on  to  the 
shoe-shop.  When  the  necessary  alterations  had  been  com- 
pleted, these  boxes  were  picked  up  by  our  truck.  It  next 
collected  holdalls,  carefully  packed  at  the  Bureau  of  Equip- 
ment. These  holdaiis  containing  the  rest  of  the  nurse's 
articles,  were  tagged  with  her  name.  By  this  system  both 
boxes  and  holdalls  were  delivered  to  the  various  hotels  where 
nurses  were  staying. 

So  crowded  did  our  quarters  become  that  we  found  it  neces- 
sary to  have  the  units  assemble  for  equipment  at  various  halls 
loaned  to  us  liy  dilferent  organizations  in  the  vicinity  of 
]\[adison  Square.  In  the  meantime,  our  stock  had  increased  to 
carry  numberless  articles  not  included  in  the  c(pii])nient 
issued,  but  which  the  nurses  needed  and  which  we  sold  to 
them  at  cost.  All  through  that  summer  of  1!)18.  the  line  of 
nurses  waiting  outside  the  Bureau  of  h]qui])nient  seemed  end- 
less, stretching  from  the  elevators  down  the  long  liall  to  the 
counter  of  the  stoiXToom.  nurses,  dozens,  hundriMls  of  them, 
dietitians,  sfcrctaries.  reconstruction  aides  and  other  worki-rs 
sent  us  by  the  Ked  Cross  lUireau  of  Personnel.  One  of  our 
workers,  Marv  M.  r>rown,  establislied  a  charming  cusloni  of 
sendiniT  a  box  of  flowers  to  each  unit,  so  that  e\erv  worker 


374   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

going  overseas  could  have  at  least  one  blossom  as  a  tiny  per- 
sonal message,  a  word  of  greeting  and  a  Godspeed. 

For  nurses  serving  directly  under  Red  Cross  commissions 
to  the  Allied  Powers,  Miss  Delano  and  Miss  Noyes  had  adopted 
the  same  uniform  as  that  of  the  Army  and  Navy  Nurse  Corps. 
Of  the  equipment  of  these  nurses,  Mrs.  Moody  wrote: 

Before  they  reported  to  the  bureau  for  equipment,  Miss 
Johnson  saw  individually  every  nurse  sailing  under  the  Eed 
Cross  flag.  How  interesting  it  all  was  for  us  when  a  unit  was 
being  sent  to  so  romantic  a  country  as  Palestine  or  Porto 
Pico  and  how  eagerly  we  revised  and  planned  their  equipment 
to  meet  these  particular  services  ! 

A  nurse  on  active  duty  with  Red  Cross  foreign  commissions 
wore  upon  her  hat  band,  upon  her  shoulders  and  upon  the  lapels 
of  her  coat,  the  symbol  of  the  organization.  Without  consulta- 
tion with  the  Army  Nurse  Corps  or  with  National  Headquar- 
ters, the  Red  Cross  Commission  for  France  adopted  in  1918, 
upon  the  authority  of  the  Chief  Surgeon,  American  Expedition- 
ary Forces,  a  distinctive  emblem  made  by  placing  an  enameled 
Red  Cross  upon  the  caduceus  of  the  Medical  Corps.  The  bronze 
letters  "U.  S."  were  worn  with  this  device  and  insured  for  the 
wearer  recognition  and  protection  in  the  foreign  theaters  of 
war  where  the  American  Armies  were  operating. 

Previous  to  August,  1918,  nurses  serving  in  Army  hospitals 
in  the  United  States  had  been  permitted  to  wear  the  uniform 
of  their  school,  provided  it  was  not  extreme  in  cut,  when  on 
duty,  but  when  off  duty,  they  had  worn  civilian  clothes.  Fol- 
lowing an  increase  of  salary  for  the  members  of  the  Army  and 
Navy  Nurse  Corps  from  fifty  dollars  ($50)  to  sixty  dollars 
($G0)  a  month  for  domestic  service  and  from  sixty  dollars 
($60)  to  seventy  dollars  ($70)  for  overseas  duty,  the  Surgeon 
General  authorized  that  all  members  of  the  Army  Nurse 
Corps  should  wear  the  outdoor  uniform.  On  July  23,  1918, 
Colonel  Winford  H.  Smith  transmitted  to  the  general  manager 
of  the  American  Red  Cross,  for  the  attention  of  the  Nursing 
Service,  the  following  regulations  issued  by  the  Surgeon 
General,  regarding  uniforms : 

Xurses  who  enter  the  service  at  this  time  are  permitted  to 
wear  such  wliite  uniforms  as  tliey  may  liave.  provided  that 
thcv  are  not  extreme  in  anv  wav.     AMicn  it  is  necessary  to 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  375 

replace  these  uniforms,  they  must  then  be  obtained  in  accord- 
ance with  specifications,  with  this  exception :  The  uniforms  of 
all  reserve  nurses  must  conform  in  all  respects  to  that  of  the 
Army  Nurse  Corps. 

The  use  of  the  outdoor  uniform  is  considered  advisable  and 
it  is  further  directed  that  all  members  of  the  Army  Nurse 
Corps,  including  the  reserve  nurses,  purchase  the  suit,  hat 
and  necessary  waists  within  three  months  after  they  enter  the 
service.  This  uniform  will  be  worn  at  all  times  when  not  on 
duty. 

The  overcoat  should  be  purchased  if  and  when  the  weather 
requires  its  use. 

On  August  15,  1918,  the  following  ruling  was  sent  by  the 
Surgeon  General  of  the  Army  to  the  commanding  officers  of 
all  military  hospitals  in  the  United  States : 

1.  I  am  directed  by  the  Surgeon  General  to  inclose  here- 
with specifications,  cap  pattern  and  other  data  concerning  the 
indoor  and  outdoor  uniform  of  the  Army  Nurse  Corps.  Nurses 
who  enter  the  service  at  this  time  may  be  permitted  to  wear 
such  white  uniforms  as  they  may  have,  for  a  period  of  six 
months  after  their  entry  into  the  service,  provided  they  are 
not  extreme  in  any  way.  When  it  is  necessary  to  replace  these 
uniforms,  those  made  according  to  specifications  must  then  be 
obtained.  With  this  exception,  the  uniforms  of  all  nurses, 
including/  the  cap,  must  conform  in  all  respects  to  that  of  the 
Army  Nurse  Corps. 

As  the  use  of  the  outdoor  uniform  is  considered  advisable  at 
this  time,  it  is  further  directed  that  all  members  of  tlie  Army 
Nurse  Corps  now  in  the  service,  purchase  the  suit,  hat  and 
necessary  waists  within  three  months,  and  all  those  who  enter 
the  service  hereafter  purchase  those  garments  within  three 
months  after  their  entry  into  the  service.  Before  ordering 
these  garments,  however,  those  nurses  who  are  physically  or 
otherwise  unfit  for  the  service  should  be  informed  to  that 
effect  in  order  to  avoid  placing  them  under  any  unnecessary 
expense  in  the  purchase  of  these  garments.  This  uniform  is  to 
be  worn  at  all  times  when  not  on  duty  in  the  hospital.  The 
overcoat  shovdd  be  purchased  if  the  weather  requires  its  use. 

2.  The  American  Red  Cross  will  omit  from  the  equipment 
of  nurses  ordoi'ed  overseas  the  alcove  mentioned  articles,  but 
will  continue  to  issue  to  these  nurses  exceptional  equipment. 
Four  months,  however,  will  be  allowed  for  adjustment.  The 
Ked  Cross  has  also  signified  its  willingness  to  issue  to  all 
members  of  the  Army  Nurse  Corps  on  duty  at  honie  or  abroad 


376   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  dark  blue  cape  lined  with  red,  the  use  of  which  is  hereby 
authorized.  The  insignia  of  the  Army  N'urse  Corps  and  the 
letters  "U.  S."  may  be  worn  on  the  collar  of  the  cape.  The 
chief  nurse  should  notify  the  director  of  Nursing  Service, 
Atlantic  Division,  44  East  23d  Street,  New  York,  in  regard 
to  the  number  of  capes  needed  by  the  nurses  at  the  hospital 
from  time  to  time,  giving  their  names.  If  sweaters  are  re- 
quired for  additional  warmth,  gray  ones  should  be  obtained. 

Several  months  before,  when  the  question  of  the  Red  Cross 
cape  had  been  under  lively  discussion,  the  Surgeon  General's 
office  had  contended  that  this  garment  when  worn  by  reserve 
nurses  of  the  Army  x^urse  Corps  tended  to  differentiate  them 
from  the  Regulars  and  thus  to  break  down  the  esprit  de  corps 
of  that  body.  When  National  Headquarters  offered  to  furnish 
the  cape,  without  the  Red  Cross  upon  the  left  side,  to  all 
members  of  the  Army  Xurse  Corps,  its  offer  was  immediately 
accepted  and  the  traditional  blue  garment  with  its  scarlet  lining 
was  issued  to  all  nurses  assigned  to  foreign  and  home  service. 

The  ruling  of  August  15,  1918,  which  removed  the  Red  Cross 
from  the  reserve  nurse's  cap,  w^as  made  in  the  interest  of  dis- 
cipline, but  evoked  regret  among  the  nurses.  The  following 
letter  is  typical  of  many  received  at  Red  Cross  Headquarters; 

I  am  so  glad  we  are  to  wear  outdoor  uniforms.  We've 
always  hoped  that  it  would  be  so,  but  we  who  came  into  the 
service  through  the  Ked  Cross  are  disappointed  and  hurt  to  be 
deprived  of  all  possible  sign  of  the  fact.  It  is  not  that  we 
have  any  objection  to  the  new  cap;  it  is  nice  and  neither  gives 
nor  takes  anything  from  us  as  nurses.  It  is  simply  that  we 
loved  to  be  known  as  Ked  Cross  nurses.  We  volunteered  for 
that  organization  and  would  have  liked  to  retain  somethixjg  to 
show  our  association  with  it. 

A  question  of  international  Red  Cross  policy  presented  itself 
in  reference  to  the  habit  and  insignia  of  Catholic  Sisterhoods. 
One  of  the  specific  duties  of  the  National  and  Local  Committees 
on  Red  Cross  Xursing  Service,  was  "to  keep  on  file  lists  of 
Sisterhoods  and  other  orders  and  women  volunteers,  available 
for  Red  Cross  relief  work  involving  the  care  of  the  sick  and 
wounded,  either  in  time  of  war  or  calamity." 

During  the  summer  of  1!»18,  the  Red  Cross  was  especially 
anxious  to  utilize  the  services  of  Sisters  of  Charity,  who  had 
alwavs  held  nn  hrmorcd  place  in  military  nursing.     They,  too, 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  377 

earnestly  desired  to  serve.  Miss  Delano  wrote  on  June  10  to 
Miss  Thompson  stating  that  some  time  before,  she  had  secured 
a  list  of  the  Catholic  Sisterhoods  in  the  United  States,  but 
had  never  written  to  them  asking  for  the  probable  mimber 
available  for  service  in  tim(>  of  need.  "I  shall  be  very  glad/' 
concluded  ^Miss  Delano,  "if  you  will  tell  me  if  you  think  it 
desirable  for  me  to  send  out  a  letter  requesting  this  informa- 
tion."    ^liss  Thompson  replied  on  June  18: 

Eelativc  to  the  use  of  Koman  Catholic  Sisters  in  Army  hos- 
pitals, I  have  referred  this  matter  to  Colonel  Smith  of  the 
Hospital  Division  with  the  result  it  is  believed  advisable  to 
place  on  file  the  resources  of  the  Sisterlioods  of  the  couiitrv-, 
provided  tiiey  are  graduate  nurses  and  eligible  for  enrolhnent. 
Should  it  be  necessary  to  use  these  Sisters,  your  office  will  be 
so  informed  at  once. 

It  is  believed  there  might  be  some  trouble  in  regard  to 
accommodations  for  the  Sisters.  Many  of  the  nurses  are 
obliged  to  live  in  dormitories.  Furthermore,  in  many  hospi- 
tals, tlie  nurses  are  obliged  to  wear  a  large  white  apron  over 
their  uniform,  as  well  as  a  mask  over  their  faces.  This  would 
be  difficult  for  the  Sisters.  They  are  obliged  in  all  cases,  I 
understand,  to  wear  the  habit  of  their  order. 

After  some  slight  misunderstanding,  Colonel  Smith  wrote  on 
July  3,  1918,  to  !Miss  Delano  that  "indeed  there  is  every  reason 
why  enrollment  should  be  made  of  all  such  nursing  Sisters 
who  are  graduate  nurses.  It  should  be  understood,  however," 
he  added,  "that  if  ordered  to  active  duty,  they  will  come  in  on 
exactly  the  same  terms  and  under  the  same  regulations  as  to 
conduct,  uniform  regulations,  etc.,  as  all  other  members  of  the 
Army  Xurse  CVu-ps." 

The  matter  stood  thus  until  the  mobilization  of  Base  Hos- 
pital Xo.  102  which  had  among  its  nurses  ten  Daughters  of 
Charity.  A  special  ruling  was  then  made  which  permitted  these 
Sisters  to  wear  the  garl)  of  their  order  but  the  Surgeon  (Jen- 
eral's  ofiwo  again  stated  that  if  members  of  the  Catholic  Sister- 
hoods wer(>  assigned  in  the  future  to  the  Army  Xurse  Corps,  it 
would  be  with  the  understanding  that  they  wear  the  regulation 
uniform  of  that  Corjjs.-"' 

This  decision  promis(>d  to  inundate  \lcd  Cross  H(\ul(piarters 

="  Sec  iiitcr-dnicc  letter  written  July  !».  I'.US.  hy  Miss  Delano  to  -Miss 
Ken-,  director  of  the  Uiireau  of  I'-iirollinent. 


378   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

with  criticism  from  the  Catholic  Press  similar  to  that  of  1917, 
before  Sisterhoods  clearly  understood  that  the  Surgeon  Gen- 
eral's office  and  not  the  Red  Cross  Nursing  Service  was  debar- 
ring them  from  active  duty.  Colonel  Smith,  however,  wrote 
JMiss  Delano  on  August  3,  1918: 

deferring  to  your  recent  letter  relative  to  the  admission  of 
Catholic  Sisters  to  the  Army  Nurse  Corps,  I  am  directed  by 
the  Surgeon  General  to  inform  you  that  a  recommendation 
lias  been  made  to  the  Secretary  of  War  to  the  effect  that 
chould  the  Sisters  be  admitted  to  the  Corps,  as  graduate 
nurses,  they  must,  when  on  duty  in  the  wards,  wear  the  uni- 
form of  the  Corps,  with  the  exception  of  the  head  covering, 
which  may  be  a  modification  of  the  nurse's  cap  which  will 
satisfactorily  meet  the  situation. 

It  is  further  recommended  that,  when  on  the  street,  they  be 
permitted  to  wear  the  habit  of  their  order.  Until  a  reply  has 
been  received  from  the  War  Department,  a  definite  decision 
cannot  be  recommended.  You  will,  however,  be  advised  as 
soon  as  the  reply  has  been  received 

Service  in  the  Army  Nurse  Corps  was  made  possible  for  tLe 
Sisterhoods  on  September  10,  1018,  in  the  following  order 
transmitted  by  Colonel  Smith  to  Miss  Delano : 

Your  attention  is  invited  to  tlie  recent  decision  of  the 
Adjutant  General  as  quoted  below. 

1.  Orders  are  being  issued  directing  that  Army  Nurses  who 
are  members  of  Catholic  orders,  whose  vows  require  the  wear- 
ing of  a  distinctive  garb,  are  authorized  to  wear  the  garb  of 
their  order  while  traveling  on  land  in  this  country  without 
troops  and  while  traveling  on  transports. 

2.  You  will  prescribe  a  suitable  device  to  be  worn  with  this 
religious  garb,  wbich  will  clearly  mark  the  wearer  as  a  member 
of  the  Army  Nurse  Corps. 

3.  You  will  also  prescribe  a  cap  to  cover  the  entire  head 
which  shall  be  worn  by  them  while  on  duty. 

The  device  referred  to  in  paragraph  2  will  be  the  regular 
insignia  of  the  Army  Nurse  Corps:  the  letters  T'.S.  and  the 
badge  or  caduceus  with  the  gilt  letters  "A.N.C."  superim- 
posed. This  insignia  will  be  worn  on  the  Sisterhood  garb  at 
such  times  when  it  is  approved  that  they  be  worn.  Tlie  Super- 
intendent of  the  Army  Nurse  Corps  will  prescribe  the  cap  to 
be  worn. 

By  direction  of  the  Surgeon  General. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  379 

On  Anj^ist  1,  1918,  the  Surgeon  General  of  the  Army  re- 
quested the  American  Red  Cross  to  make  preparations  through 
its  !New  York  I^ureau  of  Equipment  to  fit  out  completely  one 
thousand  nurses  a  week  for  overseas  duty.  The  staff  of  the 
Bureau  of  Xurse§'  Equipment  then  numbered  twenty-two  per- 
sons. "Airs,  lloody  and  all  her  assistants,"  wrote  ^liss  Johnson 
to  !Miss  Xoyes  on  August  8,  ^'are  as  anxious  as  we  are  to  have 
the  nurses  ready,  even  though  the  Army  may  not  be  able  to  send 
them  over  as  rapidly  as  we  can  equip  them."  Men  and  women 
who  were  doing  war  work  in  Washington  and  in  New  York 
during  the  oppressive  heat  of  August  and  September,  1918,  will 
appreciate  in  part  the  intense  strain  under  which  all  branches 
of  the  Government  were  laboring. 

While  the  Xew  York  Bureau  was  stru^ling  with  the  problem 
of  equipment,  the  Chief  Surgeon  of  the  American  Expedition- 
ary Forces  notified  the  American  Red  Cross  Commission  in 
Paris  that  the  Xurses'  Equipment  Shop  there  would  probably  be 
called  upon  during  the  early  autumn  to  replenish  at  cost  worn- 
out  articles  of  clothing  for  ten  thousand  nurses  and  to  furnish 
extraordinary  equipment  for  nurses  assigned  to  the  zone  of 
advance,  especially  those  of  forty  mobile  hospitals. 

The  early  base  hospital  units  assigned  to  the  British  forces 
had  sailed  before  the  American  Red  Cross  made  its  generous 
appropriation  for  equipping  nurses.  The  London  Chapter  had 
sent  them  gray  uniforms,  aprons,  boots,  rain  hats,  rubber  sheets, 
woolen  knickerbockers  and  other  necessities.  Great  need  ex- 
isted, however,  in  France  for  some  central  agency  through  which 
inequalities  in  the  initial  supply  of  and  replenishment  of  worn- 
out  articles  could  be  adjusted. 

Through  the  efforts  of  ^fartha  ]\L  Russell,  first  chief  nurse 
of  the  American  Red  (^ross  Commission  to  France,  more  ade- 
quate winter  clothing  and  shoes  had  been  forwarded  to  nurses 
in  bases  of  the  British  and  American  forces  during  that  first 
bleak  winter  of  active  service.  But  the  Red  Cross  had  never 
undertaken  to  relniuip  nurses  free  of  charge,  nor  was  it  then 
doing  so.  In  a  letter  written  Xovember  IG,  1917,  to  !^[iss 
Russell,  Aliss  Xoyes  stated  _tliat  the  Red  Cross  "could  hardly 
undertake  the  replacement  of  worn-out  articles  in  any  wholesale 
way.  As  nurses  are  on  a  salary,"  she  pointed  out,  "there  would 
seem  to  be  no  reason  why  they  should  not  provide  such  ad- 
ditionnl  articles  as  are  required  in  the  same  way  that  they 
would  do  were  thev  in  this  countrv," 


380  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

An  interesting  comment  on  the  equipment  question  was  con- 
tained in  a  letter  written  June  13,  1918,  by  Miss  Russell  to 
Miss  Delano: 

The  equipment  now  given  the  nurses  is  generous  and  suit- 
able. I  think  there  is  some  feeling  among  the  nurses  that  they 
should  be  clothed  all  the  time  that  they  are  in  the  service  and 
1  think  that  Major  Perkins  tliought  1  was  a  stingy  person 
because  I  stood  by  the  statement  we  had  when  I  first  went  to 
France,  that  the  Ked  Cross  furnished  initial  equipment  and 
then  the  imrse  attended  to  her  own  needs  afterwards.  I 
believe  that  there  is  a  certain  pauperizing  effect  in  giving 
equipment.  The  British  give  each  nurse  a  sum  of  money  and 
require  her  to  present  herself  with  the  regulation  outfit  for 
inspection.  Now  our  way  results  in  greater  uniformity,  but  I 
have  heard  so  much  complaint  that  1  would  like  to  see  each 
nurse  made  to  feel  more  personal  responsibility  about  her 
equipment. 

As  to  salaries,  in  the  general  emotional  upset  due  to  war 
conditions,  it  is  highly  difficult  to  adjust  money  matters. 
The  service  the  nurses  can  render  is  priceless;  yet  1  believe 
that  every  one  who  goes  into  the  service  really  believes  in  her 
heart,  as  one  of  them  said  to  a  man  who  asked  her  if  she  was 
to  get  a  bigger  salary  than  she  had  been  receiving  in  civilian 
work :  "It  is  my  privilege  to  serve  my  country  and  the 
allowance  is  sufficient  for  all  my  needs."  I  really  believe  that 
the  nurses'  pay  of  sixty  dollars  a  month  and  maintenance  is 
not  so  great  a  reduction  in  income  for  tlie  private  duty  nurse, 
if  taken  in  the  average,  unless  of  course  she  is  depending  on 
"gifts"  as  too  many  do.  For  a  school  nurse  there  must  be  a 
decided  advantage  in  the  sixty  dollars  salary  and  live  hundred 
francs  maintenance.  However,  the  nurses  complain  now  and 
then  to  the  men  in  Paris,  men  whose  wealth  makes  them  think 
the  sixty  dollars  is  barely  enough  for  an  evening's  entertain- 
ment, and  they  pity  the  nurses  and  encourage  them  to  ask  for 
further  gifts  in  the  way  of  equipment.  ...     - 

If  the  licd  Cross  could  make  possible  a  systematic,  intelli- 
gent development  of  esprit  de  corps  in  the  American  military 
nursing  service,  it  would  be  a  far  greater  gift  to  the  nurses 
themselves  and  to  the  profession  than  any  amount  of  fur 
trench  coats  and  })ianos  for  recreation  houses.  .  .  . 

Early  in  the  spring  of  1918,  the  Red  Cross  Commission  for 
France  felt  that  the  establishment  of  an  equipment  center  in 
Paris  where  nurses  could  secure  articles  of  clothing  iind  equip- 
ment to  replenish  worn-out  ones  at  cost,  or  nearly  cost,  would 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  381 

be  a  ^'cat  convenience.  The  War  Department  and  National 
llea(]([uarters  concurred  in  this  opinion  and  a  Nurses'  Equip- 
ment Shop  was  developed  and  maintained  at  the  Paris  Head- 
quarters, under  the  cliief  nurse  of  the  American  lied  Cross 
in  France.  A  report  of  these  activities  will  be  found  in  a  sub- 
sequent chapter. 

Tiie  iirst  definite  movement  of  the  Government  to  furnish 
equipment  for  Army  nurses  was  made  in  August,  1918.  Gen- 
eral Pershing  then  cabled  to  the  War  Department,  re(]uesting 
that  forty-three  thousand  pairs  of  shoes,  rubbers,  raincoats, 
sununer  underwear,  norfolk  jacket  suits  in  regulation  sizes, 
coats,  hats,  etc.,  should  be  sent  to  France  at  Government  expense, 
a  recpiest  which  argued  towards  the  possibility  that  the  Ameri- 
can Expeditionary  Forces  contemplated  the  establishment 
under  their  own  direction  of  a  department  for  the  replenish- 
ment of  nurses'  equipment  and  uniforms. 

At  the  crisis  of  the  nursing  situation,  when  the  War  Depart- 
ment was  calling  for  fifty  thousand  graduate  and  student  nurses 
by  July,  1919,  Colonel  Winford  Smith,  Medical  Corps,  took 
up  again  in  a  letter  written  November  6,  1918,  to  the  General 
Manager  of  the  American  lied  Cross,  the  old  question  as  to 
whether  the  Ked  Cross  or  the  Army  should  pay  for  nurses' 
equipment : 

I  am  directed  by  the  Surgeon  General  to  acknowledge  the 
receipt  of  a  recent  letter  from  the  general  manager  of  the 
Eed  Cross,  stating  that  inasmuch  as  the  War  Council  of  the 
Eed  Cross  understands  that  the  Government  is  to  provide  for 
the  equipment  of  nurses  for  overseas  service,  the  Red  Cross  is 
preparing'-  to  disband  its  organization  which  has  had  this 
phase  of  work  in  hand. 

The  Surgeon  General  has  again  requested  that  the  Govern- 
ment equip  the  nurses,  but  at  this  writing  we  have  no  assur- 
ance that  favorable  action  will  be  taken  on  this  request. 

Inasmuch  as  we  believe  that  it  would  seriously  interfere 
with  the  recruiting  ot"  nurses  who  are  so  urgently  needed,  if 
the  Ked  Cross  stops  issuing  equipment  and  the  Government 
fails  to  j)rovide  for  it,  it  is  hoped  that  until  definite  arrange- 
ments have  been  made  by  the  Government,  the  Red  Cross  will 
feel  like  continuing  its  custom  of  equipping  the  nurses  as 
heretofore. 

General  Peyton  C.  ^Farch,  Chief  of  Staff,  issued  on  December 
IT,  191S,  (Icneral  Orders  No.  SC,  as  follows: 


382   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  order  to  enable  them  immediately  to  comply  with  regu- 
lations requiring  the  wearing  of  uniforms,  a  single  initial 
uniform  outfit  is  hereby  authorized  for  issue  to  members  of 
the  Army  Nurse  Corps  upon  their  first  entry  into  the  service, 
as  follows:  One  navy  blue  norfolk  suit;  one  navy  blue  over- 
coat; one  navy  blue  flannel  waist;  one  navy  blue  velour  hat 
for  winter;  one  navy  blue  straw  hat  for  summer;  two  sets 
insignia,  United  States ;  two  pairs  insignia,  badge  of  Corps. 

When  members  of  the  Army  Nurse  Corps  are  ordered  to 
duty  overseas  with  the  American  Expeditionary  Forces,  the 
following  articles  will  be  issued  to  them :  six  gray  cotton  uni- 
forms ;  one  gray  woolen  sweater ;  one  gray  woolen  muffler ;  one 
raincoat ;  one  blanket  for  use  on  transport ;  one  sleeping  bag ; 
one  steamer  trunk. 

2.  Nurses  who  have  been  enrolled  for  service  during  the 
existing  emergency  and  who  have  not  been  supplied  with 
uniform  outfits  by  the  American  Eed  Cross  without  cost  to 
themselves,  will  be  entitled  to  the  issue  herein  authorized. 
The  Quartermaster  General  will  supply  the  necessary  articles 
of  uniform  for  issue  and  sale  at  cost  price,  when  issue  is  not 
authorized.  The  details  of  material,  make  and  design  will 
conform  to  the  specifications  prescribed  by  the  Surgeon  Gen- 
eral and  no  change  therein  will  be  made  without  his  authority. 
By  order  of  the  Secretary  of  War. 

The  American  Red  Cross  at  its  New  York  Bureau  Nurses' 
Equipment  equipped  between  April  7,  1917,  and  December 
31,  1918,  the  following  personnel  for  overseas  duty: 

Army 

10,519  Nurses  at  an  average  of  $180  each $1,893,420.00 

266  Civilian  employees  at  an  average  of  $180 

each   47,880.00 

134  Dietitians  at  an  average  of  $180  each.  .  24,120.00 
365  Eeconstruction  aides,  at  an  average  of 

$180  each 65,700.00 

$2,031,120.00 
Na\'y  3<* 

334  Nurses  at  $180  each $60,120.00 

•"These  figures  are  inclii(l«>cl  here  lo  give  an  idea  of  the  proportion  of 
service  rendered  by  the  Red  Cross  to  the  Army  in  comparison  to  tliat 
given  to  the  Navy  and  to  Red  Cross  foreign  commissions,  also  to  give 
in  one  table  a  complete  summary  of  the  activities  of  the  Bureau  of  Nurses' 
Equipment. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  383 

Red  Choss  (Foreign  Activities) 

573  Nurses  at  $180  each $103,140.00 

351  Nurses'  aides  at  $100  each 35,100.00 

4  Dietitians  at  $180  each 720.00 

$2,230,200.00  " 

Of  the  equipment,  Miss  Noyes  wrote  in  her  request  to  the  War 
Council  for  an  appropriation  to  cover  these  expenditures: 

A  maximum  amount  allowed  for  equipment  was  $200 
per  individual,  but  only  in  a  few  instances  was  this  amount 
given,  while  in  many  other  instances  it  fell  below  the  $180. 
The  average  cost  per  nurse  for  the  equipment  was  $180 
each. 

The  equipment  for  the  nurses'  aides  was  approximated  at 
$100  each.  Some  of  them  were  given  entire  equipment, 
others  partial,  while  in  a  great  many  instances  the  equipment 
was  provided  by  the  nurses'  aide. 

These  figures  do  not  include  the  equipment  issued  to  the 
nurses  in  home  service,  which  consisted  of  the  cape;  neither 
does  it  include  the  equipment  issued  to  the  nurses  in  the 
sanitary  zones,  as  this  is  provided  from  a  separate  appropria- 
tion. The  approximate  amount  of  money  spent  for  capes  at 
the  present  time  was  $280,000.^^ 

The  Red  Cross  appropriated  more  than  three  million  dollars 
for  equipment  for  nurses,  nurses'  aides  and  dietitians.  The 
estimates  which  ]\Iiss  Noyes  gave  above  were  based  upon  the 
ratio  of  $180.00  for  each  nurse.  Equipment  required  for  some 
nurses  exceeded  this  amount  and  required  the  expenditure  of 
$200,  the  maximum  which  the  War  Council  allowed  for  an 
individual.  Prices  of  materials  and  labor  varied  from  time  to 
time  and  these  conditions  caused  equipment  to  exceed  three 
million  dollars.^" 

Clara  D.  Xoycs,  Caroline  Van  Blarcom,  Florence  Johnson, 

Sophie  Kiel,  ^lary  ^lagoun  Brown  and  Claude  G.  Moody  stand 

out  prec'minently  among  the  group  of  lied  C^ross  women  whose 

interest   and   tireless   effort   made   smooth   the   embarkation   of 

those  thousands  of  overseas  workers.     Sophie  Kiel  (St.  Luke's 

Hospital,    X.    Y.    City)    was   ^liss   Van   Blarcom's   and   ^liss 

Johnson's  assistant   in  the  Atlantic  Division.      Following  her 

''  Sec  Anu'rioan   Red   Cross  War   Council   Kecjiu'st  for   Aiiprojjrialion  No. 
9!»8,   Fi'bniary   14,    iniO. 

^  "Tlu'  Work  of  till'  AiiR'rican  Red  Cross  during  tht-  War,"  p.  33. 


384  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

return  from  Khoi,  Persia,  in  1916,  she  organized  one  of  the 
Red  Cross  detachments  for  the  Navy.  Though  her  status  con- 
tinued as  that  of  a  Navy  chief  nurse,  the  superintendent  of  the 
Navy  Nurse  Corps  released  her  from  active  service  to  assist 
in  the  Atlantic  Division  until  August  22,  1918,  when  she  was 
assigned  by  Mrs.  Higbee  to  the  U.  S.  Army  Transport  George 
Washington. 

The  attitude  of  mind  which  characterized  the  Red  Cross 
executives  and  their  assistants  who  handled  the  often  vexatious 
details  of  equipment  was  described  by  Miss  Brown,  herself  a 
member  of  Miss  Johnson's  staff.  ''As  I  recall  those  busy  days," 
she  wrote,  "one  outstanding  point  remains  freshly  in  my  mem- 
ory. Miss  Johnson  and  her  associates  drew  so  much  vivid 
interest  and  enthusiasm  from  the  new  groups  of  nurses  coming 
from  all  parts  of  the  country,  all  fired  by  the  same  ideals  of 
service,  that  they  themselves  seemed  forever  unmindful  of 
personal  fatigue  and  genuine  labor  and  inconvenience."  Mrs. 
Moody  wrote,  "Armistice  Day  found  the  Bureau  of  Equipment 
with  an  organization  of  thirty  more  than  willing  workers,  a 
staff  which  knew  no  hours  of  service, — its  inspiration  gained 
from  that  long  line  of  nurses  who,  with  never  a  thought  of  self, 
just  marking  time  until  their  actual  work  overseas  might  begin, 
had  come  and  gone  before  us." 

National  Headquarters  provided  other  comforts  for  the  wel- 
fare of  American  nurses  in  Army  service  overseas  and  mention 
of  them  may  be  included  in  this  chapter.  The  Minutes  of  the 
War  Council,  which  record  all  appropriations  made  from  the 
Red  Cross  coffers,  briefly  mention  two  other  items.  On  ]\rarch 
19,  1917,  $77,500  was  appropriated,  "of  which  so  much  as  may 
be  necessary  shall  be  expended  for  the  purchase  of  'safety  suits' 
for  the  use  of  nurses  and  members  of  hospital  staffs,  with  the 
understanding  that  should  the  War  Department  wish  to  reim- 
burse the  Red  Cross  for  these  suits,  it  should  be  permitted  to 
do  so."  ^^  The  high  seas  were  alive  with  U-boats.  In  addition 
to  keeping  a  person  afloat  for  an  indefinite  time,  these  particular 
safety  suits  afforded  protection  from  exposure,  "a  cause  of  many 
of  the  deaths,"  stated  this  minute  of  the  War  Council,  "follow- 
ing the  sinking  of  ships." 

Before  the  declaration  of  war  on  Germany  by  the  United 
States,  the  War  Department  had  allowed  forty  cents  per  day 
for  food  for  Army  nurses  and  patients.  This  allowance  could 
^Minutes  of  the  War  Council,  Vol.  IIT,  pages  787-789. 


RELATION  OF  NURSING  SERVICE  TO  THE  ARMY  385 

not  be  changed  without  Congressional  action.  The  Surgeon 
(ieneral  accordingly  asked  the  Ked  Cross  to  assume  the  re- 
sponsibility of  providing  the  ditlerence  between  the  legal  al- 
lowance and  seventy-five  cents,  which  was  conceded  to  be  a 
proper  amount  of  subsistence.  For  a  period  of  eleven  months, 
these  thirty-five  pennies  given  daily  for  food  for  every  Army 
nurse  and  every  sick  or  wounded  soldier  in  Europe  amounted 
to  well  over  $185,007.  "('olonel  Ireland,"  recorded  the 
Minutes  of  the  War  Council  for  May  18,  1918,  "stated  that 
ample  provision  has  now  been  made  by  the  Government  for  the 
sick  in  hospitals  and  for  the  members  of  the  Army  Nurse 
Corps." 

The  Red  Cross  furnished  laundry  allowance  for  nurses  serving 
on  the  Mexican  border,  but  did  not  make  similar  provision 
for  nurses  on  duty  during  the  European  War  in  the  cantonments 
or  on  foreign  assignments  because  of  the  vast  amount  of  clerical 
detail  that  would  have  been  required. 

Whatever  the  American  Red  Cross  did  for  the  war  nurse, 
were  she  of  the  Army  or  i^avy,  the  U.  S.  Public  Health  Service 
or  the  Red  Cross,  was  given  back  indirectly  in  service  by  her 
to  the  American  soldier.  His  comfort,  often  his  very  life,  de- 
pended upon  that  gray-uniformed  nurse  who  from  time  to  time 
accommodated  her  own  personality  to  the  needs  of  her  patients; 
she  was  sometimes  cheerfully  frivolous ;  she  was  sometimes 
seemingly  callous  and  unsympathetic ;  she  was  sometimes  the 
very  reincarnation  of  that  woman  who  sixty  years  ago  walked, 
lamp  in  hand,  among  the  wounded  at  Scutari.  That  nurses 
themselves  were  grateful  for  the  gifts  which  American  gen- 
erosity enabled  the  Red  Cross  to  make  them,  is  shown  in  this 
one  letter  chosen  from  among  many  of  similar  content: 

American  Expeditionary  Forces, 

France,  September  27,  1918. 

Everywhere  we  look,  everywhere  we  go.  there  arise  evi- 
dences of  your  consideration  and  love.  The  wardrobes  you 
gave  us  best  manifest  this. 

It  is  hard  to  determine  which  of  the  articles  you  chose  arc 
the  most  useful  and  attractive.  When  we  notice  liow  the 
peasant  women  eye  us,  we  tliink  it  is  our  smart  jackets  and 
skirts,  ^\'hen  the  weather  gets  cold  and  our  ulsters  fit  snugly 
about  our  throats,  we  are  sure  we  need  these  great  coats  more 
than  anything  else.  Wlien  it  rains  the  next  day,  we  exclaim. 
''Mw  wasn't  it  lucky  for  us  that  tlu>  IJed  Cross  }ia\e  us  l)oo!:-. 


386   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

slickers  and  raincoats  !"  When  we  crawl  into  bed  at  night 
with  hands  and  feet  numb  with  cold,  we  bless  you  for  giving 
us  warm  pajamas  and  sleeping  bags.  But  when  the  gray 
morning  comes  all  too  soon,  then  our  wool  underwear  cer- 
tainly feels  best  of  all ! 

Many  times  when  1  have  been  lonely,  heart-sick,  soul-weary, 
the  sight  of  my  equipment  and  the  thought  of  why  it  was 
given  to  me  has  brought  me  new  courage,  has  made  me  into  a 
better  soldier. 


CHAPTER  VII 

THE  EUROPEAN  WAB 

Cantonments  of  the  New  Armies — EmharJcation — With  the 
A  merican  Expeditionary  Forces  in  Great  Britain — With  the 
American  Expeditionary  Forces  in  France — The  Zone  of 
the  Base,  A.  E.  F.  in  France — The  American  Red  Cross 
Commission  for  France — Nurses'  Equipment  Shop,  Paris — 
With  the  French  Service  de  Sante — Emergency  Hospitaliza- 
tion, A.  E.  F.  in  France — The  Zone  of  the  Advance,  A.  E.  F. 
in  France — With  the  A,  E.  F.  in  Italy — With  the  A.  E.  F. 
in  North  Russia 

THE  United  States  entered  the  European  War  on  April  6, 
1917.  Twenty  days  later  the  American  Nurses'  Associa- 
tion met  for  its  Twentieth  Annual  Convention  in  Phila- 
delphia, with  a  record  attendance.  The  Red  Cross  session  was 
held  on  Monday  evening,  April  30,  in  the  Academy  of  Music. 
Every  one  of  the  3000  seats  was  filled  and  all  available  standing 
room  occupied.  In  the  red,  white  and  blue  of  the  Red  Cross 
uniform,  nurses  sitting  in  the  orchestra,  the  balcony  and  the 
galleries  formed  line  upon  line  of  color,  splendidly  vivid  against 
the  somber-hued  furnishings  of  the  auditorium.  Their  faces 
under  the  winged  Red  Cross  cap  were  tense  and  expectant. 
Realization  of  the  responsibilities  soon  to  be  placed  upon  them 
hushed  the  idle  conversation  which  usually  runs  lightly  through 
an  audience  before  the  program  begins.  On  that  night,  the  very 
air  seemed  charged  with  patriotic  ardor. 

]\[iss  Noyes,  Dr.  Warren  P.  Wilson,  of  Columbia  University, 
and  Eliot  Wadsworth,  acting  chairman  of  the  Red  Cross 
Central  Committee,  were  the  speakers  of  the  evening,  ^fiss 
Delano  presided.  Her  introduction  of  Miss  Xoycs  was  prefaced 
in  part  by  the  following  words : 

It  is  eiglit  years  ago  tbis  month  since  T  stood  before  tlie 
American  Nurses'  Association  and  begged  of  tbem  to  ratify 
tbe  atliliation  whlvh  tlie  l^ed  Cross  had  offered  to  us  and  to 

387 


388   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

pledge  themselves  to  the  organization  of  a  J^ursing  Service 
which  I  believed  we  should  organize  for  the  benefit  of  our 
country.  At  that  time,  so  far  as  I  know,  all  the  nations  of  the 
earth  were  at  peace.  We  began  this  work  with  no  thought 
that  within  a  comparatively  short  period,  eight  years,  we 
should  be  called  upon  to  meet  the  needs  and  service  of  the 
greatest  and  most  horrible  war  that  the  world  has  ever 
known,^ 

After  giving  an  outline  of  the  development  of  war  nursing, 
Miss  Noyes  voiced  the  responsibility  confronting  the  American 
nursing  profession: 

As  I  stand  facing  you  to-night,  sister  nurses,  under  the 
shadow  of  war,  we  know  not  what  we  as  nurses  shall  be  called 
upon  to  do.  We  know,  however,  that  our  Eed  Cross  Nursing 
Service  exists  but  for  one  purpose, — the  reserve  of  the  Army 
and  Xavy  Nurse  Corps  in  time  of  war.  You  may  be  called 
upon  to  give  fully,  to  make  great  personal  sacrifices,  but  we 
know  you  are  prepared,  we  know  that  you  are  ready,  we  know 
that  we  can  depend  upon  you  to  carry  the  spirit  of  Red  Cross 
service,  as  well  as  its  banner,  wherever  our  Army  and  Navy 
may  be  sent,  whether  to  the  Pacific  or  Atlantic  coasts,  to  the 
cantonments,  to  the  frontiers  of  France  or  Eussia,  or  to  far- 
distant  Mesopotamia.  It  must  be  written  upon  the  pages  of 
history  for  all  time  that  our  Eed  Cross  nurses  were  prepared, 
that  in  this  war  our  soldiers  at  least  were  not  neglected  and 
that  they  were  properly  nursed.^ 

Following  an  address  by  Dr.  Wilson  on  Rural  Nursing,  Eliot 
Wadsworth,  acting  chairman  of  the  Red  Cross  Central  Com- 
mittee, spoke  in  part,  as  follows : 

In  these  days  of  alarm  and  excitement,  when  the  whole 
country  is  thinking  of  war  and  when  at  every-  cross-road  and 
in  every  railroad  train  the  people  are  debating  as  to  the  extent 
to  which  the  country  is  prepared  ...  I  have  come  here  really 
to  say  a  word  of  appreciation  for  what  the  nurses  have  done 
by  their  systematic  organization,  and  what  they  will  be  called 
upon  to  do,  n(jw  that  the  need  has  arisen.  The  Rod  Cross  has 
enrolled  for  service  more  than  8000  nurses  whose  qualifica- 
tions are  known,  who  have  taken  all  the  steps  required  by  the 
Army  Medical  Corps  to  permit  their  immediate  enlistment  in 

^23rd  Annual  Report,  National  League  of  Nursing  Education,  1917,  p. 
223. 
'  Ibid. 


THE  EUROPEAN  WAR  389 

this  service.  .  .  .  And  as  a  result,  tlie  Red  Cross  Nursing 
Service  is  ready  at  tliis  hour,  more  ready  than  perhaps  any 
branch,  official  or  unollicial,  of  the  United  States.^ 

As  Mr.  Wadsworth  concluded,  the  vast  body  of  American 
women  rose  as  one  and  pledged  themselves  "to  give  our  best 
service  to  the  nation  wherev(!r  called  upon  to  render  it,  either 
in  home  or  foreign  field,  in  the  daily  routine  of  civil  or  military 
hospital,  or  in  the  equally  great  eii'ort  to  conserve,  protect  and 
strengthen  the  health  and  endurance  of  the  civilian  population, 
the  men,  women  and  children  at  home  in  our  land." 

Even  then,  the  call  to  the  colors  had  sounded.  Orders  for 
the  immediate  mobilization  of  six  Red  Cross  base  hospitals  for 
duty  with  the  British  Expeditionary  Forces  had  been  sent  the 
day  before,  April  29,  by  the  Surgeon  General.  One  after  the 
other,  these  and  other  Red  Cross  sanitary  units  were  assigned  to 
active  foreign  service,  while  at  home  the  building  of  future 
American  Armies,  of  which  nurses  were  to  form  a  vital  part, 
began. 

History  was  swift  in  the  making  during  that  memorable 
spring  and  summer  of  1017.  Congress  in  special  session  passed 
the  Selective  Service  Law  on  May  19  and  the  first  registration 
on  June  5  brought  thousands  of  recruits  to  the  cantonments  of 
the  new  Armies.  The  building  of  sixteen  camps  for  the  Na- 
tional Guard  and  sixteen  cantonments  for  the  Xational  Army 
had  been  authorized  in  ^fay;  the  last  site  for  these  temporary 
gray  cities  was  secured  on  July  6.  Accommodations  were  ready 
on  September  4  for  4-30,000  men.  This  capacity  was  shortly 
increased  to  provide  for  the  care  of  770,000  men,  an  average 
capacity  per  cantonment  of  48,000,  l^ivisions  of  the  Regular 
Army  were  trained  both  in  camps  and  cantonments  and  at 
various  Army  posts.  Training  schools  for  the  Artillery,  Avia- 
tion, Engineer,  Tank  and  Quartermaster  Cor])s  and  for  Chem- 
ical Warfare  were  established,  with  proving  grounds  and  testing 
fields.  Embarkation  camps  were  built  at  Xew  York  and  Xew- 
port  Xews  and  afforded  housing  accommodations  for  more  than 
300,000  men.'' 

Each  of  the  thirty-two  camps  and  cantonments  included  as 
part  of  its  organization  the  development  and  maintenance  of  a 

^   \t)irrirnn  Journal  of  \ursi»(j.  Vol.  X\'IT.  jip.   l].");]-.")!.  ScplcmluT.  1017. 

*"Tlu"  War  with  Ccniiany.  .V  Statistical  Sutntnary,"  T.conard  P.  Avres, 
(^)I()ncl.  (u'lUTal  StalT.  V.  R.  Arniv,  pp.  17-29.  "Government  Printing 
Olliee,  Washington,  1).  C,   1919. 


390   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospital  of  one  thousand  beds.  The  nurses  of  these  hospitals 
were  secured  largely  from  Red  Cross  emergency  detachments. 
In  a  letter  written  September  22,  1917,  to  all  Local  Committees 
on  Red  Cross  Nursing  Service,  Miss  Noyes  stated  that  "we  are 
being  asked  for  many  hundreds  of  nurses  for  cantonment  duty. 
.  .  .  Will  you  not  'round  up'  as  many  as  possible  for  this  work  ? 
The  physical  examination  of  each  nurse  will,  of  course,  have 
to  be  on  file  in  this  office  before  she  can  be  assigned  to  duty, 
but  it  will  not  be  necessary  for  her  to  complete  immunity  treat- 
ment." 

The  Surgeon  General  also  asked  the  Nursing  Service  to 
nominate  chief  nurses  for  several  of  the  cantonment  hospitals. 
Susan  Hearle,  Alice  Beatle,  of  the  Mercy  Ship  Relief  Expedi- 
tion, Mary  Roberts,  Estelle  Campbell  and  Sophia  Rutley  were 
appointed.  ''Each  chief  nurse,"  wrote  Miss  Noyes  in  the  Red 
Cross  columns  of  the  Journal  of  Nursing  for  November,  1917, 
"has  been  asked  to  organize  groups  of  nurses  as  a  nucleus  for 
her  personnel,  but  should  she  not  be  able  to  secure  the  required 
number  by  the  time  the  cantonment  hospital  is  ready  for  occu- 
pancy, it  is  expected  to  fill  the  deficit  from  emergency  detach- 
ments." 

As  rapidly  as  barracks  could  be  erected  in  the  cantonments, 
they  were  filled  with  recruits  from  the  Selective  Draft.  Base 
hospital  construction,  including  the  erection  of  nurses'  quarters, 
was  deferred  until  after  the  barracks  were  completed.  The  need 
for  medical  and  nursing  service  increased,  however,  with  each 
new  assignment  of  men  to  the  cantonments.  Immediately  upon 
their  arrival,  the  "rookies"  were  inoculated  for  various  con- 
tagious diseases  and  many  of  them  became  ill.  Others,  long 
accustomed  to  more  sedentary  and  luxurious  habits  of  living 
and  to  food  different  from  Army  rations,  were  slow  to  become 
acclimated  to  the  rigors  of  military  life  and  so  fell  an  easy  prey 
to  dipenso.  Thus  came  about  the  acute  need  for  nurses  in  the 
camps  and  cantonments,  which  Mites  Noyes  set  forth  in  a  letter 
written  October  30  to  all  Local  Committees  on  Red  Cross  Nurs- 
ing Service : 

We  have  just  receivofl  a  definite  call  from  the  War  Depart- 
ment for  nearly  TOO  nurses  for  immediate  cantonment  service. 

Tlie  National  romniittee  feels  very  strongly  that  this  seri- 
ous need  should  be  brought  very  forcibly  to  the  attention  of 
individual  members  of  the  Eed  Cross  Nursing  Service.  It  is 
far  from  patriotic,  far  from  the  purpose  of  the  Eed  Cross  to 


THE  EUROPEAN  WAR  391 

have  nurses  continue  to  refuse  home  service  where  the  need  is 
urgent,  in  favor  of  foreign  assignment,  where  the  demand  is 
not  so  great.  Nurses  whom  the  committees  consider  available 
for  cantonments  and  who  continue  to  refuse  service  should  be 
reported  at  once  to  National  Headquarters. 

The  need  is  indeed  pressing.  There  are  from  GOO  to  800 
desperately  ill  men  in  several  of  these  hospitals,  with  an 
average  of  ten  nurses  on  duty. 

Nurses  themselves  held  back  from  volunteering  for  canton- 
ment service  because  they  felt  that  foreign  service  would  be  more 
attractive,  more  interesting.  In  the  January,  1918,  issue  of  the 
American  Journal  of  Nursing,  Miss  Palmer,  the  editor,  soundly 
rated  the  nursing  profession  in  an  editorial  bearing  the  title: 
*'Are  we  slackers  f 

Appeals  are  being  made  constantly  from  Red  Cross  Head- 
quarters for  the  enrollment  of  nurses  for  home  service.  The 
situation  is  rendered  difficult  for  the  reason  that  nurses  who 
are  enrolled  in  base  hospitals  are  being  held  back  to  some 
extent  for  foreign  service,  while  many  others  are  failing  to 
respond  because  they  are  hoping  for  a  chance  to  go  abroad  and 
desire  to  do  tliat  rather  than  volunteer  for  service  in  the  can- 
tonments in  their  own  country. 

The  waiving  of  one  of  the  requirements  for  enrollment  in 
the  Eed  Cross,  that  of  membership  in  the  American  Nurses' 
Association,  will  make  large  numbers  of  nurses  eligible  who 
have  been  debarred  up  to  this  time.  We  wish  to  call  the 
attention  of  our  readers  again  to  Miss  Delano's  report  in  the 
last  issue  of  the  Journal,  which  showed  that  during  tlie  war 
period  the  age  limit  is  abolished  so  that  older  women  who  are 
in  vigorous  health  may  be  enrolled  for  liome  service.  It  is 
going  to  be  possible,  also,  for  nurses  from  the  smaller  hospitals 
to  be  recognized  under  certain  conditions. 

One  reason  given  by  nurses  of  all  ages  for  not  enrolling  is 
that  their  families  object  to  their  serving.  We  want  to  say 
that  if  any  woman  is  old  enough  to  be  out  in  the  world  sup- 
porting herself  and  perhaps  helping  iier  family,  she  is  old 
enougli  to  decide  such  questions  for  herself. 

Returns  whicli  are  coming  in  from  tlie  survey  of  nursing 
resources  being  made  tliroughout  the  country  show  that  a 
comparatively  small  proportion  of  the  registered  nurses,  in  the 
twenty  states  that  luive  reported,  are  enrolled  witli  the  Ked 
Cross.  The  percentages  vary  from  one  and  three- fourths, 
which  is  the  low<'st  received,  tliroui^h  seven  and  eiuht.  whit'h 


302  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

are  the  most  common,  to  thirty-two  and  forty-one,  the  last 
being  to  the  credit  of  the  District  of  Columbia. 

Do  not  let  it  go  down  in  history  that  when  the  young  men 
of  our  country  were  called  into  service  in  defense  of  the 
democracy  of  the  world,  the  nurses  held  back,  because  of 
financial  reasons,  or  because  they  shrink  from  the  hardships 
of  war  service. 

Among  letters  of  sharp  criticism  which  came  to  National 
Headquarters  was  one  which  had  been  written  by  a  registered 
nurse  fifty-eight  years  old.  After  roundly  upbraiding  younger 
nurses  who  refrained  from  offering  their  services,  she  asked 
for  assignment  in  the  Army  Nurse  Corps.  In  replying  to  her 
on  February  28,  1918,  Miss  Delano  gave  the  following  reasons 
for  the  existing  shortage  of  nurses: 

In  the  first  place,  camps  were  erected  before  the  hospitals 
were  built  and  I  believe  the  hospitals  took  precedence  over  the 
nurses'  quarters.  Bringing  hundreds  of  thousands  of  young 
men  together  in  camp  life  made  it  possible  for  an  epidemic  of 
contagious  diseases  to  develop,  which  came  on  in  a  great  flood 
before  adequate  preparations  had  been  made  for  their  care. 

Jn  some  cases,  quarters  for  nurses  were  not  available.  In 
other  instances,  there  was  temporary  difficulty  in  securing  an 
adequate  number  of  nurses  to  meet  an  emergency.  This  was 
due  to  various  causes,  chief  among  them,  T  believe,  being  the 
fact  that  we  had  several  hundred  nurses  mobilized  and  waiting 
for  service.  This  fact  was  generally  known  throughout  the 
country.  It  was,  therefore,  difficult  to  convince  nurses  at 
large  of  the  extreme  need  when  they  knew  that  at  the  same 
time  we  had  several  hundred  nurses  mobilized  at  Ellis  Island 
who  were  not  called  upon  for  cantonment  duty.  It  was  difli- 
cult  to  explain  to  nurses  at  large  that  these  groups  at  Ellis 
Island  might  receive  sailing  orders  at  any  moment. 

We  have  met  all  the  demands  of  the  Navy  and  the  II.  S. 
Public  Health  Service  and,  I  believe,  are  meeting  satisfac- 
torily today  the  needs  of  the  Army.  This  is,  I  think,  proven 
by  the  fact  that  we  are  enrolling  over  a  thousand  nurses  a 
month  and  are  sending  large  numbers  into  immediate  service, 
both  at  home  and  overseas. 

I  agree  with  you,  however,  that  if  we  as  a  profession  are  to 
meet  the  obligations  that  this  war  has  thrust  upon  us,  the 
rank  and  file  of  the  nursing  profession  must  realize  that  noth- 
ing is  more  important  than  tlie  care  of  our  soldiers  here  in  our 
own  country. 


THE  EUROPEAN  WAR  393 

After  the  adoption  of  the  ruling  that  nurses  should  be  "sent 
to  cantonment  hospitals  in  this  country  to  determine  their  pro- 
fessional and  physical  fitness  for  overseas  service,"  many  nurses 
from  the  staffs  of  base  hospital  units  were  assigned  to  canton- 
ment duty.  But  the  need  for  nurses  in  this  branch  of  the  service 
still  continued.  On  May  IG,  1918,  Miss  Thompson  wrote  iMiss 
Noyes  that  "in  view  of  the  fact  that  550  'casuals'  are  to  be  rushed 
to  Europe  in  addition  to  the  base  hospitals  now  awaiting  trans- 
portation in  New  York,  the  ctmtonments  will  be  in  urgent  need 
of  nurses,  I  fear,  in  a  short  time.  .  .  .  Therefore,  will  you  not 
do  all  within  your  power,"  she  concluded,  "to  nominate  as  many 
nurses  as  possible  for  immediate  duty?  One  thousand  could 
be  placed  today  without  difficulty." 

Cantonment  service  was  full  of  the  hubbub,  the  change,  the 
excitement  of  armies  in  the  making.  Emergencies  made  up  the 
very  fabric  of  the  nurses'  crowded  days.  Rachel  Golzar,  Re- 
serve Nurse,  A.  N.  C,  wrote  from  Camp  McClellan,  Anniston, 
Alabama : 

A  few  months  ago,  this  region  was  a  stretch  of  wilderness. 
The  first  division  of  men  worked  this  place  through  to  what  it 
is  at  present.  The  hospital  is  perched  on  a  hill-top  and  l)elow 
the  hill  are  the  drill  grounds  and  tents.  The  camp  ground 
occupies  some  seventeen  thousand  acres.  The  base  hospital, 
extending  over  sixty-two  acres,  has  at  present  thirty-two 
wards ;  more  are  in  process  of  construction.  Surgical  wards, 
a  medical  and  dental  department,  X-ray  room,  nose,  ear  and 
throat  section,  eye  clinic,  contagious  and  tuberculosis  divi- 
sions ;  one  ward  for  mental  cases  and  one  ward  for  sick  officers, 
comprise  our  line-up.  Each  ward  is  a  barracks  by  itself.  We 
have  now  between  six  hundred  and  seven  hundred  patients 
and  a  wide  variety  of  cases,  perhaps  more  than  in  any  large 
hospital  of  a  city. 

When  we  seven  arrived,  we  found  ourselves  the  first  group 
of  nurses  that  ever  trotted  these  grounds.  We  were  not  ex- 
pected so  soon  nor  was  anything  ready  for  us.  No  department 
store  in  New  ^'ork,  liowever.  delivered  things  more  ra])idly 
than  the  (Quartermaster  Cor])s  brought  us  beds,  furnisldn^s 
and  other  comforts. 

In  our  wooden  barracks,  acrid  with  tlu^  pungent  odor  of 
raw  pine,  our  rooms  already  have  (h'essers  and  little  rugs. 
Small  rockers,  shades  and  scrim  curtains  have  arrived.  We 
expect  our  own  cook  and  two  maids  later  to  attend  to  the 
nurses'  home. 


394   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  American  Journal  of  Nursing  published  in  May,  1918, 
a  special  Military  Number,  which  was  made  up  of  articles  which 
had  been  written  by  nurses  in  various  types  of  war  nursing  and 
which  described  their  personal  experiences.  As  Miss  Delano 
took  a  large  part  in  securing  these  articles,  extracts  from  them 
are  quoted  as  primary  sources  in  this  history. 

Of  the  cantonment  near  Boston,  at  Ayer,  Massachusetts,  Jane 
G.  Mo  Hoy  (City  and  County  Hospital,  San  Francisco)  wrote: 

Camp  Devens,  named  after  General  Dcvens  of  Civil  War 
fame,  is  in  the  iSTortheast  Division.  Its  development,  spread 
over  ten  thousand  acres,  is  a  feat  of  engineering.  Twenty 
miles  of  road  were  laid ;  four  hundred  miles  of  electric  wiring 
were  done;  sixty  miles  of  heating  pipes  were  connected,  all  in 
less  time  than  is  ordinarily  taken  to  erect  our  municipal 
buildings. 

It  is  a  small  world  that  you  must  see  for  yourself.  The 
hospital  itself  is  a  little  town.  Its  corridors  measure  tliree 
and  one-half  miles.  They  are  enclosed  and  each  is  named  as 
are  streets  in  a  well  laid  out  village,  each  ward  numbered  as 
are  houses  in  a  city  block. 

Patients  who  filled  the  wards  of  cantonment  base  hospitals 
during  1917  and  during  the  spring  and  summer  of  1918  were 
generally  medical  and  contagious  and  accident  cases.  Soldiers 
wounded  in  active  service  in  France  had  not  yet  begun  to  come 
back  to  the  United  States.  However,  the  jiurses  who  were 
assigned  to  cantonment  duty  worked  very  hard,  especially  dur- 
ing the  epidemic  of  contagious  diseases  to  which  Miss  Delano 
referred  in  the  letter  of  February  28,  1918, -quoted  above.  The 
virulence  of  this  epidemic  and  the  need  which  it  caused  for 
expert  nursing  service  was  described  by  Eleanor  Hall,  Army 
Nurse  Corps,  in  a  letter  written  from  Camp  Taylor,  Louisville, 
Kentucky : 

On  April  1,  1918,  I  was  assigned  to  day  duty  on  "7C,"  a 
pneumonia  ward.  We  seem  to  work  in  a  treadmill  here;  we 
riish  from  morning  till  night  and  yet,  in  spite  of  all  we  can  do, 
the  boys  get  sicker  and  sicker  and  we  have  had  several  deaths. 
The  other  day  we  lost  one,  measles,  bronchial  pneumonia  and 
meningitis.  It  seemed  as  if  his  head  was  filled  with  pus 
which  oozed  from  his  eyes,  his  ears,  his  nose  and  mouth.  .  .  . 
When  one  gets  measles  here,  it  is  serious,  for  the  infection 
which  causes  measles  also  causes  abscessed  eyes,  ears,  throat 
infections,  and  then  it  goes  to  the  lungs  and  w^e  have  pneu- 


THE  EUROPEAN  WAR  395 

monia,  bronchitis,  erysipelas  (there  are  four  cases  in  the  ward 
now)  and  pleurisy.  Between  the  last  day  of  health  till  the 
first  day  of  "at  the  point  of  death"  is  sometimes  only  thirty- 
six  or  forty-eight  hours. 

Ethel  Haigitt  (St.  Michael's  Hospital,  Toronto,  Canada), 
reserve  nurse,  wrote  in  the  Military  Number  of  the  Journal 
of  her  work  at  Fort  Riley,  a  Regular  Army  Post,  near  Junction 
City,  Kansas: 

They  were  very  busy  on  the  wards,  so  we  were  asked  to  be 
ready  for  duty  by  nine  o'clock.  The  large  gray  stone  build- 
ings, which  had  been  previously  used  as  barracks,  band  quar- 
ters, prison,  mess  hall,  etc.,  were  fast  being  cleaned,  painted 
and  remodeled ;  also  a  very  good  plumbing  system  was  being 
put  in.  As  we  walked  along  Cavalry  Drive  with  the  chief 
nurse,  she  requested  us  to  wait  for  her  while  she  took  one  of 
our  number  into  one  of  these  buildings  known  as  sections, 
where  she  assigned  her  to  duty.  So  we  passed  on  until  it 
came  my  turn  and  1  was  ushered  into  a  section  marked  "C," 
"Isolation,"  ".Measles." 

Here  I  found  two  nurses  and  a  head  nurse,  but  the  one 
whose  place  I  was  taking  was  to  go  on  night  duty.  This 
section,  though  full  of  patients,  probably  140,  had  only  had 
nurses  there  for  about  two  weeks ;  there  were  none  to  put  there 
before.  Here,  as  in  other  sections,  the  carpenters  and  plumbers 
were  at  work. 

As  you  may  judge,  we  were  very  short  of  nurses  through  all 
the  Fort.  We  decided  to  put  all  the  sickest  patients  and  those 
requiring  the  most  treatment  in  one  large  ward,  thereby  saving 
time  and  steps.  We  found  the  ward  masters  and  corpsmen 
invaluable  helpers,  many  times  willing  to  do  things  out  of 
their  province.  During  the  first  two  weeks  I  must  admit  I 
was  very  tired  and  the  bed  looked  good  to  me  at  night.  We, 
the  day  staff,  had  only  eight-hour  duty;  that  usually  meant 
four  hours  on  and  four  hours  olf.  The  night  nurses  worked 
twelve  hours. 

When  1  had  been  in  this  section  three  weeks,  the  chief 
nurse  informed  me  that  she  wished  to  open  another  building 
(by  that  she  meant  to  place  nurses  in  it)  and  wanted  me  to 
take  charge  of  it.  Being  still  short  of  nurses,  she  could  give 
me  only  one,  but  promised  more  as  soon  as  they  could  lie 
obtained.  When  I  left,  1  had  nine  nurses  for  day  and  three 
for  night  duty.    So  you  see  she  ke])t  her  promise.  .   .  . 

Within  a  few  weeks,  th(>  epldennc  was  checked  and  the 
pressure  of  work  lightened  j)roporti()nately   in  the  cantonment 


396    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospitals.  Then  the  nurses  enjoyed  an  eight-hour  day,  which 
gave  ample  opportunity  for  rest  and  recreation.  Jane  Molloy 
wrote  of  the  facilities  for  recreation  at  Camp  Devens : 

Do  not  believe  that  a  nurse  is  always  "over-worked"  in  the 
Army.  When  she  leaves  the  wards,  she  is  completely  and 
gloriously  "off  duty."  This  total  freedom  from  all  responsi- 
bility means  an  opportunity  to  relax  and  enjoy  the  interval 
between  hours  of  duty,  rarely  possible  in  other  vocations. 

Xor  is  there  dearth  of  entertainment.  Something  is  going 
on  at  all  times.  Though  it  is  work  for  the  company  to  drill, 
it  is  entertainment  for  the  observer.  I  have  yet  to  see  a  com- 
edy staged  that  can  compare  with  the  "Awkward  Squad." 
Many  of  the  best  plays  of  the  season  have  been  produced  at 
our  camp  theater.  The  Boston  Symphony  Company  gave  one 
of  its  fine  concerts  here  during  the  winter ;  and  the  movies  are 
always  to  be  seen. 

And  above,  around  and  behind  all  this,  the  great,  stupen- 
dous work  goes  on — the  training  of  brawn  and  muscle,  of  mind 
and  will.  The  Army  changes  no  one;  it  simply  proves  what 
we  are. 

In  its  professional  phases,  military  nursing  differed  greatly 
from  institutional  or  private  duty  nursing.  In  a  letter  written 
from  Camp  Taylor,  Louisville,  Kentucky,  Eleanor  Hall  de- 
scribed these  aspects: 

The  nursing  experience  we  get  here  is  invaluable.  We  learn 
much  in  various  lines  which  is  not  essential  in  private  duty 
nursing  but  which  is  very  necessary  in  Army  service.  The 
nurses  have  come  from  all  types  of  schools,  from  all  states  and 
from  all  walks  of  life.  They  are  thrown  together  here  and 
must  quickly  accustom  themselves  to  the  Army  discipline. 
Lengtli  of  service  at  a  given  post,  and  that  alone,  puts  one 
nurse  above  anotlier.  The  head  nurses  for  the  wards  are 
selected  entirely  from  among  the  nurses  who  have  been  longest 
at  Camp  Taylor.  In  a  ward,  the  head  nurse  rules,  except  that 
each  nurse  is  free  to  do  her  work  according  to  her  training, 
provided,  of  course,  that  she  does  it  correctly.  When  a  ques- 
tion arises,  however,  the  nurse  who  lias  been  on  duty  for  the 
greatest  length  of  time  in  the  ward  has  the  greatest  amount  of 
autliority.     We  must  learn  to  accept  this.  .  .  . 

We  must  learn  to  close  our  eyes  to  many  things  which  we 
would  like  to  do,  and  stick  instead  to  the  essentials.  We  must 
refrain  especially  from  doing  anything  or  everything  that  the 
orderlies  or  the  patients  can  do,  because  there  is  so  much  to 


THE  EUROPEAN  WAR  397 

be  (lone  that  a  nurse  alone  can  handle,  such  as  hypodermics, 
medicines  of  a  dan<ier<)us  nature,  treatments  and  general 
supervision,  that  a  nurse  has  no  right  to  waste  her  time  and 
energy  doing  non-essentials. 

One  of  Hiss  Hall's  letters  contained  the  following  comment 
upon  the  JVIedical  Corps  men: 

I  never  saw  college  boys  work  the  way  our  orderlies  do. 
(Most  of  them  come  from  excellent  families  and  are  of  good 
education.)  They  get  up  at  4  a.m.;  walk  three  miles  to  their 
breakfast;  come  on  duty  at  G  a.m.;  sweep,  mop,  scrub,  lift, 
carry  heavy  loads  and  help  the  nurses  in  every  possible  way; 
take  "bossing,"  complaints  and  fault  finding  from  the  doctors, 
nurses  and  patients  and  have  no  "comeback";  have  one  half 
hour  off  for  lunch ;  and  go  off  duty  again  at  six  o'clock,  drill 
and  march  three  miles  home  again.  Some  of  the  very  young 
ones  are  dears,  gentle  and  sweet,  courteous  and  patient,  yet 
not  sissy  or  goody-good  at  all.  .  .  . 

The  Red  Cross  provided  many  little  comforts  for  the  nurses 
in  military  service  in  the  United  States.  In  thirty-six  camps 
and  cantonments,  the  use  of  the  Red  Cross  motor  cars  was 
extended  t()  nurses  for  shopping  trips  or  for  recreation.  Tennis 
courts  were  built  and  maintained.  During  the  intense  heat 
of  11)18,  awnings  and  porch  curtains  were  provided  and  electric 
fans,  to  cool  the  dormitories  and  mess-halls.  At  Fort  ^[cPher- 
son,  Georgia,  a  committee  of  women  from  the  Atlanta  Chapter 
did  mending  for  the  nurses.  At  Fort  Doniphan,  Oklahoma,  a 
cottage  in  ^Medicine  Park,  about  seven  miles  from  camp,  was 
rented  and  three  nurses  at  a  time  were  taken  there  by  the  Red 
C^-oss  ^lotor  (\irps  for  short  vacations.  Wlion  a  fire  at  Camp 
Dodge,  Towa,  destroyed  the  personal  belongings  of  the  nursing- 
staff,  the  Red  (^ross  suppli(Hl  uniforms  and  clothing  within  two 
hours.  Loans  were  made  to  nurses  whose  resources  had  been 
completely  exhausted. 

Camp  life  with  its  bustle  and  its  constant  noises  ranging 
from  the  bray  of  an  Army  mule  to  the  melodious  echoes  of 
the  bugle  calls,  was  vastly  wearisome  and  the  nurses  sorely 
needed  a  place  where  they  could  be  alone.  The  "Y.  ^I."  oi-  \lcd 
Cross  huts  were  always  crowded  with  visitors  and  the  siglit  of 
soldi(>rs  and  tlieir  fiMcnds  and  families  wlio  gatlicrcd  tlicrc  was 
among  the  last  things  which  tired  nurses  wanted  to  see  after 
eight  or  t<'n  hours  on  duty  in  the  wards,     ^'et  these  places  and 


398    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  rooms  in  the  nurses'  quarters,  shared  by  others  with  nerves 
equally  taut,  were  their  only  refuge  until  the  Red  Cross  built 
special    recreation   houses    for    nurses.      The    following   letter 

from  a  nurse  at  Camp  J is  quoted  to  show  the  need  for 

these  buildings: 

...  If  we  could  in  our  hearts  wish  you  such  luck,  we 
would  wish  you  were  here ;  for  our  sakes,  though,  and  not  for 

yours.    Miss ,  who  has  been  in  the  service  for  about 

a  year,  is  our  chief.  At  first  we  hoped  for  some  sort  of  home 
life.  .  ,  .  Our  quarters  are  built  probably  like  those  at  every 
other  cantonment.  As  you  enter,  there  are  small  rooms  on 
either  side  of  the  hall.  Our  chief  nurse  insists  that  there  is 
no  provision  for  a  sitting  room  in  these  quarters  for  nurses, 
though  the  rooms  are  not  yet  all  filled.  I  told  her  that  I 
never  would  believe  that  anybody  meant  to  set  fifty  nurses 
down  in  the  woods  without  some  place  to  receive  a  guest. 
Several  people  have  called  whom  we  could  not  invite  in  and 
several  more  have  asked  to  call.  It  hurts  my  feelings  to  have 
to  say  "no."  We  have  five  hundred  patients  and  work  on  the 
wards  goes  smoothly.  When  we  get  off  duty,  we  go  to  bed  to 
get  warm  and  because  there  is  no  other  place  to  go. 

The  Army  deplored  the  lack  of  recreation  rooms  and  other 
facilities  and  in  almost  all  cases  later  supplied  attractively 
furnished  living-rooms  for  the  nurses,  but  in  the  interim  the 
Red  Cross  recreation  houses  filled  a  great  need. 

At  a  total  cost  of  $245,000,  the  American  Red  Cross  built 
these  recreation  houses  for  the  exclusive  use  of  the  nurses  in 
thirty-seven  camps,  cantonments  and  training  centers.  Though 
outwardly  these  structures  resembled  in  their  monotonous  gray- 
ness  an  ordinary  barrack,  within  there  was  quiet  and  comfort. 
Each  had  a  large  assembly  room,  bright  with  cretonne  hangings ; 
at  one  end  of  it  wicker  chairs  stood  cozily  about  a  deep-throated 
fire-place.  In  the  rear  of  the  building  was  a  small  kitchenette, 
in  which  the  nurses  might  prepare  afternoon  tea  for  their 
friends.  Nearby  was  a  laundry.  A  balcony  encircled  the  assem- 
bly room  and  afforded  the  nurses  a  sewing  room  and  small 
alcoves  where  they  might  read,  write  letters  or  serve  supper. 
There  was  a  library  and  many  of  the  books  brought  welcome 
relaxation  to  nurses  wearied  of  bandages  and  the  care  of  sick 
men. 

Encircling  the  military  boundaries  of  the  cantonments  were 
areas  in  which  the  many  types  of  people  who  follow  an  army. 


A  Kocreation  House  built  l)y  tlio  Amprioan  Ecd  Cross  for  tlie  iiursinjr  staff 
of  the  U.  S.  Army  i5ase  Hospital  at  Fort  Mcllenry,  Maryland. 


Xurst's'   Mess.  Camp   Dt'vens,  Massacluisetts. 


THE  EUROPEAN  WAR  399 

gathered  to  ply  their  trades.  The  sanitary  conditions  prevailing 
in  stalls  where  food  and  soft  drinks  were  sold,  in  dance-halls,  in 
shooting  galleries,  in  motion-pictnre  theaters  and  in  houses 
where  soldiers,  eluding  the  sharp  discipline  by  which  the  Army 
endeavored  to  check  such  practices,  met  immoral  women,  di- 
rectly affected  the  fighting  strength  of  the  new  Armies.  The 
United  States  Public  Health  Service,  therefore,  drew  cordons 
of  sanitary  protection  around  the  camps  and  cantonments, 
calling  these  outlying  districts  extra-cantonment  zones,  and,  in 
c©r)peration  with  the  Army  and  with  the  Red  Cross,  assigned 
trained  sanitarians  and  public  health  nurses  to  these  areas  to 
safeguard  the  health  of  the  soldiers  by  bettering  the  general 
health  conditions  in  these  localities. 

While  sanitary  officers  of  the  U.  S.  Public  Health  Service 
supervised  the  drainage  of  malaria-infested  swamps  and  ditches, 
condemned  the  venders  of  dirty  or  tuberculous  milk  and  rigidly 
ferreted  out  the  carriers  of  communicable  diseases,  Red  Cross 
public  health  nurses  assisted  in  clinics,  dispensaries  and  isola- 
tion hospitals,  or  "followed  up"  cases  into  homes  surrounding 
the  military  areas.  Varied  and  interesting  indeed  were  the 
duties  of  nurses  assigned  to  these  health  zones.  A  nurse  wrote 
in  the  ]\Iilitary  Is^umber  of  the  Journal: 

Our  district,  covering  a  territory  of  five  miles  about  a  camp, 
consisted  of  the  city  of  Spartanburg,  South  Carolina,  of  about 
twenty  thousand  inliabitants  in  normal  times,  but  now  of  at 
least  double  that  number.  Tn  the  numerous  cotton-mill  vil- 
lages outside  the  city,  the  population  comprises  about  twenty- 
five  hundred.  There  were  a  few  farms  with  small  groups  of 
negro  laborers  and  tenants. 

Our  unit  was  part  of  the  U.  S.  Pul)lic  Health  Service.  The 
director  and  the  larger  part  of  the  unit  was  U.  S.  Public 
Healtli  Service  personnel,  but  we  know  no  difference  save  that 
of  the  uniforms.    We  had  a  car  for  the  use  of  tlie  nurses. 

Tlie  city  had  a  board  of  health,  a  full  time  director  of 
health  and  one  public  health  nurse  who  acted  as  quarantine 
officer  and  clerk  :  slie  investigated  cases  of  illness  and  gave 
instructive  care.  There  was  no  county  health  officer,  no  free 
hospital  beds  or  clinic  facilities.  A  local  ])hysician  made 
charity  calls  on  a  fee  basis.  There  were  good  scliools  with  an 
enrollment  of  about  four  thousand  children.  Xo  systematic 
medical  inspection  of  schools  was  beinfj  done,  b\it  volunteer 
inspection  had  been  made.  Xo  follow-up  work  had  been 
undertaken. 


400   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

During  the  second  week  after  the  arrival  of  this  unit,  several 
cases  of  typhoid  fever  were  reported  in  nearby  cotton  villages. 
The  Red  Cross  public  health  nurses  immediately  visited  the  cases 
and  gave  instructive  care.  The  sanitarians  investigated  the 
water  and  milk  supply.  The  water  came  largely  from  shallow 
wells,  all  of  which  were  found  to  be  contaminated,  some  to  the 
extent  of  ninety-eight  per  cent  bacillus  coli.  The  director 
of  the  unit  immediately  closed  the  most  dangerous  wells  and 
initiated  other  forms  of  health  protection,,  with  such  success 
that  neighboring  villages  also  having  typhoid  cases,  asked  for 
similar  service. 

How  effective  the  unit  was  is  shown  in  the  nurse's  short  state- 
ment of  accomplishment : 

Before  we  had  been  in  the  field  two  months,  we  had  as  our 
nursing  staff  the  supervising  nurse  and  assistant,  paid  by  the 
Eed  Cross;  a  school  nurse,  paid  by  the  U.  S.  Public  Health 
Service;  and  the  city  health  department  nurse.  This  co- 
ordinated all  the  nursing  service  in  this  zone.  We  organized 
a  council  of  social  agencies  and  had  regular  monthly  meet- 
ings. jMary  E.  Lent,  supervising  nurse  for  the  V.  S.  Public 
Health  Service,  suggested  rules  which  were  approved  by  our 
medical  director. 

Often  the  work  was  of  the  most  primitive  type.  Mary 
Pritchard  (Poli-clinic,  Chicago)  wrote  in  the  Military  i^umber 
of  the  Journal,  the  following  account  of  her  work  in  the  canton- 
ment zone  at  Charlotte,  ^NTorth  Carolina : 

When  I  came  here  on  short  notice  six  months  ago,  I  had 
visions  of  doing  general  visiting  nursing.  Upon  arrival  they 
informed  me  that  I  was  to  do  tuberculosis  work.  The  one 
visiting  nurse  in  town,  who  was  supported  by  the  churches, 
gave  care  to  l)edridden  cases  when  she  had  time.  An  indus- 
trial nurse  looked  after  insured  cases.  I  had  to  cover  a  city 
of  fifty-five  thousand  inhabitants,  besides  the  mill  villages. 
We  often  walked  ten  and  twelve  blocks  at  a  stretch  to  make  a 
call.  Outside  the  lieart  of  the  city  some  of  the  districts  do 
not  know  what  a  sidewalk  or  a  bit  of  pavement  is;  the  soil  is 
red,  sticky  clay.  Snow,  rain  and  mud  makes  you  stick  and 
slip  and  sink  over  your  rubbers,  ford  creeks,  climb  up  embank- 
ments and  hurdle  ditches. 

The  population  included  mill-hands,  foreign  and  native, 
white  and  colored.      ^liss  Pritchard's  report  continued: 


THE  EUROPEAN  WAR  401 

The  colored  districts  have  small  separate  houses  or  cabins, 
usually  old  and  dilapidated.  About  half  of  these  have  no 
sewer  connections  and  those  which  have  are  very  poorly 
equipped  with  the  outside  flush  toilets,  so  often  out  of  order. 
Tiie  only  means  of  lieating  in  most  cases  is  the  old-time  fire- 
place. .  .  .  When  a  nurse  wants  hot  water,  all  she  has  to  do  is 
to  set  a  pan  of  water  into  the  fireplace. 

The  mill  houses  usually  have  four  or  five  rooms;  they  are 
better  constructed  and  kept  up  than  the  houses  built  to  rent, 
but  are  terribly  cold  in  winter.  Only  one  of  the  eleven  mill 
villages  has  sewer  connections.  Two  mills  have  put  in  aseptic 
tanks  for  the  outside  toilets;  the  others  will  be  compelled  to 
do  so  this  sjjring  on  account  of  the  camp  being  here.  We  have 
the  problem  of  the  lodger,  both  male  and  female,  in  the  mill 
homes  as  well  as  among  the  colored  people. 

]\riss  Pritchard  described  some  of  the  difficulties  under  which 
the  unit  set  to  work : 

I  first  called  upon  the  local  physicians.  Three  had  their 
office  girls  inquire  very  carefully  if  I  were  soliciting  funds  for 
the  Ked  Cross  before  they  would  consent  to  see  me. 

Most  of  them  thought  that  there  was  a  great  deal  of  tuber- 
culosis here  which  was  only  being  reached  by  the  physicians 
after  the  liopeful  stage  was  past.  The  state  sanatorium  had 
such  a  long  waiting  list  that  such  patients  as  would  consent  to 
go  so  far  away  from  home  usually  died  before  there  was  a  bed 
for  them.  As  tlicre  was  no  system  of  follow-up  work,  home 
care  had  ])r()ven  very  unsatisfiK'tory.  Tbe  colored  physicians 
were  deeply  interested,  speaking  especially  of  the  problem  of 
house  infection.  One  tuberculous  family  would  move  out  and 
a  healtby  one  move  in  only  to  become  infected,  and  this 
process  would  he  repeated  over  and  over.  Susceptibility,  ])oor 
living  conditions  and  the  fact  that  ])atients  were  so  loath  to 
admit  that  they  had  the  disease,  as  it  kept  them  from  getting 
emjdoynient,  made  their  work  most  discouraging. 

A  young  negro  man  came  to  the  dis])ensary  about  three 
weeks  ago.  referre(|  hv  bis  doctor  for  a  diagnosis.  He  ))r(,)ved 
to  be  an  dpen  case  of  tuberculosis  and  seemed  intelligent  and 
cociperat  i\e.  I  tuld  his  motlier  what  his  trouhle  was  and  made 
quite  satist'actDry  sleejjing  arrangi'inents  for  him.  On  my 
next  visit,  the  oh!  hidy  int'ornied  me  that  she  never  heard  of 
such  foolishness  and  she  was  going  to  take  iicv  hnhy  (who  is 
twenty-six)  and  mo\e  away  frc)m  here;  he  nuly  had  a  cold  and 
I  *"n(>edn"t  tei-  come  interroiratin"  round  dar  any  morel" 


402   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Contact  between  carriers  of  communicable  diseases  and  the 
soldiers  in  nearby  cantonments  was  often  direct.  Miss  Pritchard 
wrote : 

This  work,  done  primarily  to  protect  the  troops,  has  brought 
out  some  interesting  facts.  Two  colored  women  came  to  the 
dispensary,  one  an  old  lady  going  blind  and  the  other  with  a 
cough  of  long  standing.  One  was  found  to  be  syphilitic  and 
the  other  an  open  case  of  tuberculosis.  Both  had  been  doing 
soldiers'  washing.  In  another  squalid  home  I  found  the 
mother  of  two  tuberculous  children  ironing  the  soldiers" 
clothes  and  putting  them  on  a  filthy  bed. 

I  was  also  assigned  to  the  venereal  clinic,  maintained  by  the 
U.  S.  Public  Health  Service.  Two  physicians  of  this  service 
are  in  attendance.  A  nurse,  formerly  connected  with  the 
medical  social  service  department  of  a  large  city  hospital, 
was  assigned  by  the  Eed  Cross  to  do  dispensary  and  "follow- 
up"  work.  A  male  nurse  assists  in  the  clinic.  It  is  estimated 
that  forty  per  cent  of  the  colored  people,  who  comprise  one- 
third  of  the  population  here,  have  venereal  infection ;  the  per- 
centage is  almost  equally  high  among  the  whites. 

Emily  C.  Snively  (W.  C.  A.  Hospital,  now  Jennie  Edmonson 
^lemorial  Hospital,  Council  Blnfls,  Iowa),  supervising  nurse 
of  the  Red  Cross  Sanitary  Unit  No.  5,  wrote  in  the  Military 
Number  of  the  Journal: 

When  necessity  demands,  as  it  did  in  our  extra-cantonment 
zone  when  a  typhoid  epidemic  was  raging,  the  U.  S.  Public 
Health  Service  or  the  American  Red  Cross  sends  a  laljoratory 
car  all  equipped  to  take  care  of  all  bacteriological  work  until 
the  local  laboratory  can  be  established. 

The  laboratory  test  is  the  only  positive  proof  of  diphtheria. 
.  .  .  The  taking  of  throat  aiul  nose  cultures  by  the  nurse  is  a 
very  important  part  of  her  work,  both  in  diphtheria  and 
meningitis.  The  actual  k'lowledge  that  is  obtained  in  regard 
to  milk  is  invaluable.  Samples  of  milk  are  collected  regularly 
from  the  local  dairymen  while  on  their  routes  and  systematic 
examination  is  made  in  the  laboratory  to  determine  the  chemi- 
cal and  bacteriological  contents  and  value  for  infant  feeding. 
Examiiuitioji  is  also  made  to  detect  any  adulteration,  ])rescrva- 
tives  or  coloring  matter,  which  are  so  detrimental  to  the 
health  and  life  of  innocent  babies.  ...  It  did  not  take  long  to 
convict  a  man  for  adding  formaldehyde  to  his  milk,  when  the 
baby  of  the  chief  of  police  was  ill  from  tliat  cause.  May  the 
day   be   hastened   when   those   who  are   in   ])ower   will    l)e   as 


THE  ELliOPEAN  WAR  403 

interested  in  protecting  the  babies  of  the  unknown  mother  and 
father  as  they  are  their  own  ! 

The  analysis  of  specimens  in  the  laboratory  car,  which  led 
to  the  diagnosis  of  venereal  disease,  was  one  of  the  most  im- 
portant phases  of  extra-cantonmeut  zone  work  of  this  type. 
Miss  8nively  wrote : 

In  the  sanitary  zone,  liquor,  vice  and  disease  are  tlie  three 
foes  which  are  fought.  The  liquor  prol)lem  is  handled  by  the 
police,  but  vice  by  both  police  and  health  departments.  Any 
prostitute  can  be  taken  by  the  police  to  the  health  officer  .  .  . 
and  in  a  very  short  time  it  is  known  positively  whether  that 
girl  is  diseased.  If  |the  reaction  is|  negative,  she  is  released; 
if  positive,  she  is  put  away  so  as  to  safeguard  the  soldier.  The 
farm  adjoins  our  city,  so  the  deputy  state  health  officer  .  .  . 
defines  tlie  farm  as  tlie  place  of  isolation.  Medical  treatment 
is  given  and  no  one  is  released  until  three  smears  are  taken 
which  prove  negative.  A  splendid  woman  is  superintendent 
of  this  farm  ami  these  girls  are  surrounded  with  such  good 
wholesome  environment  that  many  have  more  home  life  than 
they  have  had  for  years. 

When  the  War  Council  of  the  American  Red  Cross  went  out 
of  office  in  Februarv,  li)10,  its  chairman  published  a  report 
giving  in  statistical  form  the  finances  and  accomplishments  of 
the  society  during  the  period  when  it  was  operated  by  this 
body,  May  10,  1!)17  to  hVbruary  28,  1 !)!!).  This  report' states 
that  Ived  Cross  public  health  nurses  assigned  to  sanitary  zones 
paid  a  total  of  I34;5,943  nursing  visits.  The  number  of  new 
patients  visited  were  53,G18;  the  nursing  visits  were  90,602; 
the  instructive  visits  were  104,818  ;  the  school  visits  were  21,094 
and  the  "follow-up''  visits  were  73,811.  In  the  field  of  school 
medical  inspection,  inspection  work  was  done  in  562  schools; 
229,0.30  children  were  examined  ;  81,983  children  were  found 
to  be  defective  and  4389  corrections  were  reported  to  have  been 
made. 

Public  health  nurses  in  extra-cantonment  zones  rendered 
yeoman  service  in  the  pandemic  of  Spanish  influenza  which 
swept  the  country  during  the  autumn  and  winter  of  1918-1919. 
Kupert  I)hu\  tluui  Surgeon  (lencral  of  the  U.  S.  Public  Health 
Service,  cited  several  h(>roic  examples: 

At  Muscle  Shoals  Sanitary  Distriit,  on  the  night  of  Octo- 
ber '2.  a   \1(h\  Cross  public  health  nnrse,  assisted  by  two  en- 


404    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

listed  men,  received  and  cared  for  one  hundred  and  thirty-nine 
patients,  among  whom  there  was  only  one  death  in  three  days. 
In  another  instance  a  ])ublic  health  nurse  worked  for  twenty- 
eight  hours,  though  herself  ill,  and  after  five  hours'  sleep 
returned  to  duty.  In  still  another  instance,  a  public  health 
nurse  was  on  duty  forty-eight  hours  with  only  two  hours' 
sleep.  This  same  nurse  paid  nine  hundred  visits  in  Florence, 
Alabama,  in  the  period  of  one  week. 

Within  military  bounds,  the  situation  was  equally  desperate. 
Conditions  at  Camp  Dodge,  as  reported  by  the  Ked  Cross  Field 
Director,  Department  of  Military  lielief,  were  typical  of  other 
cantonments.  On  September  2!J,  the  total  number  of  patients  in 
the  base  hospital  was  1204-,  with  245  nurses  on  duty.  On 
October  10,  there  were  7868  patients,  with  seven  deaths  and 
442  nurses  on  duty.  Six  days  later  ,5000  patients  had  been 
admitted,  50  had  died  and  595  nurses  were  on  duty.  An  increase 
of  one  hundred  and  fifty  per  cent  in  the  cantonment  nursing 
staff  was  sigiiificant  of  the  great  activity  on  the  part  of  the 
Red  Cross  in  securing  nurses  for  such  service  at  a  time  when 
the  Army  was  also  endeavoring  through  Ked  Cross  efi^ort  to 
send  overseas  one  thousand  nurses  a  week.  The  nurses  were 
mobilized  for  Camp  Dodge  through  a  nurses'  registry  in  Des 
Moines  and  were  brought  out  to  the  camp  in  vehicles  of  the 
Red  Cross  Motor  Corps.  They  were  housed  in  the  nurses' 
dormitories  and  in  the  lied  Cross  recreation  house. 

Many  of  these  nurses  had  been  sent  from  the  Department 
of  Nursing  at  lied  Cross  Central  Division  headquarters, 
Chicago.  ]\liss  Ahrens  described  the  exodus:  "At  a  few  hours' 
notice,  one  thousand  nurses,  old  ones,  young  ones,  Ked  Cross 
nurses  and  nurses  not  enrolled,  nurses  available  for  service 
later  on  and  nurses  who  would  lU'ver  be  eligible  for  permanent 
enrollment,  packed  their  kits,  Ix^arded  the  trains  and  proceeded 
like  soldiers  to  the  camps." 

The  ofHcial  suiiinuiry  prepared  by  Colonel  Leonard  P.  Ayres, 
chief  of  the  Statistics  Branch,  General  Stati',  IL  S.  Army, 
stat(!d  that  "the  hospital  capacity  in  this  country  (112,220 
beds)  was  exceeded  only  during  the  influenza  epidemic,  when  it 
became  necessary  to  take  over  barracks  for  hospital  pur- 
poses."''' The  fact  th;it  four  deaths  per  thousand  soldiers^ 
occurred  each  week  in  the  United  States  during  October  and 

="'Tli('  War  with  Gormanv,"  pp.  12!)-i:30. 
"Ihul.,  p.   ]2(}. 


THE  EUROPEAN  WAR  405 

November,  1918,  shows  t\w,  vinilonce  of  the  disease.     This  loss 
of  life  was,  indeed,  a  tragic  accompaniinejit  of  war. 

An  interesting-  experiment  in  the  assignment  of  colored 
nurses  to  a  military  cantonment  hospital  was  dcjveloped  at 
Camp  Sherman,  Ohio,  during  the  intluenza  epidemic.  The 
question  of  utilization  of  colored  nurses  had  been  the  cause  of 
prolonged  discussion  between  the  Surgeon  General's  office  and 
the  American  Red  Cross.  At  a  meeting  of  the  National  Com- 
mittee on  Red  Cross  Nursing  Service,  held  in  Continental 
Memorial  Hall  of  the  Daughters  of  the  American  Revohition 
on  December  5,  1911,  the  following  action  was  taken  regard- 
ing the  enrollment  of  colored  nurses: 

Tlie  question  of  the  enrollment  of  colored  nurses  was  dis- 
cussed at  length  and  in  the  meantime  a  conference  had  been 
held  with  the  Surgeon  General  in  regard  to  the  appointment 
of  colored  nurses  as  meml)ers  of  the  Army  Nurse  Corps. 
Owing  to  the  impossibility  of  securing  proper  quarters  for 
them,  it  has  never  been  the  policy  of  the  Surgeon  General's 
office  to  consider  the  appointment  of  colored  nurses. 

In  view  of  this  fact  it  was  moved  by  ^Irs.  Draper  and 
seconded  that  for  the  present,  at  least,  colored  nurses  should 
not  be  enrolled  for  service  under  the  Red  Cross.  The  motion 
was  carried.'^ 

The  ]\linutes  of  the  National  Committee  on  Red  Cross  Nurs- 
ing Service  for  a  meeting  held  June  16,  1917,  recorded  a  mo- 
tion made  and  carried  which  approved  ''a  plan  for  the  utiliza- 
tion of  colored  nurses  in  connection  with  base  hospitals,  if  such 
were  organized  for  colored  troops  alone."  This  plan  was  modi- 
fied at  the  next  meeting  of  the  National  Committee,  held  on 
June  20,  1917: 

The  chairman  stated :  The  next  question  is  the  assign- 
ment of  colored  nurses  to  duty.  The  understanding  was  that 
we  should  not  open  a  general  enrollment  for  colored  nurses, 
but  if  the  Surgeon  (ieneral  finds  a  way  to  use  them  (as  seems 
possible  in  Iowa)  we  will  enroll  them  for  that  special  service, 
securing  colored  nurses  as  they  may  be  needed,  to  go  out  in  the 
uniform  of  the  K'ed  Cross  nurse  and  to  be  given  tlie  Red  Gross 
badge.  It  was  not  a  general  enrollment,  but  when  enrolled 
tluy  would  ])e  on  the  same  footing  ujjon  assignment  to  duty  as 
were  other  nurses. 

'^limitcs    of    Uu'    Xatioiial    Commit  tee    on    Red    Crows    Nursing    Service, 
Vol.  1,  pj).  4.")  4". 


406   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

After  some  general  discussion,  the  resolution  in  regard  to 
colored  nurses,  offered  at  the  meeting  on  June  16,  was  changed 
by  the  insertion  of  the  words :  "Wherever  there  is  opportunity 
for  assignment  of  colored  nurses  for  duty,  they  be  enrolled  for 
that  service  and  assigned  to  that  duty."     Motion  carried. 

On  December  18,  1017,  Miss  Delano  asked  Miss  Thompson 
regarding  the  probability  of  the  Surgeon  General  assigning 
colored  nurses  to  duty.  Miss  Thompson  replied  the  following 
day  that  there  was  no  immediate  prospect  of  calling  upon  them, 
but  she  stated  that  she  thought  it  would  be  advisable  to  enroll 
them  "wath  the  understanding,  however,  that  their  assign- 
ment is  an  uncertain  proposition." 

During  the  influenza  epidemic,  the  base  hospital  at  Camp 
Sherman,  Ohio,  asked  the  Local  Red.  Cross  Chapter  on  Octo- 
ber 10  to  supply  it  with  additional  nurses.  Among  those  re- 
sponding to  the  call  was  a  registered  colored  nurse  whose  serv- 
ices were  refused.  Catherine  L,  Leary,  then  chief  nurse  at 
Camp  Sherman,  wrote  Xovcmber  21,  1918,  to  Miss  Thompson, 
giving  the  reason  for  this  refusal : 

The  evening  this  colored  nurse  arrived  at  Camp  Sherman 
for  duty,  the  response  to  the  appeal  through  the  Red  Cross 
had  been  acted  upon  so  quickly  that  we  had  many  nurses  at 
the  time.  I  therefore  had  to  refuse  a  numl}er  that  day,  among 
whom  was  this  attractive  and  intelligent  young  colored 
woman. 

She  seemed  much  disappointed  after  having  come  all  the 
way  from  Columbus.  I  offered  her  a  bed  for  the  night,  which 
she  accepted  and  later  refused,  deciding  to  return  to  Columbus 
as  her  services  were  not  needed.  I  felt  very  sorry  that  she 
should  have  to  go  away  disappointed,  so  I  paid  her  fare  to  and 
from  Cohinibus  to  the  camp,  telling  her  that  wlien  our  quar- 
ters for  colored  nurses  were  ready,  we  would  be  glad  to  have 
her  when  we  needed  her  services. 

An  emergency  dotachmcnt  consisting  of  nine  colored  nurses 
from  Frei^dman's  Hospital,  Washing-ton,  D.  C,  and  of  one 
mirse  from  Battle  Crock,  ^Fichigan,  was  assigned  during  the 
early  part  of  December  to  Camp  Sherman.  Aileen  B.  Cole, 
reserve  nurse,  wrote  December  3  of  their  reception: 

We  first  interviewed  tlie  cliief  nurse,  who  received  us  very 
cordiallv.     We  then   visited   the  colored   hostess  house.     Dr. 


THE  EUROPEAN  WAR  407 

Amanda  Gray,  of  Wasliinjjton,  who  is  chief  hostess  there, 
introduced  us  to  the  f^uests.  We  also  attended  the  colored 
Y.  M.  C.  A.  services  that  evening  and  it  warmed  our  hearts 
to  see  how  thoroughly  glad  those  hoys  were  to  have  us  with 
them  and  to  hear  them  choer ! 

We  are  accepting  conditions  exactly  as  we  find  them.  We 
have  met  with  individual  prejudice,  hut,  generally  speaking, 
every  one  so  far  has  hcen  exceedingly  kind. 

Clara  A.  Rollins,  reserve  nurse,  described  their  quarters: 

Each  nurse  has  her  own  room  and  everything  to  make  her 
feel  at  home.  Our  living  room  is  to  have  a  piano,  Victrola, 
desks,  chairs  and  many  other  comforts  to  break  the  monotony 
of  camp  life. 

The  work  is  very  interesting.  Our  boys  are  in  the  same 
wards  with  the  white  soldiers.  Members  of  our  unit  have 
been  assigned  to  the  accident  and  wounded  from  overseas 
ward ;  surgical,  ear,  nose  and  throat  ward  ;  the  psychiatric ;  the 
observation  and  contagious  wards;  and  medical  wards  of 
various  types.  Miss  Ball  is  the  only  masseuse  in  the  hospital 
and  they  were  very  glad  indeed  to  have  her. 

^larv  ^r.  Roberts,  chief  nurse  of  Camp  Sherman  at  the 
time  when  the  detachment  of  colored  nurses  was  ordered  there, 
wrote : 

Clara  A.  Eollins  T  hope  I  shall  never  forget,  because  of  her 
splendidly  cooperative  sj)irit  shown  throughout  her  service  at 
Sherman.  No  matter  what  ])roblem  arose  in  regard  to  the 
colored  group,  1  could  always  depend  on  Miss  Eollins  to  think 
the  matter  through  with  me  and  to  coo])erate  with  any  solution 
I  might  have  to  offer.  She  was  so  well  loved  by  the  boys  in  a 
surgical  ward  that  I  never  changed  her  from  her  first  position. 
I  recall  one  amusing  instance  which  occurred  when  a  change 
of  personnel  in  the  ward  seemed  logical  and  imminent.  A 
request,  signed  by  every  man  in  the  ward,  was  sent  to  my 
office  begging  that  ^liss  liollins  l)o  not  taken  from  them.  The 
boys  always  called  her  "the  Major""  and  the  day  before  she 
left  camp  they  bad  a  special  corcniony  and  made  her  a  "Lieu- 
tenant Colonel."'  As  I  recall  that  group  of  patients,  there 
were  very  few  colored  men  in  it. 

Of  tlio  living  conditions  and  social  life  of  the  colored  nurses, 
!Miss  Roberts  wrote : 


408   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

They  had  their  own  quarters  with  its  dining  room  and 
kitchen.  We  very  early  made  connection  with  the  colored 
"Y"  in  camp  and  such  other  arrangements  as  we  could  for  a 
reasonably  normal  social  life.  After  their  conference  with 
me,  they  agreed  that  they  would  not  expect  to  share  in  the 
social  activities  of  the  white  nurses.  It  was  to  be  understood 
that  they  were  most  welcome  at  all  the  "program"  affairs.  We 
were  careful  to  reserve  the  Ked  Cross  recreation  hut  for  their 
use  occasionally,  as  we  reserved  it  for  other  groups  for  special 
occasions  such  as  parties  given  by  the  aides,  the  students  or 
the  graduate  nurses. 

Of  the  value  of  the  work  rendered  by  the  unit  as  a  whole, 
Miss  Roberts  wrote : 

I  do  not  mind  saying  that  I  was  quite  sure,  when  orders 
came  for  the  colored  group,  that  I  was  about  to  meet  my 
Waterloo.  ]\ry  feeling  now  is  that  it  was  a  valuable  experience 
for  them  and  for  me.  They  really  were  a  credit  to  their  race, 
for  they  did  valuable  service  for  our  patients  and  it  was  a 
service  that  the  patients  appreciated.  I  now  find  myself 
deeply  interested  in  the  problems  of  all  colored  nurses  and 
believe  in  giving  them  such  opportunities  as  they  can  grasp  for 
advancement.  .  .  , 

The  War  Department  reported  that  the  services  of  seven 
members  of  this  detachment  of  colored  nurses  were  satisfac- 
tory in  every  respect.  Two  were  recorded  as  "Grade  2."  This 
was  highly  creditable  in  view  of  the  fact  that  the  detachment 
was  the  first  one  of  colored  nurses  in  the  service. 

A  second  detachment  of  colored  nurses  was  organized  and 
assigned  early  in  December,  1918,  to  service  at  Camp  Grant. 
Of  tliis  group,  Anne  Williamson,  then  chief  nurse  of  Camp 
Grant,  wrote: 

In  the  latter  part  of  the  year,  1918.  our  commanding 
officer.  Colonel  Tl.  C.  ]\Iichie,  received  definite  information 
that  we  were  to  have  a  contingent  of  colored  nurses  at  Camp 
Grant.  Action  to  construct  quarters  for  their  accommodation 
was  immediately  taken  and  ])y  the  time  that  nurses  arrived 
their  home  of  about  twenty  rooms  was  in  readiness. 

A  colored  cook  and  a  maid  were  assigned  to  this  group. 
One  nurse  was  appointed  housekeeper,  ordered  supplies, 
planned  the  meals  and  under  the  direction  of  the  chief  nurse 
conducted  the  household  affairs. 


THE  EUROPEAN  WAR  409 

The  first  nurse  reported  for  duty  December  3,  1918,  and 
within  a  few  days  about  thirteen  nurses  had  arrived.  Several 
of  the  nurses  were  from  the  Lincohi  Hospital,  Xew  York  City, 
one  from  the  Freedman's  Hospital,  Washington,  D.  C,  and 
several  from  Providence  Hospital,  Chicago. 

Since  the  white  and  colored  patients  were  not  assigned  to 
separate  wards,  these  nurses  were  assigned  to  the  general 
wards  under  the  direction  of  the  head  nurse.  They  were 
serious-minded,  quiet,  business-like  young  women,  well  quali- 
fied to  take  cliarge  of  wards,  had  our  colored  patients  been 
segregated.  For  a  time,  colored  troops  were  stationed  at 
Camp  (^.rant  and  the  nurses  liad  opportunity  for  quite  a  bit  of 
social  life.  They  gave  several  dinners  and  dances,  entertain- 
ing the  officers  from  the  troops  mentioned.  I  believe  that  one 
nurse  subsequently  married  an  officer  whom  she  had  met  at  the 
camp. 

Colored  nurses  served  with  distinction  during  the  influenza 
epidemic  at  Camp  Sevier,  South  Carolina.  Sajres  L.  Milli- 
ken,  who  was  at  the  time  chief  nurse  at  Camp  Sevier,  wrote: 

At  the  peak  of  the  influenza  epidemic  at  Camp  Sevier, 
South  Carolina,  about  fifty  per  cent  of  the  nurses  were  ofi: 
duty,  sick,  and  the  hospital  contained  about  3000  patients. 
It  became  necessary  to  employ  locally  every  nurse  who  could 
be  secured.  A  medical  officer  on  duty  at  Camp  Sevier  who 
was  from  that  section  of  the  country  said  that  there  were 
several  good  colored  nurses  who  could  be  secured  in  the  vicin- 
ity of  S{)artaiiburg,  South  Carolina.  The  idea  of  securing  the 
services  of  colored  nurses  did  not  immediately  meet  with 
enthusiasm,  as  fully  seventy-five  per  cent  of  the  nurses  were 
women  of  Southern  birth  and  had  very  positive  objections  to 
working  with  colored  nurses.  The  need  was  so  imperative  that 
it  was  decided  to  employ  them,  furnishing  tliem  quarters  and 
a  mess  separate  from  the  white  nurses. 

About  twelve  reported  for  duty.  They  were  assigned  to  the 
wards  in  the  hospital  in  subordinate  positions  and  with  the 
exception  of  one  or  two  who  were  not  young  enough  to  ada})t 
themselves  to  the  trying  conditions  under  wliich  every  one  was 
working,  these  young  women  were  found  to  be  well-trained, 
quiet  and  dignified,  and  there  was  never  at  any  time  evidence 
of  friction  l)etween  the  white  and  colored  nurses.  They  serv(Ml 
for  a  period  of  possibly  three  weeks.  ...  I  should  say  tliat, 
although  these  nurses  had  no  opjiortunity  to  display  e\e(uti\e 
al)ility,  they  did  and  can  fill  a  valuable  ])lace  in  the  nursing 
profession. 


410   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Four  types  of  assignment  characterized  war  nursing  service 
in  the  United  States.  At  the  base  of  the  military  pyramid  were 
the  barrack  wards  of  the  cantonments  where  the  recruits  of 
the  Selective  Draft  were  trained.  The  National  Guard  did 
not  need  so  thorough  a  schooling,  military  theorists  argued, 
and  it  was  housed  under  canvas.  Sometimes  a  nurse  found 
herself  in  the  shining  tiled  corridors  of  Walter  Reed  or  Letter- 
man  U.  S.  Army  General  Base  Hospitals,  permanent  estab- 
lishments of  the  Reg-ular  Army.  Fortunate  indeed  was  the 
nurse  whose  orders  took  her  to  an  embarkation  encampment ! 
Stella  Godard,  reserve  nurse,  wrote  in  August,  1918,  from 
Camp  Stuart,  Newport  News,  Virgina: 

After  the  preliminary  business  of  arrival  and  reporting  my- 
self to  the  chief  nurse,  I  was  taken  over  to  a  long  barrack-like 
building  and  found  a  bed  allotted  to  me  in  a  dormitory  with 
about  fifty  other  nurses.  I  must  admit  that  this,  for  a  first 
impression,  was  rather  daunting.  The  place  was  littered 
from  end  to  end  with  clothes,  trunks  and  grips.  Even  the 
beds  themselves  were  occupied,  some  by  night  nurses  trying  to 
sleep,  others  by  day  nurses,  reading,  writing,  sewing  and 
resting.  I  could  see  no  possibility  of  the  faintest  trace  of 
privacy  for  the  undressing  and  the  dressing  hour.  Neither 
was  there  any  and  later  I  learned  there  was  no  water  for  any 
purpose  nearer  than  the  main  building.  We  had  rough 
wooden  shelves  to  put  our  things  on  and  a  few  nails  on  which 
to  hang  our  clothes.  To  get  a  bath  we  had  to  walk  outside  to 
the  main  building,  two  blocks  away.  At  all  times  of  the  day, 
nurses  were  to  be  met  a  la  negligee  passing  to  and  from 
their  ablutions.  When  it  stormed,  the  rain  leaked  down  upon 
us  from  the  roof;  when  it  blew,  the  sand  whirled  in  and  ahnost 
buried  us,  and  the  flies  were  a  veritable  plague. 

But  all  this  was,  I  am  glad  to  say,  only  temporary  dis- 
comfort, for  now  we  have  very  nice  quarters,  all  brand  new 
and  clean.  I  often  look  back  and  laugh  to  think  of  my 
chagrin  and  realize  that  it  was  not  so  bad  as  it  seemed  after 
all. 

Here  in  Haiupton  Koads  were  the  shifting  sights  and  sounds 
of  maritime  traffic.     ]\[iss  Godard  wrote: 

The  hospital  wards  are  built  facing  the  fine  water  front. 
Both  day  and  ni^ht  its  ever-changing  beauty  refreshes  and 
charms  one.  During  the  day.  we  see  the  ships  that  come  and 
go  to   and   from    tho   busy   ])orts   around   here.      Transports, 


THE  EUROPEAN  WAR  411 

battleships,  coaling  vessels  and  innumeral)le  other  craft  lie  at 
Hampton  Roads,  a  groat  air  of  indomitable  purpose  and  mys- 
tery surrounding  them.  Then  when  night  falls,  stillness 
comes  over  the  water  and  the  long  road  of  silver  light  made 
by  the  moon  shimmers  up  to  meet  the  stars.  Then,  too,  there 
are  the  little  birds  that  live  in  the  reeds  and  long  grasses  by 
the  water's  edge,  that  all  night  long  make  weird,  restless  little 
noises,  neither  a  song  nor  a  call,  but  a  sound  that  fills  one  with 
inexplicable  longings. 

The  romance  of  war,  now^  doubly  potent  because  of  the  ne- 
cessity for  absolute  secrecy,  enveloped  the  constant  movement 
of  the  troops.     Miss  Godard  wrote: 

The  troops  are  continually  entering  and  leaving.  For  a 
few  days  the  camp  will  be  crowded  with  men  busy  about  their 
drills,  parades,  exercises,  a  continually  moving  mass. 

Several  times  I  have  come  off  night  duty  to  see  a  regiment 
leaving  in  the  early  morning.  The  colonel  addressed  his  men 
in  a  few  brief  words,  poignant  with  pride,  hope  and  high 
courage.  The  emotion  which  he  would  have  hidden  was  evi- 
dent only  in  tlie  deep  vibration  of  his  voice.  He  saluted  his 
men,  his  officers,  then  stepped  up  to  the  head  of  his  regiment. 
The  band  struck  up,  the  order  rang  out  and  they  all  swung 
forward  with  brisk  tread,  enthusiasm  like  a  glory  shining  from 
their  faces. 

When  you  stepped  out  on  the  front  porch  that  morning,  you 
would  find  the  long  rows  of  barracks,  the  water  front  and  the 
camp  streets  empty,  deserted  and  silent,  a  deathly  and  haunt- 
ing stillness  over  all,  where  only  a  few  hours  before  there  had 
been  movement  and  laughter,  song  and  banter,  the  playing  of 
bands  and  the  shrill  call  of  bugles.  From  two  hundred  to  two 
thousand  men  had  been  literally  spirited  away  during  the 
night  on  to  the  transports  and  it  will  be  many  a  long  day 
before  the  tramp,  tramp  of  their  marching  feet  will  be  heard 
upon  this  camping  ground  again. 

By  noon,  however  the  vacated  barracks  and  parade  grounds 
would  be  filled  again.  At  the  main  gate  new  regiments  would 
come  marching  in,  fine  l)odies  of  men,  neat  and  trim,  their 
overseas  caps  set  smartly  on  the  sides  of  their  heads.  Follow- 
ing them  would  come  carts,  wagons,  trucks  laden  with  para- 
phernalia for  liorses  and  men,  magnificent  and  inspiring, 
soldiers  and  equipment  alike  the  best  America  has  to  offer. 

Twelve  thousand,  seven  hundred  and  ninety-three  members 
of  the   Army   Xurse   Corps,    rc^gulars   and   reserves,    scrvt^l   in 


412   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

military  cantonment  and  camp  hospitals  in  the  United  States 
dnring  the  European  War.  A  certain  amount  of  gossip  was 
whispered  about  regarding  the  discomforts,  the  unreasoning 
discipline,  the  overwork,  the  monotony  and  the  loneliness  of 
this  branch  of  the  service.  In  sharp  contrast  to  the  few 
nurses  who  complained  bitterly  yet  humanly  of  their  assign- 
ment to  cantonment  duty,  there  were  many  who  looked  behind 
the  surface  annoyances  and  inconveniences  of  camp  life,  the 
tedium  of  nursing  accident  cases  and  minor  ailments  and  the 
lack  of  consideration  on  the  part  of  some  of  their  superior 
officers  and  saw  the  real  meaning  of  cantonment  duty,  sensed 
its  tremendously  vital  part  in  the  war  plan  and  accepted  their 
assignment  like  the  good  soldiers  that  they  were.  This  sports- 
manlike and  altruistic  spirit  was  well  expressed  in  the  follow- 
ing letter  written  by  a  reserve  nurse: 

U.  S.  Army  Base  Hospital, 

Camp ,  May  25,  1918. 

And  so  the  summons  came  and  I  answered.     I  am  one  of 

the  one  hundred  and  forty-eight  nurses  at  Camp ,  an 

atom.  For  as  I  write,  there  march  before  me  sixty  thousand 
fighting  men,  undaunted,  ready  and  supreme.  Here  we  stand 
togetlier,  one  hundred  and  forty-eight  nurses  and  sixty  thou- 
sand of  the  youth  of  America. 

The  number  on  my  Red  Cross  pin  is  .     In  October, 

1916,  happy  in  safe  aml)itions,  in  a  gay  loyalty  to  an  idea 
which  sprouts  in  cadets'  training,  I  enrolled  in  the  American 
Eed  Cross.  1  still  have  a  circular  letter,  dated  March  18, 1918. 
It  is  an  appeal,  almost  a  prayer  to  sixty-five  thousand  regis- 
tered nurses  of  our  nation.    It  asked  for  volunteers. 

And  today  there  are  one  hundred  and  forty-eight  nurses  to 

sixty  thousand  men  in  Camp trying  to  accomplish 

the  work  of  twice  their  number  and  more.  Tomorrow  they 
Journey  on  ilie  great  adventure  and  their  footsteps  nuist  be 
followed  by  otlier  women  to  wlioni  the  war  means  more  than 
knitting  socks  and  sweaters  and  using  wlu^it  substitutes. 

It  seems  to  me  tliat  tiiis  titanic  militarv  struggle  lias  be- 
come a  test  for  our  profession;  a  test  of  its  faith  in  sacrifice;  a 
test  of  woman's  willingness  and  ability  to  share  hardship; 
a  test  of  woman's  right  to  be  heard  in  the  councils  which  shall 
create  new  ideals  from  this  holocaust  of  war. 


THE  EUROPEAN  WAR  413 

From  hospitals  and  from  private  homes,  from  camps  and 
from  cantonments,  American  nurses  on  their  eager  way  to  for- 
eign service  went  to  New  York  and  to  lloboken,  the  embarka- 
tion port  for  tlie  American  Expeditionary  Forces.  From  tliere 
they  sailed  when  transportation  could  be  secured. 

The  attitude  of  the  embarking  nurses  offered  an  interesting 
psychological  demonstration  of  the  value  and  eilect  of  dis- 
ciplined training.  Nurses  are  taught  to  suppress  their  per- 
sonal reactions  and  emotions.  They  are  primarily  ministers 
to  others  in  time  of  crisis  and  suffering  and  it  is  not  for  them 
to  show  feelings  of  fear,  of  hysterical  sympathy,  even  of  joy, 
when  they  are  working  in  a  professional  capacity.  This  prin- 
ciple of  nursing  ethics  is  well  illustrated  by  an  incident  which 
occurred  during  a  recent  disaster.  The  mutilated  bodies  of 
the  dead  were  lying  in  an  improvised  morgue,  awaiting  identi- 
fication, and  relatives  were  passing  down  the  lino.  A  number 
of  Red  Cross  nurses  were  on  duty.  As  an  attendant  lifted  tlic 
sheet  which  covered  a  body,  one  of  the  younger  nurses  grew 
dizzy  at  the  sight.  She  turned  to  the  nurse  in  charge  and 
said,  "I  am  going  to  faint." 

The  older  woman  leaned  toward  her  and  whispered  sharply: 
"Don't  you  dare!  Other  people  have  a  right  to  faint.  You 
haven't." 

The  young  nurse  bowed  her  head  for  a  moment,  pulled  her- 
self quickly  together  and  went  on  with  her  work. 

This  professional  poise,  which  is  attained  only  through  dis- 
cipline and  experience,  is  the  first  prere(iuisitc  of  the  good 
nurse.  Under  it,  however,  must  lie  a  fountain-spring  of  sym- 
pathy and  altruism,  without  which  no  woman  could  stand  the 
sights  and  render  the  services  expected  of  nurses.  War 
touched  these  emotions  and  stirred  them  deeply,  but  the  dis- 
cipline of  training  led  nurses  to  cover  their  real  feelings  with 
a  crust  of  cool  unconccn-n.  They  accepted  the  details  of  embar- 
kation with  a  sdvoir  fdire  which  some  observers  called  "hard- 
boiled  indifference."  So  the  ten  thousand  nurses  went  down 
to  New  York,  donned  their  uniforms  and  boarded  the  trans- 
ports with  an  anin/.ing  (piietness  impossible  of  achievement 
had  not  the  nurses  themselves  willed,  by  forc(>  of  their  training, 
to  go  (juietly.  No  mere  orders  of  the  War  Department  could 
have  silenced  ten  thousand  women  and  have  made  them  go  to 
France  to  nurse  the  wounded  under  the  conditions  prevailing 
in  111  IT,  without  even  a  ripple  of  public  acclaim. 


414   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Embarkation  was  a  tedious,  a  bewildering  and  a  somewhat 
disappointing  experience  for  these  nurses,  so  many  of  whom 
had  cherished  since  girlhood  the  hope  of  nursing  the  wounded 
in  war  J  for  indeed  the  name  of  Florence  Nightingale  had  led 
more  women  into  schools  of  nursing  than  had  the  remunerative 
phases  of  the  profession.  During  long  hours  of  night  duty  in 
city  hospital  wards  and  later  in  isolated  cantonment  bases, 
nurses  had  lived  in  anticipation  again  and  again  the  day  when 
they  should  at  last  set  out  for  war  service.  Stories  of  physical 
hardships  and  exhausting  work,  stories  told  by  American 
nurses  who  had  served  on  the  Western  Front  during  the  early 
days  of  the  war,  rumors  of  submarine  attacks  and  veiled  sug- 
gestions which  were  circulated  in  1917  of  atrocities  committed 
on  nurses,  did  not  help  to  dispel  any  natural  apprehensions 
which  these  women  might  have  felt  when  embarking  upon  a 
service  as  precarious  as  war  nursing.  For  most  of  them  the 
old  life,  the  old  sheltered  life  within  hospital  walls,  ended  once 
and  for  all  time.  The  Great  Adventure,  long-anticipated,  had 
begun,  but  like  all  experiences  which  have  been  lived  many 
times  in  anticipation,  the  actual  going-out,  thougli  pictur- 
esque enough  in  itself,  was  less  colorful,  less  dramatic  than 
had  been  their  conception  of  it. 

The  first  contingents  of  the  American  Army  to  sail  for  Eu- 
rope in  May,  1917,  were  the  six  American  Ked  Cross  base  hos- 
pitals which  General  Gorgas  assigned  to  the  British  Expedi- 
tionary Forces.  The  embarkation  of  the  first  two  units  was 
so  hurried  that  the  nurses  were  not  even  allowed  to  wait  in 
New  York  until  the  newly-adopted  Red  Cross  outdoor  uniforms 
could  be  completed.  They  sailed  instead  in  civilian  attire, 
having  received  only  such  articles  of  equipment  as  were  then 
immediately  available  in  Red  Cross  storerooms. 

United  States  Army  Base  Hospital  No.  4  (Lakeside)  which 
had  had  a  trial  mobilization  in  Fairmont  Park,  Philadelphia, 
in  the  fall  of  1916,  was  remobilized  in  Cleveland,  Ohio,  thirty 
days  after  the  United  States  declared  war,  for  immediate  serv- 
ice overseas.  Grace  Allison,  chief  nurse,  described  the  sailing 
of  the  unit: 

Sixty-two  nurses  from  various  parts  of  the  Ignited  States 
assembled  on  ^lay  (i  with  the  general  unit  at  Cleveland  and 
entrained  for  an  unknown  destination.  Arriving  in  New 
York,  wc  were  quietly  transferred  to  the  Cunard  liner, 
Orduna.     Here  ]\Iiss  Xoyes  distributed  our  capes,  caps  and 


THE  EUROPEAN  WAR  415 

other  equipment.  Miss  Xutting,  Mrs.  Helen  Hartley  Jenkins, 
Mrs.  Draper,  Mr.  Samuel  Mather,  president  of  the  Board  of 
Directors  of  the  Lakeside  Hospital  and  many  others  hade  us 
Godspeed  hefore  ropes  were  loosened  May  8  and  we  moved 
down  the  harhor. 

United  States  Army  Base  Hospital  No.  5,  of  Peter  Bent 
Brigham,  Boston,  Massachusetts,  sailed  on  May  11  without 
the  serge  dress,  ulster  and  velour  hat  which  had  just  been 
standardized  as  the  outdoor  uniform  for  reserve  nurses  of 
Red  Cross  base  hospital  units  assigned  to  foreign  service. 

The  sixty-tive  nurses  of  the  Presbyterian  Unit,  U.  S.  Army 
Base  Hospital  No.  2,  which  embarked  May  14,  were  uniformed 
and  equipped  by  the  American  Red  Cross.  On  May  19,  three 
other  units,  U.  S.  Army  Base  Hospital  No.  121  (Washington 
University  Medical  School,  St.  Louis),  U.  S.  Army  Base  Hos- 
pital Xo.  10  (Pennsylvania  Hospital,  Philadelphia)  and  U.  S. 
Array  Base  Hospital  No.  12  (Xorthwestern  University  Medi- 
cal School,  Chicago)  also  sailed  with  outdoor  uniforms  and 
more  complete  equipment.  ]Miss  Xoyes  in  the  August  issue, 
1917,  of  the  American  Journal  of  Nursing  described  the  spirit 
in  which  the  nurses  of  these  pioneer  units  accepted  foreign 
service : 

It  is  an  inspiring  picture  to  see  the  nursing  personnel  of  a 
base  hos})ital  ready  to  embark.  The  dignified  uniform  of 
dark  blue  cloth,  the  scarlet  lining  of  the  cape,  the  caduceus 
and  the  letters  "V.  S."  on  the  collar,  em])hasizing  the  close 
relationship  to  the  ^fedical  Corps  of  the  Army,  are  significant 
and  impressive.  Complete  understanding  of  the  nature  of  the 
mission  is  expressed  in  their  faces.  There  is  no  laughing  or 
joking,  yet  there  are  no  tears.  Courage  is  written  on  each 
comitenajice  and  service  wlierever  required  is  their  purpose. 

During  ^lay,  1917,  ^liss  Xoyes  made  as  many  as  three  trips 
a  week  to  Xcw  York,  going  over  at  midnight  to  see  a  unit  sail 
the  following  day,  returning  again  at  night  to  be  ready  for 
work  the  following  morning  on  the  lists  of  personnel  of  other 
units  th(>n  awaiting  assignment.  By  these  trips,  ^liss  Xoyes 
started  th(»  practice,  wliich  was  later  carried  on  by  ^liss  John- 
son, of  explaining  to  the  nurses  sailing  for  Kuropi^  their  new 
relation  to  the  Army  or  the  Xavy  and  tlie  Red  Cross,  and  a 
little  of  tli(>  types  of  service  whicli   they  might   meet   and   the 


416   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

responsibilities  they  might  be  expected  to  shoulder.  She  im- 
pressed upon  them  the  fact  that  they  were  privileged,  above 
all  other  women,  to  work  in  the  closest  and  most  appealing  re- 
lationship with  the  American  soldier,  the  relation  of  wounded 
man  and  nurse,  and  she  urged  them  always  to  remember  that 
their  conduct  would  not  only  bring  honor  or  discredit  upon  the 
American  Red  Cross  and  the  American  nursing  profession 
but  as  well  upon  American  womanhood. 

Early  in  Jvme,  1917,  the  Army  established  a  mobilization 
center  for  nurses  on  Ellis  Island.  Edith  Agnes  Mury  was 
chief  nurse.  A  Californian  by  birth  and  parentage,  Miss 
Mury  was  graduated  from  the  Waldeck  Hospital  Training 
School  in  San  Francisco.  Following  institutional  work  in 
western  and  Philippine  hospitals,  she  served  three  years  in  the 
Navy  Nurse  Corps  and  was  transferred  July  18,  1916,  to  the 
Army  Xurse  Corps.  Later  she  was  appointed  assistant  su- 
perintendent of  the  Corps  and  served  in  the  Surgeon  General's 
office  for  some  time.  In  June,  1917,  while  she  was  on  duty 
on  the  Mexican  border,  orders  came  directing  her  ''to  pro- 
ceed to  IS^ew  York  and  report  on  arrival  there  to  the  Command- 
ing General,  Eastern  Department,  at  Governors  Island,  for 
duty  as  chief  nurse  of  a  mobilization  station  for  nurses  to  be 
established  at  Ellis  Island,  Xew  York  Harbor."  Mina  Kee- 
nan,  a  regular  of  the  Army  Xurse  Corps,  was  also  assigned  to 
Ellis  Island  as  Miss  Mury's  assistant. 

Three  large  buildings  on  Ellis  Island,  which  had  been  used 
as  hospitals  by  the  Immigration  Department,  but  which  had 
been  empty  since  1914  owing  to  the  decrease  in  immigration 
since  the  beginning  of  the  war,  were  turned  over  to  the  Army 
Xurse  Corps.  "On  the  day  of  our  arrival,"  wrote  Miss  Mury, 
"we  were  faced  with  these  three  huge,  empty  buildings  and 
with  a  telegram  stating  that  sixty-six  nurses  would  arrive  the 
next  day.  .  .  .  Beds,  bedding  and  a  few  accessories  were 
brought  by  Quartermaster  tugs  from  the  Supply  Depot  in  Xew 
Voik.  Infautrvincii  from  Governors  Island  cleaned  the  wards 
aiul  set  up  the  furniture.  When  those  sixty-six  nurses  arrived 
the  next  day,  they  had  clean  white  hospital  beds  but  little  else. 
.  .  .  For  a  while  it  seemed  as  if  we  were  not  to  eat,"  ^liss 
Murv  coiK-hidcd,  "but  the  Immigration  officials  hospital)ly  threw 
open  their  employees'  dining  room  to  us." 

Within  a  few  weeks,  ^liss  Mury  and  !Miss  Keenan  had  de- 
veloped a  smoothly-running  organization.     .Miss  Mury  wrote: 


THE  El  ROPEAN  WAR  417 

With  the  help  of  a  female  civil  service  stenographer  and 
men  from  the  Hospital  Corps,  I  handled  the  ollice  work  while 
Miss  Kecnan  managed  the  housekeeping  and  looked  after  the 
comfort  of  the  nurses  in  tiieir  respective  quarters.  Our  accom- 
modations at  first  were  only  for  two  hundred  and  fifty  nurses. 
Later  we  took  over  a  fourth  huilding  and  could  then  accom- 
modate five  hundred  nurses  at  one  time. 

The  wards  were  converted  into  dormitories.  The  heds 
were  placed  close  together  down  the  sides  of  each  room. 
There  were  no  clothes  closets  and  the  nurses  lived  practically 
in  their  small  steamer  trunks.  Although  they  were  so 
crowded,  we  heard  remarkahly  few  complaints. 

The  procedure  by  which  nurses  joined  the  Army  Nurse 
Corps  through  the  Red  Cross  Ileserve  has  already  been  de- 
scribed. After  the  nurses  of  a  base  hospital  or  other  type  of 
unit  had  received  their  travel-orders,  they  executed  their  oath 
of  office  at  home  and  served  an  apprenticeship  in  the  hospital 
of  a  camp  or  cantonment,  then  went  to  New  York  for  foreign 
service.  The  first  base  hospitals,  however,  reported  directly 
to  Ellis  Island  and  there  the  Army  absorbed  them  completely. 
Miss  ]\Iury  wrote: 

When  we  were  informed  of  a  unit's  arrival  in  Xew  York, 
men  of  the  Hospital  Corps  who  had  been  detailed  to  our 
station  for  miscellaneous  duty  met  the  nurses  at  the  depot  and 
escorted  them  to  Ellis  Island.  ]\[en  with  Army  trucks  ob- 
tained the  ba.ijcgage  and  sent  it  to  us  by  boat.  When  the 
nurses  arrived,  they  came  single  fde  through  my  oflfice,  where 
a  sergeant,  the  stenogra})her  and  I  received  their  papers  and 
secured  such  information  as  was  necessary  for  our  records. 
Miss  Kcenan  tlien  took  them  in  charge  and  they  were  given 
beds  and  mess  assignments  at  the  Immigration  dining  room. 

Every  morning  at  0  A.^r.  roll  call  for  all  nurses  of  every 
unit  at  the  station  was  held.  Permission  was  never  given  to  a 
nurse  to  be  absent.  Kach  individual  had  to  be  accounted  for 
once  a  (lay.  After  roll  call,  shore  leave  was  granted  to  any  one 
until  nii(hiigbt  unless  a  unit  was  being  held  under  sailing 
orders.  If  u  new  unit  had  arrived  the  day  before,  tbey  were 
held  after  roll  call  for  an  e.\])lanatiou  of  tbeir  new  duties,  the 
Army  regulations  to  which  they  would  now  have  to  ailbere. 
the  local  rules  of  the  mobilization  station  and  something  of 
the  traditions  of  the  Army  of  which  tbey  were  now  an  integral 
part. 

The  next  step  in  the  preparation  of  a  unit  for  sailing  was 


418   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  procuring  of  passports,  which  in  the  early  days  of  the  war 
were  necessary. 

Of  some  of  the  details  by  which  nurses  secured  their  identi- 
fication cards  and  passports,  Glenna  L.  Bigelow  wrote  in  the 
Military  il^umber  of  the  Journal: 

We  went  this  morning  to  Hobokeu,  where  we  are  to  get  our 
identification  cards  and  finger  prints.  I  surely  feel  as  if  my 
"fate  was  hung  around  my  neck"'  now. 

After  this  episode,  we  all  filed  into  another  room,  small  and 
stuffy,  where  were  a  glaring  electric  light  and  a  huge  camera. 
A  fleissige  Berthe  would  not  have  been  more  formidable. 
However,  each  one  in  turn  sat  down  before  the  dreadful  object 
while  two  dozen  companions  uncompromisingly  criticized  her 
camera  expression.  Then,  "Smile  and  look  at  me,"  said  the 
operator;  click,  and  the  thing  was  done.  In  exactly  seven 
minutes  the  picture,  dripping  from  its  acid  bath,  was  finished, 
developed  and  printed.  And  as  the  Scotch  woman  said  when 
she  saw  her  first  photograph,  '"It  was  a  humblin'  sight." 

Equipment  was  the  next  business  in  hand.  Miss  Bigelow 
described  from  the  point  of  view  of  the  individual  nurse  this 
phase  of  embarkation : 

Tuesday,  February ,  1918.    Unit went  en  masse 

to  the  tailors  to  be  measured  for  uniforms.  The  wonderful 
system  of  outfitting  the  crowds  of  nurses,  ranging  all  the  way 
from  "small  thirty-two'"  to  large  "forty-four,"  seems  perfect. 
The  fitters  were  ver}-  amiable  until  about  lunch  time  when 
one  of  them  insisted  that  a  certain  coat  was  all  right.  His 
client  (a  social  service  nurse  who  had  picked  up  some  stray 
phrases  of  the  Ghetto),  spoke  to  him  in  Yiddish  and  then  he 
discovered  that  it  was  all  wrong  and  marked  it  up  and  down 
and  all  .over  with  his  chalk.  .  .  . 

Friday  our  equipment  arrived  on  the  fern,-  boat,  great  pack- 
ages and  boxes  from  Xew  York.  We  stood  in  line  alpha- 
betically to  receive  our  consignment  and  marveled  at  the 
order  and  dispatch  with  which  that  great  pile  of  things  was 
dissipated.  Every  person's  name  was  on  exactly  the  right 
box,  in  exactly  the  right  place,  so  that  there  was  no  con- 
fusion and  presently  we  found  ourselves  back  in  our  dor- 
mitory, staggering  under  our  load  of  gifts.  It  was  like  an 
individual  Cliristmas  tree  all  around  and  we  were  immensely 
grateful.  We  realize  what  really  hard  work  it  is  and  how 
monotonous  the  packing  of  those  kits  must  become  after  the 


THE  EUROPEAN  WAR  419 

novelty  has  worn  off.  It  is  true  that  we  nurses  have  the 
excitement,  the  (•han<;e,  the  danger  perhaps,  while  they  are 
getting  the  Jull,  stay-at-home  part.  We  bless  them,  every  one, 
for  these  unnumbered  comforts  which  will  smooth  our  way 
over  there.  .  .  . 

Saturday  night.  The  dormitory  is  the  most  amusing  place 
in  the  evening,  when  all  the  nurses  come  back  from  town.  It 
is  a  veritable  Grand  Street,  with  all  the  coats  and  dresses 
hung  up  on  frames  over  the  beds  and  bundles  strewn  about. 
Articles  are  bought,  sold  and  swapped,  appraised  and  depre- 
ciated. Shylock  would  find  some  kindred  spirits  in  our  little 
Kialto  and  his  glittering  eyes  would  certainly  approve  our 
spirit  of  bargaining.  By  the  way,  we  have  a  feminine  Harry 
Lauder  among  us,  whose  Scotch  burr  caresses  the  ether  with  a 
subtle  touch.  She  is  the  most  optimistic  of  people  and  when 
the  conversation  hovers  about  U-boats,  her  only  concern  is 
whether  Providence  or  sticking  plaster  keeps  the  sailors'  caps 
on  their  heads ! 

After  the  nurses  had  received  their  passports  and  identifi- 
cation tags,  after  they  had  donned  their  ontdoor  uniforms  and 
packed  away  the  other  articles  of  equipment,  they  entered  into 
the  most  trying  period  of  embarkation.  Until  Jidy,  1918, 
troops  and  supplies  for  the  American  Expeditionary  Forces 
were  given  right  of  way  to  France  and  the  nurses  were  often 
kept  waiting  on  Ellis  Island  for  weeks  at  a  time  until  the  trans- 
portation officer  would  supply  sailing  accommodations  for 
them.  During  the  tedious  days  of  waiting,  an  Army  sergeant 
drilled  them  in  the  rudiments  of  military  formations.  Ellis 
Island  in  1917  presented  a  martial  appearance.  "As  our  build- 
ings were  on  the  sea  wall  directly  in  front  of  the  channel  to  the 
ocean,"  wrote  !Miss  ^lury,  "all  the  activities  of  a  harbor  given 
over  to  war  went  on  in  our  front  yard.  Also  there  were  a 
thousand  interned  Germans  and  imprisoned  German  agents 
under  heavy  guard  on  Ellis  Island  and  their  presence  produced 
rather  a   shadow  of  apprehension." 

Flora  A.  Graham  (Albany  City  Hospital,  New  York),  a 
nurse  member  of  Ease  Hospital  Xo.  3.3,  wrote  in  the  Military 
Xumber  of  the  Journal  of  the  recreation  facilities: 

On  Island  Xo.  1  there  is  also  an  innnenso  hall  wlicro  the 
Y.  l\r.  C.  A.  ])rovides  aniusomont  three  times  each  week  for 
soldiers  and  sailors  and  Army  nurses.  These  amusements 
consist   of   motion    ])ictures.   lectures,    popular   and    ])atriotic 


420   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

songs  and  are  largely  attended  and  appreciated.  On  one 
occasion  I  noticed  that  the  hoys  were  especially  enthusiastic 
over  the  song,  "IMother,  Bid  Your  Baby  Boy  Good-bye."  The 
screen  picture  that  night  was  "Tom  Sawyer"  and  it  gave  us 
all  great  pleasure. 

The  chief  nurse  of  base  hospitals  spent  many  hours  in  try- 
ing to  master  Army  paper  work.  ''Chief  nurses  from  civilian 
hospitals,"  wrote  Miss  Mury,  "had  had  no  opportunity  to  be- 
come familiar  with  the  special  duties  of  an  Army  chief  nurse. 
It  was  my  duty  to  instruct  them  in  the  methods  of  keeping  rec- 
ords and  preparing  official  reports  pertaining  to  the  Corps. 
I  fear  that  the  methods  of  routine  that  had  taken  me  years  to 
learn,"  concluded  ]\Iiss  Mury,  "I  often  expected  those  chief 
nurses  to  acquire  in  a  single  day." 

In  December,  11)17,  the  old  Colony  Club  building  in  New 
York  City  was  offered  to  the  War  Department  by  Mrs.  Gene- 
vieve Walsh  for  use  as  a  mobilization  station  for  nurses  await- 
ing transportation  overseas.  As  the  space  on  Ellis  Island  was 
limited,  the  offer  was  accepted  at  once  and  proved  a  veritable 
Godsend,  as  one  hundred  and  thirty  nurses  could  be  accommo- 
dated there  at  one  time.  Its  central  location  was  an  added  ad- 
vantage. ]Mary  E.  vSheehan  was  the  first  chief  nurse  there 
and  was  followed  by  Minnie  Winslow.  The  building  was  used 
until  the  spring  of  1918. 

From  the  nurses  mobilized  in  New  York  were  drawn  hun- 
dreds who  participated  in  the  Ked  Cross  parades  which  were 
beld  during  1017  and  1918.  Led  by  Miss  Delano,  Miss  Noyes, 
Miss  Thompson,  j\lrs.  Higbee,  Miss  Van  Blarcom  and  other 
national  executives,  column  after  column  of  mirses,  some  clad 
in  white  with  their  scarlet-lined  capes  flung  back,  others  march- 
ing row  upon  row  in  the  smart  blue  uniforms  of  the  Army  and 
Navy,  swung  down  Fifth  Avenue  in  that  first  historic  parade 
of  Octol)er  9,  1917,  the  most  spectacular  pageanty  of  women 
mobilized  for  war  that  New  York  City  had  ever  witnessed. 

The  delay  in  the  embarkation  of  nurses  from  Ellis  Island 
was  due  principally  to  the  acute  shortage  of  American  and 
Allied  tonnage.  The  transportation  of  American  combat  troops 
and  supplies  was  necessarily  given  the  right  of  way  over  that 
of  medical  personnel  and  hospital  supp]i(>s,  especially  after  the 
German  offensive  of  ^Farcli,  1918.  The  United  States  par- 
ticipated in  the  European  War  for  nineteen  months  and  dur- 
ing that  period  iiiove  tliaii   2, 000, 000  American   soldiers  went 


THE  EUROPEAN  WAR  421 

to  France,  500,000  of  them  during  the  first  thirteen  months 
and  1,500,000  during  the  last  six  months.  At  first,  the  Army 
had  only  a  few  American  and  British  troop  ships  which  they 
chartered  directly  from  the  owners,  but  during  the  winter 
months  of  1917-11)18  the  German  liners  which  had  been  seized 
were  brought  into  use  and  the  movement  of  troops  gradiudly 
increased.  Early  in  1918,  the  British  Cjovernmcnt  agreed  to 
assign  three  of  its  large  liners  and  four  smaller  troop  ships  to 
the  American  Army  and  an  increase  of  5779  men  in  .March, 
1918,  over  the  preceding  month  resulted.  Also  in  j\Iarch  oc- 
curred the  disastrous  Picardy  Drive,  with  results  which  threat- 
ened to  end  in  German  victory.  "Every  ship  that  could  be 
secured,"  wrote  Colonel  Ayr(>s,  chief  of  the  Statistics  Branch 
of  the  General  Staff,  "was  pressed  into  service.  The  aid  fur- 
nished by  the  British  was  greatly  increased.  ...  In  ]\Iay  and 
in  the  four  following  months,  .  .  .  the  transportation  miracle 
took  place.  The  number  of  men  carried  in  May  was  more  than 
twice  as  great  as  the  number  for  April.  The  June  record  was 
greater  than  that  of  ^lay  and  before  the  first  of  July,  1,000,000 
men  had  been  embarked.''  ^ 

In  July,  over  .300,000  American  soldiers  were  carried  to 
France  and  by  October  31,  1918,  2,000,000  had  sailed  from  the 
United  States.  During  many  weeks  in  the  summer,  10,000 
men  embarked  every  day  for  P]urope.  "Among  every  hundred 
men  who  went  over,"  wrote  Colonel  Ayres,  "forty-nine  went  in 
British  ships,  forty-five  in  American  ships,  three  in  those  of 
Italy,  two  in  French  and  one  in  Russian  shipping  under  British 
control."  " 

In  the  late  spring  of  1918,  the  War  Department  found  it 
necessary  to  use  the  buildings  on  Ellis  Island  for  hospital  pur- 
poses, so  the  Knott  chain  of  hotels  in  N^ew  York  C\t\  was  taken 
over  by  the  Army  and  mirsos  were  mobilized  there.  An  ad- 
ministration center  was  established  at  Hotel  Albert.  Mary 
C.  Jorgensen  followed  Miss  Alury  as  chief  nurse  of  the  mobiliza- 
tion station  in  New  York.     She  wrote: 

Soon  the  daily  ri'ijorts  showed  nearly  one  tliousand  mirsos 
housed  in  twenty  dillVrent  hotels,  stretc  hing  from  Wasliinuton 
Square  to  Seventy-Second  Street.  There,  in  America's 
largest  city,  it  was  no  easy  task  to  keep  an  eye  on  them 
all.  .  .  .     ^ 

""The  \\i\v  with  Gorinanv,''  pj).  37-.'58. 
"Ibid.,  p.  41. 


422   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Confusion  was  necessarily  present  to  a  great  degree.  The 
corridors  and  the  none-too-large  offices  provided  in  the  hotels 
commandeered  for  mobilization  stations  seemed  overflowing 
with  swarms  of  women  asking  all  sorts  of  questions  dealing 
with  equipment,  War  Eisk  Insurance,  allotments  and  pay. 
All  were  so  truly  eager  to  be  of  service  that  the  objective 
was  the  proper  functioning  of  the  great  machine  centered  in 
Washington.  Units  prided  themselves  on  the  correct  wearing 
of  the  uniform  and  on  proper  drilling  and  a  spirit  of  friendly 
rivalry  existed  between  the  various  groups  as  to  which  were 
the  better  soldiers.  As  each  unit  became  equipped,  its  mem- 
bers, earnest  and  intensely  eager,  with  trunks  packed,  waited 
on  the  qui  vive  for  orders  to  sail.  The  most  scrupulous  pre- 
cautions had  to  be  exercised  in  giving  out  sailing  dates;  only 
the  chief  nurse  was  told  when  her  unit  would  go. 

The  greatest  single  problem  encountered  during  the  entire 
period  of  mobilization  was  the  arrival  of  the  five  hundred  and 
fifty  "casuals"  who  were  withdrawn  from  the  cantonments  in 
May  for  immediate  assignment  overseas.  Their  arrival  in  New 
York  extended  over  a  period  of  several  nights  and  days  and  they 
were  housed  in  seven  different  hotels.  They  had  no  chief 
nurse  to  assume  responsibility.  ''They  seemed,"  wrote  Miss 
Jorgensen,  "to  be  in  a  chaotic  state  of  disorganization.  Finally 
they  were  all  assembled  at  the  Ylst  Infantry  Armory,"  she  con- 
tinued, "one  of  their  number  was  designated  as  chief  nurse 
and  she  appointed  five  assistants.  Conditions  improved  to  a 
considerable  extent." 

The  six  hundred  odd  Red  Cross  nurses  sent  overseas  to  work 
directly  under  lied  Cross  foreign  commissions,  found  less  rou- 
tine in  embarkation  than  did  those  attached  to  the  Army.  They 
were  mobilized  at  the  house  of  Joseph  A.  Aucrbach  on  West 
Tenth  Street.  This  house,  which  had  been  loaned  to  the  New 
York  County  Chapter,  was  more  than  just  a  beautiful  place 
for  nurses  to  stay  in  until  the  Red  Cross  secured  their  pass- 
ports and  passage.  It  soon  became  a  meeting  place  for  Army 
and  Xavy  reserves  as  well  as  for  nurses  destined  for  strictly 
Red  Cross  foreign  service.  After  roll  call  in  the  morning,  Miss 
elohnson  usually  gathered  together  the  different  units  of  nurses 
sailing  each  week  and  explained  to  them  their  new  relation  to 
the  Army  or  to  the  Navy  and  to  the  Red  Cross,  her  resolute, 
human  philosophy  of  service  often  being  the  last  message  which 
the  nurses  received  b(>for(!  they  embarked. 


THE  EUROPEAN  WAR  423 

Solemn  indeed  for  the  nurses  was  the  long  anticipated  hour 
when  they  boarded  ship.  Though  her  official  duties  concerned 
only  nurses  enrolled  in  the  Red  Cross,  Miss  Johnson  saw  almost 
every  American  nurse  oif  for  Europe.  She  described  the 
docks : 

Sometimes  we'd  crawl  out  of  bed  at  three  A.M.  and  drive 
down  to  the  East  River  or  over  to  Hobokeu  to  meet  the  nurses 
on  the  docks.  Often  it  would  be  raining  torrents.  Again 
the  cold  sleet  numbed  us.  Our  arms  were  always  piled  high 
with  every  conceivable  kind  of  bundle.  We  Ked  (^rossers  had 
great  difficulty  in  getting  supplies  to  the  other  side,  so  every 
nurse  en  route  to  the  Paris  office,  went  laden  down  with 
bundles  and  resembled  an  immigrant  at  Ellis  Island. 

When  our  nurses  went  over  on  an  Army  transport  we'd 
find  the  docks  crowded  with  troops.  The  boys  invariably  had 
a  friendly  greeting  for  the  nurses.  The  Red  Cross  Canteen 
women  were  there,  too,  no  matter  how  hot  or  cold,  how  early 
or  how  late  it  miglit  be.  Sometimes  we'd  wait  hours  on 
sweltering  docks,  so  hot  that  the  pitch  oozed  out  of  the  cracks 
and  the  boys,  panting  with  heat  and  fatigue,  would  lie  down 
to  sleep  as  best  they  could. 

The  "dazzle  painting"  of  the  liners  and  transports  further 
heightened  the  sensations  of  weird  unreality  which  the  nurses 
experienced  as  they  waited  on  the  docks.  This  type  of  paint- 
ing, popularly  termed  "camouflage,"  made  it  more  difficult  for 
a  subnuirine  commander,  peering  through  a  periscope  for  only 
a  few  seconds  at  a  tinu\  to  determine  the  course  of  a  vessel  so 
decorated.  "The  Carpathm"  wrote  Priscilla  J.  Hughes,  Army 
Nurse  Corps,  chief  nurse  of  Evacuation  Hospital  Xo.  :^2, 
"had  the  most  fearful  and  wonderful  camouflage,  the  design 
of  which  was  supposed  to  represent  large  teeth  encircling  her 
bow  and  stern  to  show  that  she  had  sunk  a  submarine — so  they 
told  us !  Each  ship  of  our  convoy  of  fourteen  had  a  different 
fantastic  pattern." 

Hiss  ^lury  summarized  briefly  the  spirit  of  the  ten  thousand 
nurses  who  embarked  through  Ellis  Island  for  service  with  the 
American  Expeditionary  Eorces: 

When  sailing  orders  were  received  for  a  unit,  shore  leave 
was  stopped,  no  coniinunication  with  friends  or  relatives  was 
allowed;  trunks  were  inspected  and  locked  and  the  unit  stood 
by  for  tlie  tug  which  was  to  take  them  to  tlie  traiisjinrt.  On 
arrival  of  the  tug,  the  connuand  "Fall  in  I"  was  given,   fol- 


424   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

lowed  by  "Forward  March !"  and  sixty-five  silent,  blue-clad, 
white-faced  women  with  chins  well  up  and  eyes  to  the  front 
marched  down  the  dock  and  on  to  the  tug  in  soldierly  for- 
mation. Usually  as  the  boat  shoved  off  a  lilting  song  came 
drifting  back,  "Pack  up  your  troubles  in  your  old  kit  bag  and 
smile,  smile,  smile."  One  knew,  however,  that  the  wonderful 
spirit  of  American  womanhood  strengthened  ■  by  hospital 
training  enabled  those  nurses  one  and  all  to  face  so  bravely 
the  journey  across  the  submarine-infested  sea  and  the  fur- 
ther unknown  dangers  of  military  hospital  duty  in  a  war- 
stricken  foreign  land. 

To  the  nurses  watching  and  awaiting  their  turn,  the  depar- 
ture of  a  unit  was  full  of  tense  emotion.     Miss  Bigelow  wrote : 

The  sky  was  blue  and  the  sun  shone  brightly  on  the  little 
procession  of  fifty  nurses,  so  dignified  and  smart  in  their  dark 
blue  uniforms.  They  emerged  from  their  quarters,  marched 
silently  along  the  quay  of  Island  No.  3  and  over  the  bridge 
to  the  chapel  on  Island  No.  1,  when  we  lost  sight  of  them  for 
a  moment.  Soon  they  came  out  and  marched,  two  by  two, 
toward  the  tender  which  was  to  take  them  out  to  their  ship. 
Their  leader  carried  the  flag.  That  mass  of  color  crushed  in 
her  arms  .  .  .  seemed  like  a  dart  of  flame,  an  imprisoned 
thing  seeking  freedom. 

It  happened  that  a  company  of  sailor  boys,  out  for  morn- 
ing drill,  was  drawn  up  at  "attention"'  right  at  the  gang 
plank  wlien  the  unit  embarked;  their  presence  added  tre- 
mendously to  the  impressiveness  of  the  picture.  But  the 
silence  was  terrible, — no  fanfare  of  trumpets,  no  admiring 
friends,  no  flowers,  only  the  grimness  of  parting.  The  little 
boat  shrieked  out  a  warning,  warped  away  from  the  pier  and 
silently  disappeared  around  the  Island. 


Great  Britain,  the  gateway  through  which  passed  one-half 
of  the  two  million  American  soldiers  who  served  at  the  Western 
Front  during  tlie  European  War,  was  the  scene  of  extensive 
American  Jfcd  Cross  nursing  service  in  the  field. 

Early  in  1!)14,  it  will  be  remembered,  a  grouj^  of  American 
citizens  resident  in  England  had  desired  to  express  their  sym- 
pathy for  the  Allied  cause  and  especially  for  England  by  the 
establishment  and  maintenance  of  a  war  hospital.  The  Ameri- 
can Women's  War  Iieli(;f  Fund  was  raised  and  the  Committee 
responsible  for  its  disl)ursenient  opened  "Oldway  House"  Hos- 


THE  EUROPEAN  WAR  425 

pital,  Mr.  Paris  Singer's  estate  at  Paigiitou,  Devonshire.  When 
the  American  Red  Ooss  offered  two  medical  nnits  of  the 
;Mercy  Ship  to  the  British  Uovernment  in  Angnst,  1914,  the 
War  Office  assigned  Unit  F  and  later  Unit  D  to  Paignton  and 
they  remained  there  for  one  year.  After  their  recall,  the 
committee  continued  the  maintenance  of  "Oldway  House"  Hos- 
pital and  also  estahlished  a  small  officers'  hospital  at  Lancas- 
ter Gate,  Hyde  Park,  J^ondon. 

Upon  the  entry  of  the  United  States  into  the  European  War, 
memhers  of  the  American  colony  in  England  desired  to  take  a 
more  active  part  in  war  relief  work  than  was  afforded  them  in 
the  maintenance  of  these  two  hospitals.  They  accordingly  pe- 
tioned  National  Headquarters  to  grant  them  a  charter  as  an 
American  Red  Cross  Chapter.  Thus  on  May  24,  1917,  came 
into  existence  the  London  Chapter  of  the  society. 

Mr.  Walter  H.  Page,  then  American  Ambassador,  was  the 
first  honorary  president.  ]\lrs.  Page  and  Mrs.  Robert  P.  Skin- 
ner were  honorary  vice-presidents ;  Mrs.  Whitelaw  Reid  was 
chairman;  i\Irs.  Irwin  Laughlin,  vice-chairman;  Boylston  A. 
Real,  honorary  secretary ;  and  Robert  Grant,  Jr.,  honorary 
treasurer.     W.  H.  l^uckler  served  as  administrative  director. 

Six  base  hospitals  organized  by  the  American  Red  Cross  were, 
it  will  be  remembered,  the  first  branches  of  the  American  Army 
to  go  overseas.  The  nurses  of  these  columns  were  cordially  re- 
ceived in  London  by  members  of  the  London  Chapter.  As  other 
base  hospital  units  arrived  in  England  on  their  way  to  service 
with  the  American  Expeditionary  Forces  in  France,  urgent 
need  developed  for  a  large  central  club  where  transient  nurses 
might  be  housed  and  entertained.  A  committee  of  the  London 
Chapter  was  organized,  with  Viscountess  LLircourt  as  chair- 
man and  this  committee  established  in  June,  1917,  the  Ameri- 
can Nurses'  (Mub,  at  No.  42  Grosvenor  Place.  This  club  soon 
became  so  popular  with  Army,  Navy  and  Red  Cross  nurses  on 
their  way  to  France  or  on  brief  holiday  in  J^ondon,  that  the 
Chapter  furnished  an  annex  to  it  on  a  floor  of  Forbes  LLnise, 
the  home  of  the  Countess  of  Granard  in  Halkin  Street.  ^Mrs. 
Cavendish  l^entinck  opened  an  extensive  suite  of  rooms  in  her 
house.  No.  4  Richmond  Terrace,  and  latin-  the  committee  l(>ased 
another  building.  No.  4;")  Grosvenor  Place.  Agnes  Ijirtles,  an 
American  Red  Cross  nurse  on  duty  in  Great  Britain,  wrote 
that  "]io  one  who  has  not  been  a  stranger  herself  in  London  can 
realize  what  it  has  meant  to  us  to  have  an  attractive  place  to  go 


426   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  in  a  strange  city.  Everything,  even  to  serving  our  break- 
fasts to  us  in  bed,  was  done  for  our  comfort." 

In  the  fall  of  1917,  two  long-pending  developments  of  the 
American  military  situation  brought  about  an  urgent  need  for 
more  extensive  American  Red  Cross  operations  in  Great  Britain 
than  could  be  handled  solely  through  the  London  Chapter.  The 
first  of  these  was  the  decision  to  brigade  American  troops  with 
the  British  Armies  in  northern  France ;  this  brought  with  it 
the  certainty  that  American  sick  and  wounded  would  be  sent 
to  Great  Britain  for  care  and  treatment.  American  hospital 
facilities  in  England  for  these  men  would,  therefore,  be  neces- 
sary. 

The  second  development  was  the  enormous  increase  in  the 
numbers  of  American  soldiers  who  were  being  landed  on  Brit- 
ish soil  while  en  route  to  France.  Of  the  2,000,000  American 
soldiers  who  served  on  the  Western  Front,  1,025,000  of  them 
were  carried  across  the  Atlantic  in  British  ships.  Early  in 
the  spring  of  1918,  the  British  Government  assigned  three  of 
its  big  liners  and  four  of  its  smaller  troop  ships  to  the  use  of 
the  American  Army.  These  ships  took  on  American  soldiers 
at  Quebec,  Montreal,  St.  John,  Halifax,  Portland,  Boston, 
New  York,  Philadelphia,  Baltimore  and  Norfolk  and  dis- 
charged them  at  Glasgow,  Manchester,  Liverpool,  Bristol  Ports, 
Falmouth,  Plymouth,  Southampton  and  London.  After  a  short 
time  spent  in  American  rest  camps  established  by  the  American 
Army  near  these  ports,  the  soldiers  were  transported  to  France 
by  means  of  the  Cross-Channel  Fleet. 

Following  the  decision  of  the  War  Department  to  send 
American  troops  to  France  by  way  of  the  British  Isles,  the  Sec- 
retary of  War  established  in  October,  1917,  in  England,  L^nited 
States  Army  Base  Section  No.  3  and  placed  Major  General 
George  T.  Bartlett  in  command.  Brigadier  General  Francis 
Winter  was  assigned  as  Chief  Surgeon  of  the  American  Armies 
in  Great  Britain.  His  office  did  not  at  this  time  include,  how- 
ever, a  representative  of  the  Army  Nurse  Corps. 

Wherever  branches  of  the  American  Army  were  sent  during 
the  European  War,  representatives  of  the  American  Red  Cross 
followed  to  offer  them  the  service  which  its  charter  of  1905 
authorized  the  society  to  give.  T^pon  the  arrival  in  Great 
Britain  of  large  numbers  of  American  troops,  the  need  for  Red 
Cross  service  increased  to  proportionate  dimensions.  This  ser- 
vice entailed  the  purchase  and  distribution  of  vast  quantities  of 


THE  EUROPEAN  WAR  427 

supplies  to  the  American  Army  and  the  establishment,  if  the 
Army  Medical  Corps  so  desired,  of  Red  Cross  hospital  facilities 
for  American  sick  and  wounded  soldiers.  Although  tiie  London 
Chapter  was  organized  in  JMay,  1017,  it  was  the  policy  of  the 
War  Council  to  conduct  activities  of  this  nature  through  foreign 
commissions  sent  out  from  National  Headquarters.  Local 
Chapters,  if  such  existed  in  the  foreign  field,  lacked  both  the 
funds  and  the  knowledge  of  national  and  international  Red 
Cross  policy  to  administer  the  diversified  activities.  The  War 
Council  appointed  the  members  of  each  commission,  appro- 
priated from  the  Red  Cross  General  Fund  the  moneys  neces- 
sary for  their  work  and  directed  their  activities  entirely  from 
National  Headquarters. 

The  first  of  these  commissions,  the  American  Red  Cross 
Commission  for  Europe,  as  will  be  recounted  in  a  subsequent 
section,  arrived  in  Paris  early  in  June,  1917,  and  set  up  its 
headquarters  at  No.  5,  Rue  Francois  Ir,  ^[ajor  Grayson  ^I.-P. 
^furphy,  of  New  York  City,  was  the  commissioner.  Among 
the  seventeen  men  who  formed  his  staff  w^as  William  Endicott, 
of  Boston,  Massachusetts. 

Early  in  July,  a  need  was  felt  both  by  National  Headquarters 
and  by  the  Conmiission  for  Europe  for  an  American  Red  Cross 
representative  in  London.  The  War  Council  voted  on  July  12, 
1017,  "that  a  Commission  for  Great  Britain  be  immediately  or- 
ganized." The  need  for  a  "direct  representative  in  London" 
was  echoed  again  in  the  Minutes  of  the  War  Council,  meeting 
August  7,  1017,  and  on  August  22,  "Edgar  H.  Wells  was 
recommended  and  appointed  as  deputy  commissioner  for  Great 
Britain." 

During  July  and  August,  the  Commission  for  Europe  was  ex- 
periencing its  initial  difficulties  in  securing  supplies  in  France. 
Major  Endicott  was  accordingly  dispatched  to  England  to  act 
as  "purchasing  agent"  for  the  Paris  office.  He  hung  up  his 
cap  September  10,  1017,  in  a  room  at  tlu>  Cha])ter  h('ail(|u;ii' 
ters  on  Grosvenor  Gardens  which  was  loan(>d  to  him  by  the 
London  Chapter,  and  in  this  office  six  we(>ks  later,  the  Ameri- 
can Red  (^ross  Commission  for  Gi'cat  IJritain  came  into  exist- 
ence, with  Major  Endicott  as  connnissioncr.^"  His  office,  thougli 
numbering  seven  persons,  did  not  at  this  time  include  a  repr(>- 
sentative  of  the  American  Red  Cross  Nursing  Service. 

The  first  work  of  the  Commission  was  the  establishnieut  near 
'"Si'c  Minutes  of  the  War  Council,  October  2:5,    1(117:   Vol.   II,  p.  3.">(;. 


428    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Liverpool  of  American  Red  Cross  Military  Hospital  No.  4. 
On  ISTovember  19,  1917,  Major  Endicott  leased  an  English 
country  estate,  Mossley  Hill,  which  was  located  within  fifteen 
minutes  by  motor  from  the  docks.  The  Red  Cross  immediately 
began  the  renovation  and  equipment  of  the  fine  old  mansion 
house  as  a  war  hospital. 

Small  numbers  of  American  troops  were  then  being  sent  to 
England  in  the  available  passenger  space  on  commercial  liners. 
They  were  concentrated  at  the  United  States  Army  Rest  Camp 
at  Winchester  and  the  first  American  Army  hospital  in  Eng- 
land was  opened  there.  It  was  located  on  the  crest  of  Morn 
Hill,  two  miles  from  the  city  and  was  designated  as  United 
States  Army  Camp  Hospital  No.  35.  It  was  opened  for  pa- 
tients on  December  15,  1917.  Nine  Army  nurses,  with  Ada 
J.  Allan  as  chief  nurse,  were  assigned  to  duty  there  on  Feb- 
ruary 22,  1918.  The  capacity  of  the  hospital  was  gradually 
increased  to  600  beds  and  the  nursing  staif  raised  to  thirty 
members.  ^^ 

On  January  9,  1918,  American  Red  Cross  Military  Hos- 
pital No.  4,  Mossley  Hill,  received  its  first  patients.  Its  ca- 
pacity then  included  only  forty  beds,  but  eight  barracks  were 
soon  constructed  within  the  spacious  grounds,  which  brought 
up  the  total  capacity  of  the  hospital  to  500  beds.  An  officer  of 
the  United  States  Medical  Corps  was  placed  in  charge.  The 
Nursing  Service  at  National  Headquarters,  Washing-ton,  sup- 
plied the  nurses.  Marion  Weller  (New  York  Hospital)  was 
chief  nurse ;  she  was  installed  by  Major  Endicott  previous  to 
the  opening  of  the  hospital  and  she  and  her  nurses  worked 
with  great  devotion  to  transform  the  old  mansion  into  a  hos- 
pital.    One  of  these  was  Agnes  C.  Birtles.     She  wrote : 

j\ry  first  assignment  to  duty  upon  my  arrival  on  Decomber 
1,  1917.  at  r.iveri)()ol.  was  to  a  new  Red  Cross  hospital  tlieii 
being  ])repared  for  the  reception  of  American  troops  tak(Mi  ill 
in  crossing.  As  we  were  unable  to  secure  any  kind  of  labor, 
we  seven  nurses  set  to  work  cleaning,  scrubbing,  painting 
floors,  un])acking  furniture  ;uul  ])utting  up  beds.  The  beau- 
tiful old  house  had  been  empty  for  a  long  time. 

1  shall  ne\er  forget  our  first  patients,  those  ill,  homesick 
boys  wlio  canie  to  us  from  other  hospitals  or  directly  from 
the  docks.     Some  had  been  taken  to  English  hospitals  where 

"  Soo  IJcport  of  tlie  Director  of  Nursinfr  Service,  American  Expeditionary 
Forct's,  p.  27. 


THE  EUROPEAN  WAR  429 

they  had  received  the  best  of  care,  but  English  people,  kind 
as  they  are  and  English  surroundings,  clean  and  often  luxu- 
rious, were  not  American.  Our  bare  wards  seemed  like  home. 
New  buildings  were  soon  erected  and  never  a  bed  was  empty. 
More  than  once  we  put  our  patients  on  mattresses  in  the  halls 
while  the  erection  of  new  barracks  was  speeded  up. 

In  July,  1918,  this  hospital  was  transferred  from  the  Red 
Cross  Commission  to  the  American  Expeditionary  Forces  in 
Ehig-land  and  was  staffed  by  reserve  nurses,  Army  Nurse 
Corps.  Hospital  Unit  "T,"  which  had  been  organized  by  the 
Red  Cross  for  the  Army,  was  transferred  from  Sarisbury  Court 
for  duty  at  ^Mossley  Hill.  Nellie  Brookbanks  was  chief  nurse. 
The  capacity  of  the  hospital  was  later  raised  to  500  beds,  with 
a  permanent  nursing  staff  of  forty-five.^- 

The  Red  Cross  Commission  for  Great  Britain  next  took  oyer 
three  hospitals  in  England  which  had  preyiously  been  con- 
ducted by  the  American  Women's  War  Relief  Committee  and 
by  the  London  Chapter.  The  Commission  assumed  financial 
responsibility  for  these  already  successful  hospitals,  greatly  ex- 
tended their  activities  to  meet  the  new  demands,  centralized 
the  management  and  brought  about  economy  of  personnel  and 
funds. 

The  largest  of  these  three  hospitals  was  "Oldway  House," 
Paignton,  which  the  American  Women's  War  Relief  Commit- 
tee turned  over  on  January  1,  1918,  to  the  American  Red 
Cross.  It  was  designated  as  American  Red  Cross  Military 
Hospital  iSTo.  21.  Its  sixty  rooms  accommodated  250  patients. 
By  the  acquisition  of  other  buildings  on  the  estate  and  of  the 
Redcliffe  and  the  Esplanade  Hotels  in  Paignton,  the  Commis- 
sion raised  the  bed  capacity  of  the  hospital  to  700.  Like  other 
Red  Cross  military  hospitals  in  England  and  France,  officers 
of  the  United  States  Army  Medical  Corps  were  in  command. 
A  British  Matron  was  in  charge  of  the  nursing  staff  which  con- 
sisted of  English  sisters,  numerous  V.  A.  1).  members,  and 
American  Red  Cross  nurses  of  the  ^Mercy  Sliip,  who  had  elected 
to  remain  at  "Oldway  House"  after  the  recall  of  the  units.  On 
August  17,  1918,  twenty-five  reserves  of  the  Army  Xurse  Ct)rps, 
who  had  gone  overseas  as  members  of  Base  Hospital  Xo.  40, 
were  assigned  to  teni])orary  duty  at  Paignton  and  all  others 
were  released.  Mary  Murpliy,  a  graduate  of  the  Carney  Hos- 
pital,  South  Boston,  was  chief  nurse. 

"  S(H>  Report  of  the  Director  of  Nursing  Service,  American  Expeditionary 
Forces,  p.  28. 


430    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  other  hospital  formerly  administered  by  the  American 
Women's  War  Relief  Committee  was  a  small  institution  at 
Lancaster  Gate,  Hyde  Park,  London,  which  the  committee 
had  opened  in  March,  1917,  for  British  officers.  The  Ameri- 
can Red  Cross  Commission  for  Great  Britain  took  over  this  hos- 
pital, gave  it  the  designation  of  American  Red  Cross  Military 
Hospital  No.  22  and  expanded  its  original  capacity  of  forty- 
eight  beds  so  that  it  ultimately  accommodated  approximately 
150  American  officer  patients.  The  nursing  staff  was  made  up 
of  English  Sisters  and  nursing  members  of  Voluntary  Aid  De- 
tachments of  the  British  Red  Cross.  A  British  nurse  was 
Matron.  The  presence  of  three  American  Red  Cross  nurses 
added  an  American  touch  during  the  spring  and  summer  of 
1918,  but  they  were  recalled  by  autumn.  The  success  of  the 
Lancaster  Gate  Hospital  was  due  largely  to  the  efforts  of  Vis- 
countess Harcourt. 

The  third  hospital  to  be  taken  over  by  the  Commission  was 
St.    Katharine's    Lodge,    Regent's    Park,    London.      In    June, 

1917,  Mrs.  William  Salomon,  of  New  York,  had  offered  her 
house,  a  rambling  two-story  lodge  built  by  George  IV  in  four 
acres  of  royal  parks,  to  the  London  Chapter  of  the  American 
Red  Cross  to  be  used  for  hospital  purposes.  The  London  Chap- 
ter accepted  the  gift  and  St.  Katharine's  Lodge  was  first  main- 
tained as  an  auxiliary  of  the  British  Military  Orthopedic  Hos- 
pital at  Shepherd's  Bush.     Upon  its  transfer  on  January  1, 

1918,  to  the  Commission  for  Great  Britain,  it  was  designated 
as  American  Red  Cross  Military  Hospital  No.  23,  but  its  thirty- 
eight  beds  continued  to  be  used  for  the  care  of  British  officers. 
It  was  staffed  by  eleven  American  Red  Cross  nurses,  with  Isa- 
belle  F.  Carson  as  chief  nurse.  In  midsummer  of  1918,  St. 
Katharine's  Lodge  was  militarized  and  became  an  American 
officers'  ward  of  L^nitcd  States  Army  Base  Hospital  No.  29, 
at  Tottenham,  near  London. 

So  successful  was  St.  Katharine's  Lodge  as  an  officers'  hos- 
pital that  ]\Ir.  Chester  Beatty,  an  American  mining  engineer, 
and  his  wife  offered  in  January,  1918,  the  use  of  their  London 
residence,  Baroda  House,  for  hospital  purposes  to  the  Red 
Cross  Commission.  ]Major  Endicott  accepted  tlie  gift  and  on 
March  20,  1918,  Baroda  House  was  opened  as  American  Red 
Cross  ^lilitarv  Hospital  No.  24.  ~Mr.  and  ]\lrs.  Beatty  con- 
tributed the  funds  re([uired  for  the  maintenance  of  the  hos- 
pital and  tlie  American  Red  X'ross  Commission  supplied  the 


THE  EUROPEAN  WAR  431 

professional  staff,  the  orderlies  and  the  medical  and  surgical 
supplies.  Five  American  lied  Cross  nurses  and  four  V.  A. 
I),  members,  were  assigned  to  duty  there. 

In  location  and  in  execution,  Baroda  House  was  charmingly 
suited  for  use  as  an  officers'  hospital.  Though  in  the  center 
of  London,  it  adjoined  Kensington  Palace  Gardens  and  was 
removed  from  traffic, — a  quiet  and  soothing  place.  Its  founder 
had  been  an  Indian  prince,  the  Gaekwar  of  Baroda,  and  the 
spacious,  square,  high-ccilinged  rooms  still  contained  in  their 
furnishings  a  quaint  and  Eastern  flavor.  Tall  windows  on  the 
ground  floor  opened  directly  upon  lawns  and  a  garden  where 
convalescent  patients  in  wheel-chairs  and  on  beds,  drowsed 
through  the  sunny  afternoons. 

American  Red  Cross  military  hospitals  in  Great  Britain 
thus  on  March  20,  1918,  consisted  of  No,  4,  Mossley  Hill,  Liver- 
pool ;  No.  21,  Paignton ;  'No.  22,  Lancaster  Gate,  London ;  No. 
23,  St.  Katharine's  Lodge,  London ;  and  No.  24,  Baroda  House, 
London. 

The  development  of  hospital  activities  in  England,  both  of 
the  Army  and  of  the  Red  Cross,  was  greatly  accelerated  during 
the  spring  and  summer  of  1918  by  the  aid  which  the  British 
Government  gave  the  United  States  War  Department  in  the 
transportation  of  American  troops.  The  movement  of  Ameri- 
can troops  for  March  showed  an  increase  over  February  of 
almost  6000  men.  During  the  same  month,  the  disastrous 
Picardy  offensive  occurred  and  every  available  British  ship 
was  immediately  pressed  in  service  to  transport  American  rein- 
forcements for  the  almost-exhausted  Allied  armies  holding  the 
Western  Front.  The  number  of  men  transported  to  France 
in  April  showed  an  increase  over  March  of  33,000  and  in  May, 
the  number  transported  was  more  than  tw^ce  as  many  as  in 
April.  By  July  1,  1,000,000  men  had  been  embarked  and  a 
great  number  of  them  passed  through  England. 

This  increase  in  the  number  of  American  troops  passing 
through  England  brought  about  a  need  for  more  extensive  hos- 
pitalization in  Base  Section  No.  3.  The  establishment  of  new 
hospitals  requiring  large  staffs  of  nurses  created  a  need  also 
for  a  representative  of  the  Army  Nurse  Corps  to  serve  on  Gen- 
eral Winter's  staff.  'Vwo  reserve  nurses  of  the  Army  Xurs(> 
Corps,  Nellie  E.  McGovern  (^lanhattan  State  Hospital,  New 
York  City)  and  Nellie  V.  Brookbanks  (Bellevue  Hospital) 
were  assigned  on   Felu'uary   22,   1918,   by  the  Chief  Surgeon, 


432    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

American  Expeditionary  Forces  in  France,  to  the  office  of  the 
Chief  Surgeon,  American  Annies  in  Great  Britain,  and  into 
their  hands  was  pLiced  responsibility  for  the  conduct  of  the 
Army  Nurse  Corps  in  England. 

During  the  early  spring  of  1918,  General  Winter  estab- 
lished a  camp  hospital  at  Liverpool  and  an  Army  base  hospital 
at  Hursley  Park,  Winchester.  The  first  of  these,  U.  S,  Army 
Camp  Hospital  No.  40,  was  located  at  Knotty  Ash,  Liverpool, 
and  was  opened  on  March  26,  1918,  It  drew  patients  from 
the  big  American  Rest  Camp  at  Knotty  Ash,  which  then  ac- 
commodated 10,000  troops.  The  initial  bed  capacity  of  Camp 
Hospital  No.  40  was  250,  but  it  was  raised  during  the  summer 
and  fall  of  1918  to  500  beds.  Twenty-one  nurses  of  Hospital 
Unit  "W,"  which  had  been  organized  by  the  American  Red 
Cross  for  the  Army,  were  assigned  to  duty  there  on  May  28 ; 
Amanda  Metzger,  a  graduate  of  the  Springfield  (Illinois)  Hos- 
pital, w^as  chief  nurse.  The  strength  of  the  nursing  staff  was 
later  increased  to  forty-five  members  and  was  maintained  at 
this  number  by  the  assignment  of  nurses  from  various  base 
hospital  units  to  temporary  duty  there.  ^^ 

The  first  United  States  Army  hospital  in  England,  No.  204, 
opened  its  doors  April  23,  1918,  at  Hursley  Park  in  south- 
eastern England,  five  miles  distant  from  Winchester.  The 
British  War  Office  turned  over  to  the  American  Army  Medical 
Corps  wooden  barracks  which  they  had  built  for  the  hospitali- 
zation of  their  own  troops  and  Base  Hospital  No.  204  opened 
its  doors  to  patients  on  April  23,  1918.  The  nursing  staff 
was  composed  of  twenty-two  members  of  Hospital  Unit  ''I". 
Lora  B.  Roscr,  a  graduate  of  the  Culver  Union  Hospital,  Craw- 
fordsville,  Indiana,  was  chief  nurse.  The  capacity  of  the 
hospital  was  later  raised  to  eight  hundred  beds  and  the  strength 
of  the  nursing  staff  to  fifty  permanent  members.^'*  Hursley 
Park  Hospital  was  repaired  and  reequipped  by  the  Red  Cross. 

The  Red  Cross  Commission  for  Great  Britain  was  permitted 
to  take  an  important  part  in  the  establishment  of  the  next  hos- 
pital for  American  troops  in  England.  In  the  spring  of  1918, 
the  American  x\rmy  Rest  Cainp  at  Winchester  overflowed,  so 
the  American  Army  in  England  took  over  a  second  camp  six 
miles  away  at  Romsey.     Nurses  will  remember  that  one  of  the 

"  See  Report  of  the  Director  of  Nursing  Service,  American  Expeditionary 
Forces,  p.  27. 
"Ibid. 


THE  EUROPEAN  WAR  433 

Nightingale  estates  was  situated  near  Romscy,  in  ITampshire, 
and  the  young  Florence  Nightingale  especially  enjoyed  the  sum- 
mers spent  there. 

The  camp  at  liomsey  which  the  American  Army  took  over 
had  formerly  helonged  to  the  British  Army  and  had  accommo- 
dations for  seven  thousand  troops.  Its  hospital  facilities  con- 
sisted, however,  of  a  row  of  tents  along  one  of  the  camp  streets. 
These  tents  were  equipped  only  with  straw  ticks  laid  upon 
boards  raised  about  six  inches  from  the  floor.  During  the  pleas- 
ant English  suniuK^r,  these  quarters  had  been  comfortable 
enough  for  the  British  sick  and  wounded  to  spend  a  few  hours 
in  before  British  ambulances  transported  them  to  nearby  bases. 
A  different  situation  confronted  the  American  Army.  They 
had  only  the  one  base  hospital,  at  ITursley  Park.  Thus  for  the 
raw  English  winters,  they  needed  permanent  hospital  facili- 
ties at  Romsey.  The  Chief  Surgeon  called  upon  the  Red  Cross 
Commission  for  Great  Britain  to  construct  a  permanent  hos- 
pital of  at  least  two  hundred  and  fifty  beds. 

The  commission  immediately  undertook  the  work  and  Major 
Endicott  set  about  the  discouraging  task  of  securing  supplies 
and  labor.  While  he  was  searching  for  wood  or  concrete  or  stone 
or  any  building  materials,  not  necessarily  the  most  desirable 
but  those  actually  to  be  had,  an  Army  lieutenant  secured  an 
option  for  some  bricks  and  he  turned  it  over  to  ^lajor  Endicott, 
The  necessary  lumber  was  sawed  by  small  portable  mills  in  the 
New  Forest  and  was  swiftly  transported  by  Army  trucks  to 
Romsey.  Working  scpiads  of  the  American  Armies  were  as- 
signed to  bricklaying.  Sometimes  the  hospital  construction 
progressed  uninterruptedly  for  as  long  as  three  weeks.  Then 
the  troops  were  ordered  to  Plymouth  or  Southampton,  the 
transports  steamed  out  into  the  Channel  and  the  hospital  walls, 
half-raised,  stood  undisturbed  in  the  quiet  camp  until  the  next 
detachments  came  swinging  down  from  Liverpool  and  con- 
struction began  again.  By  June,  1018,  the  neat  little  hospital 
with  long  sunny  wards,  completely  appointed  op(>rating  and 
X-ray  rooms,  diet  kitchens,  milk  pasteurizing  plant  and  gas 
and  electric  equipment  was  ready  for  occupancy,  perhaj^s  by 
some  of  those  same  whistling  Yankees,  who  had  lighthcnrt- 
edly  laid  a  brick  in  tlu^  walls  of  this  hospital  in  Eiighnid 
against  the  day  when  they  or  their  "buddies"  might  be  s(Mit 
back  in  mortal  need  of  hospital  care  from  the  trenches  which 
thev  were  then  so  eauer  to  reach. 


434   HISTORY  OP  AMERICAN  RED  CROSS  NURSING 

The  hospital  at  Romsey  was  designated  as  United  States 
Army  Camp  Hospital  No.  34.  Ten  nurses,  "casuals"  and  mem- 
bers of  various  base  hospital  units  with  Nellie  McGovern  as 
chief  nurse,  were  assigned  on  August  4,  1918,  to  this  hospital. 
The  permanent  staif  was  later  raised  to  seventeen  nurses. 

The  next  institution  to  be  opened  by  the  Red  Cross  Com- 
mission for  Great  Britain  was  a  convalescent  hospital  for  Ameri- 
can officers.  This  was  opened  June  1,  1918,  at  Lingfield,  about 
thirty-five  miles  from  London,  on  the  country  estate  of  Colonel 
Spender  Clay  and  his  wife,  who  was  the  daughter  of  Lord 
Astor.  This  convalescent  hospital  was  designated  American 
Red  Cross  Convalescent  Hospital  No.  101.  The  house  accom- 
modated more  than  one  hundred  patients. 

Previous  to  May,  1918,  the  American  Red  Cross  Commission 
for  Great  Britain  had  not  included  a  representative  of  the  Nurs- 
ing Service.  Many  American  Red  Cross  nurses  were  on  duty, 
however,  in  the  five  American  Red  Cross  military  hospitals 
then  being  conducted  by  the  commission  for  the  Medical  Corps. 
Also  many  reserve  nurses  of  the  Army  Nurse  Corps  were  in 
active  service  in  England.  On  May  14,  1918,  Major  Endicott 
wrote  Miss  Delano : 

]\Iiss  Carrie  Hall,  who  has  lately  been  the  Matron  at  Gen- 
eral Hospital  Xo.  13.  British  Expeditionary  Forces,  Boulogne, 
is  our  newly-appointed  Chief  Xurse  of  the  American  Eed 
Cross  in  Great  Britaiii,  assigned  to  the  position  by  the  Chief 
Surgeon,  American  Expeditionary  Forces  [in  France] .  She 
will  have  entire  charge  here  in  Great  Britain  of  the  enroll- 
ment, assignment  and  direction  of  Red  Cross  nurses.  We 
have  asked  her  to  report  directly  to  the  Bureau  of  Xursing 
Service  of  the  American  Ked  Cross  in  Washington. 

This  appointment  was  made  without  conference  with  Miss  De- 
lano and  Miss  Noycs.  A  precedent  for  such  action  had  already 
been  established  by  the  American  Red  Cross  Commission  for 
Europe  and  a  detailed  discussion  of  the  policies  involved  will 
be  found  in  a  subs('(pient  section. 

A  few  weeks  later,  the  Chief  Surgeon,  American  Expedi- 
tionary Forces  in  France,  notified  General  Winter,  Chief  Sur- 
geon of  the  American  Armies  in  England,  that  a  permanent 
chief  nurse  of  IJase  Section  X'o.  3,  Grace  E.  Leonard,  had 
been  appointed.  With  her  assistant,  Annie  C.  Porter,  Miss 
Leonard  reported  for  duty  on  flune  19,  1918,  on  General  Win- 
ter's staff.     Miss  Mc(jlovern  was  transferred  to  Romsev  as  chief 


THE  EUROPEAN  WAR  435 

nurse  of  Camp  Hospital  No.  34  and  Miss  Brookbanks  to  ^loss- 
ley  llill  as  chief  nurse  of  American  Ked  Cross  ^lilitary 
Hospital  No.  4. 

The  appointment  of  a  chief  nurse  for  the  American  Ex- 
peditionary Forces  in  England  and  the  appointment  of  a  chief 
nurse  for  the  American  Red  Cross  Commission  for  Great 
Britain  marked  the  beginnings  of  an  authoritative  and  per- 
manent nursing  service  in  England. 

In  her  first  report  to  ^fiss  Delano  regarding  the  Red  Cross 
nursing  situation  in  England,  Miss  Hall  wrote  on  June  6 : 

Plans  are  under  way  for  opening  here  in  London  a  hospital 
of  about  sixty  be£ls  for  sick  and  wounded  American 
nurses.  .  .  . 

There  are  now  in  England  six  hospitals  nominally  under 
the  American  Ked  Cross.  At  least  two  of  these  are  respon- 
sible directly  to  the  British  War  Office  and  with  regard  to 
them,  I  propose  no  interference,  except  perhaps  to  withdraw 
slowly  such  American  nurses  as  are  now  in  them,  replacing 
them  witii  English  nurses  and  so  leaving  the  nursing  staff 
entirely  English  in  character.  By  using  the  American  nurses 
to  fill  in  the  ga]is  in  other  more  distinctly  American  hospitals, 
we  can  thus  attempt  to  have  complete  American  staffs  and 
American  methods  in  these  later  institutions. 

We  shall  need  a  good  many  nurses  in  England  for  our  own 
Bed  Cross  work,  apart  from  those  assigned  as  reserves  to  the 
Army  Xurse  corps.  ]\rajor  Endicott  informs  me  that  some 
time  ago  be  asked  for  fifty  nurses ;  I  hope  they  will  be  forth- 
coming during  the  next  few  weeks.  I  am  recommending  to 
him  today  that  he  apply  through  the  proper  channels  for 
fifty  additional  ones. 

Upon  the  authorization  of  the  Nursing  Service  at  National 
IIead(iuarters,  ]\Iiss  Hall  organized  a  Local  Committee  in  Lon- 
don to  undertake  the  enrollment  in  the  American  Bed  Cross 
Nursing  Service  of  American  inirses  then  in  Great  Britain. 
!Miss  Hall  estinuited  that  over  one  hundred  nurses  were  enrolled 
thus  through  the  London  office. 

One  of  the  most  important  things  which  ]\riss  ILiIl  accom- 
plished at  London  Heacbiuarters  was  the  establisbnunit  of  a 
budget  syst(>m  and  an  ('([uipmciit  section.     !Miss  ILilI  wrote: 

I'revious  to  my  tenure  of  office,  nurses  assigned  to  Ifnl 
Cross  duty  l»y  the  conunissioiu'r  ov  l\v  the  London  ChapttT 
bad  been  scantily  equipped,  the  exj)ensc  of  wbicli  bad  tnen 


436   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

charged  to  the  hospital  where  the  individual  was  assigned  to 
duty.  I  stated  the  case  to  the  comptroller,  showing  that 
nurses  should  be  enrolled  and  equipped  who  were  not  as- 
signed to  any  hospital  in  England  but  might  be  transferred 
to  the  Eed  Cross  in  France  or  to  the  Army  in  England.  He 
saw  the  need  for  a  separate  budget  for  the  nursing  depart- 
ment and  immediately  secured  it.  That  enabled  me  to 
establish  means  for  supplying  equipment  in  London  which 
was  parallel  to  the  equipment  supplied  to  nurses  sent  from 
home. 

In  June,  July  and  August,  1918,  870,988  American  soldiers 
were  landed  in  France.  A  large  portion  of  these  troops  passed 
through  England.  During  this  period.  General  Winter  estab- 
lished another  camp  hospital  and  four  additional  Army  base 
hospitals  in  Base  Section  i^o.  3. 

United  States  Army  Camp  Hospital  No.  36  was  opened 
July  1,  at  Southampton,  the  principal  port  of  embarkation  for 
France.  This  institution  had  a  capacity  of  eighty  beds  but  was 
capable  of  expansion  to  five  hundred  beds. 

United  States  Army  Base  Hospital  jSTo.  33  was  assigned  to 
Portsmouth,  England.  This  base  hospital  had  been  organ- 
ized by  the  American  Eed  Cross  at  the  Albany  Hospital,  Al- 
bany. Xew  York.  Sally  M.  Johnson,  superintendent  of  the 
Albany  Hospital  School  of  Nursing,  had  organized  the  nursing 
staff  of  the  unit,  but  Mattie  M.  Washburn,  her  assistant,  led 
the  nurses  into  active  service. 

Base  Hospital  No.  33  had  waited  two  months  at  Ellis  Island 
before  embarkation.  The  unit  sailed  April  22,  1918,  on  the 
S.  S.  Carmania,  w^hich  also  carried  the  entire  28th  Division. 
Upon  the  arrival  of  the  unit  at  Liverpool  on  May  15,  the  nurses 
were  temporarily  billeted  at  United  States  Army  Base  Hos- 
pital No.  204  at  Hursley  Park.  On  June  1  they  entrained  for 
permanent  quarters  at  Portsmouth  and  were  finally  assigned 
to  the  Portsmouth  Borough  Asylum,  three  miles  from  the  cen- 
ter of  the  city.  This  institution  had  been  built  and  maintained 
by  the  Board  of  Asylum  Control  of  London.  It  consisted  of 
one  main  building  of  modern  ])rick  and  stone  construction  and 
of  several  detaclied  villas  surrounded  by  eight  acres  of  farm- 
land. 

The  American  unit  took  possession  on  July  8  and  imme- 
diately began  the  tedious  and  irksome  task  of  changing  the 
asylum  to  a  hospital.     Like  Miss  Nightingale's  supplies  which, 


THE  EUROPEAN  WAR  437 

buried  under  ammunition,  had  gone  up  the  Bosphorus  past 
Scutari,  the  equipment  of  Base  Hospital  No.  33  had  been  car- 
ried to  France.  The  (listr(!ssed  unit  was  able  to  secure  only 
the  most  essential  articles  from  the  generous  stores  with  which 
the  Local  Red  Cross  Chapter  at  Albany  had  supplied  them. 
The  asylum  authorities,  the  British  War  Office  and  the  Admi- 
ralty and  the  American  K(m1  Cross  Commission  donated  ma- 
terials until  the  bed  capacity  of  Base  Hospital  No.  33  num- 
bered three  thousand  with  an  additional  emergency  expansion 
of  one  thousand  patients.  The  Red  Cross  erected  a  theater, 
seating  an  audience  of  twelve  hundred,  and  built  tennis  courts 
and  the  best  baseball  diamond  in  England. 
Miss  Washburn  wrote  of  their  first  patients : 

Surgical  casualties  which  had  arrived  on  hospital  ships  at 
Southampton  were  brought  to  us  July  2-i  by  motor  ambu- 
lances and  hospital  trains  within  thirty-six  hours  from  the 
time  they  had  been  wounded. 

On  September  '22,  we  had  seven  hundred  patients.  Word 
was  then  received  that  the  S.  S.  Olympic,  with  six  thousand 
troops  on  board,  tlie  greater  number  of  them  suffering  from 
influenza,  had  come  to  port  in  Southampton.  Sixty-six  tents 
were  immediately  secured  from  the  British  to  set  up  in  the 
court  yard  of  Base  Hospital  No.  33.  Convalescent  patients 
and  members  of  the  detachment  were  immediately  transferred 
to  these  tents  and  the  wards  were  cleared  for  the  reception  of 
influenza  patients.  Within  one  week  seven  hundred  and 
ninety-seven  cases  had  come  to  us,  one  hundred  and  forty- 
four  of  whom  were  nurses  and  female  members  of  the  Signal 
Corps.  Both  pneumonia  and  meningitis  developed.  Of  our 
one  hundred  and  twenty-nine  deaths  among  these  patients, 
eleven  were  nurses  and  one  was  a  dietitian. 


United  States  Army  Ease  Hospital  Xo.  37,  the  largest 
American  military  hospital  in  Kngland,  crowned  the  crest  of 
a  hill  at  Uartford,  fifteen  miles  from  London.  It  was  located 
in  wooden  barracks  and  in  brick  buildings  of  a  former  con- 
valescent fever  hospital  of  the  .Metr()])olitaii  Asylums  I>oard 
and  had  a  capacity  of  two  thousand  beds.  In  the  valley  below 
was  a  large  overllow  liospital  where  the  Hritish  Army  cared 
for  twelve  hundred  wounded  (lerman  prisoners  of  war. 

The  nursing  personnel  of  Base  Hospital  Xo.  ."JT,  which  had 
been    organized    largely    from    the    King's    County    Hospital, 


438    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Brooklyn,  New  York,  with  Annie  F.  Mack  as  chief  nurse,  had 
arrived  in  England  on  May  31,  1918,  and  had  been  assigned 
to  temporary  duty  at  Hursley  Park.  On  June  10,  they  were 
transferred  to  Camp  Efford  at  Plymouth,  but  as  the  hospital 
there  was  not  then  completed,  they  were  scattered  on  temporary 
assignments  among  various  other  hospitals.  The  entire  unit  of 
ninety-nine  nurses  was  collected  on  July  18  and  was  assigned 
to  permanent  duty  at  Dartford. 

Meantime  in  the  outskirts  of  London,  at  Tottenham,  United 
States  Base  Hospital  No.  29,  organized  within  the  Medical 
School  of  the  University  of  Denver,  Colorado,  had  established 
a  permanent  base  in  buildings  taken  over  by  General  Winter 
from  the  Metropolitan  Asylums  Board.  The  nursing  staff 
of  this  unit,  which  was  composed  of  one  hundred  reserve 
nurses,  was  assigned  to  duty  there  in  July.  Laura  A.  Beecroft 
was  chief  nurse.  Tottenham  Base  was  one  of  the  largest 
American  military  hospitals  in  Great  Britain  and  had  a  ca- 
pacity of  fifteen  hundred  beds. 

During  the  summer  of  1918,  the  American  Red  Cross  Com- 
mission for  Great  Britain  established  two  additional  convales- 
cent homes  and  one  base  hospital  for  the  American  Armies  in 
England.  One  of  these  homes  was  located  in  Putney,  Lon- 
don, at  Colebrook  Lodge,  the  estate  of  John  T.  Ryan,  of  To- 
ronto, and  was  used  as  a  convalescent  home  for  Army,  Navy 
and  Red  Cross  nurses  and  other  American  women  workers  in 
the  Military  Establishment.  Colebrook  Lodge  was  a  three- 
story  modern  building,  constructed  on  the  three-hundrcd-year- 
old  foundations  of  Putney  Manor  and  the  nurses  thoroughly  en- 
joyed their  stay  tliore,  their  walks  among  the  gardens  and  over 
the  downs  of  Putney  Heath  and  Wimbledon  Common. 

The  Red  Cross  Commission  took  over  on  August  1.")  the  es- 
tate of  Percy  Chubb  at  Wimbledon,  which  the  British  had  main- 
tained as  a  convalescent  home  for  British  officers.  The  Com- 
mission designated  this  house  as  American  Red  Cross  Convales- 
cent Hospital  No.  102  and  maintained  it  for  the  British  Army 
with  the  understanding  that  it  should  be  used  exclusively  for 
convalescent  American  officers,  if  such  a  need  should  arise. 
Its  capacity  was  seventy-five  beds. 

The  final  and  most  ambitious  project  which  the  Commission 
undertook  for  the  American  Expeditionary  Forces  in  England 
was  the  preparation  for  occupancy  of  United  States  Army 
Base  Hospital  No.  40  at  Sarisbiiry  Court,  near  Southampton. 


fiff 


Nurses  on  the  l)alcony  of  tlie  American   Rod  Cross  Xnrses'  Club,  London, 
overlookin"'  the  Gardens  of  Buckin<fliam  Palace. 


t 


Colclirook  L()(li:o.  a  coinuicst-ciit  lioiiip  u>y  AiiK>rica!i  Ai'iiiy.  \avv  and  l!i'd 
Cross  7Uirsfs  establislicd  at  Putney,  near  London,  hy  the  Aineriean  Ked 
Cross. 


THE  EUROPEAN  WAR  439 

The  report  of  the  Coniniission  for  Great  Britain  described  the 
establishment  of  this  base: 

In  April,  1918,  the  Commission  for  Great  Britain  com- 
menced negotiations  for  the  purchase  of  a  large  estate  in 
Hampshire  between  Southampton  and  Portsmouth,  known 
as  Sarisbury  Court.  .  .  . 

The  estate  lies  in  the  bend  of  the  ITamble  river,  sloping 
down  to  the  water  on  two  sides.  The  manor  house,  a  massive 
three-story  building  of  severe  Tudor  architecture,  stands  on 
high  ground  and  its  tower  is  visible  on  a  clear  day  from 
points  twenty  miles  distant.  Though  built  twenty-live  years 
ago,  the  house  provided  an  excellent  nucleus  for  a  hospital. 
Acres  of  hut  wards,  quarters  for  nurses,  doctors  and  men,  an 
administration  building  and  store  houses  were  immediately 
planned  and  construction  was  begun  to  raise  it  to  its  esti- 
mated capacity  of  three  thousand  beds. 

Speed  was  essential.  American  wounded  from  France  were 
already  pouring  into  England.  The  difficulty  in  obtaining 
lumber  made  necessary  the  establishment  of  saw  mills  on  the 
property,  so  that  timber  from  the  woodland  pastures  could 
be  utilized.  Concrete  for  the  wards  was  mixed  in  little  fac- 
tories from  sand  and  gravel  found  on  the  estate.  To  supple- 
ment the  ward  buildings  in  emergencies  seventy  large  tents, 
double-roofed  and  with  windows,  were  also  erected.  .  .  .^^ 

The  problem  of  cows  for  the  hospital  farm  was  solved  by 
the  generosity  of  the  people  from  the  little  islands  of  Jersey 
and  Guernsey,  located  a  few  score  miles  out  of  Southampton 
in  the  English  Channel.  Sixty  cows  of  their  fine  herds  were 
offered  as  a  gift  to  the  American  base.  .  .  . 

The  nursing  personnel  of  Base  Hospital  'No.  40  had  been 
organized  at  the  Good  Samaritan  Hospital,  Lexington,  Ken- 
tucky, and  upon  arrival  in  England  on  July  20,  1918,  consisted 
of  one  hundred  and  seven  m.embers.  Elizabeth  McCormack 
Bogle  was  chief  nurse.  The  nurses  of  the  Good  Samaritan 
Unit  were  first  stationed  at  Sarisbury  Court,  but  as  the  hos- 
pital was  not  then  ready  to  receive  patients,  they  were  distrib- 
uted on  temporary  assignments  among  other  American  military 
base  and  camp  hospitals.  Five  of  them  were  sent  to  Base  Hos- 
pital Xo.  15  in  France;  seven  others,  "casuals"  who  had  been 
attached  to  the  unit  only  during  the  tri])  over,  went  on  to 
France.      When   Sarisbury   Court   was  ready   for  patients  on 

"An  inttTt'stiiip  account  of  the  diflicultios  oncounterod  by  tlic  Red  Crosr^ 
in  tlio  cstablislinient  of  this  base  may  be  found  in  "Tlie  Passin;:  Lcrrions,'" 
by   George   Buchanan    Fife,   pp.   202-211;    The   Macmilhui   Company,    1920. 


440    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

September  4,  the  nurses  of  the  original  Good  Samaritan  Unit 
were  returned  there  for  duty. 

Base  Hospital  Ko.  40  rendered  yeoman  service  during  the 
last  week  of  September,  1018,  when  the  influenza  epidemic 
was  at  its  height.  The  liner  Olympic,  with  four  hundred  cases 
of  influenza  aboard,  docked  at  Southampton  on  September  29 
in  a  cold,  raw  mist.  The  six  thousand  troops  which  she  had 
brought  overseas  came  from  southern  states  and  were  keenly 
susceptible  to  the  change  of  climate.  The  medical  authorities 
hesitated  to  assign  even  the  well  men^  exposed  as  they  had  been 
on  shipboard  to  the  influenza,  to  Southampton  Rest  Camp, 
where  they  would  have  to  sleep  in  cotless  tents  on  floors  con- 
sisting of  a  layer  of  thin  boards  a  few  inches  above  the  wet 
ground. 

The  troops  were  detained  aboard  the  Olympic  for  a  few  days. 
The  influenza  then  became  so  virulent  that  the  soldiers  were 
finally  disembarked  and  taken  to  Southampton  Rest  Camp. 
Pneumonia  developed  among  full  one-third  of  the  men  who 
had  contracted  the  influenza  on  shipboard. 

Although  Sarisbury  Court  was  not  yet  equipped  to  receive 
a  large  number  of  patients,  the  Commission  swiftly  made  ar- 
rangements so  that  the  hospital  could  accommodate  about  three 
hundred  men.  Some  of  the  personnel  of  Base  Hospital  Xo. 
40  had  already  arrived  there  but  many  of  the  surgeons  and 
nurses  had  been  scattered  on  temporary  assignments  to  other 
bases.  They  were  (juickly  recalled  and  they  worked  day  and 
night  without  respite  until  the  epidemic  was  checked. 

During  the  suniincr  of  1018,  an  important  change  of  policy 
was  adopted  l)v  tlie  Chief  Surgeon,  American  Expeditionary 
Forces  in  England,  whicli  oreatly  diminished  the  need  for  ex- 
tensive American  Red  Cross  medical  and  nursing  service  in 
Great  Britain.     ]\liss  Hall  wrote  ]\Iiss  Xoyes  on  August  2: 

Tlif  gpiioral  poliry  of  tlio  Army  here  in  England  at  the 
present  time  is  that  all  lK)S])itals  shall  be  directly  ujider  the 
Army.  The  I'od  Cross  will  therefore  establish  no  further 
hospitals  as  se])arate  l^ed  Cross  institutions.  I  hope,  how- 
ever, that  wo  will  still  bo  able  to  staff  the  ones  already  in 
existence  with  IJfd  Cross  nurses.  Imt  many  of  these  will  be 
transferred  to  the  Army  l?eservo.  My  work  as  chief  nurse 
of  the  American  Tied  Cross  in  Great  Britain  now  becomes 
quite  secondary  to  that  of  the  chief  nurse,  Army  Nurse 
Corps,  Base  Section  Xo.  3. 


THE  EUROPEAN  WAR  441 

On  September  18,  ^liss  Ilall  commented  again  upon  the  ces- 
sation of  Red  Cross  activities: 

The  whole  situation  in  England  has  undergone  great 
changes  during  the  summer  months.  In  the  early  spring,  the 
policy  of  brigading  our  troops  with  the  British  in  France 
brought  forth  a  big  lujspital  building  policy  in  England.  In 
pursuance  thereof,  much  work  has  been  done  in  starting  Army 
hospitals.  Then  the  Chief  Surgeon  continued  consistently 
to  take  over  these  institutions,  with  the  result  that  so  far  as 
hospital  and  nursing  work  are  concerned,  there  will  be  no 
further  developments  in  England  for  the  American  Hed  ("ross. 

It  has  been  decided  that  I  am  to  go  to  Paris  the  latter  part 
of  this  month  to  help  out  in  ]\Iiss  Stimson's  office. 

Miss  Stimson,  at  this  time  chief  nurse  of  the  American  Red 
Cross  in  France,  was  in  need  of  an  assistant  at  the  Paris  Head- 
quarters of  the  organization  and  ^liss  Hall  was  assigned  to  duty- 
there  on  September  28,  1!)18.  After  Miss  Hall's  departure, 
Rachel  Torrance,  whose  name  is  familiar  to  readers  of  this  his- 
tory in  connection  with  ^liss  Hay's  work  in  Sofia  and  Philip- 
popolis,  became  Chief  ]S^urse,  American  Red  Ci"oss  in  Great 
Britain.  On  October  1,  1U18,  fifty-seven  nurses  were  on  duty 
directly  under  the  American  Red  Cross  in  Great  Britain. 

By  November  11,  1918,  the  American  Red  Cross  Commis- 
sion for  England  had  established  six  hospitals  and  three  con- 
valescent homes  for  the  use  of  sick  and  wounded  members  of 
the  American  ^Military  Establishment  in  England.^"  At  the 
signing  of  the  Armistice,  the  Chief  Surgeon,  Base  Section  Xo. 
3,  was  conducting  five  base  hospitals  and  four  camp  hospitals 
for  the  service  of  the  American  Armies  in  England.^'' 

Of  the  number  of  American  Army  nurses,  regulars  and  ro- 
serves,  on  active  duty  in  llase  Section  'No.  3,  in  October,  1918, 
Miss  Leonard  wrote : 

The  largest  nuni])er  of  nurses  on  duty  at  any  time  was  five 
hundred  and  forty-seven  permanent  jjersoniiel.  supplemented 
by  three  hundred  nurses  belonging  to  groups  A  autl  1)  and 
Base  Hospital  Xo.  n7.  en  route  to  France,  wlio  werc^  jilaced 
on  duty  in  ()etoh(>r.  litis,  to  relie\<'  the  siluatimi  duriiiir  the 
epidemic  of  influenza.  As  even  these  additional  niiises  were 
insutlicient.  liel])  was  recpu'sted  from  the  British  War  Olliee 
and  one  hundred  members  of  the   \'.  A.  D.  Xur.-iiig  Service 

"For   a   list  of  those  hospitals,  sec   A|iji('ii(lix. 


442   HISTORY  OP^  AMERICAN  HED  CROSS  NURSING 

were  immediately  placed  at  our  disposal.  During  this  time, 
there  were  more  tlian  one  thousand  emergency  beds  in  use 
and  every  hospital  was  taxed  to  its  utmost  capacity. 

Twenty-four  nurses,  largely  British  subjects  trained  in 
America,  have  been  transferred  from  the  American  Eed  Cross 
to  active  service  in  the  Army  Xurse  Corps  through  this  office. 

Miss  Leonard  reported  November  15  to  the  Chief  Surgeon 
in  Tours  to  serve  as  assistant  Director  of  the  Nursing  Serv- 
ice, American  Expeditionary  Forces  in  France.  Annie  G.  Por- 
ter followed  her  as  Chief  Nurse,  American  Forces  in  England. 

Immediately  following  the  declaration  of  war  by  the  United 
States,  the  British  Government  sent  the  Balfour  Mission  to 
Washington  to  confer  W'ith  President  Wilson  regarding  the 
coordination  of  the  fighting  strength  of  the  two  nations.  One 
of  the  members  of  this  mission  was  Sir  John  Goodwin,  Colonel, 
Royal  Army  JMedical  Corps,  and  since  1918  Surgeon  General 
of  the  Britisk  Army.  He  had  been  detailed  by  the  British 
War  Office  for  duty  in  the  Surgeon  General's  office,  United 
States  Army.  Upon  the  arrival  of  the  Balfour  Mission  in 
Washington  on  April  22,  1917,  General  Goodwin  requested 
that  the  Surgeon  General  assign  immediately,  if  possible,  six 
American  base  hospitals  to  service  with  the  British  Expedi- 
tionary Forces  in  France.  The  German  submarine  blockade, 
then  tightening  about  the  British  Isles,  made  it  inadvisable 
for  the  British  War  Office  to  attempt  the  transportation  of  their 
sick  and  wounded  to  England  and  this  decision  created  press- 
ing need  for  additional  British  hospitals  in  France.  More- 
over, some  of  the  nurses  and  surgeons  who  had  seen  three 
years'  continuous  service  on  the  Western  Front,  were  greatly 
exhausted  and  casualties  from  disease  were  growing  more  fre- 
quent among  their  ranks.  General  Gorgas  called  upon  the 
American  Red  Cross  to  nnister  into  active  duty  six  of  the 
twenty-iive  base  hospitals  which  were,  on  April  0,  1917,  prac- 
tically comph'te  in  organization,  e(]uipment  and  personnel. 

I'he  Lakeside  Unit,  Base  Hospital  No.  4,  on  April  28  was 
sent  notification  of  impending  mobilization.  The  Surgeon  Gen- 
eral did  not  call  out  tlie  nurses'  aides  who  had  been  attached 
to  the  base  hospital  units,  but  authorized  that  fifteen  additional 
nurses  should  be  selected  from  the  reserve  nurses  already 
authorized  and  should  go  forward  in  their  place.  All  nurses 
werc!  instructed  to  report  either  to  the  J^akeside  Hospital  or  to 


THE  EUROPEAN  WAR  443 

Red  Cross  licaJquarters  in  New  York  City,  if  tlicv  were  then 
located  nearer  the  port  of  embarkation  than  Cleveland. 

The  reasons  as  understood  by  the  Nursing  Service  of  the 
Surgeon  General  for  not  assigning  the  twenty-tive  nurses'  aides 
attached  to  each  base  hospital  unit  to  active  service  were  given 
in  a  lett(^r  written  by  ^liss  Xoyes  August  9,  1917,  to  Major 
Fred  T.  ^lurphy,  director  of  J^ase  Hospital  No.  21: 

The  decision  against  the  use  of  our  nurses'  aides  in  France 
was  rendered  |  by  the  representative!  of  the  English  Govern- 
ment. Their  arguments  appeared  to  us  well-grounded. 
Briefly,  they  amounted  to  this:  although  the  utilization  of 
lay  women  of  French  and  English  birth  was  necessary  be- 
cause of  the  lack  in  France  of  a  professional  nursing  body  and 
an  inadequate  su])i)ly  in  England  and  although  tliey  luul  per- 
formed good  service  in  many  instances,  tlieir  assignment  had 
been  considered  upon  the  whole  an  unsatisfactory  way  of 
meeting  the  situation.  Constant  changes  were  necessary. 
I\rany  of  the  nurses'  aides,  unused  to  hardships  and  long  hours 
of  work,  had  to  be  returned  home.  xVs  the  hospitals  were  not 
far  removed  from  either  Great  Britain  or  the  aides'  homes  in 
France,  this  was  not  dillicult.  It  became,  however,  a  differ- 
ent problem  when  the  nurses'  aides  would  need  to  be  trans- 
ported over  three  thousand  miles  of  ocean.  This,  briefly,  is 
the  reason  for  the  decision  as  rendered  by  our  Government 
ui)ou  the  advice  of  the  French  and  English. 

Tlie  chief  nurse  of  Base  lIos])ital  Xo.  4  was  Grace  Allison 
and  this  history  is  indebted  to  her  for  an  excellent  report  of 
the  experiences  of  her  unit.  ^liss  Allison  was  born  in  Port 
Austin,  ^Michigan.  Following  her  graduation  from  the  Lake- 
side Training  School  f(U'  Xurses,  Cleveland,  Ohio,  she  was  for 
one  year  superintendent  of  the  iSTorth  I'acific  Sanatorium, 
Portland,  Oregon.  In  1909,  she  matriculated  at  Teachers  Col- 
lege, New  York,  but  interrupted  her  work  there  from  1910  to 
1911  to  tak(>  the  position  of  assistant  principal  at  tlw  Lakeside 
School  for  Xurses.  She  returned  to  Xew  York  in  1!>11  as  su- 
]>(U'intendent  of  nurses  at  the  Polyclinic  Hospital  and  remain(Ml 
in  that  position  for  two  years.  In  191."5,  she  again  took  up  her 
work  i\t  Teacliers  ('oll('g(%  reccMved  her  P.  S.  d(>gree  in  Jun(\ 
linf),  and  went  back  to  Cleveland  as  ])rincipal  of  the  Lakeside 
School  for  Xurses.  From  this  position,  she  was  ordered  with 
her  unit  into  active  service.  Dr.  Crilc,  it  will  be  remembered, 
wa.s  tlie  director  of  this  unit. 


444    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Base  Hospital  No.  4  embarked  May  8 ;  Miss  Allison  reported 
the  arrival  of  the  unit  in  France : 

From  Southampton  we  were  transferred  to  the  hospital 
ship  Western  Australia.  Morning  came  and  we  lay  at  anchor 
in  the  Seine  Kiver.  The  fog  had  disappeared  and  the  sun 
shone  brightly.  .  .  . 

L^p  to  this  time  war  seemed  remote.  As  we  passed  small 
villages  or  lonely,  thatched  cottages  with  their  groups  of  aged 
peasant  folk  with  perhaps  one  or  two  young  children  or  in- 
fants, we  realized  keenly  how  the  three  and  one-half  years 
of  warfare  had  deprived  them  of  their  sons  and  fathers. 
Young  women  had  gone  forward  to  munition  plants  and 
factories.  From  a  German  prison  camp  hundreds  of  soldiers 
gazed  with  interest  through  a  barb-wire  fence  upon  us  but  I 
doubt  if  they  comprehended  the  significance  of  the  entrance 
of  America  into  the  war.  Later  one  remarked,  when  seeing 
the  insignia  of  the  United  States  upon  the  uniform  of  an 
American  officer:    "America!    And  are  you  with  us  at  last?" 

At  the  close  of  the  day.  May  26,  we  approached  Rouen. 
As  the  ship  steamed  toward  the  dock,  great  throngs  of  people 
crowded  to  the  wharf.  Women  dressed  in  mourning  and 
children,  with  pale,  emaciated  faces  and  black  aprons,  pre- 
sented a  sad  picture.  Their  cries  of  "Vive  VAmerique!"  we 
will  not  soon  forget. 

After  debarkation  came  a  two  mile  march  through  the  deep- 
ening twilight,  then  a  trip  in  dusty  ambulances  and  the  unit 
finally  reached  its  destination,  No.  9  General  Hospital,  British 
Expeditionary  Forces,  liouen,  France. 

No.  9  General  Hospital  was  located  in  twenty-five  long 
brown-stained  wooden  huts  and  many  dun-colored  tents  lying 
in  parallel  streets.  The  buildings  were  surrounded  by  neatly- 
trimmed  lawns  and  vegetable  gardens.  Near  the  administration 
building  was  a  flag  pole  froin  wdiich,  upon  the  arrival  on  May 
27,  1917,  of  this  first  contingent  of  the  American  Expedi- 
tionary Forces  upon  Allied  soil,  the  Stars  and  Stripes  floated 
for  the  first  time  with  the  Union  Jack  and  the  Red  (Jross  flag. 

No.  9  General  Hospital  was  of  twenty-two  hundred  and  fifty 
bed  capacity,  with  an  emergency  expansion  which  allowed  for 
three  hundred  and  fifty  additional  patients.  The  medical  di- 
vision consisted  of  ten  large  huts,  each  accommodating  about 
forty  beds.  Potatoes  were  planted  between  the  parallel  rows  of 
brown  wooden  buildinas.     This  vegetable  was  hard  to  secure 


THE  EUROPEAN  WAR  445 

in  the  French  markets.  The  administration  bnildings,  the 
operating-room  pavilion,  the  patient's  recreation  and  mess 
halls  and  the  Quart(n-master's  department  occupied  the  center  of 
the  hospital  gi'onnds.  To  the  right  was  the  snrgical  division, 
sitnated  in  fourteen  tents  and  in  ten  huts  similar  to  those  of 
the  medical  division. 

The  wards  differed  from  those  of  the  American  military 
hospitals  chiefly  in  the  type  of  furniture  and  supplies.  Miss 
Allison  wrote : 

The  iron  beds  are  painted  black  with  a  short  head  and  foot 
piece  so  attached  to  the  legs  of  the  bed  as  to  permit  their 
being  doubled  under,  making  a  flat  surface  which  may  be  con- 
veyed easily  from  place  to  place. 

The  sheets  are  one  hundred  and  five  inches  long.  They 
are  turned  back  over  the  blanket  at  the  top  of  the  bed  and 
also  folded  u])permost  at  the  foot  of  the  bed  for  twelve  inches. 
When  a  sheet  is  soiled  at  the  top  from  coming  in  contact  witii 
the  patient's  food,  it  may  be  reversed,  to  provide  a  clean  space 
at  the  head  of  the  bed  and  prevent  the  soiled  part,  still  turned 
uppermost  at  tbe  foot,  from  coming  in  contact  with  the 
patient's  feet.  This  device  is  necessary,  not  always  because 
of  the  shortage  of  linen,  but  because  of  the  great  laundry 
problem.  In  many  places  in  France,  laundry  is  done  on  tbe 
stones  adjoining  a  creek.  Hot  water  seemed  almost  impos- 
sible to  procure  on  account  of  the  lack  of  fuel.  Our  soiled 
linen  had  to  be  transported  forty  miles  by  two  large  Army 
trucks. 

The  British  Red  Cross  Society  equipped  the  recreation  hall 
with  reading-tables,  books,  desks,  newspapers,  magazines  and 
games;  patients  constructed  a  stage  and  painted  the  curtains 
and  several  "sets."  The  British  Red  Cross  supplied  soap, 
toothbrushes,  treasure  hags,  buttons,  washcloths,  sweets,  cig- 
arettes, socks,  gowns,  hinders,  stationery,  small  pillows  and 
other  necessities  to  "Tonnny  Atkins."  During  the  spring  of 
liUS,  American  troops  were  brigaded  with  the  British  and  the 
wounded  of  both  nations  were  alike  sent  down  through  British 
bases  for  medical  and  nursing  care.  As  Anu'rican  wounded 
thus  occupied  an  average  of  l.")0  beds  a  month  at  Xo.  !)  Gen- 
eral Hospital,  the  American  Red  Cross  established  stores  nearby 
and  scu'ved  these  patients  with  cigarc^ttes,  chocolate,  stationery 
and  other  comforts  and  luxuries  furnished  by  tlu>  American 
Red  Cross  to  American  troops  wherev(>r  they  were  detailed. 


446    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

After  a  few  days  during  wliicli  the  Americans  were  learning 
the  well-established  routine  of  Xo.  9  General  Hospital,  the 
British  sisters  were  withdrawn.  On  the  morning  after  their 
departure,  the  bewildered  American  nurses  found  of  the  furni- 
ture which  had  formerly  been  in  the  nurses'  quarters  only  a  few 
boxes  and  some  neatly-stocked  bedding.  It  was  their  first 
intimation  that  the  camp  kit  which  the  British  War  Office 
supplied  each  of  its  nurses  was  carried  by  them  from  one  post 
of  duty  to  another.  This  kit  was  composed  of  three  army  blan- 
kets and  a  large  canvas  bag  containing  a  folding  cot,  a  cork 
mattress,  a  washstand,  a  small  table,  a  chair,  a  canvas  pail  in 
which  to  carry  water,  a  lantern,  an  enameled  plate,  a  drinking 
cup,  a  knife,  a  fork  and  a  teaspoon.  The  practice  was  different 
in  the  United  States.  The  American  Army  furnished  the 
quarters  of  the  nurses,  rather  than  issued  the  articles  direct 
to  each  nurse.  But  General  Pershing's  First  Division  had  not 
yet  landed  in  France  and  there  was  no  one  to  furnish  the  quar- 
ters of  these  first  American  nurses  assigned  to  British  bases. 
However,  the  British  Government  came  immediately  to  the 
rescue  and  supplied  the  necessary  articles  for  the  American 
nurses  both  at  No.  9  General  Hospital  and  at  the  five  other 
bases  to  which  American  nursing  personnel  had  been  assigned. 
Mrs.  Whitelaw  Reid,  of  the  London  Chapter  of  the  American 
Bed  Cross,  sent  each  nurse  articles  of  personal  equipment, 
notably  aprons.  The  practice  of  the  British  Army  and  the 
great  need  in  the  harsh  climate  of  France  for  extra  articles 
such  as  boots,  sou'westers,  ponchos  and  sleeping  bags  were  im- 
portant factors  in  convincing  the  War  Council  that  the  Ameri- 
can Red  Cross  should  issue  complete  equipment  to  nurses  as- 
signed to  active  service  overseas. 

Miss  xVllison  commented  upon  the  comfort  and  cheerfulness 
of  their  newly-furnished  quarters : 

They  consisted  of  five  long  wooden  buildings,  each  accom- 
modating eighteen  nurses,  and  se\cral  small  canvas-covered 
Armstrong  huts.  The  night  nurses'  hut  or  "red-curtained 
hut*'  had  crimson  liangings  cleverly  arranged  to  shut  out  the 
light  and  to  serve  as  partitions.  In  our  cheerful  living  room, 
with  its  chintz-(C)vored  wicker  furniture,  piano  and  ahundance 
of  fresh  flowers,  afternoon  tea  was  served  daily. 

"Nurses'  ^Niess,''  where  we  hreakfasted  usually  on  sardines, 
bread,  hutter,  jam  and  coffee,  was  much  more  attractive  than 
one  might  suppose  from  the  bare  wooden  walls  and  cross-beam 


THE  EUROPEAN  WAR  447 

ceiling.  The  floors  were  covered  with  plain  brown  linoleum. 
Eight  large  windows  with  pretty  creton  draperies  and  large 
white  covered  tables  contributed  much  toward  the  cheerful 
appearance  of  the  room. 

The  nursing  staff  of  Base  Hospital  No.  4  was  reenforced  in. 
July,  1917,  by  the  arrival  of  additional  nurses.  A  second 
detachment  of  seventeen  nurses  from  Cleveland,  Ohio,  joined 
the  unit  in  September  of  that  year. 

When  the  rigorous  winter  set  in  at  No.  9  General  Hospital, 
patients,  surgeons  and  nurses  suffered  from  the  bitterly  cold 
weather.     !Miss  Allison  wrote  Miss  Noyes  January  7,  1918: 

Our  water  pipes  have  all  frozen  and  for  three  days  we  had 
no  water,  except  that  which  could  be  carried  from  a  distance 
of  a  quarter  of  a  mile.  Our  huts  are  only  summer  buildings 
and  there  is  scarcely  a  room  that  the  outside  cannot  be  seen 
through  many  cracks  in  the  walls.  In  the  nurses'  quarters  we 
have  provided  oil  stoves  and  in  the  mess  hall  we  have  two  coal 
stoves. 

We  are  now  on  fifty  per  cent  rations  of  oil,  which  means 
only  a  pint  a  day  for  each  stove.  Tliis  provides  only  about 
two  hours  of  heat  for  our  rooms  out  of  the  twenty-four  hours. 
During  the  warmest  part  of  the  day,  the  temperature  in  the 
wards  varies  from  thirty-two  to  forty  degrees.  The  nurses 
are  suffering  from  chilblains. 

The  work  at  Xo.  9  General  Hospital  followed  the  theory  of 
military  procedure  as  set  forth  in  preceding  sections.  The 
wounded  were  carried  on  stretchers  from  the  trenches  to  the 
nearest  First  Aid  dressing  station,  which  was  located  in  as 
sheltered  a  spot  as  possible  just  back  of  the  firing-line.  After 
they  had  received  treatment  there,  motor  ambulances  trans- 
ported them  to  the  nearest  casualty  clearing  station.  These 
stations  were  located  from  four  to  ten  mil(>s  behind  the  first  line 
trenches  and  usually  consisted  of  four  separate  hospitals  grouped 
near  one  anotlu^r,  each  with  its  own  complete  organization. 
Patients  whose  wounds  showed  upon  examination  that  immediate 
attention  was  not  imperative,  were  rushed  at  once  to  the  nearest 
base;  others  recpiiring  immediate  aid  or  operation  were  cared 
for  at  once  at  the  casualty  clearing  station  by  surgical  teams 
composed  of  two  surgeons,  an  anesthetist,  two  nurs<>s  and  two 
orderlies,  sent  up  from  the  various  base  hospitals  nearest  the 
station. 


448    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

From  the  casualty  clearing  station,  hospital  trains  conveyed 
the  wounded  sixty  to  one  hundred  miles  to  the  zone  of  the  base. 
Ammunition  trains,  however,  had  the  right  of  way,  so  that  the 
wounded  were  often  completely  exhausted  upon  their  arrival. 
Rouen  was  the  clearing  center  for  eleven  British  hospitals  in 
its  immediate  vicinity.  Here  the  deputy  director,  Medical 
Service,  received  information  regarding  all  incoming  cases, 
allotted  as  many  new  patients  to  each  of  the  hospitals  in  his 
zone  as  their  free  beds  would  accommodate  and  informed  each 
base  of  the  type  and  number  of  cases  they  might  expect  within 
a  given  time.  The  reception  of  patients  was  described  by  Miss 
Allison : 

When  the  ambulance  trains  arrived  at  the  station,  they 
were  met  by  automobile  ambulances,  to  which  the  wounded 
were  hurriedly  transferred  and  taken  to  the  particular  hos- 
pitals to  which  they  were  assigned.  The  main  roadway  was 
often  lined  for  a  distance  of  three  or  four  miles  with  ambu- 
lances coming  and  going.  The  procession  continued  for 
hours. 

The  convoy  bugle  call  at  the  hospital  announced  the  ap- 
proach of  tlie  ambulances.  Old  sight-seeing  ears,  such  as  we 
formerly  saw  in  our  cities  before  the  war,  were  usually  the 
first  to  appear  and  were  filled  with  the  walking  wounded. 
These  patients,  assisted  by  those  less  seriously  wounded  or  by 
orderlies,  hobbled  out  and  were  assigned  to  regular  quarters 
as  "walking  convalescent  patients."  The  dressing  of  their 
wounds  was  done  in  a  separate  department.  With  the  assist- 
ance of  orderlies  and  convalescent  patients,  300  dressings  a 
day  were  often  done  by  three  nurses. 

The  arrival  of  stretcher  cases  necessitated  intense  activity  on 
the  part  of  nurses  and  orderlies.     Miss  Allison  continued: 

From  the  admission  hut,  the  patients  were  quickly  de- 
spatched to  the  wards,  where  they  were  carefully  placed  on 
the  beds,  over  which  convoy  blankets  had  been  spread.  These 
beds  were  screened  off  and  the  orderlies  bathed  each  wounded 
man.  Hot  liquid  nourishment  was  then  provided,  though  the 
patient  often  had  to  be  awakened  from  the  sleep  of  utter 
exhaustion. 

Nurses  cut  down  all  dressings  for  the  inspection  of  the 
surgical  staff.  Scjine  ))atients,  who  had  lain  in  shell  holes 
without  medical  attention,  came  with  wounds  infected  with 
maggots;  others  were  admitted  who  had  lost  both  legs,  while 


THE  EUROPEAN  WAR  449 

still  others  were  found  with  great  pieces  of  muscle  and  flesh 
torn  away  by  shell  and  shrapnel.  .  .  . 

With  eyes  swollen  and  discharging,  the  body  covered  with 
blisters-and  ai)parcnt  (iisconifort  in  the  respiratory  tract,  the 
gassed  patients  presented  one  of  the  saddest  sights.  They 
expectorated  quantities  of  blood  and  nearly  all  were  unable 
to  speak  above  a  whisper.  In  a  single  day,  seven  hundred 
came  to  our  hospital. 

A  ward  often  admitted  as  many  as  twenty  new  stretcher 
patients  at  one  time.  Two  nurses  were  usually  assigned  to 
the  medical  service  and  perhaps  three  to  the  surgical  division 
of  each  hut. 

One  of  Miss  Allison's  descriptions  brings  up  the  picture 
of  another  woman  who  sixty  years  before  at  far-away  Scutari 
ministered  to  England's  wounded: 

Nursing  at  night  was  extremely  diflficult;  few  lights  were 
permitted,  owing  to  the  frequent  air  raids.  The  night  nurse 
inspected  the  dressings,  going  from  bed  to  bed  with  a  lantern 
shaded  to  prevent  the  light  from  being  seen  through  the  win- 
dows. One  nurse  detected  eight  hemorrhages  in  a  single 
night.  Xot  one  patient  at  this  base  has  met  death  for  reason 
of  delay  in  recognizing  a  hemorrhage.  One  instance  occurred 
where  the  life  of  a  Tommy  was  saved  by  a  nurse  who  made 
constant  pressure  with  her  bare  hand  buried  deeply  in  the 
wound  until  assistance  arrived. 

Evacuation  of  convalescents  occurred  almost  nightly.  Each 
patient  was  given  clean  linen,  warm  covering,  fresh  dressings 
and  hot  food  before  his  stretcher  was  hoisted  into  an  ambulance 
for  "Blighty."  But  the  closing  of  the  Channel  to  clear  it  of 
mines  sometimes  disrupted  this  smoothly  running  process  by 
which  Enghind  cared  for  the  wounded  coming  back  from  Ypres, 
Hooge,  Loos,  Amiens  and  the  Somme. 

Xever  at  any  time  was  the  work  light  at  Xo.  9  General 
Hospital.  Air  raids  added  to  the  strain  of  crowd(>d  wards  and 
s(>('mingly  endless  convoys.  Miss  Allison  described  the  bomb- 
ing of  the  British  bases: 


'& 


As  the  firing  lino  drew  nearer,  we  often  experienced  five 
successive  night  raids  in  one  week.  When  notice  of  an  ap- 
proaching ]ilane  was  received,  the  electric  power  was  entirely 
shut  off.     Kven  smoking  and  the  use  of  torches  was  strictly 


450   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

forbidden  in  all  areas.  The  wailing  siren  or  pop  of  an  anti- 
aircraft gun  was  usually  the  first  signal. 

All  nurses  were  required  to  dress  quickly  and  remain  in 
quarters  as  a  protection  from  the  falling  shrapnel,  until 
ordered  to  the  ahris.  Eouen  was  well  fortified  with  anti- 
aircraft guns  and  they  contributed  deafening  sound  during 
a  raid. 

Often  we  were  obliged  to  go  to  the  ahris  dug  for  our  pro- 
tection. Only  twenty-five  per  cent  of  our  personnel  were 
issued  trench  or  steel  helmets.  Those  having  none  sought  the 
use  of  water  pails,  wash  basins  or  similar  devices,  as  a  head 
covering.  Wlien  we  arrived  muddy  and  wet  in  the  trenches, 
there  was  nothing  to  do  but  wait,  watch  and  listen.  In  look- 
ing above  and  around  the  city,  we  could  see  in  the  distance 
pairs  of  sausage  balloons  suspended  at  different  heights  in 
the  air.  Between  each  a  cable  was  stretched,  cleverly  devised 
to  catch  the  wings  of  a  plane  which,  if  entangled,  would  drop 
to  earth.  Amid  the  sound  of  the  anti-aircraft  guns  we  could 
distinguish  the  destructive  roar  of  an  exploding  enemy  bomb. 
Each  plane  usually  carried  six  bombs,  so  it  was  comparatively 
easy  to  follow  its  general  direction.  Occasionally  a  rocket 
illuminated  the  ground  for  a  wide  area.  At  other  times  in- 
cendiary fires  in  the  petroleum  tanks,  thought  to  be  the  work 
of  spies,  burned  for  twenty-four  hours. 

Some  nurses  did  not  even  have  the  protection  of  a  water- 
filled  trench.  Night  nurses  and  officers  remained  on  duty 
through  all  air  raids  to  assist  in  any  emergency.  Each  hut  was 
barricaded  with  sand  bags  which  protected  it  effectively  in  case 
a  bomb  dropped  between  the  buildings.  The  sand  bags  were  of 
no  use,  however,  in  case  of  a  direct  hit.  Miss  Allison  wrote 
that  "it  was  surprising  to  find  how  little  fear  was  felt  during 
the  apparent  danger.  One  learned  to  become  a  fatalist  and  to 
hold  oneself  in  readiness  for  any  happenings." 

As  increased  activities  in  the  zone  of  the  advance  made  neces- 
sary the  presence  of  additional  surgeons,  nurses  and  sanitary  sol- 
diers in  casualty  clearing  stations  and  evacuation  hospitals  at 
the  British  Front,  mobile  hospitals  and  professional  teams 
were  organized  from  among  the  personnel  of  base  hospitals  in 
the  rear.  Happy  indeed  was  the  nurse  whose  skill  sent  her 
forward  to  the  line !  Miss  Allison  described  this  type  of 
service : 

During  the  summer  of  1917,  ]\robile  Unit  Xo.  5,  consisting 
of  about  ten  oiricers,  twenty  nurses  and  thirty  corpsmen,  wui 


THE  EUROPEAN  WAR  451 

temporarily  detached  from  Base  Hospital  No.  4  for  service 
nearer  the  front.  Betty  Connelly,  of  Cleveland,  was  chief 
nurse.  This  unit,  with  its  complete  equi])ment  for  a  live 
hundred  bed  hosj)ital.  was  transported  from  place  to  place 
by  trucks  especially  desi^Mied  for  the  purj)ose.  At  one  time 
this  supplemented  the  bed  capacity  of  an  over-crowded  hos- 
pital and  at  another  maintained  itself  as  an  independent  in- 
stitution near  the  firing  line. 

Canvas  tents  were  stretched  over  a  steel  framework,  which 
not  only  held  the  structure  securely,  but  offered  the  advantage 
of  having  no  center  posts  which  so  often  obstructed  the  pas- 
sage way.  Each  betl  was  apportioned  a  15"  x  15"  window. 
The  wards  were  connected  by  canvas-covered  corridors,  which 
also  joined  all  necessary  departments  of  the  hospital.  The 
sterilizing  plant  was  made  stationary  on  a  truck  which  farmed 
one  wall  of  the  operating-room.  Permanently  fixed  on  this 
truck  was  a  fire  l)ox,  a  boiler  and  instrument  and  dressing 
sterilizer.  A  small  room  adjacent  was  fully  equipped  for 
the  necessary  X-ray  work  and  permitted  the  patient  being 
wheeled  in  on  the  operating-room  table  and  out  again.  A 
laundry  was  also  established  on  two  adjoining  trucks.  On 
the  one  was  the  firebox,  boiler,  washer  and  extractor  and  on 
the  trailer  was  the  dryer  with  a  small  stove  in  the  rear. 

Hospitals  are  primarily  places  of  life  and  death.  The  work 
of  caring  for  the  dead  was  as  inexorable  as  that  of  caring  for 
the  living.  !^Iiss  Allison  described  the  burial  of  soldiers  who 
died  at  ^^o.  9  General  Hospital : 

At  the  far  corner  of  the  base  was  situated  a  small  building 
in  front  of  which  was  a  mound  surrounded  by  flowers  and  an 
ivy  vine  which  climbed  up  over  the  windows.  A  narrow 
pathway  led  into  a  small  mortuary.  Against  the  white  board 
walls  rested  a  flower-decked  altar. 

Many  of  our  Tommies  and  American  boys  found  here  rest 
after  the  days  of  battle.  Burial  services  were  conducted  in 
the  small  chapel  within  the  cemetery  grounds,  livery  after- 
noon rough  cotlins  were  carried  there  u])on  the  shoulders  of 
eight  British  or  American  soldiers  and  lowei-ed  into  a  deep 
trench,  three  collins,  one  upon  another.  Often  a  single  rela- 
tive had  arrived  from  l"]nghind  and  stood  alone  in  her  grief 
except  for  the  nurses  ;icconi])anying  her.  The  chaplain  read 
tlie  sim]ilt>  scr\ice,  tlie  three  volleys  rang  out  and  the  cadeiu-e 
of  the  "Last  Post"'  came  echoing  sweetly  back.  The  aching  of 
those  lonely  hearts  was  usually  too  deep  for  tears. 


452    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

During  the  first  twelve  months  in  which  Base  Hospital  No.  4 
was  stationed  at  No.  9  General  Hospital,  82,179  patients  were 
cared  for  by  the  Americans.  The  largest  single  day's  work  was 
that  of  March  27,  1918,  when  1125  patients  were  convoyed  in 
and  out. 

Overlooking  the  English  Channel,  midway  between  Calais 
and  the  mouth  of  the  Somme,  lay  the  French  village  of  Dannes 
Camiers,  the  destination  of  United  States  Army  Base  Hos- 
pital No.  5,  organized  at  the  Peter  Bent  Brigham  Hospital  and 
at  Harvard  Medical  School,  Cambridge,  Mass. 

The  second  of  the  lied  Cross  base  hospitals  to  go  overseas, 
this  unit  has  been  termed  both  the  Peter  Bent  Brigham  Unit 
and  the  Second  Harvard  Unit.  It  will  be  remembered  that 
the  first  Harvard  Unit  had  been  organized  without  assistance 
from  the  American  Red  Cross  and  had  been  assigned  during 
the  spring  of  1915  to  service  at  No.  23  General  Hospital, 
British  Expeditionary  Forces.  To  avoid  confusing  Base  Hos- 
pital No.  5  with  the  first  Harvard  Unit,  it  will  be  designated  in 
this  history,  when  its  military  appellation  is  not  used,  as  the 
Peter  Bent  Brigham  Unit. 

Dr.  Harvey  Cushing  had  organized  this  unit  and  was  its 
director.  Colonel  Robert  Urie  Patterson,  formerly  chief  of 
the  Red  Cross  Bureau  of  Medical  Service  at  National  Head- 
quarters, was  detailed  by  the  Surgeon  General  as  commanding 
officer  of  Base  Hospital  No.  5  after  it  was  mustered  into  the 
Medical  Corps  and  he  led  the  unit  into  foreign  service.  Carrie 
M.  Hall  was  chief  nurse.  Following  her  graduation  from  the 
Massachusetts  General  Hospital,  ^liss  Hall  was  superintendent 
for  four  years  of  the  Margaret  Pillsbury  General  Hospital, 
Concord,  New  Hampshire.  She  then  entered  Teachers  College 
for  a  course  in  training  school  administration.  In  1912  she 
became  superintendent  of  the  Training  School  of  Peter  I]ent 
Brigham  Hospital,  of  Boston,  and  remained  in  this  position 
until  as  cliief  nurse  she  was  ordered  with  the  Peter  Bent 
Brigham  Unit  into  active  service. 

The  personnel  of  Base  Hospital  No.  5  mobilized  in  Boston 
on  May  C  and  sailed  from  New  York  five  days  later.  Upon 
their  arrival  at  Dannes  Camiers  on  Alay  '31,  they  took  over 
No.  11  General  Hospital,  ]3ritish  Expeditionary  Forces,  a 
well-established  British  ])ase  of  two  thousand  beds. 

In  organization  and  in  work,  No.  11  General  Hospital 
chjsely  resembled   the  type  of  institution  which  has  been  de- 


THE  EUROPEAN  WAR  453 

scribed  in  the  section  which  recounts  the  experiences  of  the 
Lakeside  Unit.  No.  11  General  Hospital  was  housed,  however, 
chiefly  under  canvas. 

Of  the  ten  thousand  American  nurses  who  served  with  the 
American  and  British  Expeditionary  Forces  during  the  Euro- 
pean War,  only  three  were  wounded  in  line  of  duty.  One  of 
the  three  was  Eva  «Tean  Parmelee,  a  member  of  Base  Hos- 
pital No.  5.  She  descrilx^d  the  air  raid  which  brought  the 
first  mortalities  to  the  Americans  at  Dannes  Camicrs: 

On  a  bright  moonlight  Tiight,  September  4,  came  our  initial 
experience  with  bombs.  It  was  10:30  P.^I.  and  my  two  long 
tents  were  absolutely  quiet.  Our  lights,  controlled  by  a  cen- 
tral switch,  had  no  sooner  winked  out  than  the  siren  of  tbe 
cement  factory  blew  its  air  raid  warning.  ]\Iy  orderly,  Oscar 
Tugo,  came  running  from  his  supper;  1  met  him  in  the  road 
in  front  of  our  two  tents.  Suddenly  above  us  we  heard  tlie 
hum  of  tlie  planes,  saw  a  sputtering  streak  of  sparks  drop 
from  tbe  sky  and  Tugo  cried  out,  "Why,  they're  here!"' 

After  a  deafening  report,  1  found  myself  in  the  ditch.  The 
choking,  sulphurous  smell  and  the  noise  made  me  feel  as  if  1 
were  being  stirred  up  in  a  great  bowl  of  reeking  gunpowder. 
Four  more  reports  followed  and  I  said  to  myself :  "We're 
done  for — they're  wiping  us  out !" 

Then  I  heard  the  calls  of  the  wounded :  "Sister — Sister !" 
I  jumped  up  and  flashlight  in  hand  (for  we  clung  to  our 
lights)  ran  to  the  tent  door.  A  glance  showed  the  nearest 
man  to  be  bleeding  badly.  Doctors,  nurses  and  men  with 
stretchers  were  arriving.  ...  I  crossed  over  to  the  other  tent 
and  found  the  whole  front  section  had  been  blown  up,  beds, 
lockers,  floor  and  all.  Not  a  patient  was  in  sight.  Though 
wounded,  however,  they  were  all  living  and  had  been  placed 
in  other  wards.  In  the  officers'  quarters  and  the  reception 
tent,  seven  of  the  command  lost  their  lives  and  several  were 
gravely  wounded.  Tugo,  my  orderly,  had  been  killed.  I 
escaped  with  two  tiny  face  wounds  and  a  black  eye,  though 
shrapnel  had  torn  my  skirt  and  apron  and  cut  away  my  wrist 
watch  so  that  only  tlic  strap  remained. 

The  Peter  Bent  Brigham  Unit  was  transferred  November  1, 
1917,  to  Boulognc-sur-^ler  to  take  over  No.  V]  General  Hos- 
pital, British  Expeditionary  Forces.  Here  during  the  spring 
and  summer  of  1!)18,  th(\v  shared  the  hard  service  which  all  the 
British  hospitals  experienced. 


454   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

On  the  great  cliffs  above  the  fretful  Channel  at  nearby 
fitretat,  U.  S.  Army  Base  Hospital  No.  2,  organized  as  the 
Presbyterian  Hospital  Unit,  New  York  City,  took  over  on 
June  10,  1917,  No.  1  General  Hospital  of  the  British  Expedi- 
tionary Forces.  Dr.  George  Emerson  Brewer  was  director 
of  the  unit.  Miss  Maxwell  had  organized  the  nursing  staff  but 
Janet  Christie,  her  assistant,  accompanied  the  unit  as  chief 
nurse  when  it  was  ordered  into  the  field.  Mrs.  Christie  was 
a  graduate  of  the  Presbyterian  School  of  Nurses  and  for  thirteen 
years  had  served  in  various  executive  capacities  at  this  institu- 
tion. She  was  among  the  first  hundred  nurses  who  had  been 
enrolled  in  1905  in  the  American  Red  Cross. 

Etretat,  the  Hamlet  of  the  Setting  Sun,  had  been  a  favorite 
resort  for  artists  and  authors,  because  of  the  beauty  of  its  cres- 
cent-shaped beach  and  its  high  cliffs  overlooking  the  Channel. 
The  many  hotels  and  villas  were  requisitioned  during  the  war 
for  use  as  hospitals.  No.  1  General  Hospital  was  located  in  the 
Casino  and  in  various  hotels.  A  large  private  house  formed 
an  ofiicers'  hospital.  A  newly-built  villa,  charming  both  in 
architecture  and  in  location,  was  fitted  up  by  the  British  Army 
as  a  home  for  sick  nurses. 

During  the  German  offensives  of  March-July,  1918,  this 
hospital  received  between  sixty  and  seventy  British  and  Ameri- 
can nurse  refugees.  As  the  German  lines  were  advanced,  many 
of  the  casualty  clearing  stations  and  evacuation  hospitals  of  the 
Allies  were  bombed  and  shelled  completely  out  of  existence. 
The  nurses  and  surgeons  had  been  working  night  and  day  to 
care  for  the  greatly-increased  numbers  of  wounded  and  when 
the  lines  broke  under  savage  assaults  of  the  enemy,  the  nurses 
fell  back  to  Etretat  in  a  state  of  almost  total  collapse. 

United  States  Army  Base  Hospital  No.  2  sent  forward 
operating  teams  during  1017  and  1918  for  service  at  casualty 
clearing  stations  on  the  British  Front.  Anne  Penland,  who  had 
been  anesthetist  at  the  Presbyterian  Hospital,  was  sent  up  with 
the  first  team  and  held  the  honor  of  being  one  of  the  first,  if 
not  the  first,  inirsc  auestlietists  to  go  officially  to  the  British 
Front.  Major  Darracli,  of  tlie  Presbyterian  Unit,  was  one  of 
the  surgeons  to  take  up  a  team  and  he  told  tlie  incident  by 
which  ]\Iiss  Penland  won  the  cr)nfidence  of  the  British  officers. 
When  they  arrived  at  the  casualty  clearing  station,  the  British 
officer  asked,  '•p)Ut  whct'c  is  your  anesthetist  T' 

Major  Darrach  indicated  ]\Iiss  Penland,  a  small,  quiet  woman. 


THE  EUROPEAN  WAR  455 

"But  often  there  are  eight  or  ten  patients  at  once,  big  chaps," 
expostulated  the  Britisher,   ''And  they  struggle !" 

"Wait  and  see,"  promised  Major  Darrach. 

During  a  lull  in  the  work  which  followed,  the  British  officer 
came  back  to  Major  Darrach,  praised  Miss  Penland's  work 
and  concluded,  "But  she  always  seems  to  draw  the  quiet,  peace- 
ful chaps." 

"Come  and  see  why,"  suggested  the  American  surgeon. 

They  approached  the  table  where  Miss  Penland  was  anesthet- 
izing a  broad-shouldered  Tommy  who  seemed  inclined  to  fight 
the  ether.    ^liss  Penland  loaned  over  and  murmured  soothingly: 

"There,  dear,  it  won't  hurt  you  a  bit, — there, — there." 

At  the  sound  of  her  low,  distinctly  feminine,  southern  voice, 
the  Tommy  looked  up  in  surprise,  then  gxinned  with  perfect 
confidence  and  "went  under"  without  a  struggle.  So  success- 
ful was  her  work  that  the  British  decided  to  train  their  own 
nurses  for  this  service  and  thus  relieve  several  hundred  doctors 
for  medical  and  surgical  work.  Several  hospitals  in  the  Rouen 
and  Le  Trcport  areas,  among  them  Xo.  1  General,  were  chosen 
as  training  centers  for  these  British  nurses. 

Other  operating  teams  were  sent  forward  during  the  winter 
and  spring  of  1918.  Twenty-three  nurses  of  Base  Hospital 
No.  2,  with  Jane  Bignel  as  chief  nurse,  wei'e  detached  from 
the  staff  at  Xo.  1  General  Hospital  at  Etretat  and  were  sent 
forward  to  the  American  Front  to  form  the  nursing  staff  of 
Mobile  Hospital  Xo.  12,  American  Expeditionary  Forces. 

Xo.  1  General  Hospital  drew  patients  largely  from  the  Third 
Army  Sector  of  the  British  Front  and  evacuated  them  by  ambu- 
lance through  Le  Havre.  French,  Italian,  Colonial,  East  In- 
dian, Arab  and  Portuguese  wounded,  and  American  wounded 
after  the  First  Division  had  entered  the  lines,  found  rest  and 
care  in  the  seven  hotels  which  the  British  Army  had  ccjuipped 
as  hospitals.  The  personnel  of  liase  Hospital  Xo.  2  were  always 
busy.  In  transmitting  a  connnunication  to  Xational  Headquar- 
ters, Mrs.  Christie  suinniari/.cd  their  work  in  a  few  words 
which  p()int(>d  to  the  most  worth-while  service  that  war  nurses 
can  give:  "Our  exjx'riciices  w(>re  not  spcctacuhir  in  any  way. 
We  occasionally  heard  gims  and  got  our  warnings,  but  the 
greater  })art  of  the  tinie  we  simply  had  steady,  hard  work." 

Thongh  the  Preshyterian  Fnit  was  located  well  Ix'hind  the 
lines,  both  casualties  from  air  raids  of  the  enemy  and  death  from 
overwork  and  exposure  brought  to  its  members  a  realization  of 


4.56   HISTORY  OF  AMERICAN  JRED  CROSS  NURSING 

the  sadness  of  war.  Beatrice  Mary  MacDonald,  a  member  of 
this  unit,  was  the  first  American  nurse  to  be  wounded  in  the 
European  War.  She  had  been  sent  forward  as  a  member  of  a 
detached  team  to  ^o.  01  Casualty  Clearing  Station,  near  St. 
Sixte's  Convent,  Belgium.  Seven  surgical  teams,  five  British 
and  two  American,  were  on  detached  duty  here  during  July, 
1917;  the  two  American  teams  had  been  organized  from  the 
Presbyterian  and  the  Pennsylvania  units.  Helen  Grace  Mc- 
Clelland, a  nurse  serving  with  the  Pennsylvania  team,  de- 
scribed the  air  raid  of  which  Miss  MacDonald  was  a  victim: 

Miss  MacDonald  and  I  had  been  relieved  at  4  P.M.,  August 
17,  1917,  and  were  expected  to  report  for  duty  again  at 
twelve.  We  had  been  asleep  and  were  awakened  by  the  hum- 
ming of  German  motors.  I  looked  at  my  watch  to  see  if  it 
were  time  to  go  on  duty,  but  it  was  only  10:15  P.M.  Then 
the  bombs  began  to  drop.  We  reached  for  our  tin  hats  which 
we  always  kept  hanging  with  our  gas  masks  on  the  cot.  I 
put  mine  on  the  side  of  my  head  and  covered  up  again.  Miss 
MacDonald  was  slightly  raised  on  her  elbow  when  two  bombs 
struck  the  cook  liouse  nearby  and  a  piece  of  shrapnel  came 
through  our  tent  wall  and  penetrated  her  eye;  another  piece 
struck  her  clieek.  Two  English  nurses  were  also  wounded 
and  the  nurse  in  the  tent  next  to  ours  was  thrown  out  of  bed 
by  the  concussion. 

Our  tent  was  about  twenty-five  or  thirty  feet  from  the 
place  where  the  bombs  struck.  In  the  field  alongside  our 
compound,  there  was  a  row  of  five  holes  where  they  had 
dropped  their  bombs.  Even  with  my  eyes  closed  I  had  seen 
the  flashes  from  the  explosions.  The  concussion  was  terrific 
and  things  came  fiying  through  our  tent,  tearing  great  holes 
out  of  it.  The  cook,  who  had  just  returned  that  day  from 
leave  in  England,  was  blown  to  pieces. 

The  officers,  who  had  been  in  their  mess  tent  when  the 
bombs  struck,  came  over  at  once,  calling:  "Are  any  of  the 
Sisters  hurt?"  I  answered,  "Yes,"  and  two  of  them  entered 
with  flashlights.  ]\Iiss  ^MacDonald  was  then  placed  on  a 
stretolier  and  taken  to  the  o]:)erating-tent  for  a  more  thorough 
examination.  As  there  was  an  ambulance  train  on  the  track 
then  being  loaded  for  the  zone  of  the  base,  she  was  put  on  it 
and  it  was  ordered  to  Boulogne,  the  ophthalmic  center. 

Although  ]\Iiss  ]\lacl)onald  lost  the  sight  of  her  right  eye,  she 
returned  to  duty  at  Boulogne  and  remained  in  service  with  her 
unit  until  two  months  after  the  Armistice. 


THE  EUROPEAN  WAR  467 

Fourteen  base  hospitals  served  during  the  winter  of  1917- 
1918  in  France;  six  of  them  were  attached  to  the  British  Ex- 
peditionary Forces  and  eight  to  the  American  forces.  All  of 
the  nurses  found  the  rigorous  climate  and  the  heavy  work  a 
more  severe  test  of  their  stamina  than  the  bombs  of  enemy 
raiders.  First  one  nurse  and  then  another,  among  the  staff  of 
one  hundred  in  each  hospital,  grew  sick  during  the  bleak  winter 
months  and  here  and  there  in  the  British  and  American  bases, 
a  nurse  died  and  was  buried  with  military  honors.  The  fol- 
lowing account  of  the  funeral  of  Amabel  S.  Iloberts,  a  nurse 
and  a  member  of  the  Presbyterian  Unit,  was  published  in  the 
Military  Number  (May,  1918)  of  the  American  Journal  of 
Nursing: 

At  6:15  P.M.  on  Thursday,  January  17,  1918,  Amabel  S. 
Roberts,  reserve  nurse,  Army  Xurse  Corps.  .  .  .  Xo.  1,  Gen- 
eral Hospital,  fitretat,  France,  gave  up  the  life  she  had  de- 
voted to  the  service  of  others.  Her  illness,  one  of  the  most 
deadly  of  infections,  had  lasted  barely  three  days. 

.  .  .  The  services  were  to  be  held  at  the  Blanquet,  the 
nurses'  quarters,  and  in  a  moment  the  narrow  street  was 
choked  with  troops  who  formed  in  a  long  double  rank  on 
either  side  of  the  street  leading  to  the  gate.  For  fifteen  min- 
utes the  men  stood  at  attention  while  the  simple  services  were 
being  held  inside  the  Blanquet  and  then  the  leaden  casket  was 
brought  out  and  placed  on  a  stretcher  carriage  covered  with 
flags.  The  carriage  moved  slowly  down  the  street  between  the 
two  ranks  of  men  who  uncovered  their  heads  as  it  passed.  As 
it  reached  the  end  of  the  lines,  the  files  telescoped  on  them- 
selves and  fell  in  behind. 

It  was  an  impressive  procession.  .  .  .  The  masses  of 
flowers  that  buried  tbe  casket  flamed  against  the  somber  back- 
ground. .  .  .  The  dark  blue  uniforms  of  the  nurses  blended 
with  the  blue  and  leather  of  tlicse  of  the  aminilance  drivers 
and  both  were  relieved  by  the  flowing  white  head-dresses  of 
members  of  the  Y.  A.  Ds.  And  then  came  the  olive  drab  as 
the  officers  marched  past,  heading  the  solid  ranks  of  men  in  a 
long  column  of  fours,  with  the  horizoTi  blue  of  th(>  poilu.'i 
following.  One  felt  sure,  somehow,  that  she  would  have  been 
glad  to  know  that  the  poihis  were  there.  Th(y  were  all 
wounded  and  some  of  them  hobbled  alone:  on  sticks  while 
one  or  two  gave  an  arm  to  a  comrade  who  had  risked  his 
strength  to  come.  .  .  . 

More  khaki  as  the  British  marched  and  then  the  patients. 
Some  of  them  wore  uniform  coats.  Inii  most  of  tlicm  were  in 


458  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

blues,  that  strange  ill-fitting  garb  of  the  convalescent.  After 
these  came  all  Etretat,  women  and  old  men  unfit  for  serv- 
ice ..  .  in  clumping  wooden  shoes,  some  leading  little  chil- 
dren, the  lame,  the  halt  and  the  blind,  the  old  and  the  weak, — 
they  knew  of  bitter  experience  and  they  could  sympathize. 
It  was  not  an  impersonal  sorrow  that  the  French  gave.  They 
had  known  her.  .  .  . 

Some  of  us  have  felt  from  time  to  time  that  in  this  old 
world  we  have  found  only  a  land  out-worn,  devitalized  and 
cold,  but  as  the  funeral  procession  of  our  sister  passed  through 
the  narrow  streets  between  the  rows  of  Xorman  houses  with 
their  gabled  roofs,  that  feeling  changed  and  there  was  com- 
fort in  the  change.  One  felt  a  sense  of  sheltering  protection, 
the  promise  of  a  mother  old  in  the  ways  of  pain, — that  she 
would  care  for  that  which  we  bequeathed  her  until  such  time 
as  we  could  claim  our  own.  Through  the  outskirts  of  the 
town  the  column  went,  past  the  old  Xorman  church  with  its 
strong,  restful  lines,  and  into  the  cemetery. 

There,  beyond  the  civilian  portion  with  its  crowded  tombs 
and  quaint  head  stones,  upon  a  little  slope  above  the  rest  is  a 
phalanx  of  black  wooden  crosses  which  mark  the  resting 
places  of  those  who  have  died  that  a  better  world  might  come 
into  being.  Here  the  procession  halted.  A  grave  had  been 
dug  in  the  center,  between  the  two  larger  plots.  Far  off  in 
one  corner  of  the  cemetery  lay  a  German,  a  prisoner  of  war, 
and  one  felt  that  in  the  great  democracy  of  death,  all  war  had 
been  forgotten. 

At  the  foot  of  the  grave  stood  Padre  Johnston;  at  the  head 
and  on  the  upper  side  were  grouped  the  nurses.  Further  up 
were  the  officers  and  behind  them  and  extending  down  behind 
the  nurses  were  the  enlisted  men  of  all  nationalities.  The 
sun  shone  warmly  and  a  soft  wind  came  up  from  the  sea. 
Tlie  beautiful  service  of  the  Church  of  England  was  read 
through.  ...  At  last  the  pall  bearers  stood  clear  and  the 
buglers  stepped  forward.  Taps  were  blown  for  the  first  time 
in  fitretat  over  an  open  grave.  We  had  become  so  used  to 
the  "Last  Post''  that  we  had  almost  forgotten  the  real  beauty 
of  Taps  but  now  its  piercing  sweetness  struck  home.  .  .  . 
"Go  to  sleep.  Go — to — sleep."  It  was  an  end  and  a  be- 
ginning. 

A  plain  wooden  cross  will  mark  her  grave,  a  cross  differing 
in  nowise  from  the  crosses  which  surround  it,  except  in  the 
name  painted  in  wliite  upon  its  arms.  It  was  suggested  that 
some  more  elaborate  memorial  might  be  fitting  but  surely 
none  could  fit  so  well.  It  is  a  soldier's  cross  for  one  who  died 
like  a  soldier. 


THE  ET  ROPE  AN  WAR  459 

No.  16  General  Hospital,  British  Expeditionary  Forces,  was 
located  at  Le  Treport,  France,  an  hour's  journey  by  motor  from 
Dieppe,  and  was  the  destination  of  U.  S.  Army  Base  Hospital 
No.  10.  The  personnel  of  tiiis  unit  had  been  chosen  from  among 
the  alumnse  and  the  staff  of  the  Pennsylvania  Hospital,  Phila- 
delphia, Pa.  ])r.  liichard  H.  Harte  was  the  director  and 
Marg-aret  A.  Dnnlop  was  the  chief  nurse. 

Miss  Dunlop  was  a  veteran  in  war  service.  The  daughter 
of  a  Connecticut  clergyman,  she  was  educated  at  Normal  Col- 
lege, New  York  City,  and  at  the  Presbyterian  Hospital,  Phila- 
delphia, Pa.  For  ten  years  she  was  assistant  directress  of 
nurses  at  the  Presbyterian  Hospital.  She  became  Matron  and 
superintendent  of  nurses  at  the  Pennsylvania  Hospital  in  1009. 
Immediately  following  the  declaration  of  war  in  August,  1914, 
the  American  Ambulance  called  her  to  Paris  as  chief  nurse. 
Upon  her  return  to  the  United  States  in  1916,  she  organized 
the  nursing  staff  of  Base  Hospital  No.  10.  Her  strong,  ener- 
getic personality,  her  initiative  and  her  ready  humor  made  her 
admirably  fitted  for  war  nursing. 

The  Pennsylvania  Unit  mobilized  on  May  6,  1917,  in  Phila- 
delphia and  sailed  on  May  19  from  New  York  with  the  St. 
Louis  Unit  on  the  S.  S.  St.  Paul  bound  for  Liver])ool.  Miss 
Dunlop  marshalled  her  nurses  in  orderly  formations  which  would 
have  done  credit  to  a  veteran  sergeant  of  the  United  States 
Begulars.  The  nurses  of  tho  unit  were  divided  into  different 
groups,  each  with  its  group  leader  who  received  all  orders  for 
the  nurses  in  her  section  directly  from  !Miss  Dunlop  and  who 
was  responsible  to  ]\Iiss  Dunlop  for  the  promptness  of  the 
nurses  of  her  section,  for  the  appearance  on  time  of  the  baggage 
and  for  all  other  matters  which  related  to  her  section.  "Never 
during  the  many  days  of  travel,"  wrote  ]\Iiss  Dunlop,  "were 
we  hampered  by  unpunctuality  or  disobedience." 

The  Pennsylvania  and  St.  Louis  units  were  the  third  and 
fourth  branches  of  the  American  Army  to  arrive  in  London 
and  the  reception  which  the  British  gave  them  was  cordial 
indcM'd.  Hospitable  Londoners  took  the  nurses  sight-seeing  in 
tlie  day  time  and  asked  tliem  to  the  theaters  every  night.  Pedes- 
trians noticed  the  nurses'  uniforms  on  the  street,  stopped  them 
to  point  out  places  of  historical  interest  and  insisted  on  taking 
them  off  to  tea.  One  of  the  doctors  of  the  Pennsylvania  Unit 
langliingly  said  that  "from  the  time  the  employees  of  th(>  P(Min- 
svlvania    Railroad    cheered    tlicni    in    -lersev    Citv    until    their 


460   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

arrival  in  France,  the  whole  journey  was  one  long  glorification 
for  the  nurses !" 

This  cordial  reception  helped  greatly  to  unify  the  British 
and  American  groups.  ^liss  Dunlop  wrote  that  ''the  period 
in  London  seemed  to  us  at  first  a  wonderful  joy  ride,  but  later 
the  wisdom  of  the  scheme  was  understood.  It  brought  the 
American  units  who  were  to  work  with  the  Allies  into  a  bond 
of  kinship  and  good  feeling  which  perhaps  could  not  have  been 
produced  in  any  other  way." 

The  Pennsylvania  Unit  left  London  on  June  8,  bound  for 
Southampton  and  France.  They  arrived  at  Dieppe  at  one  o'clock 
in  the  morning  of  June  11  and  found  waiting  for  them  British 
"chauffeurines"  with  their  ambulances.  The  Americans  were 
driven  through  the  mud  and  rain  to  Le  Treport  and  arrived 
at  two  o'clock  at  Xo.  16  General  Hospital,  British  Expedition- 
ary Forces.  Miss  Dunlop  wrote  Miss  Noyes  that  "the  Matron 
was  one  of  God's  own ;  she  and  her  nurses  turned  out  and  gave 
us  their  beds.  We  were  a  sorry  lot,  without  even  hand  lug- 
gage." 

No.  16  General  Hospital  was  composed  of  eight  low  huts 
which  comprised  the  nurses'  quarters,  thirty-six  long  brown- 
stained  wards,  nine  huts  and  seven  tents  called  barracks  where 
walking  cases  were  housed  and  numerous  temporary  buildings 
of  the  isolation  department.  As  it  was  located  in  one  of  the 
most  forward  points  of  the  British  Zone  of  the  Base,  it  was 
always  busy.  During  the  first  week  the  Americans  were  in 
charge,  the  hospital  with  a  staff  of  sixty-five  nurses  and  eighteen 
members  of  V.  A.  Ds.  received  fourteen  hundred  patients,  many 
of  them  heavy  surgical  and  mustard  gas  cases.  The  gassed 
soldiers  evoked  the  keenest  sympathy.     Miss  Dunlop  wrote : 

These  patients  were  horrible  pictures  of  misery.  They 
poured  upon  us  in  ^reat  numbers,  six  hundred  in  less  than 
forty-eiijlit  hours,  and  their  suff{'rin,£rs  were  pitiful  to  see,  but 
their  Ijraverv,  unselfishness  and  fortitude  stiffened  up  our  own 
courage  at  tliis  our  first  soul  harassing  introduction  to  the 
indescribal)]('  liarbarity  l)y  wliich  war  is  inflicted  upon  the 
individual  soldier.  l^)einor  untrained  to  the  handling  of  such 
largo  numbers  of  wounded  and  not  yet  inured  to  the  immen- 
sity of  tlie  work,  it  was  a  tremendous  strain  on  the  minds, 
hearts  and  bodies  of  the  medical  and  of  the  nursing  staff.  Of 
necessity,  the  nurses  liad  many  dressings  to  do.  They  soon 
grew  ex])ert.     Our  jiatient's  one  answer,  when  we  asked  even 


THE  EUROPEAN  WAR  461 

the  desperately  wounded  if  they  were  in  pain  was  always: 
"Not  too  bad,  Sister." 

During  that  summer  of  1917,  we  had  our  baptism  of  horror 
and  work,  but  after  a  few  months  the  wliole  unit  settled 
down  to  the  inevitable.  As  we  grew  more  efficient  in  handling 
large  numbers  of  wounded,  we  grew  less  fearful  that  we 
would  not  prove  equal  to  the  tasks  demanded  of  us. 

Late  in  July,  1917,  the  surgical  teams,  each  composed  of  a 
surgeon,  an  anesthetist,  a  nurse  and  an  orderly  of  Base  Hos- 
pital No.  10  were  sent  forward  from  No,  IG  General  Hospital 
for  duty  in  casualty  clearing  stations  at  the  British  Front. 
Helen  Fairchild  ^^  and  Helen  Grace  McClelland  were  the  nurses 
chosen  for  this  coveted  assignment.  The  team  left  the  base 
at  six  o'clock  on  July  21  in  ambulances  driven  by  British 
''chauffeurines."  Their  first  stop  was  at  Abbeville;  they  then 
proceeded  on  to  Hesden  where  they  spent  the  night  at  a  hotel 
which  had  formerly  been  a  hunting  lodge  of  one  of  the  Bour- 
l)ons.  The  V.  A.  D's.  who  drove  the  British  ambulances  were 
not  allowed  to  go  to  the  front,  so  the  surgical  teams  proceeded 
forward  the  next  morning  with  new  drivers.  Miss  McClelland 
wrote : 

After  we  had  left  ITesden,  the  ambulance  ahead  of  us  had 
some  tire  troul)]e  so  we  stopped  on  the  crest  of  a  high  hill 
beyond  the  forests  and  saw  miles  away  a  puff  of  blue  smoke 
from  one  of  the  big  guns  and  knew  before  long  that  we  would 
see  some  of  the  destruction  and  agony  which  they  were 
causing. 

We  had  dinner  at  Steenwoorde.  The  town  was  filled  with 
Belgian  troops  and  we  soon  caught  up  on  the  road  beyond 
with  great  numbers  of  Portuguese  soldiers.  From  this  point 
on,  we  saw  more  and  more  of  the  tremendous  numbers  of 
men  and  the  vast  amount  of  material  which  are  demanded 
by  war.  Here  were  thousands  of  pontoon  bridges  for  use  in 
the  drive  to  cross  tlie  Canal  at  Ypres ;  here  were  British 
Tommies  with  that  tired,  questioning  look  on  tlieir  faces,  that 
look  which  we  saw  later  in  the  eyes  of  all  those  who  had 
bitterly  come  to  know,  as  the  Tummies  said,  that  ''a  bit  o' 
war  was  on."' 

Tlie  trallic  now  became  more  congested  and  we  were  al- 
1o\\(m1  to  tra\cl  only  on  certain  roads.  Poperinghe  was  being 
shelled    at    certain    hours,    but    we    found    everything    cpiict 

^' Died   in  line  of  duly;   s('(>  Ajipciidix :    Doccasod  Xurses. 


462   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

there.  We  proceeded  on  to  Proven  and  finally  reached  our 
station,  near  St.  Sixte's  Convent  in  Belgium.  Miss  Fair- 
child  went  on  with  her  train  to  No.  4  Casualty  Clearing  Sta- 
tion, and  I  to  No.  (51  Casualty  Clearing  Station.  The  next 
afternoon  ^liss  ^lacDonald,  of  the  New  York  Presbyterian 
Unit,  arrived.  From  the  way  we  greeted  each  other,  the 
British  sisters  thought  we  were  old  friends,  but  we  had  not 
known  of  each  other's  existence  until  we  met  there  at  the 
front. 

Surgical  teams  usually  went  up  to  casualty  clearing  stations 
for  duty  lasting  about  forty-eight  hours.  The  nurses  cared 
for  men  injured  in  a  particular  drive  and  then  returned  to  the 
base.  They  were,  therefore,  instructed  to  travel  with  as  little 
baggage  as  possible.  Five  weeks  passed  before  the  American 
nurses  were  able  to  get  more  than  the  forty-eight  hours'  supply  of 
clothing  which  they  had  brought  with  them.  During  these 
weeks,  they  did  their  own  washing  after  they  came  oft"  duty  and 
hung  it  to  dry  on  tent  ropes.  The  commanding  officer  hap- 
pened one  day  to  notice  what  was  happening  and  sent  a  special 
car  to  the  base  to  get  additional  clothing  and  the  nurses'  mail. 

Miss  McClelland  described  the  work  at  No.  61  Casualty  Clear- 
ing Station: 

There  were  seven  surgical  teams,  five  British  and  two 
American,  besides  the  regular  staff  of  officers  and  sisters. 
Four  teams  were  assigned  to  day  duty  and  four  teams  went 
on  at  night  until  a  "push"  began,  when  the  schedule  was 
changed  and  the  teams  would  work  for  twelve  hours,  go  off 
for  eight  and  come  on  again  for  twelve.  There  were  five 
operating  tables  in  a  Nissen  hut  and  two  others  in  a  large 
marquee.  The  two  American  teams  were  on  duty  at  the  same 
time  and  our  tables  stood  next  to  each  other  in  tlie  liut. 

When  the  first  big  drive  came  on,  no  one  felt  like  going 
off  duty  while  the  men  were  still  pouring  in  on  us.  One  day 
we  worked  for  twenty-four  hours,  stoppiiig  only  for  some- 
thing to  cat.  After  cleaning  up  our  tables,  we  went  to  bed 
at  2  A.M.,  1)ut  were  back  on  duty  at  4  A.M.  for  another 
twelve  hour  shift. 

We  wlio  were  new  to  the  front  were  greatly  impressed  at 
the  efficient  way  in  which  the  work  was  carried  on  (luring  the 
drives.  Those  needing  operation  went  directly  to  the  pre- 
operatiug  tent;  those  suffering  from  shock  were  sent  to  the 
resuscitation  tent;  chest  cases  to  their  section;  officers  to 
their  tents.  .  .  . 


THE  EUROPEAN  WAR  463 

During  a  drive  there  were  always  ambulance  trains  on  the 
tracks  waiting  to  be  loaded.  Only  the  worst  cases  were 
brought  into  the  clearing  stations;  the  others  were  taken 
directly  onto  the  trains,  which  carried  a  certain  number  of 
cot  cases  and  a  certain  number  of  "walkers."  As  soon  as  its 
quota  was  complete,  the  train  was  sent  down  to  the  l)ase. 

Bairnsfathers'  picture  of  a  casualty  clearing  station,  show- 
ing the  men  on  stretchers,  most  of  them  asleep,  is  very  good. 
Even  those  who  were  horribly  wounded  slept  the  sleep  of 
utter  exhaustion. 

1  shall  never  forget  those  men;  they  never  had  a  word  of 
complaint.  When  you  asked  them  if  they  were  suffering 
much  pain,  they  would  answer:  '^It's  drawing  a  bit,  Sister." 
When  a  lad  would  say  to  the  doctor  who  was  examining  him, 
"Do  you  think  it  will  be  a  Blighty,  sir?"  the  hope  in  that 
boy's  eyes  made  your  heart  ache, — you  knew  how  badly  he 
wanted  to  get  back  home,  away  from  filth,  agony  and  destruc- 
tion for  a  little  while  at  least. 

Miss  McClelland  and  Miss  MacDonald  worked  together  at 
^o.  Gl  Casualty  Clearing  Station  until  Miss  ISIacDonald  was 
wounded  August  17,  1017.  After  the  latter  had  been  sent  back 
to  Boulogne,  Miss  ^fcClelland  was  the  only  American  nurse 
at  Xo.  ()1.  She  wrote  of  the  consideration  which  the  British 
nurses  showed  her: 

As  soon  as  Miss  ^MacDonald  left,  our  team  began  work 
again.  I  missed  her  a  great  deal  and  it  was  several  weeks 
before  another  nurse  from  her  unit  came  to  take  her  place. 
The  ^latron  in  charge  of  Xo.  61  was  most  kind  and  thought- 
ful to  me.  She  would  say  every  day :  "Well,  ]\Iiss  America, 
haven't  you  had  enough  and  don't  you  want  to  go  back  to  your 
base?  ...  I  learned  to  understand  and  love  the  luiglish. 
!My  previous  ideas  of  them  had  been  formed  purely  from 
American  history  of  the  Kevolutionary  period.  I  shall  never 
forget  the  unselfish  devotion  of  those  British  Sisters  to  their 
work  and  their  kindness  to  me. 

In  the  meantime,  the  nursing  staif  at  Xo.  16  General  Hos- 
pital at  Le  Treport  had  been  augmented  on  September  22, 
1917,  by  the  arrival  of  thirty  nursc^s  \nider  the  lead(M'ship  of 
^larie  Kdcn.  ]Miss  Dunlnp  wrote  that  "during  tlu>  winter 
months,  t\\o  intense  work  slackened,  the  armies  sitting  tight  in 
the  trenches  with  only  desultory  lighting,  and  the  number  of 
patients  in  the  hospital  ran  down  as  low  as  eight  hundred  on 


464   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

one  day."  The  nurses  then  turned  their  attention  to  the  amuse- 
ment of  their  patients. 

After  the  Treaty  of  Brest-Litovsk  had  been  signed  on  March 
3,  1918,  the  German  High  Command  came  into  possession  of 
huge  quantities  of  material  and  large  numbers  of  men  which 
could  immediately  be  transferred  from  the  eastern  to  the  western 
theaters  of  war.  As  a  skeleton  for  the  new  divisions  to  be  formed 
from  the  troops  released  from  the  Russian  frontiers,  the  German 
High  Command  withdrew  from  Russia  all  the  soldiers  betw^een 
the  ages  of  twenty-five  and  thirty-five  and  formed  them  into 
aporoximately  sixty  new  divisions  of  12,000  men  each.  This 
gave  the  Germans  on  the  Western  Front  a  numerical  increase 
of  about  700,000  men. 

The  German  High  Command  selected  for  the  initial  attack 
the  point  where  the  British  and  French  lines  joined  in  Picardy, 
between  Marcoing,  near  Cambrai,  and  the  Gise  River.  The 
British  had  taken  over  this  battle-front  from  the  French  at  the 
beginning  of  the  year  1918  and  were  endeavoring  to  hold  a  line 
of  about  fifty  miles  in  length  with  the  British  Fifth  Army, 
which  totaled  about  170,000  men.  With  approximately  750,000 
men,  the  enemy  struck  a  supreme  blow  here  at  five  o'clock  on 
the  morning  of  March  21,  1918.  The  line  broke  and  the  Allied 
cause  hung  in  the  balance  while  the  fresh  German  divisions  the 
following  days  swept  down  along  the  road  to  Peronne  and  Albert, 
along  the  direct  route  from  St.  Quentin  to  Amiens  and  down  the 
Gise  River  valley  along  two  roads,  one  of  which  led  to  Paris 
and  the  other  to  the  south  of  Amiens.  On  March  24,  the  enemy 
took  Peronne  and  crossed  the  Somme;  on  March  2."),  he  captured 
Bapaume,  Xesle  and  other  villages;  on  March  26,  he  crossed 
the  old  battle-line  of  1916  in  several  places  and  captured  Xoyon, 
Rove  and  Lihon.  The  next  day  saw  the  first  perceptible  signs 
that  the  German  advance  was  slowing  up,  but  by  the  28th  of 
!March,  the  Germans  had  established  a  thirty-five  mile  salient 
towards  Amiens,  the  British  base  of  supplies.  8ome  sixty  miles 
directly  south  lay  Paris. 

With  the  Germans  eight  miles  from  Amiens,  the  situation  of 
No.  16  General  Hospital  became  threatening.  The  big  base 
was  crowded  with  patients,  the  great  majority  extremely  serious 
cases.  On  one  niaht,  when  there  were  159  patients  on  the 
"dangerously-ill  list,"'  an  evacuation  occurred  which  may  well 
serve  as  a  splendid  example  of  modern  medical  and  nursing 
skill.     Miss  Dunlop  wrote: 


THE  EUROPEAN  WAR  465 

.  .  .  With  2200  patients  crowded  in  the  hospital,  we  were 
notified  that  a  train  wliith  woukl  bring  down  320  patients 
w^oukl  be  expected  to  take  away  300  others.  This  meant  re- 
moving many  ill  patients  from  bed,  placing  them  on  stretch- 
ers and  getting  the  beds  ready  for  the  incoming  320.  At 
midnight  with  rain  coming  down  in  torrents,  with  the  floors 
of  the  wards  covered  with  the  stretchers  of  tlie  300  outgoing 
patients,  with  orderlies  filing  in  with  the  first  newcomers, 
with  the  friends  of  the  159  dangerously-ill  patients  arriving 
from  England  and  with  the  lights  suddenly  going  out  all  over 
the  camp,  our  wards  presented  a  scene  never  to  be  forgotten. 

By  the  dim  glow  of  lanterns,  in  this  chaotic  time  when 
order  seemed  to  be  an  impossibility,  through  the  steady,  quiet 
routine  of  officers,  men  and  night  nurses,  the  camp  grew  quiet, 
order  was  restored  and  the  work  was  accomplished  by  three 
o'clock,  a  feat  that  would  have  seemed  appalling  to  us  the 
previous  year.  Things  that  seem  to  stand  out  in  my  memory 
of  that  night  are  the  fortitude  and  bravery  of  the  severely- 
wounded  coming  down ;  the  patient,  uncomplaining  attitude 
of  the  sick  men  suddenly  taken  from  their  warm  beds  and 
sent  out  into  the  rain ;  the  efficient  handling  of  the  numbers 
of  patients  by  the  men  and  the  nurses;  the  quiet,  repressed 
attitude  of  the  friends  of  the  dying. 

On  March  21,  1918,  Base  Hospital  N'o.  10  sent  forward 
Casualty  Clearing  Station  Team  Xo.  28,  of  which  Isabelle 
Stanibaugh  was  the  nurse  member.  After  a  hasty  evacuation 
of  the  team  from  jSTo.  32  Casualty'  Clearing  Station  at  ^[arch- 
clcpot,  near  Peronne,  ^fiss  Stambaugh  was  assigned  for  tem- 
porary duty  at  'No.  42  Stationary  Hospital  at  Amiens.  Here 
on  ]\Iarch  23,  1918,  she  was  severely  wonnded  by  a  piece  of 
shrapnel  during  an  air  raid.  The  attack  was  described  by  the 
officer  in  command  of  her  team,  Captain  Edward  E.  Hodge, 
who  wrote  as  follows  : 

We  went  back  to  the  hospital,  Captain  McTvenzie  of  the 
Canadian  team  with  us,  as  we  had  learned  that  our  nurses, 
^liss  Stambaugh  and  Miss  Patterson,  liad  been  working  there 
since  leaving  Xo.  ;52  Casualty  (bearing  Station  on  Saturday. 
We  found  tliem  just  leaving  to  spend  tlie  night  in  Xo.  3 
branch.  .  .  .  Tht'  first  l)()inl)ing  fliglit  had  been  over  and  it 
seemed  a  good  time  to  move.  Tlie  ^latron  herself  was  going. 
While  walking  along  a  broad  boulevard  about  half  way  to  our 
destination,  more  bombers  came  over  and  dropped  four 
bombs  in  our  block. 


466   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

After  we  had  extricated  ourselves  from  the  fallen  glass  and 
plaster,  we  found  every  one  had  a  wound  in  leg  or  foot,  except 
Captain  McKenzie.  At  first  we  feared  that  he  was  killed,  he 
was  lying  so  quietly  in  the  gutter.  Later  it  appeared  he  was 
only  stunned.  An  ambulance  took  us  back  to  the  place  we 
had  just  left.  The  chaplain  gave  up  his  room  to  the  nurses, 
whose  wounds  were  the  most  serious,  and  we  found  a  place 
for  Captain  Dillard  in  a  ward.  Major  Hodge  arranged  for 
removal  of  our  casualties  by  ambulance  convoy  next  day  to 
Abbeville.    The  nurses  were  later  evacuated  to  England.  .  .  .^^ 

Meantime  in  the  Le  Treport  Area,  orders  had  come  for  trans- 
fer of  all  patients  at  Base  Hospital  Xo.  10  to  Rouen.  Miss 
Dunlop  wrote: 

This  meant  the  evacuation  of  over  ten  thousand  men  in 
two  or  three  days.  As  many  of  the  patients  had  but  small 
chance  of  living  under  the  best  of  conditions,  it  seemed  a 
heart-breaking  thing  to  do.  However,  orders  must  be  fol- 
lowed and  irrespective  of  condition,  they  were  sent  back, 
though  nine  died  en  route.  An  order  came  at  ten  one  morn- 
ing that  forty-five  nurses  should  be  ready,  bag,  bedding  and 
baggage  by  twelve  o'clock  to  be  sent  out  of  the  area.  Fifteen 
under  ^Irs.  Eden  were  sent  to  the  Cleveland  T^nit  at  Rouen 
and  fifteen  under  ]\Iiss  Gerliard  went  to  the  St.  Louis  Unit 
also  at  Kouen  and  fifteen  under  Miss  ^McXeal  fell  back  to  the 
New  York  Unit  at  Etretat.  After  much  hurry  and  bustle  and 
much  excitement,  not  knowing  whether  we  should  meet  again 
or  what  might  happen  during  their  absence,  they  got  off. 

The  remainder  of  the  nurses  were  ordered  to  l^e  packed  up 
ready  to  evacuate  with  heavy  baggage,  light  baggage  or  no 
baggage.  Anxiety  was  in  every  heart  but  we  made  little  out- 
ward sliow.  Time  went  on  and  the  Germans  were  held. 
After  two  weeks'  suspense,  a  few  patients  were  sent  to  us  and 
we  were  told  to  carry  on  without  equipment.  Little  by  little 
more  patients  came,  more  equipment  was  opened  up  until  we 
were  running  full  capacity  again.  Our  nurses  soon  returned 
and  a  new  peace  crept  into  our  hearts.  The  tide  had  turned 
and  tlie  patients  coming  down  were  no  longer  silent.  .  .  . 
Even  the  badly  wounded  seemed  in  the  best  of  spirits. 

March  2G  had  been  the  decisive  day  of  the  Second  Battle  of 

Picardy.     French  rci'nforceincnts  came  up  along  the  southern 

front  and  united  with  the  British  at  ^loreiul.     The  same  day 

saw  the  organization  of  a   new  British  Army,  under  General 

"  "TTistorv  of  the  Pcnnsvlvania  TToppital  Unit  iu  the  Great  War,"  p. 
lin.    Paul    n.   Hoebcr,   New   Surk.    1!I21. 


THE  EUROPEAN  WAR  467 

Sandeman  Carey.  This  Army  was  composed  largely  of  laborers, 
sappers  and  engineers  and  it  was  flung  immediately  into  the 
trenches  to  hold  the  gup  made  by  the  Germans.  For  six  days, 
it  fought  over  unknown  ground,  with  officers  in  charge  of  men 
they  had  never  seen  before,  until  reenforcements  could  be 
brought  up  and  the  line  made  permanent.  The  action  continued 
during  the  first  week  of  April,  but  the  Germans  failed  to  smash 
the  sides  of  the  Amiens  salient  and  the  Second  Battle  of  Picardy 
ended  with  the  German  plan  in  the  main  frustrated  and  the 
British  and  French  still  united  in  strong  defensive  positions. 

Out  of  the  disastrous  Second  Battle  of  Picardy  and  out  of 
the  subsequent  demoralization  and  almost  complete  defeat  of 
the  Allies  came  the  unity  of  command  of  the  entire  Allied  and 
American  forces  under  ]Marshal  Foch, — for  the  first  time  in 
the  European  War,  the  Allies  were  in  a  position  to  present,  in 
the  words  of  Painleve,  "a  single  front,  a  single  army,  a  single 
nation  .   .   ,   the  program  recjuisite  for  future  victory."  ^''* 

During  July,  1918,  the  Pennsylvania  Unit  received  its  first 
American  patients,  men  of  Pershing's  First  Division,  who  had 
been  brigaded  with  the  British.  From  that  time  on.  Base  Hos- 
pital oSTo.  10  shared  in  the  heavy  work  incident  to  the  Allied 
oifensive. 

United  States  Army  Base  Hospital  Xo.  21,  organized  from 
the  stall'  of  the  Washington  University  Medical  School  and 
several  other  hospitals  of  St.  Louis,  Missouri,  arrived  in  Rouen 
on  ffunc  1(\  15)17,  and  took  over  Xo.  12  General  Hospital, 
British  Expeditionary  Forces,  a  British  base  hospital  which 
had  been  established  in  August,  1914,  outside  Bouen. 

The  ancient  city  of  Bouen  was  the  center  of  the  southern 
line  of  British  base  hospitals  in  France  and  the  Rouen  area 
supported  fourteen  hospitals  and  convalescent  camps  which 
maintained  a  total  of  twenty-five  thousand  beds  for  the  British 
Expeditionary  Forces.  Ko.  12  General  and  two  others  of 
these  bases,  Xo.  1  Australian  and  Xo.  10  General,  were  lo- 
cated on  the  race  track  two  miles  from  the  center  of  the  city. 
Xo.  12  General  Hospital,  which  the  St.  Louis  Unit  took  over, 
was  the  largest  of  this  group. 

Dr.  Fred  T.  Mur])hy,  of  St.  Louis,  was  director  of  liase 
Hospital  Xo.  21  and  flulia  (\  Stinison  was  chief  nurse. 
^lajor  J.   D.    Fife,    .MiMlical   Gorps,   Reguhir   Army,   was  com- 

^""A  Rfforoiicc  llistdiy  ..f  the  War."  T.  S.  (Jucrnsoy,  p.  ST:  Dodd.  Mead 
and    Company,   New    \(irk    City,    1!>20. 


468   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

manding  officer.  The  original  nursing  staff  of  sixty-five  mem- 
bers was  augmented  in  August,  1917,  by  the  arrival  of  thirty 
additional  nurses  and  in  April,  1918,  by  Hospital  Unit  '^D," 
which  had  been  organized  by  the  Red  Cross  in  the  City  Hospital, 
Louisville,  Kentucky.  One  hundred  "casual"  American  Army 
nurses,  sent  overseas  during  the  early  months  of  1918  for 
temporary  assignment  as  need  arose  in  British  bases  and  evacua- 
tion hospital  in  the  area  between  Boulogne  and  Trouville,  had 
their  headquarters  at  Base  Hospital  No.  21  and  the  records 
of  assignment,  the  reports  and  the  expense  accounts  of  each 
nurse  while  on  various  assignments  were  kept  there. 

British  soldiers  of  the  Imperial  and  Overseas  troops  con- 
stituted the  patients  of  No.  12  General  Hospital.  The  number 
of  British  wounded,  light  during  the  summer  of  1917,  increased 
swiftly  during  the  Ulanders  offensive  on  Passchendaele  Ridge 
in  October  of  that  year.  \Yhile  the  English  Armies  doggedly 
held  the  muddy  Somme  trenches  during  the  winter  of  1917- 
1918,  medical  cases  filled  the  wards.  The  German  drive  on 
Amiens  in  March,  1918,  placed  intense  strain  upon  the  nursing 
staff  and  Miss  Stimson  wrote  of  the  heavy  service : 

We  were  all  so  hard  pushed  physically  that  Major  Murphy 
wired  for  help  and  we  received  a  mobile  unit  from  the  Ameri- 
can Expeditionary  Forces.  The  fifteen  nurses  were  soon  lost 
in  the  slniflfle.  They  were  all  young,  inexperienced,  little 
things  from  Kentucky,  who  had  not  seen  a  patient  since  they 
had  landed.  Some  of  them  were  only  twenty-one  years  old, 
fresh  from  small  hospitals.  It  seemed  a  heart-breaking  thing 
to  thrust  them  into  this  unbelievable  hell  of  a  hospital.  .  .  . 

A  little  later  I  had  occasion  to  go  down  the  lines  and  I 
looked  in  one  of  the  huts  to  see  how  one  of  the  little  new 
nurses  was  coming  on.  Just  before  I  got  to  the  hut,  a  pro- 
cession had  come  out  of  the  door,  two  men  carrying  a  stretcher 
covered  with  the  I'nion  Jack,  then  a  second  stretcher  also 
covered  by  a  flag,  then  our  supervisor  accompanying  them  to 
the  mortuary.  People  along  the  line  stood  rigidly  at  atten- 
tion and  sahitcd  as  they  passed.  I  went  into  tlie  hut.  The 
odor  was  terrific,  for  most  of  the  cases  in  this  hut  have  pene- 
trating chest  wounds  which  drain.  The  little  nurse  was 
standing  by  the  stove  stirring  something  in  a  cup.  She  was 
green-white  and  looked  utterly  nauseated.  1  did  not  dare  to 
speak  to  her,  for  fear  she  would  lose  what  control  she  had 
left.-o 
^' "Findinj,'  'J'hcinsclvcs,"'  Julia  C.  Stimson,  pp.  215-210;  The  Macmillan 
Ci).,    1918. 


THE  EUROPEAN  WAR  469 

In  July,  1918,  Mobile  Hospital  No.  4  was  orp^anized  from 
tlio  personnel  of  Base  Hospital  No.  21  and  went  forward  with 
the  advaneing  armies  through  the  St.  Mihiel  and  Argonne- 
^leuse  offensives  of  September  and  October.  A  unit  of  twenty 
n\irses  with  Ivnth  ^Eorton  as  chief  nnrse  comprised  the  nurs- 
ing staff.  Other  nurses  were  detached  from  the  big  hospital 
on  the  race  course  and  were  sent  forward  for  duty  at  casualty 
clearing  stations. 

During  the  eighteen  months  that  Base  Hospital  No.  21 
served  at  No.  12  General  Hospital,  21,543  patients  were  ad- 
mitted. Of  this  number  only  288-3  were  American  casualties 
and  they  came  from  the  27th  and  30th  United  States  Divisions 
which  were  attached  during  September  and  October,  1918,  to 
the   British   Fourth   Army. 

United  States  Army  Base  Hospital  No.  12,  which  had  been 
organized  by  the  American  Red  Cross  from  the  nurses  and 
surgeons  of  the  Northwestern  University  Medical  School  and  of 
Cook  County  Hospital,  Chicago,  was  assigned  to  No.  18  Gen- 
eral Hospital,  British  Expeditionary  Forces. 

Dr.  Frederick  Besley,  attending  surgeon  in  1916  at  Cook 
County  Hospital,  was  director  of  the  unit.  Daisy  D.  Urch 
was  chief  nurse.  As  was  true  of  many  other  women  holding 
executive  positions  in  the  nursing  profession.  Miss  Urch  had 
been  educated  as  a  school  teacher.  For  nine  years  she  had  been 
principal  of  a  public  school  in  ^lunising,  ]\[ichigan.  She  en- 
tered the  Illinois  Traiuing  School  for  Nurses  in  1910  and  after 
graduation  was  engaged  in  private  duty  nursing  and  later 
institutioiuil  work  at  (\)ok  County  Hospital.  Tliis  history  is 
indebted  to  h(>r  for  the  reports  which  give  the  experiences  of 
Base  Hospital  No.  12. 

]\nss  Urch  wrote  of  the  embarkation  of  the  Northwestern 
Unit : 

The  entire  unit  sailed  Saturday,  ^May  19,  1917,  at  2  P.M. 
on  the  S.  S.  Mongolia.  There  were  tlie  usual  precautious,  no 
hghts.  ])()at  drill  with  life  preservers,  assignment  to  life  hoats. 
lu  spite  of  unrestricted  suhuiarine  warfare,  every  one  was  in 
good  spirits. 

Sunday  UKU'ning  word  went  throu_irh  the  hoat  that  a  gun 
drill  would  take  ])hi(e  at  "2  l^^^.  All  ])asseiig(>rs  assenihle(i  on 
ih(>  deck  to  witness  it.  a  merry  care-free  grou]).  War  seemed 
remote,  except  fi»r  tht>  three  grim  guns  on  the  MongoUa, 
silent  and  nni/.zlcd  in  the  sunshine  on  i\w  calm  sea. 


470   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  target  was  thrown  overboard  and  the  drill  began.  Sud- 
denly a  defective  shell  exploded  prematurely.  Edith  Ay  res 
and  Helen  B.  Wood  were  instantly  killed.  Emma  Matzen 
received  two  serious  flesh  wounds. 

The  nurses  showed  presence  of  mind  and  self-control;  there 
was  no  confusion,  no  hysteria.  Enough  nurses  to  take  care 
of  the  immediate  situation  helped  carry  our  dead  and  injured 
into  the  nearest  cabin.  The  others  kept  quietly  out  of  the 
way. 

Instructions  by  wireless  for  the  Mongolia  to  go  back  to 
New  York  to  exchange  the  ammunition  made  it  possible  to 
send  our  dead  ashore.  Miss  Matzen  was  taken  to  a  hospital 
in  New  York  and  two  months  later  rejoined  the  unit  in 
France. 

The  Mongolia  sailed  again  on  Tuesday,  May  22.  Except  for 
a  submarine  attack  at  noon  on  June  1,  the  trip  was  uneventful. 
From  London,  the  unit  entrained  June  11  for  Folkestone, 
crossed  the  Channel  and  from  Boulogne  traveled  by  lorry  to 
No.  18  General  Hospital,  British  Expeditionary  Forces,  at 
Dannes  Camiers. 

No.  18  General  Hospital  was  located  on  a  hillside  in  Picardy, 
within  a  quarter  of  a  mile  of  the  British  base  then  being  main- 
tained by  the  Peter  Bent  Brigham  Unit,  and  was  housed  largely 
under  canvas.  Of  its  total  capacity  of  eighteen  hundred  beds, 
only  one  hundred  were  placed  in  wooden  huts.  Units  of  four 
large  tents,  nuirquecs,  grouped  together  to  form  a  ward  ac- 
commodating forty-four  patients  each,  housed  the  balance. 
Both  the  tents  and  the  huts  WTre  lighted  by  electricity,  but 
running  water  was  available  only  in  the  kitchens,  operating- 
rooms  and  wooden  buildings.  A  single  telephone  served  for 
the  entire  camp.  Cinder  paths  bordered  by  neat  rustic  fences 
led  from  one  tent  to  another.  The  ''Swiss  Navy"  of  the  l^ritish 
Army,  comparable  to  the  Fatigue  Squad  of  L'^ncle  Sam's  troops, 
kept  the  grounds  in  order,  pruned  the  old-fashioned  English 
rose  bushes  and  cultivated  extensive  vegetable  gardens.  In 
the  wards,  the  American  nurses  preferred  Scotch  orderlies 
because  Jock  made  a  more  careful  and  systematic  helper  than 
did  Tommy  Atkins. 

The  irrepressible  British  soldiers  were,  however,  a  constant 
source  of  annisement  to  tlu"  American  nurses.  ]\[iss  Urch 
gave  in  a  re])ort  bits  of  the  dialogue  between  the  laughter  loving 
patients  and  nurses: 


THE  EUROPEAN  WAR  471 

Tommy :     "Sister,  your  brogue  is  rippin' !" 

Sister:    "Oh,  1  thought  it  was  you  who  had  the  brogue!'' 

Tommy:  (after  listening  to  a  long  dissertation  on  how  to 
win  the  war)  "Yes,  you  Americans  will  win,  all  right. 
You'll  talk  Fritz  to  death." 

From  the  records  available  at  National  Red  Cross  Headquar- 
ters, this  general  deduction  may  be  drawn  about  the  British  sol- 
diers :  they  keenly  enjoyed  writing  verse.  This  tendency  may 
be  attributed  to  the  fact  that  they  possessed  either  more  natural 
talent  for  rhymed  expression  than  did  the  wounded  of  other 
nationalities,  or  less  reticence  in  showing  the  fruits  of  their 
ready  pens.  Miss  Urch's  report  contained  the  following  ex- 
ample : 

Who  put  me  in  my  little  bed. 
Then  placed  nice  dressings  on  my  head 
And  "Have  sweet  dreams  tonight,"  she  said? 
The  Sister! 

Who  talks  to  me  in  cheery  tones 
Till  I  forget  my  aching  bones. 
Until  I  cease  to  utter  moans  ? 

The  Sister! 

Who  tries  with  all  her  might  and  main 
To  make  me  strong  and  right  as  rain, 
That  1  may  fight  the  Hun  aijain? 
The  Sister! 

The  location  of  Xo.  18  General  Hospital  possessed  many 
advantages.  The  sloping  hillside  afforded  excellent  drainage, 
the  wards  were  well  ventilated  and  the  view,  moreover,  was  one 
of  great  beauty.  On  one  side  were  the  sand  dunes  and  the 
Channel,  on  the  other,  the  orchard-studded  hills  and  rich  pasture 
lands  of  Picardy. 

In  the  winter,  however,  this  location  was  less  pleasing.  The 
patients  and  the  personnel  of  No.  18,  housed  under  canvas, 
were  mercilessly  exposed  to  the  cold  winds  and  rain  of  the  harsh 
Flanders  climate.  One  gusty  morning,  a  breeze  came  over  the 
hilltop  which  threatencMl  to  blow  the  entire  hospital  into  the 
sea.  It  carried  away  fifty-five  tents,  scattered  tlu^  equipment 
broadcast  and  exposed  tlu^  sick  and  wounded  to  the  drenching 


472   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rain.  "In  their  zeal  for  their  patients,"  wrote  Miss  Urch, 
"the  nurses  seemed  endowed  with  superhuman  strength.  I  saw 
one,  single-handed,  drag  bed,  patient  and  all  over  the  rough 
ground  to  the  nearest  shelter." 

The  location  of  No.  18  General  Hospital  possessed  a  second 
grave  disadvantage,  though  the  nurses  were  not  prone  to  regard 
it  as  one.  The  big  British  hospital  camp  was  only  forty  miles 
from  the  front  and  enemy  aviators  often  visited  it.  Miss  Urch 
wrote  of  the  air  raids : 

In  the  early  spring  of  1918,  persistent  disquieting  reports 
of  the  Boche's  intent  to  destroy  our  camp  were  afloat.  Great 
preparations  for  such  an  attempt  were  made.  "Ahris"  in  the 
shape  of  trenches  were  dug  by  German  prisoners.  The  tents 
and  huts  were  sandbagged.  Special  instructions  were  given 
as  to  what  to  do  in  case  of  a  raid.  Upon  signal  all  helpless 
patients'  beds  were  to  be  lowered  to  the  floor  by  folding  under 
the  legs  of  each  cot.  One  medical  officer  wrote  in  the  order 
book,  "Flatten  all  helpless  patients."  Other  wounded,  nurses 
and  men  were  to  go  into  the  nearest  dhri.  One  nurse  stayed 
with  her  patients  who  were  so  tied  up  to  frames  that  their 
beds  could  not  be  lowered.  When  the  hum  of  Boche  engines 
and  machine-gun  fire  plainly  indicated  that  they  were  over- 
head a  Tommy  with  a  fractured  femur  and  one  broken  arm 
called,  "Sister !"  She  hastened  to  his  side.  He  pleaded  with 
her  to  go  to  a  place  of  safety.  When  she  assured  him  she  was 
not  afraid,  he  tried  with  his  one  good  arm  to  push  her  under 
the  adjoining  bed. 

Many  of  the  nurses  sat  on  the  hillside  at  Dannes  Camiers  and 
watched  the  destruction  of  nearby  Etaplcs.  No  member  of 
Base   Hospital   No.    12   was,  however,   injured. 

Before  summarizing  the  value  of  the  service  rendered  by  the 
six  American  base  hospitals  assigned  to  the  British,  it  may 
be  of  interest  to  include  a  statement  of  the  size  and  strength 
of  the  British  military  nursing  service,  both  professional  and 
volunteer.  The  official  nursing  strength  of  the  British  Empire 
during  the  World  War  was  divided  between  three  organizations  : 
Queen  Alexandra's  Imperial  ^Military  Nursing  Service;  the 
Territorial  Uorce  Nursing  Service;  and  Queen  Alexandra's 
Naval  Nursing  Service. 

Florence  Nightingale  may  well  be  called  the  first  British 
Army  nurse.  Follov»-ing  her  historic  overthrow  of  military 
nursing  traditions  during  the  Crimean  W^ar,  the  War  Otticc 


THE  EUROPEAN  WAR  473 

employed  trained  women  nurses  in  the  Boer  War  and  in  mili- 
tary hospitals  at  homo  and  abroad  in  time  of  peace.  The  Gov- 
ernment nursing  organization  in  which  these  women  served 
was  called  the  Army  Nursing  Service. 

In  1902,  the  Army  Nursing  Service  was  reconstituted  as 
Queen  Alexandra's  Imperial  ]\lilitary  Nursing  Service  under 
a  Nursing  Board  of  which  the  Matrons  of  two  civilian  hospitals 
and  the  ^latron-in-Chief  of  the  (^ueen  Alexandra's  Service  were 
members.  The  grades  were  Stali"  Nurse,  Sister,  Matron,  Princi- 
pal ^latron  and  Matron-in-Chief.  Candidates  were  required  to 
be  within  twenty-five  and  thirty-five  years  of  age  and  to  hold  the 
usual  three  years'  certificate  of  training,  although  the  wording 
of  this  clause  made  this  certificate  not  absolutely  compulsory;  a 
candidate  might  be  admitted  without  certificate  provided  the 
^latron-in-Chiof  satisfied  the  Nursing  Board  that  this  applicant 
was  fitted  as  regards  education,  character  and  social  status  for 
admission.  Before  Sisters  could  be  promoted  to  the  grade  of 
Matron,  they  were  required  to  pass  an  examination  and  to  give 
practical  evidence  of  administrative  and  teaching  ability.  Pen- 
sions were  granted  to  nurses  of  the  Service  after  twenty  years' 
membership  or  at  the  age  of  fifty  years. 

In  time  of  war,  the  membership  of  the  Queen  Alexandra's 
Imperial  Nursing  Service  was  increased  both  by  its  own  Reserve 
and  by  a  Civil  Hospital  Ivcserve.  Previous  to  the  declaration  of 
hostilities  in  IDl-i,  the  War  Office  had  approached  the  civil 
hospitals  throughout  the  Kingdom  and  had  asked  each  institu- 
tion to  employ  a  certain  number  of  trained  nurses  who  would 
also  form  a  reserve  for  (}neen  Alexandra's  lni])erial  Nursing 
Service.  These  nurses  were  called  into  the  field  in  August, 
15)14,  and  were  later  drafted  into  the  otHcial  Ivcserve. 

The  Territorial  Force  Nursing  Service  was  formed  in  1910 
primarily  for  home  service  in  the  twenty-three  territorial  areas 
of  the  British  Empire.  Nurses  in  each  of  these  localities  had 
pledged  themselves  to  serve  when  their  native  territorial  forces 
were  mobilized.  This  nnister-roll  was  revised  annually  so  that 
upon  the  outbreak  of  war,  the  members  were  ready  for 
immediate  mobilization.  AVheii  it  was  recognized  during  the 
first  month  of  conllit-t  that  (^uccn  Alexandra's  Imperial  Military 
Nursing  Service^  was  insuliicient  in  numbers  to  meet  the  de- 
mands that  would  be  made  upon  it,  the  War  OtHce  permitted 
members  of  the  I'erritorial  Force  Nursing  Service  to  volunteer 
for  foreign  service.     Many  of  them  went  abroad  early  in  August, 


474    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

1914,  and  their  places  at  home  were  supplied  by  new  recruits. 
The  Territorial  JSTursing  Service  was  directed  from  the  War 
Office  in  London  and  had  its  own  Matron-in-Chief.  It  also 
had  a  Principal  Matron  for  each  territorial  area,  who  was  re- 
sponsible for  the  recruiting  of  the  staff  and  for  the  conduct  of 
all  territorial  corps  which  might  be  opened  in  her  district. 

Queen  Alexandra's  Xaval  Xursing  Service  was  a  small  stand- 
ing service,  with  approximately  a  hundred  nurses  in  times  of 
peace.  These  Sisters  acted  as  superintendents  of  nurses  and 
trained  corpsmen  for  sick  bay  attendants.  This  organization 
was  augmented  during  the  war. 

Dame  Ethel  H.  Becher,  G.B.E.,  R.R.C.,  was  Matron-in-Chief 
of  Queen  Alexandra's  Imperial  Military  Xursing  Service  dur- 
ing the  European  War.  Her  headquarters  were  located  at  the 
War  Office  in  London  and  she  worked  in  close  cooperation  with 
the  Director  General  of  the  Medical  Department  of  the  British 
Army,  Sir  Alfred  Keogh.  Her  position  was  one  of  dignity  and 
power  and  at  public  and  Court  functions  when  visiting  nurses 
were  presented  to  Royalty,  ]\Iiss  Becher  in  her  bonnet  and 
scarlet  cape  was  a  commanding  and  picturesque  figure. 

Dame  E.  Maud  McCarthy,  G.B.E.,  R.R.C.,  was  Matron-in- 
Chief  of  the  Q.A.I.]\LX.S.,  British  Expeditionary  Forces.  She 
was  considered  a  member  of  the  Headquarters  Staff  and  her 
offices  were  in  close  proximity  to  the  headquarters  of  the 
Director  General  of  the  Medical  Department,  B.E.F.  All 
orders  for  movements  of  nurses  went  forward  signed  by  her 
and  counter-signed  by  the  Director  General.  She  was  furnished 
with  a  private  car  and  in  it  she  made  supervisory  visits  from 
one  hospital  to  another,  but  in  the  case  of  the  six  American 
base  hospital  units  assigned  to  the  British  Army,  she  did  not 
take  up  disciplinary  or  professional  problems  unless  they  were 
connected  in  some  way  to  Jiritish  Army  regulations.  In  a 
letter  dated  ]\Iarch  1,  *]018,  to  Miss  Delano,  Martha  Russell, 
then  chief  nurse  of  the  American  Red  Cross  in  France,  wrote : 


The  position  of  ]\ratron-in-Chicf,  B.  E.  F.,  is  one  of  great 
dignity  and  rosjxnisiljility.  ^liss  McCarthy's  iiifiuenee  is  felt 
throughout  the  I)ritish  Army,  her  lines  of  communication  are 
clearly  worked  out  and  her  opinion  is  considered  final  on  all 
matters  relatintr  to  the  nursing  situation.  The  British  have 
maintained  a  hi,ir  service  for  so  long  that  they  have  outgrown 
nianv  of  the  dillicnlties  with  which  we  are  now  struLTirlinLT. 


THE  EUROPEAN  WAR  475 

On  August  1,  1914,  Queen  Alexandra's  Imperial  Military 
Nursing  Service  had  numbered  only  468 ;  its  eifective  strength 
on  November  1,  11)18,  numbered  7710  members,  an  increase 
of  fifteen  hundred  per  cent. 

The  Territorial  Force  Nursing  Service  numbered  in  August, 
1914,  2783  and  in  November,  1918,  5059,  an  increase  of  one 
hundred  per  cent. 

During  the  European  War,  7710  regular  members  of  Queen 
Alexandra's  Imperial  IMilitarv  Nursing  Service  saw  active 
duty,  over  3000  of  them  at  home  stations  and  2000  others  in 
France.  The  remainder  served  at  stations  in  Italy,  Gibraltar, 
Malta,  Saloniki,  Egypt,  East  Africa,  Mesopotamia  and  India. -^ 

The  regular  members  of  the  Territorial  Force  Nursing  Serv- 
ice on  duty  during  the  European  War  were  distributed  in 
proportionate  immbers  and  in  locations  similar  to  those  of 
members  of  Queen  Alexandra's  Nursing  Service.-^ 

In  addition  to  these  1:2,7()9  members,  both  the  official  nursing 
organizations  for  the  British  Army  employed  partially  trained 
and  untrained  women  whom  the  War  Office  designated  as  Mili- 
tary Probationers.  They  were  recruited  by  the  War  Office  and 
after  a  short  experience  in  civilian  hospitals,  were  assigned  to 
assist  IJritish  Sisters  in  military  establishments  both  at  home 
and  abroad.  They  totaled  10,897,  over  two-thirds  of  whom 
served  at  home  stations."^  Including  regular  and  reserve  mem- 
bers of  Queen  Alexandra's  Imperial  Military  Nursing  Service 
and  of  the  Territorial  Forces  Nursing  Service,  and  including 
partially  trained  and  untrained  women  employed  in  these  or- 
ganizations, the  numerical  strength  of  these  two  governmental 
nursing  services  during  tlie  European  War  approximated  23.0(56 
women.      Miss   McCarthy   commented  upon  these  mmibers : 

These  figures  deal  with  Queen  Alexandra's  Imperial  ^lili- 
tary  Nursing  Service,  (^)ueon  Alexandra's  Imperial  Military 
Nursing  Service  liestTve.  Territorial  Force  Nursing  Service 
and  untrained  and  partially  trained  women  attached  to  the 
above  c()r])s.  The  War  Oflice  was  unable  to  give  me  any  of 
the  Overseas  figures  ami  the  Matrons-in-(diief  have  all  re- 
turned to  their   Dominions. 

'''At  tlic  r('(|n('st  (if  tlu>  Aiiicricaii  I'crl  ('i-os^  Xursiivir  Service,  llie  Sii])er- 
intcndeiit  of  \hv  Ari.iy  Nurse  Corps  wrote  to  the  Matrnn-in-C'hief  of  the 
Queen  Ah'xaiidra's  Imperial  Military  Xursini,'  Service  for  these  statistics, 
which  were  foiwanied  ii\  D.nne  McCarthy  to  .lulia  C.  Stinisou  on  Marcli  tJ, 
1!»2(). 


476    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  British  Eed  Cross  had  large  numbers  of  nurses,  both 
trained  and  untrained,  in  the  United  Kingdom  and  in  many 
of  the  theaters  of  war.^^ 

The  British  military  nursing  system  also  included,  a  large 
service,  both  professional  and  volunteer,  which  was  conducted 
by  the  British  Red  Cross.  The  trained  nurses  employed  by  this 
society  were  not  members  of  the  two  official  services,  but  did 
war  nursing  in  hospitals  and  convalescent  homes  established 
by  the  British  Red  Cross  and  the  Order  of  St.  John  of 
Jerusalem  in  England.  In  the  matter  of  assignment  of  nurses, 
the  British  Red  Cross  and  the  St.  John's  Ambulance  served  in 
somewhat  the  same  relation  to  the  British  Army  Medical  De- 
partment as  did  the  American  Red  Cross  in  France  to  the  Chief 
Surgeon,  American  Expeditionary  Forces.  At  the  outbreak  of 
the  war  in  1914,  both  the  St.  John's  Ambulance  and  the  British 
Red  Cross  began  to  enroll  nurses  for  work  in  France  and  Bel- 
gium. When  the  Joint  War  Committee,  under  which  these  two 
organizations  were  united  for  war  service,  came  into  existence, 
the  two  ^JvTursing  Departments  were  put  under  one  head  and 
Dame  Sarah  Swift,  late  Matron  of  Guy's  Hospital,  was 
appointed  Matron-in-Chief.  A  Principal  ]\ratron,  Nora 
Fletcher,  was  shortly  appointed  in  France  and  all  nurses  pro- 
ceeding to  France  for  service  under  the  Joint  War  Committee 
were  sent  to  her  and  were  assigned  by  her  to  various  hospitals 
and  homes. -^ 

The  requirements  for  services  as  nurses  under  the  Joint  Com- 
mittee were  set  forth  in  the  Reports  by  the  Joint  War  Com- 
mittee and  the  Joint  War  Finance  Committee  of  the  British 
Red  Cross  and  the  Order  of  St.  John  of  Jerusalem  in  England: 

Rules  for  Xurses 

1.  You  must  liold  a  eertifloate  of  tlirec  years'  consecutive 
training  of  a  (joiieral  Hospital  of  not  less  than  50  beds  and 
must  be  well  recommended  by  your  ^Matron. 

2.  Xurses  not  up  to  the  required  standard  of  training  ob- 
tain posts  as  Staff  Xurses  at  £40  per  annum.  (Staff  Xurses, 
that   is,   tliose   Avith   two   years"  training,   women's   and    chil- 

"Sce  letter  written  bv  K.  M.  McCarthy  to  J.  C.  Stimson  on  :\rareh  G, 
1020. 

"  ."^ee  Reports  liy  llie  .Joint  War  C'ominiltee  and  the  Joint  War  Finance 
Committee  of  tlie  IJritisli  T^'d  Cross  Society  and  the  Order  of  St.  John 
of  Jerusah'm  in  Enfrhmd,  ]r)]4-lf)19,  pp.  80-84;  Jlis  Majesty's  Stationary 
Ofhce,   London,   Erif'land. 


THE  EUROPEAN  WAR  477 

dren's  liospital  and  fever  training,  were  paid  at  the  rate  of 
£40  per  annum.) 

3.  Jf  your  hoaltii  certificate  and  references  are  satisfactory, 
you  will  be  registered  on  the  list  for  either  home  or  foreign 
service.  For  foreign  service,  a  good  knowledge  of  French  is 
desirable.  All  nurses  must  be  equally  willing  to  serve  on 
night  or  day  duty  at  home  or  abroad. 

4.  If  you  are  acce])ted,  it  will  be  necessary  for  you  to  lie 
inoculated  against  enteric  and  also  to  be  vaccinated,  if  not 
done  within  the  last  seven  years. 

5.  You  will  be  required  to  sign  an  agreement  to  serve  in  a 
home  hospital  for  a  period  of  six  months  at  a  salary  of  one 
guinea  per  week,  insurance,  outdoor  uniform,  laundry  at 
rate  of  :2s.  (id.  ])er  week  (unless  otherwise  provided)  ;  travel- 
ing expenses  from  London,  board  and  lodging  will  also  be 
provided.  You  will  be  lodged  at  a  hostel  between  engage- 
ments. 

C).  Y'ou  must  pro\  ide  your  own  indoor  uniform,  blue  cotton 
(or  use  what  you  have)  and  when  on  duty  must  wear  the 
badge,  which,  will  be  jjrovided. 

[Here  follow  further  details  regarding  salary,  sick  leave, 
ai)plication  forms,  etc.]  -* 

After  the  candidate  had  filled  out  the  "Form  of  Application," 
she  was  required  to  apjx^ar  l)ef()rc  a  Selection  Board.  After  a 
personal  interview,  her  references  were  looked  up  and  if  she  had 
passed  all  recpiiremcmts  satisfactorily,  she  was  engaged  by  the 
]\latron.  At  this  time,  each  nurse  was  given  the  option  of 
signing  a  contract. 

Trained  nurses  to  the  number  of  Ol^S  served  during  the 
European  War  under  the  tFoint  Committee  of  the  British  Bed 
Cr(xss  and  the  Order  of  St.  John,  4730  of  them  in  home  service 
and  the  others  in  liospitals  in  France,  Belgium,  Egypt,  Bussia. 
Siberia,  Serbia,  ^Montenegro,  Boumania,  Italy,  Holland  and 
Salonica,"''  In  ('(tnipnrisou  to  the  American  Tied  Cross  Xursiug 
Service,  it  is  interesting  to  note  that  30,")  of  this  total  number 
of  (H.^iS  w(^re  assigned  to  the  Queen  Alexandra's  Imperial  ]Mili- 
tary  Xursiug  Service.-'' 

The  greatest  numerical  strength  of  the  British  Bed  Cross 
Xursiug  Sei-\'i('e  wiis  found  by  tli(>  (Miipb^ytuent  of  nursing 
members  of  Voluntiiry  Aid  I  )etaelinieiits.  lu  order  to  ])rovide 
])ersoiinel   to  supplement   the  military  me(lical  organization  of 

-'  Ucpnrt   of  till'  .loiiit   War  I'dininiltcc,  pp.  S4-S"). 
-•  lbi<!..  p.  !•;!. 


478    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  Territorial  Force  on  home  service,  the  War  Office  had  in 
1909  issued  a  ^'Scheme  for  the  Organization  of  Voluntary  Aid 
in  England  and  Wales."  It  was  suggested  that  Voluntary  Aid 
Detachments  be  formed,  to  consist  both  of  men  and  women. 
The  Women's  Detachments  were  to  be  employed  in  forming 
railway  rest  stations,  where  meals  and  refreshments  for  sick 
and  wounded  could  be  prepared  and  served ;  and  in  taking  tem- 
porary charge  of  severe  cases  unable  to  continue  their  jour- 
ney." -^ 

In  1910,  a  revised  issue  of  the  "Scheme"  was  authorized  and 
shortly  afterwards  the  Voluntary  Aid  organization  was  ex- 
tended to  Scotland.  Women  members  of  these  Detachments 
were  taught  First  Aid,  home  nursing  and  in  many  cases 
hygiene  and  cookery.  They  "practised  the  work  of  a  hospital 
ward;  they  earmarked  buildings  suitable  for  temporary  hospi- 
tals and  learned  the  methods  of  improvising  or  obtaining  the 
necessary  equipment  and  supplies.  .  .  ."  -'^ 

On  October  14,  1914,  sixteen  Voluntary  Aid  Detachment 
members,  drawn  from  two  London  detachments  with  two 
trained  nurses  in  charge,  were  sent  to  France  with  the  sanction 
of  the  War  Office.  Dame  Katherine  Furse  was  in  charge  of  the 
group.  At  Boulogne,  they  organized  a  rest  station,  took  over 
three  wagons  and  two  passenger  coaches  and  converted  them  into 
a  dispensary,  a  kitchen,  stores  and  quarters;  witliin  twenty- 
four  hours  they  had  received  and  fed  one  thousand  wounded 
with  such  success  that  the  experiment  marked  the  beginnings  of 
the  broad  and  extensive  later  developments  of  the  British  Bed 
Cross  overseas  under  Voluntary  Aid  Detachments. 

After  about  three  months  at  Boulogne,  Dame  Furse  returned 
to  London  and  took  charge  of  the  Voluntary  Aid  Department 
at  Devonshire  House  and  Dame  Bachel  Crowdy  succeeded  her 
in  France,  later  becoming  Principal  Commandant  of  Voluntary 
Aid  Detachments  in  France. 

V.  A.  D.  nursing  members  were  employed  in  liospitals 
established  by  the  British  Red  Cross  and  the  Order  of  St.  John 
and  in  base  hospitals  maintained  by  the  Medical  Department 
of  the  British  Army.  On  February  1,  1015,  the  War  Office 
wrote  that  "in  view  of  the  fact  that  a  largely  increased  supply 
of  fully  trained  nurses  will  be  required  for  th(!  necessary  ex- 
])aiisi()n  of  military   lios])itals   at   home  and   abroad,   it   is  sug- 

^  Report  of  tho  Joint  War  Committee,  p.  189. 
'' Ihi'l.,  p.    1!»0. 


THE  EUROPEAN  WAR  479 

gestcd  that  members  of  recognized  Vohmtary  Aid  Detachments 
might  advantageously  be  employed  and  so  enable  ns  to  release 
a  number  of  fully  trained  nurses  for  duty  in  new  Hospitals."  -^ 
At  this  time,  the  War  Othce  made  the  following  suggestions  as 
to  the  conditions  of  employment  of  nursing  members  of  Vol- 
untary Aid  Detachments : 

1.  The  selected  members  must  hold  the  certificates  for 
home  nursing  and  First  Aid  and  must  be  thoroughly  recom- 
mended. 

2.  They  will  be  required  to  work  under  fully  trained  nurses 
and  will  be  under  the  direct  control  of  the  officer  in  charge 
and  the  ^latron  of  the  hospital. 

3.  They  should  be  between  twenty-three  and  thirty-eight 
years  of  age. 

4.  They  should  be  required  to  live  in  quarters  provided  for 
the  nursing  staff  of  the  military  hospitals  under  the  control 
and  supervision  of  the  ^latron. 

5.  They  will  be  required  to  adhere  strictly  to  the  time 
tables  in  force  in  military  hospitals  and  to  the  regulations 
and  standing  orders  for  Q.A.T.^I.X.S. 

fi.  They  will  have  at  all  times  when  on  duty  to  wear  the 
washing  uniform  of  their  Detachments. 

7.  They  will  be  aj^pointed  for  one  month  on  probation, — 
then  if  recommended,  they  will  be  required  to  sign  an  agree- 
ment to  serve  for  one  year  or  for  the  duration  of  the  war. 

8.  The  engagement  of  Voluntary  Aid  Detachment  mem- 
bers may  be  terminated  at  any  time  if  found  unfit  in  any 
respect  for  service. 

On  February  10,  1915,  a  second  letter  was  sent  by  the  War 
Office  which  suggested  that  nursing  members  of  Voluntary 
Aid  Detachments  be  paid  £20  a  year,  in  view  of  the  fact  that 
fully  trained  certificated  Staff  Nurses  received  £40.  This  latter 
added  that  "arrangements  will  be  made  for  accommodation  and 
an  allowance  for  board  and  washing  for  each  member,"  with 
i'l  ])er  quarter  for  the  upkeep  of  uniforms.^^ 

The  Deports  by  the  Joint  War  Committee  and  the  Joint  War 
Finance  Committee  of  the  British  Ded  Cross  and  of  the  Order 
of  St.  Jolm  for  1!)  14-1 019  state  that  the  total  number  of  nurs- 
ing members  of  Voluntary  Aid  Detachments,  on  December  20, 
1910,  was  l7,oC)7.  Of  this  number,  88(5  were  honorably  men- 
tioned in  dispatches  and  -'529  received  nursing  decorations.     One 

■-"  Report  of  tlie  Joint  War  Committee,  p.  192. 
-'  J  hid.,  p.  1!)2. 


480    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

liundred  and  twentv-eight  of  them  died  in  line  of  duty  and  "it 
is  known,"  state  the  Reports,  "that  over  one  hundred  other 
V.  A.  D.  members,  not  working  directly  under  the  V.  A.  D. 
Department,  also  laid  down  their  lives."  ^*^ 

During  the  summer  of  1916,  Miss  Maxwell  and  a  personal 
friend,  Irene  M.  Givcnwilson,  who  later  became  curator  of 
the  Red  Cross  Museum  at  National  Headquarters,  visited 
sixty-seven  French,  British  and  Belgian  hospitals  situated  in 
Paris,  in  England,  in  Belgium  and  at  various  places  near  and 
at  the  Western  Front.  Miss  Givenwilson  had  taken  the  nursing 
diploma  of  the  German  Red  Cross  at  Bonn,  Germany,  a  course 
of  elementary  nursing  in  Holland  and  another  in  England ; 
from  November,  1914,  to  March,  1915,  Miss  Maxwell  had 
allowed  Miss  Givcnwilson  to  work  in  the  wards  of  the  Presby- 
terian Hospital,  New  York  City.  With  her  previous  knowledge 
of  foreign  languages,  of  the  voluntary  nursing  services  of  Europe 
and  of  the  nursing  profession  in  the  United  States  as  she  had 
seen  it  at  the  Presbyterian  Hospital,  Miss  Givenwilson  was  in 
an  excellent  position  to  evaluate  volunteer  nursing  abroad. 
Moreover,  ]\riss  ^laxwell  edited  both  the  report  and  the  diary 
which  Miss  Givenwilson  submitted  to  National  Headquarters 
at  the  close  of  the  trip. 

Miss  Givenwilson's  report  included  the  following  statement 
regarding  the  nursing  members  of  Voluntary  Aid  Detachments : 

We  made  many  inquiries  as  to  the  efFiciency  of  the  V.A.D. 
nurses  at  British  Eed  Cross  Headquarters  and  also  of  the 
^latrons  in  cliarge  of  the  military  and  auxiliary  hos])itals.  The 
unanimity  of  opinion  on  their  usefulness  and  willingness  to 
work  under  any  conditions  impressed  us  as  remarkable.  .  .  . 
There  was  only  one  criticism  offered, — that  a  ])revious  train- 
ing of  six  months  in  a  civil  hospital  is  under  all  circumstances 
very  desirable  and  would  render  the  nursing  members  more 
useful  and  capa))le  of  accepting  some  responsibility  in  the 
wards.  The  Army  nurses  are  already  so  overworked  that  tliey 
are  unal)le  to  train  their  subordinates  in  the  wards.  This 
lack  of  training  leads  to  two  difficulties:  //r.sV,  the  members 
find  it  hard  at  first  to  adapt  themselves  readily  to  the  neces- 
sarily strict  disciplijie  of  military  and  auxiliary  hospitals  in 
time  of  war;  .^ecoiuh  tlirough  inexperience,  they  are  apt  to 
consider  the  wliolo  ]iractice  of  nursing  consists  in  the  dressing 
of  wounds  and  tliat  when  this  has  been  mastered,  they  are  of 
equal  proficiency  witli  fully  trained  nurses. 

^Ttf'port  (jf  the  Joint   War  Cdiiiniittce.   p.  203. 


THE  EUROPEAN  WAR  481 

These  difliculties  could  be  easily  overcome  by  a  regulation 
enforcing  a  definite  period  of  training  in  a  civil  hospital  for 
any  member  of  the  Ked  Cross  who  aspired  to  be  a  nurses' 
aide  in  a  military  hospital  in  time  of  war.^^ 

With  this  total  strength  of  well  over  40,000  trained  and 
untrained  women,  it  may  readily  be  appreciated  that  the  600 
American  nurses  who  served  in  the  British  base  h()s])itals  at 
Rouen,  Danncs  Camiers,  Etretat  and  Le  Tre])()rt  made  slight 
addition  to  the  numerical  strength  of  the  British  nursing  forces. 
The  institutions  which  they  staffed  did,  however,  occupy  highly 
important  positions  along  the  southern  line  of  British  hospitals 
in  France  and  the  American  nurses  and  surgeons  cared  for 
approximately  300,000  British  and  Colonial  soldiers.  More- 
over, the  arrival  of  these  six  units  in  England  and  France  dur- 
ing the  third  month  of  the  participation  of  the  United  States 
in  the  World  War  did  much  to  raise  the  morale  of  the  British 
and  French  Armies,  in  that  the  eiiicient  personnel  and  the 
s})lendid  equipment  of  these  pioneer  base  hospitals  were  a  timely 
guarantee  to  the  weary  Allies  of  the  reenforcements  soon  to 
come. 

The  experience  of  the  American  Army  reserve  nurses  who 
served  in  these  British  bases  was  an  illuminating  one  and 
fortunate  indeed  did  these  American  Red  Cross  nurses  count 
themselves.  The  disadvantages  of  assignment  to  the  British 
Expeditionary  Forces  were  of  minor  nature.  Miss  Stimson 
summarized  them : 

Chief  luirses  of  these  units  had  the  double  diniculty  of 
functioning  as  an  important  part  of  an  American  Army  or- 
ganization without  previous  experience  or  knowledge  of  Army 
ways  and  at  the  same  time  had  tlie  ditliculty  encountered  in 
takiiig  over  after  a  few  days  appreiiticeship,  the  position  of 
]\ratron  of  a  British  hospital  in  full  operation,  and  from 
which  tlie  British  nursing  personnel  was  witluh'awn  almost 
immediately.  In  the  cases  where  tlie  American  nursing  stalls 
were  insullicient  for  tlie  needs  of  the  hospitals,  stall's  of  Brit- 
ish X'ohintary  Aid  Detachments  were  left  on  under  the 
American  cliicf  luirsc  until  such  tini(»  as  nmre  American 
nurses  could  he  brought  over.  Tlu^  conihination  of  American 
graduate  nurses  and  British  volunteer  aides  did  not  lessen 
the  problems  of  the  chii-f  mirsf^s.   .   .   . 

°' llcporl  of  the  X'ciluiitaiy  XursiiiL;'  Services  of  Knj^laml  jiiid  l-'nmco : 
Irene  ^I.  (;iveii\\  ilsoiij  pp.  2(1-27,  Libnuy.  National  Jleaiiipiartirs,  Wasli- 
iiiLTtoii.   D.   V. 


482    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Our  second  difficulty  was  lack  of  "camp  kits,"  without 
which  no  English  Sister  nor  V.  A.  D.  goes  anywhere.  When 
they  withdrew,  completely  barren  rooms  confronted  the  dis- 
mayed Americans.  A  combination  of  British  courtesy  and 
generosity  on  the  part  of  the  War  Office  and  the  American 
Eed  Cross  Chapter  at  London  came  swiftly  to  our  rescue  and 
supplied  us  the  necessary  articles.^^ 

Perhaps  the  greatest  difficulty  which  the  American  nurses 
met  during  the  first  months  in  the  field  was  the  absence  of  an 
authoritative  head  of  the  American  Army  Nurse  Corps  in 
France.  Questions  arose  as  to  the  replenishment  of  uniforms, 
the  issuance  of  more  adequate  equipment  and  such  other  matters ; 
to  disciplinary  problems  such  as  transfers,  resignations  and  the 
conduct  of  nurses  when  off  duty.  Neither  Miss  Becher  nor 
Miss  McCarthy  could  undertake  to  settle  them.  Martha  Monta- 
gue Russell  had  joined  the  American  Red  Cross  Commission 
for  France  in  August,  1917,  as  the  official  representative  of  the 
Nursing  Service  at  National  Headquarters,  but  her  only  possible 
relation  to  the  members  of  the  Army  Nurse  Corps  then  in  France 
with  the  British  and  American  Expeditionary  Forces  was  of  a 
purely  unofficial  nature.  She  termed  herself  a  ''maiden  aunt" 
rather  than  a  mother  invested  with  parental  authority.  The  Sur- 
geon General  accordingly  assigned  to  the  staff  of  the  Chief  Sur- 
geon, A.  E.  F.  in  France,  Bessie  S.  Bell,  of  the  Army  Nurse 
Corps.  Miss  Bell  was  a  graduate  of  the  Boston  City  Hospital 
and  had  been  chief  nurse  of  Walter  Reed  Hospital.  Washing- 
ton, D.  C.  She  arrived  in  Paris  in  November,  1917,  and  for  a 
year  served  as  Chief  Nurse  of  the  American  Expeditionary 
Forces.  She  was  largely  engaged  in  organization  work  incident 
to  the  assignment  of  nurses  to  American  base  hospitals,  evacua- 
tion and  mobile  hospitals  and  forward  professional  teams  of  the 
U.  S.  ]\Iedical  Department  in  France,  so  she  did  not  have  much 
time  in  which  to  visit  the  well-established  and  smoothly-running 
British  bases  then  staffed  by  American  nursing  personnel. 
Moreover,  the  American  Expeditionary  Forces  did  not  furnish 
the  Chief  Nurse  special  transportation  facilities  during  Miss 
Bell's  incumbency  of  the  office.  The  chief  nurses  of  the 
American  base  hospitals  assigned  to  the  British  Expeditionary 
Forces  were  thus  thrown  largely  upon  their  own  resources  as 
regards  the  nursing  service.     However,  they  were  in  the  main 

•'^  "Ilistciry  of  tlic  Xursiiif:  Activilies  on  tlu'  Western  Front,  durinjr  the 
War  Period,"  Julia  C.  Stimson,  p.  5. 


THE  EUROPEAN  WAR  483 

strong  women  and  were  well  able  to  meet  with  sound  judgment 
the  ditterent  situations  which  arose. 

As  to  the  advantages  of  service  in  the  British  Expeditionary 
Forces,  nurses  assigned  to  these  units  experienced  none  of  the 
idleness  and  monotony  born  of  light  work  which  nurses  of  the 
American  Expeditionary  Forces  encountered  during  their  first 
summer  in  the  field.  I'he  British  troops  occupied,  during  1917 
and  11)18,  important  and  almost  constantly  active  sectors  of 
the  Western  Front,  so  both  the  surgical  and  medical  cases 
were  of  great  professional  interest.  The  American  nurses 
assigned  to  the  British  bases  shared,  moreover,  many  privileges 
accorded  the  Ih-itish  Sisters,  which  had  not  yet  been  granted  the 
younger  American  contingents.  Miss  Stimson  summarized 
them: 

Advantages  of  lea^■e ;  care  during  sickness  at  splendidly- 
equipped  "Sick  Sisters'  Hospitals"  and  convalescent  treat- 
ment on  the  coast  was  given  to  the  American  nurses.  Al- 
though the  United  States  Army  paid  the  nurses'  salaries,  the 
British  put  them  ou  the  same  mess  allowance  as  their  own 
nurses  and  many  were  the  hours  during  which  chief  nurses 
struggled  with  board  at  twenty-five  shillings  a  month,  laundry 
at  six  shillings  a  week,  field  allowance  and  other  perplexing 
problems. 

This  mess  allowance,  although  it  entailed  considerable  extra 
pa])er  work  for  the  chief  nurses,  provided  the  hospital  dietitian 
with  available  funds  with  which  to  purchase  green  vegetables 
and  other  articles  not  included  in  general  rations. 

British  nurses  occupied  a  position  of  gTcat  dignity  and  re- 
spect. The  position  held  by  American  Army  nurses  as  regards 
rank  will  be  tr(»ated  in  detail  in  a  subsequent  chapter,  but  the 
following  comment  upon  the  status  of  the  British  nurse,  which 
was  made  by  ^liss  Ilall,  bears  directly  upon  the  British  mili- 
tary nursing  system  and  is  therefore  included: 

The  IJi'itish  nurses  did  not  have  rank  as  otficers  of  the 
Britisli  Army.  Thty  did,  however,  have  a  place  in  the  P)ritish 
Army  which  was  dignified  and  envialde.  .  .   , 

In  ('\ery  area  ju'esided  over  by  a  Deputy  Director  of  Medi- 
cal Service,  there  was  a  Principal  Matron  whose  ari'a  in- 
eluded  all  the  nurses  in  the  area  covered  hy  the  Deputy 
Director  of  Medical  Service.  In  ea(  h  hospital  there  was  a 
^Matron,  assistant  Matron.  Sisters,  and  Stall'  Nurses,  with  pay 


484    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  allowances  according  to  their  status  as  just  named.  In 
the  hospitals,  a  defhiite  number  of  non-commissioned  officers 
and  men  were  assigned  directly  to  the  Matron  to  act  as  ward 
masters  and  orderlies.  She  had  entire  control  in  the  assign- 
ing of  them  to  duty,  arranging  their  time,  etc.,  and  the  po- 
sition of  the  Matron  and  those  under  her  was  so  strong  that 
there  was  never  disobedience  or  disrespect  towards  them.  In 
all  matters  of  living,  travel  and  social  functions,  the  British 
nurses  were  given  all  the  respect  and  rights  of  officers;  some- 
times even  given  preference  over  officers. ^^ 


On  June  13,  1917,  three  weeks  after  the  arrival  of  United 
States  Army  Base  Hospital  Xo.  4  at  Rovien,  Colonel  (later 
General)  A.  S.  Bradley,  the  first  Chief  Surgeon  of  the  Ameri- 
can Expeditionary  Forces  in  France,  opened  in  the  Rue  Con- 
stantine,  Paris,  the  headquarters  of  the  United  States  Army 
Medical  Corps  in  France.  With  him  were  Colonel  Francis 
Winter  and  Colonel  ]\lcrritte  W.  Ireland.  On  the  same  day, 
the  American  Red  Cross  Commission  for  Europe  landed  in 
Bordeaux.  In  view  of  the  parallel  development  of  the  medical 
services  of  the  American  Expeditionary  Forces  and  the  Ameri- 
can Red  Cross,  it  is  of  interest  that  these  organizations  arrived 
in  Paris  at  practically  the  same  time  and  began  their  develop- 
ment amid  the  same  difficulties. 

War  nursing  with  the  American  Expeditionary  Forces  in 
France  consisted  of  duty  in  tlie  zones  of  the  base  and  of  the 
advance  of  the  United  States  Armies.  In  the  zone  of  the  base. 
t(j  which  this  portion  of  this  history  relates,  nurses  served 
in  base  hospitals  established  along  the  principal  lines  of  com- 
munication. Connecting  the  zone  of  the  base  with  that  of  the 
advance  were  the  hospital  trains  of  the  U.  S.  Army  ]\ledical 
Corps  in  France;  luirses  served  on  these  sanitary  trains.  In 
the  forward  areas,  nurses  served  in  evacuation  and  mobile 
hospitals  and  on  professional  teams.  Further,  sick  and  wounded 
soldiers  of  the  American  Expeditionary  Forces  were  cared  for 
in  military  hospitals  established  by  the  American  Red  Cross, 
both  in  the  zone  of  the  base  and  the  zone  of  the  advance. 
]\Ioreovcr,  American  Red  Cross  nurses  were  even  detailed  to 
duty  in  hospitals  of  tlu^  French  Service  de  Sanie  in  order  tliat 
American  wounded  of  the  divisions  wliicli  Gen(>ral  Pershing 
had  brigaded  with  the  French  troops,  might  be  cared  for  by 

=H>ottcr   written   li\-   Ciirrii'    M.    Hall.    Sciitcnihcr   "iO,    10:21.   to   tlic  author. 


THr:  EUROPEAN  WAR  485 

American  nurses.  As  these  several  types  of  assi<i:nment  difTercd 
greatly,  they  will  be  treated  each  one  in  separate  sections  of  this 
history.  This  section  will  set  forth  the  arrival  of  the  early  Red 
Cross  base  hospitals  in  France  and  will  describe  the  experiences 
of  reserve  nurses  in  the  zon(>  of  the  base. 

T)nrin<2;  the  first  ei<iht  months  of  the  participation  of  the 
United  States  in  the  European  War,  April  through  ISTovember, 
1017,  only  eight  base  hospitals  were  on  duty  with  the  American 
Expeditionary  Forces  in  Erance.  The  American  Army  was 
expected  in  1917  to  occupy  the  southeastern  sectors  of  the 
Western  Front,  the  area  lying  roughly  between  Toul  and  Bel- 
fort.  The  American  line  of  communications  was  developed 
to  extend  from  Ijordeaux  and  St.  Nazaire  to  Dijon  and  Is-sur- 
Lille  and  from  these  centers  to  radiate  up  through  the  areas 
established  for  divisional  training  near  Neufchateau  and  the 
Toul-Belfort  sectors.  The  Chief  Surgeon  accordingly  located 
tlu>  hospitals  of  the  American  F]xpeditionary  i^orces  along  this 
line  of  communications.  He  assigned  the  first  base  hospitals 
to  Bazoillcs,  Chaumont,  Vittel  and  Contrexeville  as  forward 
centers  of  the  zone  of  the  base ;  to  Limoges,  Dijon,  Vichy  and 
Savenay  as  bases  in  the  rear;  and  to  Bordeaux  and  St.  Nazaire 
as  embarkation  centers  from  which  sick  and  wounded  soldiers 
were  to  be  returned  to  the  United  States. 

In  difficulties  met  and  in  accomplishment,  the  experiences 
of  the  first  eight  American  base  hospitals  in  France  were  so 
nearly  identical  that  a  detailed  picture  of  the  first  units  will 
serve  for  all.  In  collecting  the  source  material  for  this  section, 
Xational  Headquarters  sent  a  request,  oftentimes  repeated,  to 
all  chief  nurses  of  base  hospitals,  asking  them  for  a  sunnnary 
of  the  exiKM-icMicc^s  of  their  units.  Some  of  the  chief  nurses 
failed  to  respond  :  others  sent  in  reports  of  unusual  interest 
and  marked  liistorical  value.  In  excerpts  from  these  reports, 
to  be  quoted  later  in  this  portion  of  this  history,  may  clearly  be 
seen  the  general  jiolicies  of  the  ]\redical  Corps  in  France.  The 
effect  of  these  policies  upon  the  nursing  situation  in  the  United 
States  will  also  be  set  forth. 

United  States  Army  l^ase  Hospital  Xo.  18,  organized  at 
Johns  Hopkins  llospiral,  Baltimore,  Md.,  landed  with  the 
First  Division  of  American  tr()()])s  at  St.  Xazair(\  June  2S, 
It' 17.  The  Xa\'y  collier  CijcIdjis,  \\\v  cruiser  ('h(irh'sti)n  and  the 
transpoi't  /■^nihtm/ ,  oii  wliicli  the  Hopkins  I'liit  sailed,  in  a  zig- 
zag ])ass;ige  of   foMiieeii  (hiys  had  dodgcil  (iernuui   r-uhniai'ines 


486    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

which  were  on  their  mettle  to  catch  the  first  American  con- 
tingent. 

l)r,  Winford  Smith  had  organized  Base  Hospital  No.  18, 
but  the  Surgeon  General  claimed  his  services  at  Washington, 
Dr.  John  M.  T.  Finney  led  the  unit  into  the  field.  Bessie  Baker 
was  chief  of  the  sixty-four  nurses  and  of  a  second  unit  of  thirty- 
seven  "casuals."  Miss  Baker  was  born  in  Maryland.  Follow- 
ing her  graduation  from  the  Robert  Garrett  Hospital  for  Chil- 
dren in  13altimore,  she  entered  the  School  of  Nursing  at  Johns 
Hopkins  Hospital.  She  later  became  assistant  superintendent 
of  nurses  at  the  Women's  Hospital  in  Baltimore.  She  returned 
to  Johns  Hopkins  in  1912,  as  first  assistant  superintendent  of 
the  training  school.  Although  much  of  her  life  had  been 
spent  in  ]\Iaryland,  her  brisk  humor,  reflected  in  her  twinkling 
brown  eyes,  her  energy  and  her  enthusiasm  called  to  mind  the 
Western  rather  than  the  Southern  temperament. 

Miss  Baker  described  the  reception  of  Base  Hospital  No.  18 
at  St.  Nazaire: 

During  the  afternoon  we  received  a  visit  from  the  general 
then  iu  command  of  the  Medical  Corps  of  the  American  Expe- 
ditionary Forces  [General  Bradley).  He  remarked  that  up 
to  twenty-four  hours  before  he  had  not  been  aware  of  our 
existence,  much  less  our  expected  arrival.  An  immediate 
survey  of  the  surrounding  country  was  necessary,  if  he  was 
to  find  a  place  whereon  we  might  lay  our  heads. 

The  following  morning  brought  the  parting  from  the  18th 
Regiment,  our  companions  of  the  voyage.  It  was  hard  to  say 
the  last  word.  IMany  of  them  we  knew  we  should  never  see 
again,  unless  they  were  brought  to  us  wounded  and  miserable. 

To  their  cheers,  we  filed  down  the  gang-pbank  to  the  station 
and  entrained  for  the  village  of  Savenay.  The  quiet  peaceful- 
ness  of  tliat  first  glimpse  of  the  French  countryside,  with  its 
old  windmills  and  charming  peasant  homes!  The  wild  flow- 
ers were  riotous,  crimson  poppies,  purple  heather,  yellow  and 
white  daisies. 

Until  war  made  it  a  garrison  of  hospitals,  the  little  village 
of  Savenay,  located  on  the  orchard-covered  hills  of  Brittany, 
had  led  a  drowsy  and  peaceful  existence.  Tlie  personnel  of 
Base  Hospital  No.  18  was  tcnnporarily  assigned  there  until 
a  permanent  hospital  could  be  secured  for  them  nearer  the 
front.  U])on  tlie  arrival  of  tli(>  unit  at  Savenay,  the  jiurses 
were  billeted  in  a  dorniitorv  of  a  larm*  normal  school  for  bovs. 


THE  EUROPEAN  WAR  487 

The  democracy  of  field  service  soon  established  itself.  "In 
our  single  public  wash-room,"  wrote  Miss  Baker,  ''high  and  low, 
those  who  had  'run'  hospitals  and  those  who  had  been  'run,' 
scrubbed  crepe  garments  side  by  side."  Miss  Baker's  report 
contained  the  following  description  of  Army  "chow" : 

On  our  way  over,  we  had  inwardly  pitied  the  enlisted  men 
with  the  tin  plates  and  knives  and  forks  and  the  long  wooden 
tables.  First  mess-call  at  Savenay  told  us  that  we  too  were 
in  the  Army.  There  was  war  bread  in  heavy  slices,  there 
were  onions  and  bacon.  Heavy  tin-ware  adorned  our  cloth- 
less  table  and  backless  benches  supported  us  while  we  fed. 
How  we  laughed ! 

Unless  you  sat  near  the  end  of  the  bench,  you  had  to  be  a 
high  stepper  and  bop  over.  Black  coffee  came  around  in  huge 
galvanized  buckets,  which  we  drank  humbly  from  receptacles 
ranging  from  a  pint  tin  cup  to  a  quart  capacity  dish-pan. 
Onions  were  witli  us  morning,  noon  and  evening.  What  we 
could  never  puzzle  out  was  why  we  were  destined  to  eat  in  a 
few  weeks  all  of  that  delectable  dish  meant  to  serve  the  entire 
American  Army  during  the  period  of  the  war. 

Fifteen  of  the  thirty-seven  nurses  who  had  come  overseas 
with  the  Hopkins  Unit  were  ordered  back  to  St.  Nazaire  on 
July  5  to  staff  a  small  hospital  which  the  French  transferred 
to  the  American  Army.  Here  were  received  acute  cases  of  the 
infectious  diseases  that  had  attacked  troops  of  the  First  Di- 
vision on  their  way  overseas.  This  hospital,  first  known  as 
United  States  Army  Hospital  Xo.  1,  American  Expeditionary 
Forces,  was  later  designated  as  Base  Hospital  Xo.  101  and 
as  such  functioned  until  the  end  of  the  war.  Members  of  the 
medical  and  nursing  staffs  of  the  original  Johns  Hopkins  Unit 
who  had  been  detailed  to  St.  Xazaire,  were  returned  to  Base 
Hospital  Xo.  18  before  winter. 

The  nurses  and  surgeons  waiting  at  Savenay  for  the  com- 
pletion of  the  hospital  which  they  were  soon  to  occupy,  spent 
the  days  in  attending  French  classes  and  in  drilling.  The 
routine  of  Army  life  and  the  discipline  of  divisional  training 
sometimes  proved  irksome.  Miss  Baker  wrote  of  these  experi- 
ences early  in  July : 

It  was  bard  to  go  to  ])ed  at  10  P.^f.  when  the  sun  liad  just 
slipped  below  tlio  horizon.  From  our  back  windows,  tlic  coini- 
trv  stretched  lazilv  awav  in  tlic  distance.     Far  below  ifleanieJ 


488   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  lights  of  St.  Xazaire.  The  green  vineyards  sloped  to  the 
river  Loire  and  on  every  hillside  the  quaint  old  mills  now 
turned  leisurely  at  their  task,  now  stood  silhouetted  against 
the  pastel  sky,  with  a  wee  crescent  moon  and  a  lone  star 
standing  guard  above.  Xever  could  we  have  imagined  a 
scene  more  symbolic  of  peace  than  this,  our  first  experience  of 
war. 

As  the  days  rolled  on,  we  struggled  with  our  hopelessly  poor 
drills.  In  vain  did  the  Major  endeavor  to  make  us  military 
women.  He  finally  gave  us  up  in  despair.  Many  mornings, 
however,  we  spent  in  the  old  hay  fields  watching  the  men  mop 
and  drill  and  drill  and  mop  in  the  hot  July  sun.  The  sky- 
larks flitted  up  into  the  blue  sky  and  an  occasional  Zeppelin 
hovered  in  the  distance  far  beyond  us.  .  .  . 

After  a  month  at  Savenay,  the  personnel  of  Base  Hospital 
No.  18  entrained  for  their  permanent  quarters.  Miss  Baker 
wrote  of  the  trip  across  France : 

Every  inch  of  this  wonderful  country  seemed  under  culti- 
vation. Hillsides  were  covered  with  vineyards.  Buckwheat, 
rye,  red  clover,  yellow  mustard,  asparagus  and  alfalfa  car- 
peted the  rolling  country.  Quaint  little  villages  peeped  out 
from  the  valleys  or  topped  the  hillsides. 

We  left  the  windmills  behind  us  overnight  and  came  to 
great  hillsides  of  rock,  with  houses  dug  out  of  them.  We 
passed  groves  of  chestnut  and  willows  and  stately  spruces, 
"fox-tail"  and  oak.  The  poplars  lined  the  fine  white  turn- 
pikes and,  like  tall  sentinels  standing  on  guard  for  miles  and 
miles,  crowned  the  crests  of  the  distant  hills. 

They  arrived  July  26  at  Bazoilles,  a  village  of  two  hundred 
inhabitants,  situated  on  the  headwaters  of  the  Mouse  Biver, 
in  the  Department  of  the  Vosgcs.  In  this  little  town,  the  chateau 
and  out-buildings  of  a  private  estate,  supplemented  by  barrack- 
like  wooden  wards,  had  been  made  into  a  hospital  of  one  thou- 
sand beds.  Tliose  buildings  woro  located  on  both  sides  of  an 
avenue  which  stretched  up  a  hillside.  The  avenue  was  roofed 
ov(>r  and  enclosed  and  through  apertures  in  the  sides,  the  nurses 
saw  below  them  as  they  went  to  and  from  the  wards,  a 
beautiful  valley  threaded  by  small  streams  and  beyond  the  foot- 
hills of  the  Vosges. 

Base  Hospital  Xo.  18  received  its  first  patients  on  July  31, 
1917;  it  served  as  a  camp  hospital  during  the  summer  for  sev- 
eral divisions  of  American  troops  then  in  training  in  nearby 


THE  EUROPEAN  WAR  489 

areas.  The  work  was  light,  so  between  assijn^ments  to  duty 
the  nurses  had  long  intervals  of  leisure  which  gave  them  op- 
portunity to  go  on  sight-seeing  trips.  Some  of  them  went  to 
Xenfehateau,  four  miles  distant,  others  to  Domremy  which  Miss 
Baker  described: 

The  valley  blazed  in  a  shimmer  of  blended  color,  the  wild 
mustard  tawny  in  the  sunlight,  the  winding  Meuse,  the 
meadows  bright  with  daisies,  gentians,  poppies.  ...  In  that 
hnml)le  chamber  where  Jeanne  d'Arc  first  saw  the  light  three 
hundred  years  ago,  I  could  not  help  thinking  today  of  the 
thousands  of  women,  French,  English,  American,  going  to 
war  for  France,  though  not  to  the  fanfare  of  trumpets  that 
cheered  the  Maid  to  Orleans  and  Kheims. 

The  rainy  season  set  in  about  Bazoilles  towards  the  end  of 
September.  The  American  troops  were  vinaccustomed  to  tho 
excessive  dampness  and  the  medical  wards  of  Base  Hospital 
No.  18  were  soon  filled  to  capacity  with  patients  suffering  from 
colds,  sore  throats,  bronchial  ailments  and  pneumonia.  A  nurse 
of  the  Hopkins  Unit  wrote  of  her  charges: 

They  are  mostly  l)oys  from  little  towns  and  from  every 
walk  in  life.  On  a  ward  of  ten,  we  have  an  Irish  policeman; 
an  Austrian  ])arl)er;  a  Philadelphia  steam  fitter;  a  marine 
with  an  Irish  mother  and  Italian  father;  a  trap  drummer 
from  the  movies  of  Chicago;  a  big  six-foot  farmer  boy  from 
Xew  England;  a  lad  of  fifteen  years  who  ran  away  from 
school  in  Indiana;  a  ])resser  from  a  tailor's  establishment  in 
Ohio;  and  a  farmer  from  ^lissouri.  So  it  goes,  often  a  college 
man  next  to  a  tramp.  To  us  they  are  just  sick  and  lonely 
boys,  whose  life  we  could  make  a  bit  more  cheery. 

The  winter  came  early  in  Xovember  with  raw  winds  and 
clinging  fogs.  Eack  of  fuel  accentuated  the  discomfort  which 
tli(>  prohmged  (l;nn])ness  ju-oduced.  U]:)on  their  arrival  at 
Bazoilles,  the  Americans  had  been  told  grim  tales  of  patients 
who  had  been  found  frozen  to  death  in  bed  the  winter  before. 
''There  came  a  time,"  wrote  ^liss  Bak(>r,  ''when  we  began  to 
f(H'l  that  there  niiglit  be  some  truth  in  these  stories."  On  many 
occasions  when  she  was  making  "rounds''  in  the  nurses'  quar- 
ters, ^liss  leaker  would  come  u})(Ui  a  nurse  who  had  been  obliged 
to  leave  her  duties  in  the  wards,  go  to  her  rocun  and  sit  with  her 
numbed  feet  in  ice  water  to  relieve  their  aching  enough  to  permit 


490   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

her  to  go  on  with  her  morning's  work.  "There  was  talk,"  con- 
tinued Miss  Baker,  "of  starting  a  Chilblain  Club,  but  such 
rivalry  for  the  presidency  arose  between  one  of  the  surgeons 
and  the  assistant  chief  nurse  that  it  had  to  be  abandoned." 

Lighting  also  offered  difficulties.  The  nurses  were  expected 
to  provide  their  own  lamps,  but  no  sooner  had  they  secured  them 
than  the  kerosene  gave  out.  As  it  was  too  cold  to  sit  up,  the 
nurses  retired  to  bed  to  read  by  the  light  of  a  single  candle  stuck 
with  tallow  on  the  head  of  their  cots.  The  picture  suggested 
by  Miss  Baker's  descriptions,  of  a  shivering,  blue-lipped  woman 
wrapped  in  sweaters,  ulsters  and  blankets  is  indeed  a  true 
picture  of  the  American  war  nurse  as  she  appeared  many  times 
when  off  duty  during  the  harsh  French  winters. 

Of  the  work  of  the  Hopkins  Unit,  Miss  Baker  wrote : 

Day  by  day  our  wards  filled  up  rapidly  with  soldiers.  At 
the  same  time  the  nurses  began  to  fall  ill  in  large  numbers. 
We  started  with  an  eight  hour  day,  but  with  many  patients  on 
the  wards  and  sick  nurses  in  the  infirmary,  the  periods  we 
spent  on  duty  became  as  many  hours  as  one  could  stand. 

At  no  time  did  the  nurses  work  any  harder  than  during 
these  cold,  dark  days  between  Xovember  and  January,  1918. 
But  the  joy  of  being  there  ready  and  waiting  to  give  to  our 
incoming  patients  the  comfort  that  good  nursing  alone  will 
bring  to  a  sick  man  !  Here  we  meant  mother,  sister  and 
sweetheart  to  those  shivering,  lonely,  homesick  boys.  What 
confidences  we  received  !  One  youngster,  just  a  wee  lad,  told 
his  nurse  that  if  he  ever  got  back  to  his  mother  she  wouldn't 
have  to  beg  him  to  eat  the  pie  she  had  baked  for  him. 

On  a  dull,  gray  Sunday  afternoon  early  in  Xovember  we 
received  our  first  American  wounded,  the  victims  of  that  first 
Frencli  raid,  16tli  Infantry  bovs  who  had  been  holding  the 
Toul  Sector. 

In  commenting  on  the  many  delicacies  with  which  the 
nurses  supplemented  rations  for  the  soldiers.  Miss  Baker  wrote: 

How  like  ]\riss  Xiglitingale's  experience  with  regard  to  diet, 
entertainment  and  many  other  mcidents,  was  our  own  I 
"Preposterous  luxuries  I''  one  of  the  old  doctors  of  her  day 
contemptuously  called  the  results  of  her  herculean  efforts  fo 
furnish  an  adequate  diet.  To  have  recreation  huts  and  the 
additional  comforts  and  dainties  which  the  Ked  Cross  and  the 
nurses  supplied  the  soldiers  may  have  been  "spoiling  the 
brutes"'  in  the  Armv  vernacular,  but  it  undoubtedly  saved  the 


THE  EUROPEAN  WAR  491 

morale  of  our  soldiers  in  1917  and  1918,  no  less  than  Miss 
Nightingale's  efforts  in  the  Crimean  War.  One  conunanding 
officer  of  Base  No.  18  remarked:  "These  men  don't  need  all 
this  female  nursing, — they  haven't  been  accustomed  to  it !" 

While  we  sat  swathed  in  blankets  around  those  miserable 
little  French  stoves  and  breathed  upon  our  numbed  fingers 
and  waited  for  the  monotonous  hours  to  drag  by,  we  nurses 
tried  to  puzzle  out  the  meaning  of  war,  of  those  sick  boys  on 
the  wards,  of  our  own  ridiculous  plight. 

We  couldn't  get  very  far  with  most  of  our  discussions,  but 
there  was  real  comfort,  to  us  at  least,  in  one  doughboy's 
words :  "The  last  thing  I  knew,  I  was  out  and  over  the  top. 
...  I  opened  my  eyes  and  there  above  me  was  a  nurse  with 
a  small  lied  Cross  on  her  cap.  1  just  turned  over  and  went 
to  sleep,  because  I  knew  then  that  everything  would  be  all 
right." 

The  New  Year  brought  better  times  for  the  overworked 
nurses  of  Base  Hospital  No.  18.  The  medical  and  nursing 
staffs  were  supplemented  in  January,  1918,  by  the  arrival  of 
Hospital  Unit  "A,"  organized  by  the  American  Red  Cross  at 
the  Presbyterian  Hospital,  Philadelphia,  Pa.  Katlierine  Liddle, 
of  Wilkinsburg,  Pa.,  was  chief  nurse  of  the  twenty-one  nurses 
who  composed  this  unit.  Toward  February  the  weatlior  at 
Bazoilles  changed  from  penetrating  dampness  to  sharp  cold ; 
and  nurses  and  doctors  alike  found  relaxation  in  winter  sports. 
Organized  recreation  was  developed  by  Oolali  ]]urner,  a  secre- 
tary of  the  Young  Women's  Christian  Association,  who  arrived 
in  February.  William  Prescott  Wolcott,  the  Red  Cross  repre- 
sentative at  Base  Hospital  No.  18,  succeeded  in  securing  a 
nurses'  recreation  hut.  A  small  nurses'  infirmary,  which  later 
drew  patients  from  surrounding  posts,  replaced  the  bare  wooden 
barracks  in  which  many  Hopkins  nurses  had  spent  days  of  sick- 
ness during  the  winter. 

During  the  early  spring  of  1918,  the  American  Expedition- 
ary Forces  first  shouldered  the  heavy  responsibilities  oi  lutlding 
a  portion  of  the  Western  Front.  The  entranc(>  of  American 
soldiers  into  the  French  and  British  trenches  made  necessary 
the  assignnuMit  of  American  professional  teams  to  the  /.on(> 
of  advance  to  care  for  tlic  AiiKU'ican  casualties  wliicli  would 
inevitably  occur  there.  These  teams,  tisually  eompos(>d  of  two 
surgeons,  an  anesthetist,  two  nurses  and  two  orderlies,  were 
organized  from  among  the  personnel  of  base  hospitals   in   the 


492   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rear  and  were  sent  forward  for  temporary  duty  in  evacuation, 
mobile  and  field  hospitals. 

The  nursing  strength  of  Base  Hospital  I^o.  18,  at  times  en- 
tirely inadequate  to  cope  with  the  volume  of  work  in  their 
wards,  was  further  reduced  by  the  formation  of  these  surgical, 
splint  and  shock  teams.  These  units  were  often  absent  from 
the  base  during  some  particular  drive, — just  at  the  time  when 
the  greatest  number  of  patients  wore  being  sent  to  the  base 
hospital, — and  the  depleted  staff  of  nurses  at  jSTo.  18  were  sorely 
overworked  on  such  an  occasion.  The  "gas  convoys"  were  par- 
ticularly distressing.  One  night  after  eleven  o'clock,  ambu- 
lances discharged  over  two  hundred  and  fifty  blindfolded  men, 
dressed  in  torn  and  dirty  horizon  blue  uniforms,  some  of  them 
stumbling  along  with  their  hands  on  their  buddy's  shoulders, 
others  quiet  on  stretchers.  "We  thought  they  were  French,"  a 
Hopkins  nurse  wrote  in  her  diary,  "but  they  proved  to  be  our 
own  men  who  had  been  brigaded  with  the  French, — gTcat  stal- 
wart chaps  now  groping  their  way  like  small  children,  blinded, 
the  tears  running  down  their  cheeks,  their  faces  blistered  and 
burned."  Of  corridors  and  pre-operative  rooms  crowded  with 
wounded,  Miss  Baker  wrote : 

As  the  long  line  of  stretchers  continued  to  be  moved  in 
hour  after  hour,  each  one  holding  what  seemed  to  be  a  case 
more  helpless  than  the  last,  we  could  only  pray  for  the  end  of 
such  brutality.  As  we  went  around  the  wards,  stepping  over 
the  stretchers^  bending  down  to  the  floor  with  a  hot  drink,  or 
with  a  match  to  light  a  cigarette  for  an  armless  man,  we  were 
almost  ready  to  cry  "quits"'  at  any  cost.  How  savage,  how 
inexpressibly  futile  has  become  this  li2:ht  valuation  of  human 
life ! 

One  of  the  early  projects  of  the  American  Red  Cross  in 
France  was  the  establishment  in  the  Vosges  of  a  dispensary 
service  for  the  benefit  of  the  civilian  population.  The  aims  and 
general  nature  of  this  service  was  described  by  Ruth  Weir,  an 
American  Red  Cross  nurse  assigned  to  duty  at  Xeufchateau,  the 
headquarters : 

In  Xovember,  1917  .  .  .  I  was  assigned  to  the  American 
^ledical  Service  for  the  civilian  population,  which  had  its 
headquarters  at  Xcufchatcau.  I'liis  service,  whicli  was  de- 
veloped under  Colonel  H.  TI.  Young,  chief  neurologist  of  the 
American  Expeditionary  l-'orces,  had  two  great  ends,  to  aid 


THE  EUROPEAN  WAR  493 

the  poor  people  deprived  of  medical  care  and  to  prevent  epi- 
demics in  localities  where  our  troops  were  billeted. 

The  work  was  carried  on  in  dispensaries  located  in  all  the 
outlying  villages.  A  doctor  and  a  nurse  visited  these  dis- 
pensaries every  two  or  three  days  and  called  on  very  sick  peo- 
ple in  their  homes.  In  this  way  we  successfully  uncovered 
stray  cases  of  scarlet  fever,  meningitis,  diphtheria  and  other 
diseases  and  treated  them,  thus  nipping  in  the  bud  the  spread 
of  contagion.  Later  on  we  had  a  perfectly-equipped  hospital 
at  Neufchateau  where  patients  requiring  special  care  and 
surgical  cases  were  treated.  From  the  moment  of  its  opening, 
the  sixty  beds  of  this  hospital  were  always  occupied.  The 
people  flocked  to  us  for  treatment  and  also,  it  must  be  con- 
fessed, to  hear  les  Americaines  speak  French.  They  were 
most  grateful  and  loaded  us  with  kindnesses. 

The  second  American  Army  base  hospital  to  arrive  in  France 
for  service  with  the  American  Expeditionary  Forces  was  No. 
15,  organized  by  the  American  Red  Cross  from  the  alumna? 
and  staff  of  the  Roosevelt  Hospital,  New  York  City.  Mary  L. 
Francis,  a  graduate  and  assistant  superintendent  of  nurses 
of  the  Roosevelt  Hospital,  was  chief  nurse. 

The  Roosevelt  Unit  arrived  in  France  early  in  July,  1917, 
and  established  a  base  hospital  of  three  thousand  beds  at  Chau- 
mont,  in  the  Department  Haute-Marne.  During  their  first 
four  or  five  months  of  service,  they  cared  largely  for  French 
wounded,  but  later  American  sick  and  wounded  soldiers  came 
to  them  from  all  the  surrounding  sectors.^'* 

Bordeaux,  destined  to  become  the  principal  southern  hospital 
center  of  the  United  States  Medical  Corps  in  France,  was  the 
destination  of  United  States  Army  Base  Hospital  No.  C,  the 
third  of  the  Red  Cross  columns  to  be  called  into  active  service 
with  the  American  Expeditionary  Forces.  This  unit  took  over 
late  in  July,  1917,  VHopital  Complementaire  No.  25,  in  the 
Lycee  dc  Talence,  situated  in  a  beautiful  park  outside  the  city. 

Base  Hospital  No.  6  had  been  organized  at  the  ]\rassachusctts 
General  Hospital,  Boston,  Mass.  Sara  E.  Parsons  was  chief 
nurse.  ^liss  Parsons  was  a  graduate  of  the  I^oston  Training 
School  of  the  Massachusetts  General  Hospital.  After  long 
executive  experience  in  various  New  England  institutions,  she 
rounded  out  a  broad  education  gained  in  this  institutional  work 

"Mention  of  the  activities  of  the  lloosevolt  I'liit  is  necessarily  liritf. 
because  at  the  writing  of  this  history  Miss  Francis  did  not  have  access 
to  her  papers  and  data  regarding  tlie  experiences  of  her  unit. 


494   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  by  foreign  travel,  by  post-graduate  training  at  Teachers 
College.  She  was  in  1U07  and  1908  superintendent  of  the 
Shepard  Pratt  Hospital  of  Baltimore  and  in  1909  returned  to 
the  ^lassachusetts  General  Hospital  as  director  of  the  Boston 
Training  School.  She  enrolled  in  the  Red  Cross  Nursing 
Service  in  1910.  She  was  a  woman  of  practical  and  energetic 
temperament,  with  snapping  gray  eyes  and  a  strong  mouth, 
which  bespoke  humor  and  fearlessness. 

The  nursing  staff  of  Base  Hospital  No.  6  arrived  at  Talence 
on  July  29,  1917,  and  were  immediately  installed  in  wards  from 
which  wounded  Senegalese  and  French  soldiers  had  been  evacu- 
ated. The  first  patients  to  come  to  the  Massachusetts  Unit  were 
sent  in  September  from  the  nearby  training  areas  of  the  Ameri- 
can Expeditionary  Forces.  Hospital  Unit  ^'0",  of  Charlotte, 
North  Carolina,  arrived  March  10,  1918,  at  Bordeaux  to  reen- 
force  the  nursing  staff.  Heavy  work  for  Base  Hospital  No.  6 
began  the  following  July  and  continued  until  the  end  of  the 
war.  On  November  11,  1918,  there  were  4319  patients  in  the 
hospital  with  ninety-nine  nurses  on  duty,  an  average  of  forty- 
four  patients  to  each  nurse.  Miss  Parsons  wrote  of  the  out- 
standing features  of  the  life  and  work  of  the  nurses  during 
their  eighteen  months  in  the  field : 

A  universal  enjoyment  of  actual  bedside  nursing  character- 
ized the  attitude  of  the  nursing  staff.  Although  thirty-eight 
of  the  original  unit  of  sixty-four  nurses  had  held  executive 
positioiis  before  joining  Base  Hospital  Xo.  6,  they  were  al- 
ways glad  to  take  subordinate  positions  where  they  could  work 
directly  with  the  patients.  Xever  did  our  nursing  staff  suffer 
from  too  many  executives,  a  complaint  of  some  other  units. 
Nor  were  the  nurses  too  tired  or  too  busy  to  do  extra  kind- 
nesses for  the  patients.  The  hours  off  duty  were  spent  mak- 
ing candy,  pies,  ice-cream  for  the  boys.  .  .  .  ]\rost  gratifying 
was  the  spirit  of  motherliness  which  pervaded  the  atmosphere 
and  the  respect  which  the  nurses  commanded. 

To  sum  up  my  impression,  the  advantage  of  knowing  one's 
personiiel  is  tremendous,  both  from  a  professional  and  a 
physical  ])oint  of  view.  Some  of  our  most  valual;le  women 
will  do  excellent  work  in  an  understanding  and  sympathetic 
environment,  but  could  Jiever  stand  the  strain  in  an  uncon- 
genial situation. 

Dijon,  below  Chaumont  in  central  eastern  France,  was  the 
next  hospital  center  to  be  established  during  the  early  summer 


THE  EUROPEAN  WAR  495 

of  1917.  In  this  city,  United  States  Army  Base  Hospital  No. 
17  on  July  29  took  over  from  the  French  military  authorities 
I'llopital  Temporaire  No.  77. 

This  fourth  Ked  Cross  unit  to  see  service  with  the  Ameri- 
can Expeditionary  Forces  in  France,  Base  Hospital  No.  17, 
had  been  organized  at  the  Harper  Hospital,  Detroit,  ^lichigan. 
Emily  A.  McLaughlin  was  chief  nurse.  Miss  McLaughlin 
was  educated  in  convent  schools  of  Brooklyn  and  Detroit  and 
was  graduated  from  the  Farrand  Training  School,  Harper  Hos- 
pital. During  the  Spanish-American  War,  she  served  at  Lex- 
ington, Kentucky,  at  Columbus,  Georgia  and  at  Matanzas,  Cuba. 
She  remained  in  military  service  until  November,  1901,  when 
she  returned  to  the  Farrand  Training  School  as  night  super- 
visor. In  1909,  she  became  principal  of  the  training  school 
there  and  remained  in  that  capacity  until  she  was  again  called 
into  military  nursing  as  chief  nurse  of  l^ase  Hospital  No.  17. 

The  Harper  Unit  arrived  at  Dijon  on  July  29,  1917,  and 
was,  with  the  exception  of  an  American  bakery,  the  first  branch 
of  the  American  Expeditionary  Forces  to  invade  that  ancient 
city.  A  French  military  hospital,  VHopital  Temporaire  No.  11 , 
was  assigned  to  them.  The  main  building  had  formerly  housed 
the  School  of  St.  Ignate  and  was  a  four-storied,  ell-shaped 
structure.  Fourteen  wood(!n  barracks  of  from  thirty-tlve  to 
forty-five  bed  capacity  were  later  erected  immediately  behind 
the  larger  building.  The  normal  capacity  of  Base  Hospital  No. 
17  was  eighteen  hundred  beds,  but  it  was  capable  of  an  emer- 
gency expansion  to  two  thousand  beds.  The  nursing  staff  was 
billeted  in  houses  located  in  various  parts  of  the  city. 

As  was  the  case  with  the  surgeons  and  inirses  of  other  base 
hospitals  assigned  to  the  then  embryonic  American  Expedition- 
ary Forces,  the  personnel  of  the  Harper  L^nit  experienced  at 
first  the  tedium  of  having  too  few  patients  to  occupy  their  time. 
L'nits  of  inirses  were  sent  early  in  August  to  Paris  to  help  out 
at  the  American  Ived  Cross  dressing  station,  whicli  was  then 
drawing  on  American  bases  for  personnel.  Others  were  ordered 
to  an  American  hospital  at  liis  Orangis  to  observe^  surgical 
methods.  On  several  occasions  those  at  Dijon  assisted  in  serving 
hot  food  to  the  French  hi  esses  as  their  hospital  trains  passed 
thi-(tugh  the  city.  During  the  summer,  however,  tlie  Ititli  iMigi- 
neers  and  later  the  big  (^imoufhige  Camp,  the  United  States 
Army  Liiboratory  and  the  iirst  training  bilh'ts  of  tlie  >2nd 
Division  wt're  situated  lu'ar   Diion,  and  these  branches  of  the 


496   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

American  Expeditionary  Forces  sent  many  medical  and  acci- 
dent cases  to  Base  Hospital  No.  17. 

Hospital  Unit  "S,"  of  l^ashville,  Tennessee,  of  which  Kath- 
erine  G.  Sennott  was  chief  nurse,  arrived  at  Dijon  in  February, 
1918,  to  reenforce  the  nursing  staff  of  Base  Hospital  No.  17. 
During  the  German  offensive  of  March- July,  1918,  heavy 
casualties  occurred  among  the  American  and  Allied  Armies  then 
holding  the  Western  Front  and  many  patients  came  to  Base 
Hospital  No.  17.     Miss  McLaughlin  wrote: 

Our  first  big  convoy  of  over  three  hundred  Americans  who 
had  been  brigaded  near  Soissons  with  the  French  arrived  on 
March  IG.  From  that  time  on,  there  was  little  respite  for  us. 
We  functioned  sometimes  as  an  evacuation  hospital,  retain- 
ing our  patients  only  a  few  days. 

We  were  told  May  29  that  a  hospital  train  had  arrived  with 
about  two  hundred  patients.  This  proved  to  be  a  train  of 
nearly  twelve  hundred  British  soldiers  from  the  Soissons 
sector,  six  hundred  of  whom  were  received  at  our  base.  Many 
were  badly  wounded;  the  only  one  we  could  not  save  was  a 
terribly  wounded  Scotch  laddie,  sixteen  years  old,  who  kept 
crying:   "I  want  tae  gae  hame  tae  ma  mither!" 

On  the  18th  of  June  a  convoy  of  our  own  terribly  man- 
gled and  gassed  men  was  received  from  Chateau-Thierry, 
coming  to  us  direct  from  the  field  hospital.  Many  of  these 
were  Marines  who  had  taken  part  in  that  memorable  fight 
and  had  done  much  in  stemming  the  tide  at  this  point. 

United  States  Army  Base  Hospital  No.  8  was  the  fifth  Red 
Cross  column  to  embark  during  the  early  summer  of  1917  for 
service  with  the  American  Expeditionary  Forces  in  France. 
This  unit  had  been  organized  at  the  New  York  City  Post-Grad- 
uate  Hospital.  Amy  Florence  Patmore,  who  since  her  grad- 
uation from  the  parent  institution  of  this  unit  had  conducted 
a  private  sanitarium  in  New  York  City,  was  chief  nurse. 

Base  Hospital  No.  8  set  out  on  July  30,  1917,  on  the  S.  S. 
Saratoga.     Miss  Patmore  wrote  : 

Passing  Staten  Island,  the  S.  S.  Saratoga  slowed  up  and 
finally  dropped  anchor  off  Tompkinsville.  The  day  was  des- 
perately hot  and  after  luncheon  most  of  the  nurses  removed 
their  heavy  uniforms  and  were  lolling  about  in  their  cabins  in 
all  degrees  of  drsliahillc.  Suddenly  there  was  a  crash  and  a 
terrific  shock, — the  S.  S.  Panama  had  rammed  into  the  Sara- 


THE  EUROPEAN  WAR  497 

toga,  tearing  a  thirty-foot  hole  in  her  side.  The  ship  imme- 
diately began  to  list  and  orders  were  given  to  al)andon  ship 
at  once. 

There  was  no  hysteria  among  the  nurses.  Half-clad  as  they 
were,  they  took  their  places  in  the  boats.  All  the  smaller  craft 
in  the  harbor  rushed  to  our  assistance  and  we  were  picked  up 
and  taken  to  various  large  boats  scattered  about  the  Bay.  A 
Government  boat  finally  collected  and  carried  us  back  to  quar- 
ters on  board  the  Finland,  which  was  then  lying  at  her  dock 
in  Iloboken.  We  learned  that  seventeen  minutes  after  the 
last  person  had  left  the  ship,  the  Saratoga  submerged.  With 
her  went  not  only  our  own  personal  belongings  but  our  entire 
hospital  equipment. 

We  were  not  allowed  to  hold  any  communication  with 
friends  on  shore.  .  .  .  We  were  taken  back  to  Ellis  Island. 
The  nurses  of  Base  Hospital  Unit  No.  9  were  mobilized  there 
awaiting  orders  to  sail  and  they  opened  up  their  luggage  and 
divided  their  wearing  apparel  with  our  little  band  of 
refugees. 

The  reequipment  of  Base  Hospital  ISTo.  8  has  already  been 
detailed  in  an  earlier  section.  Eight  days  after  the  sinking  of 
the  S.  S.  Saratoga,  this  unit  reembarked  on  the  Finland,  which 
was  one  of  a  convoy  of  five  troopships.  Rigid  discipline  was 
maintained  on  board.  All  passengers  were  drilled  every  day 
and  were  ordered  to  be  fully  dressed  and  ready  to  go  on  deck 
at  2,  3  and  4  A.  ^L  every  night.  The  utter  blackness  of  their 
own  ship  and  the  huge  dim  shapes  of  other  ships  of  the  convoy 
slipping  along  beside  them  in  the  darkness  brought  to  the  nurses 
realization  of  the  danger  of  submarine  attack.  *'For  the  last 
three  nights,"  wrote  ]\[iss  Patmore,  'Sve  were  not  allowed  to 
remove  our  clothing  and  our  life  preservers  were  always  close 
beside  us." 

German  submarines  in  search  of  Allied  ships  bound  for  St. 
Xazairc  combed  the  waters  near  Belle  isle,  just  otf  the  coast  of 
France.  Several  of  them  sighted  the  American  convoy  and 
attacked  the  Finland.     IMiss  Patmore  described  the  encounter: 

Suddenly  al)Out  nine  o'clock  on  "Monday  morning,  the  sig- 
nal came,  six  short  blasts  and  tlu'  firing  of  a  cannon.  F,a(  h 
hurri('(lly  look  her  place  beside  the  boat  to  wliich  slic  liad  bt'cu 
assigned,  and  during  a  tense  hour  and  a  quarter  watched  the 
battle.  The  roar  of  cannon  and  the  sluxk  of  (le]>th  hombs 
brought  to  us  a  iirim  realization  of  naval  warfare.     Out  of  the 


498   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

five  sliips  of  the  convoy,  the  Finland  seemed  to  have  been  the 
target.  Six  torpedo  destroyers  and  two  aeroplanes  came  to 
our  rescue. 

We  were  off  the  cost  of  France  when  the  attack  occurred. 
After  the  submarines  had  been  routed,  we  proceeded  on  our 
way  to  St.  Xazaire.  When  we  arrived  there  at  seven  in  the 
evening  of  August  20,  the  populace,  who  had  heard  the  news 
of  the  battle  by  wireless,  was  waiting  to  bid  us  welcome  and 
we  docked  amid  round  after  round  of  cheers. 

The  personnel  of  Base  Hospital  l^o.  8  was  permanently  as- 
signed to  the  same  normal  school  building  at  Savenay,  in  the 
Loire  District,  in  which  the  Hopkins  Unit  had  been  temporarily 
billeted  two  months  before.  During  the  first  winter,  the  !New 
York  Post-Gradnatc  Unit  cared  for  large  numbers  of  medical 
cases  sent  in  from  training  centers  of  the  American  Expedition- 
ary Forces.  Base  Hospital  No.  8  expanded  during  the  spring 
of  1918  to  a  capacity  of  3470  beds.  Large  tuberculosis,  isolation 
and  psychopathic  departments  and  a  school  for  blinded  soldiers 
were  organized.  Classes  in  administration  of  anesthetics  were 
conducted  for  nurses.  A  diet  kitchen  was  later  developed  which 
served  2200  patients  each  day  with  delicacies  and  specially- 
prescribed  articles  of  diet. 

Hospital  I^nit  ''F,"  consisting  of  twenty-one  nurses  from  the 
Harlem  Hospital,  Xew  York  City,  arrived  February  6,  1918, 
to  supplement  the  nursing  staff  of  Base  Hospital  iSTo.  8.  Even 
with  these  reenforcements,  J^asc  Hospital  Xo.  8  suffered  from 
the  shortage  of  nurses  felt  throughout  the  early  summer  of  1918 
by  the  other  base  hospitals  attached  to  the  American  Expedition- 
ary Forces.  Patients  came  to  Savenay  from  all  parts  of  France. 
]\liss  Patmore  wrote  that  during  the  major  offensives  patients 
sometimes  were  received  from  as  many  as  three  hospital  trains 
in  thirty-six  hours,  eafh  train  bringing  between  six  and  seven 
hundred  wounded,  fully  one-half  of  whom  were  stretcher  cases. 
On  one  "peak  day"'  the  X'ew  York  Post-Graduate  Unit  had 
5010  patients  in  the  hospital  and  only  eighty-four  mirses  to 
care  for  them,  a  ratio  of  59.5  patients  to  each  nurse.  Overflow 
cases  w(>re  housed  in  buildings  which  later  became  Base  Hos- 
pital Xo.  09.  "J)uring  thos(^  hectic  months  of  the  summer  and 
autumn  of  1918,"  wrote  ^liss  Patmore,  "we  found  time  for 
little  but  real  life-saving  service.  Perhaps  the  most  wearing 
work  of  all  was  night  duty  in  the  psychopathic  depr.rtment  and 
in  those  wards  where  the  patients  were  running  high  fevers. 


THE  EUROPEAN  WAR  499 

In  their  deliruim,  these  men  lived  over  again  the  batth's  they 
had  fought,  went  over  the  top,  kilk'd  the  enemy  or  fell  back 
woniided  on  the  tield,  all  of  which  was  nerve-racking  to  the  most 
experienced  of  nurses." 

By  October  of  1918,  the  bed  capacity  of  Savenay  Hospital 
(\Miter  had  reached  14,000  and  even  this  number  proved  in- 
adequate to  cope  with  the  influenza  epidemic.  Miss  Patmore 
wrote : 

"■Flu''  first  broke  out  in  the  prison  camp  at  Savenay  where 
over  eighteen  luindred  (lorman  and  Austrian  prisoners  were 
stoekadeci.  The  very  sick  ones  Avere  brought  into  our  medical 
wards.  Caring  for  those  poor  souls  was  one  of  our  tragic 
experiences  of  service.  With  raging  fever,  glaring  eyes  and 
purple  faces,  in  their  delirium  they  too  w'cre  back  again  in 
"No  Plan's  Land"  or  on  furlough  going  home. 

On  October  i),  1918,  we  received  a  large  convoy  of  our  own 
boys  from  the  boats  at  St.  Nazaire.  They  had  been  exposed 
to  the  contagion  at  camps  in  the  United  States  and  were 
stricken  on  sliip-l)oard.  Many  of  their  comrades  had  died 
and  had  been  buried  at  sea. 

The  ISTew  York  Hospital  Unit,  Base  Hospital  'No.  9,  had 
sailed  on  the  Finland  with  Base  Hospital  Xo.  8.  This  unit 
was  assigned  on  September  7  to  Chateauroux,  Indre.  which  lay 
midway  between  Bordeaux  and  Paris.  The  French  Govern- 
ment turned  over  to  the  American  Expeditionary  Forces  new 
concrete  buildings  erected  in  1914  as  an  asylum  for  the  insane. 
Base  Hospital  Xo.  i>  immediately  set  up  an  excellently  equipped 
hospital  of  five  hundred  beds. 

As  with  all  the  American  bases,  Base  Hospital  Xo.  9  soon 
trebled  its  original  capacity.  ]\Iary  Vroom,  one  time  superin- 
tendent of  the  Greenwich  Hospital  Association,  Greenwich, 
Connecticut.  w\is  chief  nurse  of  the  New  York  Hospital  Unit 
and  she. wrote  that  "immediately  after  the  arrival  of  the  United 
States  Engineers,  barracks  sprang  up  like  mushrooms."  When 
she  was  "makino  rounds"  one  morning  at  nine  o'clock,  slu>  saw 
some  tindnu's  and  planking  lying  in  a  vacant  space  between  two 
other  buildings.  By  eight  o'clock  that  night,  a  new  barracks 
had  been  completed,  the  wards  furnished  and  lifty-four  beds 
neatly  made  with  white  sluH'ts  and  blankets  folded  back,  JJeforc 
morning  every  bed  was  tilled. 

Ouriug  1!»1S,  (^liateauroux  became  an  orthopedic  cent(U'  and 
the  lirst  Keconstruction  aides  assi«i*ncd  to  foreiy;n  service  demon- 


500  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

strated  there  the  value  of  occupational  therapy  as  an  aid  to  rapid 
convalescence. 

The  next  American  base  hospital  unit  to  go  overseas  was  No. 
27,  which  had  been  organized  by  the  University  of  Pittsburg 
^ledical  School,  Blanche  S.  Rulon  was  chief  nurse.  Miss 
Rulon  was  a  graduate  of  the  Women's  Hospital  of  Philadelphia 
and  since  1013  had  been  superintendent  of  the  Eye  and  Ear 
Hospital,  Pittsburgh.  The  nurses  of  Base  Hospital  No.  27 
came  from  six  hospitals  in  the  same  city. 

Base  Hospital  No.  27  sailed  from  New  York  on  September 
27,  after  a  delay  at  Ellis  Island  of  five  weeks.  The  early  ex- 
periences of  the  group  of  nurses  connected  with  this  unit  illus- 
trated the  entirely  unforeseen  kind  of  ability  which  Army  chief 
nurses  had  to  develop  during  the  European  War.  When  the 
unit  arrived  in  Liverpool,  the  officers  and  men  were  separated 
from  the  group  and  the  nurses  were  left  to  proceed  to  their 
destination  alone.  Without  the  help  of  any  officer  belonging 
to  their  formation  and  without  any  preliminary  instructions  or 
arrangements,  the  chief  nurse  saw  to  it  that  the  members  of 
her  group  with  all  their  baggage  were  conducted  in  Liverpool 
from  the  hotel  to  the  station,  then  later  across  London  and  aboard 
a  train,  for  Southampton,  in  spite  of  the  fact  that  the  station 
master  had  told  her  that  this  could  not  possibly  be  done.  After 
an  unheralded  and  unprepared-for  arrival  at  Southampton,  she 
got  them  on  to  a  transport  and  across  the  Channel,  although 
they  had  to  spend  the  night  in  chairs  in  the  corridors  or  two  in  a 
berth  on  the  lower  decks.  After  five  days  at  Le  Havre,  the  men 
of  the  unit  arrived  and  the  whole  organization  was  put  aboard 
a  special  train  which  took  them  to  Angers  where  they  arrived 
without  the  loss  of  a  single  nurse  or  of  a  single  piece  of  luggage. 
Only  those  who  have  been  through  similar  experiences  will 
understand  how  this  feat  was  accomplished,  without  authority, 
without  large  sums  of  money  and  without  knowledge  of  the 
French  language. 

The  Pittsburg  ]\Iedical  School  I^nit  set  up  permanent  quar- 
ters in  the  !Mongazon,  in  Angers,  in  buildings  which  had  for- 
merly housed  a  seminary  and  in  American-made  barracks  huts 
which  were  erected  aliont  the  beautiful  older  structures.  Base 
Hospital  No.  27  held  the  record  of  being  one  of  the  most  satis- 
factorily 0(111  i])i)('(l  American  Ai'iny  hospitals  in  France  and  of 
caring  for  the  largest  niiml)(n-  of  patients  in  any  one  single 
dav  in  anv  of  the  AnuM'ican  bases.     The  first  nurses  to  be  sent 


THE  EUROPEAN  WAR  601 

for  duty  on  a  hospital  train,  Helen  Burrey,  Grace  O'Donnell 
and  Edna  Cooper,  were  members  of  Base  Hospital  No.  27. 

Vittel,  a  little  town  of  the  Vosges,  thirty  miles  behind  the 
line  and  forty-five  miles  from  the  German  frontier,  was  the 
destination  of  United  States  Army  Base  Hospital  No,  36, 
organized  within  the  Detroit  College  of  Medicine  and  mobilized 
into  active  service  in  September,  1917.  Dr.  Burt  E.  Shurley 
was  director  and  Mrs.  Betsey  Long  Harris  was  chief  nurse 
of  this  unit.  A  Xew  Englander  by  birth  and  ancestry,  Mrs. 
Harris  was  graduated  from  the  New  York  Infirmary  for  Women 
and  Children.  She  was  for  some  years  superintendent  of 
nurses  of  the  Episcopal  Hospital  at  Brooklyn,  New  York.  At 
the  completion  of  post-graduate  work  in  Teachers  College,  she 
served  as  an  instructor  in  Harper  Hospital  and  in  1914  became 
superintendent  of  the  Children's  Eree  Hospital  in  Detroit. 
She  resigned  from  this  position  to  go  with  her  unit  for  active 
service  in  Erance. 

The  personnel  of  Base  Hospital  No.  36  mobilized  in  Detroit 
on  September  6  and  sailed  from  New  York  seven  weeks  later  on 
the  S.  S.  Orduna  for  Halifax,  where  they  joined  a  convoy  of 
seven  other  ships.  They  arrived  at  Vittel  on  November  18  and 
spent  the  first  three  weeks  in  putting  five  large  summer  hotels 
of  this  resort  in  shape  to  receive  patients.  ''With  no  stoves  and 
little  fuel  to  burn  in  the  few  tiny  fire-places,"  wrote  Mrs.  Harris, 
"it  was  a  bleak  time  for  all  of  us." 

A  glimpse  of  the  manner  in  which  the  rigid  climate  affected 
the  raw  American  troops  who  w-ere  in  training  nearby  was 
given  in  the  diary  of  one  of  the  nurses  of  Base  Hospital  No.  36. 
Twelve  of  the  unit  had  been  sent  to  Vaucouleurs  on  December  1, 
1917,  for  service  with  the  42nd  Division,  and  one  of  them, 
J  ennie  A.  Abramson,  wrote ; 

December  2  :  Major  Fairchild  took  us  through  the  hospi- 
tal, situated  in  two  portable  buildings  and  in  an  old  chateau 
built  in  155"^.  We  found  aljout  seventy-live  cases  of  niunins 
and  measles  in  the  loft  of  the  barn.  The  French  cots  were 
very  close  together  and  the  air  was  foul.  A  smoking  stuve 
added  to  the  closeness  but  the  boys  said  they  didn't  mind  the 
smoke  as  nuich  as  the  cold. 

Decend)er  S :  A\'o  sent  seventy-five  cases  of  nnimps  and 
measles  to  \'ittel  today.  In  this  raw  climate,  our  soldiers, 
esjieciallv  those  from  the  southern  states,  seem  to  develop  very 
easily  anything  from  whooi)iii^'  cuu;ili  to  pneumonia. 


602  HISTORY  OF  AIVIERICAN  RED  CROSS  NURSING 

By  the  end  of  November,  1917,  the  eight  American  bases 
located  at  Bazoilles,  Chaumont,  Bordeaux,  Dijon,  Savenay, 
Chateauroux,  Angers  and  Vittel,  and  the  Yale  Mobile  Unit  at 
Limoges,  comprised  the  only  American  Army  hospitals  with 
the  United  States  Armies  in  France.  The  nursing  staffs  of 
these  nine  units  then  numbered  approximately  sixty-five  nurses 
each,  these  six  hundred  women  thus  comprising  the  entire 
nursing  strength  of  the  American  Expeditionary  Forces  in 
France. 

The  nursing  personnel  of  the  six  Red  Cross  base  hospitals 
assigned  to  the  British  Expeditionary  Forces,  reenforced  by 
numerous  hospital  units,  also  numbered  about  six  hundred 
nurses. 

The  chief  nurses  of  these  early  units  had  had  little,  if  any, 
experience  in  Army  administration  before  assignment  to  active 
duty.  The  mobilization  station  for  nurses  at  Ellis  Island  had 
not  been  established  when  the  six  base  hospitals  embarked  in 
May,  1917,  for  service  with  the  British  Expeditionary  Forces, 
and  Miss  Mury  had  little  opportunity  in  the  crowded  summer 
of  1917  to  instruct  in  Army  paper  work  the  chief  nurses  of  the 
nine  units  assigned  to  the  xVmerican  forces.  Each  chief  nurse 
was  responsible  to  ]\liss  Thompson  in  Washington  for  the  con- 
duct and  discipline  of  her  unit,  but  the  standards  of  one  chief 
nurse  differed  from  those  of  another  chief  nurse  and,  moreover, 
Washington  was  separated  by  zealous  censors  and  many  miles 
of  ocean  from  nurses  on  active  duty  in  France. 

During  the  summer  of  1917,  the  office  of  the  Chief  Surgeon, 
American  Expeditionary  Forces,  was  located  in  Paris.  On 
September  1,  it  was  moved  to  Chaumont  and  all  the  records  of 
the  American  Army  nurses  then  in  France  were  kept  there. 
No  nurses  served",  however,  on  the  Chief  Surgeon's  staff".  As 
the  winter  of  1917  approached,  the  twelve  hundred  American 
Army  nurses  in  France  needed  new  and  warmer  articles  of 
clothing  and  of  equipment.  Ivcquests  for  transfers  from  one 
base  to  another  and  from  the  zone  of  the  base  to  that  of  the 
advance,  came  to  the  Chief  Surgc'on's  office  and  made  neces- 
sary the  keeping  of  various  new  records  and  accounts.  ]\[ore- 
over,  disciplinary  problems  regarding  the  conduct  of  nurses, 
])oth  on  and  otl"  duty,  constantly  arose  and  a  need  was  felt  for 
an  authoritative  re])resentative  of  the  Army  Nurse  Corps  in 
France  to  whom  cliief  iind  stall"  nurs(\s  of  Ameri<*an  l);ise  hos- 
pitals might  turn  for  decisions  u})on  these  (piestions. 


THE  EUROPEAN  WAR  503 

On  N'ovember  13,  1917,  Bessie  S.  Bell,  who  had  formerly 
been  cliief  nnrse  of  Walter  Kecd  Hospital,  Washing;ton,  D.  C, 
arrived  in  France  on  orders  from  the  Surgeon  General  to  act 
as  Cliief  Nnrse  of  the  American  Expeditionary  Forces.  Anna 
E.  Coifey,  Army  Nnrse  Corps,  accompanied  her  as  her  assist- 
ant, ^liss  Bell's  office  was  placed  in  the  Bnrean  of  Personnel, 
of  which  Colonel  E.  jM.  Welles,  Jr.,  was  in  command,  and  she 
and  her  assistant  handled  all  nursing  matters.  The  office  of 
the  Chief  Surgeon  was  moved  in  January,  1918,  to  Tours  and 
the  headquarters  of  the  Army  Nurse  Corps  in  France  was 
established  there.^^ 

Between  December,  1917,  and  the  launching  of  the  German 
offensive  on  March  20,  1918,  less  than  nine  hundred  additional 
nurses  were  sent  overseas.  j\Iany  of  these  were  members  of 
Bed  Cross  hospital  units  which  were  assigned  to  re("'nt'orce  the 
staffs  of  already-established  base  hospitals.  Others  were 
"casuals"  who  were  assigiied  to  fill  various  vacancies  caused 
by  transfers,  illness  and  death  among  the  original  staffs  of  base 
hospitals  then  on  duty  with  the  American  and  the  British 
Expeditionary  Forces,  or  to  duty  in  new  base  hospitals  and 
other  sanitary  formations  organized  by  the  Surgeon  General 
without  the  assistance  of  the  American  Bed  Cross.  During 
this  period,  Bed  Cross  archives  record  the  arrival  in  France  of 
four  additional  base  hospitals  from  among  the  fifty  original 
cohnnns  which  the  Bed  Cross  had  undertaken  to  organize  for 
the  Surgeon  (Jeneral's  office. 

The  tenth  American  Bed  Cross  base  hospital  to  arrive  in 
France  was  the  Buff"alo  Unit,  United  States  Army  Base  Hos- 
pital No.  23,  which  had  been  organized  from  the  alumiuie  and 
staff's  of  various  registered  hospitals  in  Buffalo,  New  York. 
The  personnel  embarked  November  22,  1017,  from  New  York 
and  upon  their  arrival  in  France,  were  assigned  to  duty  near 
Base  Hospital  No.  -SC),  in  the  rapidly-developing  hospital  center 
at  Vittel.  Lawrie  L.  Phillips,  a  graduate  of  the  Buffalo  Gen- 
eral Ilos])ital,  was  chief  nurse.  During  the  summer  of  li)18. 
Base  Hospital  No.  2."3  was  expanded  to  a  bed  capacity  of  28(U) 
and  it  operated  as  an  evacuation  hospital  during  the  St.  Miliiel 
drive. 

Contrexeville,  a  well-known  French  water ing-placo  in  tlie 
Vosges,  served  also  as  an  American  hospital  center  during  the 

■■-'Sec  '"nistoty   (if  tlic   Niirsiiiix   Activities  on  the   U'estern    Front    durii^t: 
War    IV'ridd,"   Julia   C   Siiinsiui,   p.   lU. 


504   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

European  War.  United  States  Army  Base  Hospital  No.  32 
arrived  there  on  Christmas  Eve,  1917.  This  unit  had  been 
organized  at  the  Indianapolis  City  Hospital,  Indianapolis, 
Indiana.  Florence  J.  Martin,  a  graduate  of  the  Pennsylvania 
Hospital,  Philadelphia,  was  chief  nurse. 

Contrexeville  possessed  famous  mineral  springs ;  it  owed  its 
reputation  especially  to  the  Pavilion  Spring,  the  waters  of 
which  had  been  prescribed  for  King  Stanislas  of  Lorraine.  It 
was  a  favorite  place  for  soldiers  on  leave  and  Miss  Martin 
wrote  that  during  the  summer  of  1918  the  town  "was  thronged 
with  French  infantrymen  in  horizon  blue,  chasseurs  in  dark 
blue  tarn  o'  shanters  with  gold  bugles  embroidered  upon  them, 
Algerians  with  scarlet  fezzes  and  gold  crescents,  Czecho-Slo- 
vaks,  British  Tommies  and  Scotch  kilties,  Italians,  Chinese, 
Hindoos  and  an  Egyptian  or  two,  to  say  nothing  of  the  men  in 
green  with  P.  W.  stamped  on  their  backs,  who  marched  to  and 
from  their  work  with  an  armed  doughboy  following  them." 

Contrexeville  was  splendidly  equipped  from  a  sanitary  stand- 
point, in  distinct  contrast  to  the  meager  provision  at  some  of 
the  other  American  bases.     Miss  Martin  wrote : 

At  our  enormous  bath-house,  with  its  hundreds  of  tubs 
rented  by  the  Eed  Cross,  dazed-looking,  slightly-wounded 
doughboys  lined  up  in  the  colonnade  on  dozens  of  benches 
waiting  their  turn  for  the  warm,  refreshing  water.  Here, 
where  formerly  only  kings  and  the  wealthy  people  of  the  earth 
bathed,  any  doughboy  who  could  walk  or  limp  enjoyed  the 
bath  to  its  fullest  extent. 

On  the  American  line  of  communications  almost  midway 
between  Dijon  and  Bordeaux  lay  the  city  of  Limoges,  the  des- 
tination of  the  United  States  Army  Base  Hospital  No.  24,  of 
Tulanc  University,  New  Orleans,  Louisiana.  This  unit  took 
over  on  March  18,  1918,  the  buildings  occupied  since  Septem- 
ber, 1917,  by  Base  Hospital  No.  39,  the  name  by  which  the 
Yale  Mobile  Unit  was  known  until  it  was  sent  in  the  spring  of 
1918  to  the  forward  area  when  it  became  Mobile  Hospital 
No.  39. 

Ethel  A.  Holmes  (Johns  Hopkins)  was  chief  nurse  of  Base 
Hospital  No.  24.  The  nursing  staff  was  composed  of  graduates 
from  twenty-six  training  schools  located  in  all  parts  of  the 
south. 


THE  EUROPEAN  WAR  505 

Belleviie  Hospital,  New  York  City,  had  been  the  first  insti- 
tution to  complete  the  organization  of  its  nursing  staif  and  had 
been  given  the  designation  of  Base  Hospital  No.  1,  but  this 
unit,  made  up  of  personnel  of  the  big  municipal  hospital,  did 
not  arrive  in  France  until  March,  1918.  They  were  assigned 
to  the  city  of  Vichy,  in  the  Department  of  Cantal,  destined  to 
become  one  of  the  principal  hospital  centers  of  the  American 
Expeditionary  Forces,  Beatrice  Bamber,  chief  nurse  of  Base 
Hospital  No.  1,  wrote  of  the  arrival  of  the  unit: 

We  reached  Vichy  about  midnight  of  March  12,  the  pio- 
neers of  the  subsequent  American  invasion  of  this  ancient 
city.  Quarters  and  wards  were  immediately  established  in 
the  larger  hotels.  Until  the  arrival  of  Base  Hospital  Xo.  19 
[Rochester,  X.  Y.]  in  June,  1918,  we  maintained  alone  a  hos- 
pital of  six  thousand  beds.  The  University  of  California 
Unit  established  in  May  their  base  in  the  Ilotel  Eoyal  and 
in  August,  the  New  York  Eye  and  Ear  Hospital  took  over 
the  Eubl  Hotel  as  Base  Hospital  Xo.  115. 

Previous  to  March,  1918,  the  American  Expeditionary 
Forces  had  taken  little  part  in  active  hostilities  on  the  Western 
Front.  The  War  Department,  it  will  be  remembered,  had  been 
occupied  chiefly  in  the  training  and  transportation  of  troops 
and  the  shipment  of  supplies.  Combat  troops  and  supplies,  it 
will  also  be  remembered,  were  given  right  of  way  over  medical 
personnel,  consequently  an  acute  shortage  of  nurses  existed 
in  tlie  American  Expeditionary  Forces.  Previous  to  March, 
1918,  the  movement  of  American  troops  had  been  compara- 
tively slow,  but  the  Army  planned  during  the  early  summer  to 
land  an  army  of  over  two  million  soldiers  on  Allied  soil  and 
did  send  during  the  last  six  months  of  hostilities  over  a  million 
and  a  half  soldiers  to  France.  Swift  and  substantial  increase 
in  the  medical  and  nursing  personnel  during  the  spring  and 
suninu^r  of  1918  was  paramount,  if  this  contemplated  army  of 
two  million  men  was  to  have  adequate  medical  and  nursing 
care. 

In  her  report  as  director  of  the  Nursing  Service  of  the 
American  Expeditionary  Forces,  ]\Iiss  Stimson  stated  that  on 
March  .'!(),  11)18,  there  were  2088  nurses  in  France,  of  whom 
approximately  7(H)  were  on  duty  with  the  British  Expc^dition- 
arv  Forces.  According  to  (\)lonel  Ayres'  olHcial  summary, 
tiiere  were  on  ]\Iart'h  oO,  1918,  about  2."}l,-'>57  American  soldiers 


506    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  France.^^  The  ratio  of  nurses  to  soldier  was  thus  110.8.  In 
accordance  with  the  estimate  agreed  upon  in  July,  1917,  by 
General  Headquarters,  that  the  sanitary  personnel  of  the  Army 
should  constitute  7.65  per  cent  of  the  total  strength  of  the 
forces,  it  is  evident  that  a  considerable  shortage  of  nurses 
existed  during  the  spring  of  1918.  In  her  report,  Miss  Stimson 
fixed  this  shortage  at  lOO  nurses.^" 

By  the  middle  of  xipril,  approximately  300,000  American 
soldiers  had  been  landed  in  France  and  the  shortage  of  nurses 
was  then  estimated  at  1121.^'  ''About  this  time,"  wrote  Miss 
Stimson,  "the  statement  was  made  that  'a  breakdown  in  medi- 
cal service  was  threatened'  and  on  May  3  a  cable  was  sent 
asking  for  the  immediate  dispatch  of  555  nurses." 

This  was  the  request,  it  will  be  recalled,  which  stripped  the 
cantonments  bare  of  nurses  in  May,  1918.  It  resulted  in  the 
immediate  dispatch  of  many  base  hospitals,  the  nursing  staffs 
of  which  had  been  scattered  among  the  cantonments. 

Among  these  units  was  United  States  Army  Base  Hospital 
Xo.  20,  organized  at  the  University  of  Pennsylvania.  The 
nurses  of  this  Red  Cross  column  had  been  stationed  during  the 
winter  of  1917  in  various  cantonments;  the  chief  nurse,  Edith 
B.  Irwin,  had  been  assigned  to  Camp  Taylor.  The  entire 
personnel  of  Base  Hospital  Xo.  20  was  mobilized  on  Febru- 
ary 18,  1918,  at  Ellis  Island.  Great  was  the  disappointment 
of  the  nurses  to  learn  that,  instead  of  sailing  at  once,  they  were 
detailed  to  take  over  the  Immigration  Hospital  in  New  York 
Harbor.  However,  overseas  orders  finally  came  on  April  20 
and  Base  Hospital  No.  20  sailed  four  days  later  on  the 
Leviathan  for  Brest.  Upon  the  arrival  of  the  unit  in  France, 
they  entrained  for  Chatclguyon,  in  the  south-central  part  of 
the  country.     Miss  Irwin  wrote  of  the  travel  conditions: 

There  were  six  nurses  in  oarli  compartment.  At  night  we 
put  our  suitcases  in  the  center  and  slept  crosswise.  Tliere  was 
no  water  on  the  train  and  two  or  three  times  a  day  we  would 
stop,  sometimes  long  enougli  for  us  to  wash  up  a  bit.  On  tlie 
second  day  of  the  trip,  the  train  stopped  at  a  place  where  one 
hydrant  and  several  tul)s  of  water  had  l)een  prejxired  for  us. 
Armed  with  soap,  towels  and  tooth-bruslies.  everybody  got 
off.  The  men  sliaved  and  the  girls  combed;  it  really  was  a 
very  funiiy  sight. 

'"■'The  War   witli   CcrmaiiN  .■'   p.   37. 

^'"History  (if  Xursiiij:  Activities  on  the  Western   Front  durinfr  tlie  War 
Period,"  Julia  C.  Stimson.  p.  7. 


THE  EUROPEAN  WAR  507 

Chatolfniyon  was  a  famous  health  resort ;  its  thirty-three 
mineral  springs,  which  yielded  daily  one  million,  two  hundred 
thousand  gallons  of  water  varying  from  seventy  to  one  hundred 
degrees  I''alirenlieit,  had  made  it  a  center  for  invalids  and  tour- 
ists from  all  parts  of  the  world.  Upon  the  arrival  there  of  the 
University  of  Pennsylvania  Unit,  Base  Hospital  Xo.  20,  it 
was  estahlished  in  thirty-two  buildings,  largely  summer  hotels 
and  jx'nsions.  The  Iloicl  du  Pare,  with  a  bed  capacity  of  three 
hundred  and  seventy-five,  was  selected  as  the  chief  surgical 
building.  Less  serious  non-ambulatory  cases  were  established 
in  the  Hotels  Splendid,  Nouvel  and  Recjence,  because  of  favor- 
able mess  facilities.  Ambulatory,  slightly  wounded  and  con- 
valescing patients  were  (quartered  in  the  Hotels  Castel-Ileyina, 
Castcl-Uuy,  l)e  France,  Elizabeth,  lion  Accueil,  Medeah  and 
Thermes.  ^Medical  patients  were  first  cared  for  in  wards  of  the 
Hotel  du  Pare;  later  the  two  Thermalias,  the  Front  Hermitage, 
the  Bniijl'res,  the  Clirysantliemes,  and  wards  of  the  Splendid, 
Nouvel  and  Recjence  Hotels  were  used  for  medical  patients.  The 
nursing  staff  was  permanently  quartered  in  the  Hotel  I^iterna- 
tional,  the  officers  in  the  Hotel  des  Princes  and  the  enlisted  men 
in  the  Villas  Florence,  Trianon  and  Palais  Royal. 

In  spite  of  their  pretentious  names,  these  summer  hotels  had 
meager  heating,  lighting  find  plumbing  facilities  and  limited 
e(pnpment.  Tt  required  herculean  labors  on  the  part  of  the 
personnel  of  Base  Hospital  Xo.  20  to  clean  and  equip  them  as 
a  base  hospital.  Seven  hundred  thousand  feet,  more  or  less, 
of  floors,  walls  and  ceilings  of  quarters  previously  occupied  by 
eight  hundred  sick  Algerian  soldiers  were  cleaned  by  the  en- 
listed personnel  of  the  Buffalo  Unit  and  ''after  the  men  had 
cleaned  the  premises  to  suit  the  male  mind,  the  nurses  literally 
got  down  on  tlieir  hands  and  knees  and  with  rag  and  brush, 
broom  and  mop,  recleaned  these  floors,  walls,  wood-work  and 
ceiling."  ^^ 

Here  as  in  other  American  sanitary  centers  in  France,  the 
acute  shortage  of  nurses  greatly  overtaxed  the  endurance  of 
tli(^  nursing  staff".  'AVe  never  had  more  than  the  original  sixty- 
fiv(>  nurses,"  wrote  Miss  Irwin,  "and  at  no  time  aftc^r  the  orga- 
nization of  the  hospital  did  we  have  even  that  number.  When 
we  wvvv  busiest  with  twenty-two  hundred  and  seventy  patients, 
w(>  had  only  forty-nine  nurses  on  duty."     Xo  "casual"  nurses 

■^■' ■•Ilistdiv   (if   r.    S.   Annv    liasc   Hospital    No.   20."   p.   37;    K.   A.    V.'riglit 
{"nm])aiiy.   I'liiladelpliia.   I'a.',   1P20. 


508   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

were  assigned  to  Base  Hospital  ITo.  20.  The  original  number 
did  all  the  nursing  at  No.  20,  staffed  Camp  Hospital  No.  44 
and  furnished  nurses  for  various  medical  and  surgical  teams  at 
the  front. 

United  States  Army  Base  Hospital  No.  46,  organized  at  the 
University  of  Oregon,  Portland,  Oregon,  embarked  for  France 
in  June,  1918.  Grace  Phelps,  chief  nurse,  and  the  other 
members  of  the  nursing  staff  had  seen  service  in  cantonments 
in  the  United  States.  Upon  its  arrival  in  France  Base  Hospital 
No.  46  was  assigned  to  supplement  the  bed  capacity  of  Bazoilles 
Hospital  Center.  From  the  little  peasant  village  which  the 
Johns  Hopkins  Unit  had  found  upon  their  arrival  there  in 
July,  1917,  Bazoilles  had  developed  by  July,  1918,  into  one  of 
the  most  important  sanitary  outposts  of  the  Medical  Corps. 
Eleanor  Donaldson,  a  member  of  Base  Hospital  No.  46,  wrote 
of  the  line  of  communications  which  passed  below  the  nurses' 
recreation  house  at  Bazoilles : 

One  of  our  doorways  faced  a  panorama  of  wood  crowned 
hills,  a  river  and  three  of  the  great  roads  in  France.  One 
road  was  tree-bordered,  a  silver  line  where  trucks  and  motors 
passed  up  and  down  endlessly.  The  second  was  the  railroad 
on  which  our  boys  went  to  the  battlefields,  singing,  waving 
and  cheering,  and  on  which  they  returned  to  us  silent,  broken 
but  undaunted.  There  was  a  special  train  known  as  "old  5G'' 
and  when  it  was  missing  from  the  tracks,  we  knew  the  errand 
on  which  it  had  gone  and  anxiously  watched  for  its  return. 
It  used  to  come  around  the  hills  so  slowly  that  one  could 
scarcely  see  it  move,  or  be  sure  it  halted  until  the  three  short 
whistles  that  meant  "convoy  in !"  called  us  to  our  posts  in 
the  wards.  The  third  road  ran  just  a  few  yards  from  our 
tent  door,  with  the  river  beyond,  the  last  road  of  all  for  the 
boys  we  left  in  France.  It  was  a  short  road,  ending  in  a  plot 
at  the  foot  of  the  hill  where  the  sunset  light  touched  the  white 
crosses,  row  on  row. 

United  States  Army  Base  Hospital  No.  13  arrived  in  France 
in  June,  1918,  and  was  assigned  to  Limoges  to  raise  the  bed 
capacity  of  that  center.  This  unit  had  been  organized  from 
the  staff  and  alumna^  of  the  Presbyterian  and  Cook  County 
Hospitals.  Chicago,  Illinois.  ]\Iabel  K.  Adams,  chief  nurse, 
had  already  served  in  the  European  War  with  Dr.  J.  B. 
]\lurphy's  Unit  which  was  attached  in  101  .">  to  No.  23  General 
Hospital,  British  Expeditionary  Forces,  l^]taples,  France.     The 


THE  EUROPEAN  WAR  609 

other  inirsos  of  Base  Hospital  ]^o.  13  had  seen  duty  at  Camp 
Dodge,  Iowa,  and  Camp  Pike,  Arkansas,  before  their  mobiliza- 
tion for  foreign  service. 

Base  Hospital  No.  13  set  up  a  hospital  in  the  Champs  de 
Juillet,  Limoges,  and  immediately  received  patients  who  had 
been  wonnded  in  the  German  offensive  of  June,  1918,  upon 
Paris.     Miss  Adams  wrote: 

In  the  long,  low  receiving  ward,  rude  and  bare,  they  were 
lifted  from  the  floor  onto  the  tables  and  their  history  was 
taken.    "Kind  of  a  rough  ride,  eh,  Buddie?" 

Next  came  the  "up  cases,"  with  their  uniforms  torn  and 
caked  with  mud,  their  faces  haggard  and  worn.  Some  of 
them  still  clutched  a  few  precious  souvenirs  tied  in  a  hand- 
kerchief or  in  an  old  rag.  Many  were  so  exhausted  that  they 
slept  while  they  waited  in  line  to  be  registered. 

Finally  the  last  ambulance  was  unloaded,  the  last  patient 
entered,  the  night  supervisor  had  gone  to  the  wards  to  help, 
the  day  nurses  had  turned  the  work  over  to  the  night  shift, 
the  secretaries,  tired  and  stiff,  left  their  typewriters  and  the 
officer  of  the  day  had  started  his  night  rounds.  With  a  dis- 
tant rumble  and  a  final  honk,  the  trucks  and  ambulances 
were  througli  for  the  night  and  the  drivers  and  stretcher  bear- 
ers crawled  into  their  wooden  bunks.  The  early  morning 
hours  found  the  camp  very  quiet,  with  only  the  guards  trudg- 
ing back  and  forth  on  their  lonely  posts. 

The  rapidity  with  which  combat  troops  w^cre  sent  overseas 
in  June,  1018,  has  been  described  in  a  previous  chapter.  Large 
numbers  of  medical  and  nursing  personnel  accompanied  these 
troops.  On  the  Baltic  which  sailed  June  4  were  Base  Hospitals 
l>[os.  19,  22  and  20,  comprising  three  hundred  nurses.  The 
convoy  of  nine  vessels,  of  which  the  Baltimore  was  one,  with 
destroyers,  aeroplanes,  hydroplanes  and  submarine  chasers,  car- 
ried thirty  thousand  men  and  twelve  hundred  officers  for  the 
American  Expeditionary  Forces. 

Base  Hospital  Xo.  10  (Rochester  Homeopathic  Unit)  re- 
ported at  Vichy.  Base  Hospitals  Xos.  115  and  110  which 
sailed  later  in  June,  were  also  assigned  to  Vichy.  Base  Hos- 
pital Xo.  28  (  i\ansas  City)  sailed  during  the  last  weeks  in 
,Iune  and  was  assigned  to  duty  at  Limoges. 

July  15,  1018,  saw  the  failure  of  the  last  German  offensive 
on  Paris.  'J'he  (Mioniy  had  attacked  simultaneously  on  both 
sid(>s  of  Ivheinis  but  his  path  was  everywhere  blocked  by  the 


510   HISTORY  or  AMERICAN  RED  CROSS  NURSING 

French  and  American  armies.  Three  days  later,  July  18, 
Marshal  Foch  seized  the  initiative  which  passed  from  General 
Lndcndorif  and  launched  the  great  Allied  offensive,  which  was 
destined  to  break  the  Hindenburg  Line  and  result  in  the  final 
collapse  of  the  German  Army. 

Eighty-five  thousand  American  troops  of  the  Forty-second, 
the  Third  and  the  Twenty-eighth  Divisions  had  been  engaged  in 
the  battle  of  July  15  which  checked  the  German  advance  across 
the  Marne.  In  the  counter-offensive  of  July  18,  the  First, 
Second,  Third,  Fourth,  Tw^enty-sixth,  Twenty-eighth,  Thirty- 
second  and  Forty-second  Divisions,  together  with  selected 
French  troops,  went  into  action. 

At  the  beginning  of  the  Allied  offensive,  July  18,  1918,  the 
Medical  Corps,  American  Expeditionary  Forces,  was  main- 
taining forty-five  base  hospitals  in  France  and  England.  Thirty- 
nine  of  these  were  units  which  had  been  organized  and  equipped 
by  the  American  Red  Cross. 

]\liss  Stimson  summarized  the  nursing  needs  of  the  American 
Expeditionary  Forces  in  France  at  this  crucial  time:  "On 
July  27,  reports  stated  that  'the  recent  fighting  has  been  so 
severe  that  the  resources  of  the  Medical  Division  have  been 
practically  exhausted  in  so  far  as  personnel  is  concerned."  On 
August  10,  General  Headquarters,  A.  E.  F.,  sent  a  cable  which 
requested  absolute  priority  for  medical  organizations,  including 
2312  nurscs.3» 

This  shortage  had  been  foreseen  by  the  Surgeon  General's 
office  and  General  Gorgas  had  issued  an  order  on  August  1, 
1918,  that  one  thousand  nurses  should  be  sent  overseas  each 
week  for  a  period  of  eight  weeks.  The  Surgeon  General  re- 
quested the  American  Red  Cross  to  prepare  to  equip  these 
nurses  as  they  came  down  to  New  York  for  embarkation.  ^More- 
over,  he  called  upon  the  Nursing  Service,  as  the  reserve  of  the 
Army  Nurse  Corps,  to  enroll  one  thousand  nurses  a  week  for 
the  same  period  of  eight  weeks  to  fill  the  vacancies  which  would 
be  caused  in  the  cantonments  by  the  withdrawal  of  nurses  for 
foreign  service. 

By  the  early  summer  of  1918,  th(>  ^lodical  Corps  liad  finished 
the  establishment  of  the  principal  sanitary  centers  of  the 
American  Fxpeditidiiarv  Forces  along  the  American  line  of 
communications.     l'li(>  additional  base  hospitals  which  arrived 

"'"History    of    Nursinp    Activities    on    tlic    Wcstoni    Front    diirinfj    War 
Period,"  Julia  C.  Stinisnn.   d.   S. 


THE  EUROPEAN  WAR  511 

in  France  between  June  and  Xovembcr  were  assigned  to  these 
already  established  centers  to  raise  the  bed  caj)aeity  of  the 
Medical  Corps  at  that  given  point.  The  new  units  did  not 
lose  their  identity  in  that  of  the  original  base  hospital  located 
there,  but  they  formed  instead  individual  units  of  a  group  of 
base  hospitals.  These  groups  were  designated  as  hospital 
centers. 

One  thousand  nurses  arrived  in  France  in  August.  Among 
these  was  the  staff  of  Base  Hospital  Xo.  14,  organized  from  St. 
Luke's  and  Michael  Keese  Hospitals,  Chicago,  which  reported 
August  16  at  the  hospital  center  at  Mars-sur-Allier,  to  re- 
lieve nurses  of  Base  Hospitals  Nos.  48  and  08,  then  detached 
from  their  own  units  at  ]\resves.  Base  Hospital  Xo. 
449  (University  of  iSTebraska),  which  had  sailed  August 
26,  was  ordered  also  to  ]\Iars-sur-x\.llier.  As  other  base 
hospitals  which  had  been  organized  by  the  Surgeon  Gen- 
eral's office  or  the  Ked  Cross  reported  for  duty  in  France  in 
August  and  September,  1918,  they  were  housed  in  wooden  bar- 
racks and  thus  developed  the  great  hospital  centers  of  the 
American  Expeditionary  Forces  at  AUerey,  Bazoillcs,  Beau 
Desert,  Mars,  Mesves,  Le  Mans,  Nantes,  Savenay,  Toul,  Vichy, 
Kerhuon,  Pan,  Connnercy,  Orleans,  Beaune,  Tours,  Vittel- 
Contrexeville,  Clermont-Ferrand,  Limoges,  Kimaucourt,  Lan- 
gres,  Vannes,  Angers,  Perigueux  and  the  hospital,  largely  con- 
valescent, of  the  liiviera  district. 

At  the  signing  of  the  Armistice,  the  Medical  Division  of  the 
American  Expeditionary  Forces  was  maintaining  one  hundred 
and  fifty-three  base  hospitals  in  France  and  the  nurses  on  active 
duty  in  these  formations  suffered  in  varying  desirees  from  in- 
convenience and  discomfort  caused  by  cold,  crowded  and  often 
meagerly  e(}ni])])e(l  (piarters.  A  difHcnlt  housing  ]n-ob]em  con- 
fronted the  C^hief  Surgeon  of  the  American  Expeditionary 
Forces.  Colonel  Sanford  H.  Wadhams,  representative  of  the 
c'hief  Surgeon's  office,  (Jroup  !>,  (J. 4,  on  the  General  Staff  of 
the  American  Expeditionary  Forces,  wrote: 

Buildings  acquirod  from  the  French  l)cf()re  it  was  iwssible 
to  coiistnict  hospitals,  comprised  French  hospitals  taken  over 
intact,  liotcls.  lijirrai  ks.  schools  and  e\en  stahh's.  Avaihd)ie 
l)uildings  ill  France  at  this  time  which  coidd  answer  tlie 
])ur]iose  of  proxiiliiii:  hospital  facilities  were  very  limited. 
The  French.  r)rili>li,  F.diiian  and  Italian  (io\('rniiients  had 
all  had   their  choice  and  there  wt're  also  a   lari:e  mmiher  of 


512   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospitals  maintained  by  volunteer  aid  societies  from  different 
parts  of  the  world.  Consequently  the  buildings  obtained  were 
generally  of  a  most  unsatisfactory  character,  very  expensive 
to  maintain,  difficult  to  administer  and  usually  required  an 
excessive  number  of  personnel  to  operate  them  properly.  Few 
school  buildings  had  running  Avater,  sewer  connections,  or 
toilet  facilities.  The  hotels  taken  over  were  largely  summer 
hotels,  without  heating  facilities  and  with  insufficient  water 
and  very  limited  plumbing. 

This  shortage  of  suitable  buildings  which  could  be  secured  for 
hospitalization  purposes  and  the  dearth  of  building  materials 
in  France  made  necessary  the  crowding  of  many  nurses  into 
limited  quarters.     Colonel  Wadhams'  report  continued : 

Soon  after  starting  their  construction  program,  the  Gen- 
eral Staff  faced  the  prospect  of  being  unable  to  have  trans- 
ported to  France,  or  to  obtain  there,  sufficient  building 
material  to  carry  on  the  many  construction  projects  con- 
fronting these  forces.  The  first  change  in  the  plans  prescribed 
by  General  Headquarters  was  to  reduce  the  space  in  the  living 
quarters  allowed  to  officers,  nurses  and  enlisted  men  (G.  0. 
4G,  1917,  A.E.F.).  The  Chief  Surgeon's  office  was  willing 
to  make  sacrifices  as  regards  officers  and  enlisted  men,  but 
strenuously  opposed,  without  success,  reducing  the  modest 
allowances  that  had  been  prescribed  for  the  nurses  in  these 
units. 

Despite  our  protestations  and  as  adopted,  the  order  pre- 
scribed that  our  nurses  sleep  in  double-tier  bunks,  with 
scarcely  sufficient  floor  space  to  get  around.  This  subjected 
these  wortby  women  to  considerable  hardship  that  seemed 
unwarranted.  This  inconsistent  attitude  on  the  part  of  the 
authorities  who  reviewed  our  plans  was  later  changed,  largely 
due  to  the  individual  effort  and  critical  reports  rendered  by 
the  Inspector  General  of  these  Forces.  As  amended,  the 
nurses  eventually  were  given  living  quarters  and  the  same 
allowance  as  was  prescribed  for  junior  officers. *° 

In  many  cases  the  cement  floors  of  the  barracks  were  con- 
stantly wet  and  trunks,  bags,  shoes  and  anything  left  on  the 
floor  mildewed  immediately.  Often  the  roof  and  walls  of  the 
barracks  let  in  wind  aiid  rain.  The  most  satisfactory  type 
of  building   was   the   regulation   brick   or  wood   barrack  with 

*"('..  ().  r)8,   litis,  A.  v.   v..  (■(,].  Uadliani'ri  Report,  p.  927,  Surgeon  Gen- 
eral's Oiliee,  U.  8.  A.,   Washington,  D.   C. 


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THE  EUROPEAN  WAR  513 

separate  entrance  for  every  four  rooms  and  with  indoor  toilet 
facilities  and  running  water.  A  stove  sufficiently  large  to  heat 
all  four  rooms  was  located  in  each  hallway.  Generally  not 
more  than  two  nurses  were  quartered  in  each  room.  **The  com- 
fort of  these  quarters,"  wrote  ^liss  Stimson,  "compared  to  the 
large,  hare,  cold  dormitories  in  French  huildings  which  had  to 
be  used  by  from  twenty  to  tifty  women,  which  had  no  con- 
veniences and  most  inadequate  toilet  and  washing  facilities, 
was  really  all  that  could  he  hoped  for  in  the  field." 

Kations  for  Army  nurses  were  the  same  as  those  allowed  for 
patients  and  were  on  the  whole  varied  and  ample.  Previous  to 
1917,  Congress  had  allowed  forty  cents  a  day  for  food  for 
patients  and  Army  nurses,  but  experience  proved  this  amount 
to  be  inadequate  in  view  of  the  greatly  increased  cost  of  sup- 
plies during  the  war  period.  The  Surgeon  General  accordingly 
asked  the  American  Ked  Cross  to  make  an  additional  daily 
provision  of  thirty-five  cents  for  each  patient  and  nurse,  bring- 
ing the  allowance  to  seventy-five  cents,  an  amount  conceded  to 
be  satisfactory,  until  Congressional  action  could  be  passed  affix- 
ing the  legal  allowance  at  seventy-five  cents.  The  Red  Cross 
appropriated  funds  for  this  purpose  until  May,  1918;  the 
amount  expended  for  food  for  patients  and  Army  nurses  was 
well  over  $185,000.  "Colonel  Ireland,"  recorded  the  Minutes 
of  a  meeting  of  the  Red  Cross  War  Council,  May  18,  1918, 
"stated  that  ample  provision  has  now  been  made  by  the  Govern- 
ment for  the  sick  in  hospitals  and  for  members  of  the  Army 
^urse  Corps." 

The  nu'thod  in  which  nurses'  meals  were  cooked  and  served 
depended  largely  upon  local  conditions.  Sometimes  nurses 
stood  up  in  the  "chow-lines"  with  their  mess-kits,  as  did  the 
doughboys.  Sometimes  they  messed  with  the  officers  of  their 
unit.  In  base,  evacuation  and  camp  hospitals,  the  staffs  of 
which  were  large  enough  to  make  such  an  arrangement  practica- 
ble, a  separate  nurses'  mess  was  considered  by  Miss  Stimson  to 
be  the  most  satisfactory  plan.  An  excellent  combination  was 
to  put  such  a  mess  under  the  direction  of  a  nurse  "whose  duty  it 
was  to  cooperate  with  the  regular  moss  officer  and  in  addition 
to  give  her  personal  attention  to  the  cooking  and  serving  of 
meals,"  and  to  employ  Army  cooks  to  cook  them  and  French 
women  to  serve  tlieni.^^ 

""•History   of  tlu>   Nursinji   Activities.  A.   E.   ¥..   on   the  Western   Front 
during  tJic  War   Period,"  Julia  C.   Stimson,   p.    13. 


614   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Perhaps  the  greatest  single  continued  discomfort  which 
nurses  experienced  on  active  service  with  the  American  Expe- 
ditionary Forces  was  the  doing  a  large  part  of  their  own  laun- 
dry work.  Some  hospitals  maintained  their  own  establish- 
ments ;  others  were  able  to  send  the  nurses'  laundry  to  com- 
mercial firms  in  nearby  towns.  But  in  the  large  proportion  of 
hospitals,  the  nurses  were  obliged  to  wash  their  uniforms  and 
other  articles  of  clothing  themselves,  because  there  appeared  to 
be  no  other  way  of  getting  it  done.  "Particularly  during  the 
times  when  the  actual  physical  strength  of  the  nurses  was  taxed 
to  the  very  utmost  in  their  care  of  the  patients,"  wrote  Miss 
Stimson,  "this  was  a  great  hardship."  A  nurse  wrote:  "Wash- 
ing clothes  at  night  after  nursing  all  day  wore  us  out." 

If  recreation  in  a  cantonment  hospital  in  the  United  States 
was  difficult  to  get,  it  was  well  nigh  impossible  at  an  isolated 
base  in  France.  Mud  and  sleet  made  walking  practically  out 
of  the  question  during  the  winter  months.  The  nurses'  quarters 
were  usually  so  crowded  that  the  nurses  found  little  relaxation 
there.  The  Red  Cross  soon  constructed  in  the  principal  base 
hospital  centers  recreation  huts  for  the  patients  and  the  li- 
braries in  these  huts,  as  well  as  motion  picture  programs  and 
other  performances  which  were  provided  there,  were  open  to 
the  nurses.  American  Red  Cross  canteen  and  recreation  hut 
workers  were  assignied  to  duty  and  nurses  had  reason  to  be 
grateful,  indeed,  to  them  for  many  services  faithfully  and 
sympathetically  rendered. 

The  American  Red  Cross  also  built  in  many  hospital  centers 
special  recreation  houses  for  the  nurses  and  upon  the  recom- 
mendation of  the  Army  chief  nurses,  invited  the  Young 
Women's  Christian  Association  to  send  secretaries  to  act  as 
hostesses  at  these  liouses.  The  success  of  this  work  was  due  in 
large  part  to  the  tactfulness  and  administrative  ability  of  ]\Iar- 
garet  S.  ]\Iorriss,  who  resigned  from  the  faculty  of  Mount 
Holyoke  College  and  went  overseas  in  December.  11)17,  as  a 
Y.  W.  C.  A.  Secretary.  She  was  first  assigned  to  Base  Hos- 
pital Xo.  27  at  Angf'rs,  where  the  value  of  the  service  which 
she  had  come  to  render  to  nurses  was  proven  beyond  a  doubt. 
In  the  early  summer  of  1!»18,  she  was  sent  to  the  Head(]uarters 
of  her  association  in  Paris  and  there  took  charge  of  this  phase 
of  the  work  of  the  Young  Women's  Christian  Association  in  all 
the  base  hosjntals  of  rhc  Aineriean  Expeditionary  Forces  to 
which  secretaries  were  assiuned. 


THE  EUROPEAN  WAR  516 

Far  more  discouraging  than  the  crowded  quarters,  the  some- 
times unsavory  food,  the  huindrv  problem  and  the  hiok  of  rec- 
reation was  the  exhaustive  burden  of  professional  work  which 
the  general  shortage  of  nurses  in  the  American  Expeditionary 
Forces  placed  upon  the  Army  nurses  on  duty  in  the  zone  of 
the  base.  This  shortage  has  been  emphasized  in  previous  para- 
graphs but  it  should  be  noted  that  it  still  continued,  due  to  the 
transportation  situation  and  the  dire  military  need  for  giving 
combat  troops  and  supplies  the  right  of  way  over  medical  per- 
sonnel. To  stinuilate  nurses  to  enter  military  service,  General 
Ireland,  then  Chief  Surgeon  of  the  A.  E.  F.,  cabled  National 
Headquarters  on  ISeptember  4,  1!)18,  ''that  the  American  Expe- 
ditionary Forces  need  at  present  four  thousand  nurses.  We 
will  need,"  he  continued,  "one  hundred  nurses  with  each  addi- 
tional base  hospital  and  there  are  four  to  each  division ;  forty 
nurses  with  each  evacuation  hospital  and  there  are  two  to  each 
division.  In  addition  to  this,  we  need  a  great  mimber  of  nurses 
for  camp  hospitals  and  emergency  calls  we  receive  daily." 

The  War  Diary  of  September  9,  11)18,  stated  that  ''base  hos- 
pitals have  been  stripped  of  every  a^^'a liable  officer  and  nurse 
for  the  purpose  of  forming  surgical  teams  and  in  the  event  of 
extreme  activity  of  our  troops  at  the  front,  there  undoubtedly 
will  be  the  greatest  difficulty  in  taking  care  of  patients  sent 
back  to  the  base  hos])itals  in  the  S.  O.  S.  The  situation,"  con- 
tinued this  entry  of  the  Diary,  "was  saved  only  by  the  self- 
sacrificing  spirit  of  officers,  nurses  and  men.  During  the  period 
from  fluly  IS  to  November  11,  the  amount  of  work  done  was 
such  that  no  })raise  would  be  great  enough.  It  was  not  at  all 
uncommon  for  nurses  to  work  fourteen  to  eighteen  hours  a 
day  for  weeks  at  a  time.   .   .   .'"  ■*- 

Statistics  of  the  "peak  days"  at  hospital  centers  showed  sharp 
contrast  between  actual  conditions  and  the  estimated  ratio  of 
ten-beds-to-one-nurse  which  the  War  Department  felt  in  11>1T 
would  be  a  safe  margin  on  which  to  reckon  the  nursing  needs 
of  the  Army.  In  the  six  hospitals  at  Alars,  there  was  on  Xo- 
vember  K!,  Ill  IS,  aii  average  of  21). 0  patients  to  each  nni'se. 
In  the  seven  hospitals  at  Toul,  there  was  on  November  2S  an 
average  of  '.-A. 2  jiaticnts  to  each  nui'sc.  In  the  six  hospitals  at 
Allercy,  there  was  on  \o\-cnil)('i-  17  an  average  of  4  7.<)  {)aticnt3 
to  each  nurse.     And  at  Mesves  ("enter,  in  its  ten  hospitals,  there 

^- "1 1  istf>i-y  of  the  Niir<iiiLr  A(li\  it  i's,  A.lvl'".,  oii  tlic  Wi'^-tiTii  I'nuil  dur- 
iim  the   War    I'd-iod.'"  •).   ('.   Siiiiison.   p.    l.'i. 


616   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  on  I^ovember  16  an  average  of  51.2  patients  to  each 
nurse."*^ 

Like  cantonment  duty  in  the  United  States,  field  service  in 
base  hospitals  in  France  lacked  the  horrible  yet  stimulating 
pageantry  of  nursing  at  the  front.  Periods  of  intense  strain 
characterized  the  service  both  in  the  forward  areas  and  in  the 
zone  of  the  base,  but  the  duration  of  such  periods  in  the  base, 
observed  Miss  Stimson,  averaged  a  longer  period  than  did  the 
most  severe  periods  in  evacuation  and  mobile  hospitals.  Nor 
was  there  present  in  the  zone  of  the  base  the  excitement  of 
real  emergency  and  the  thrill  of  danger  to  challenge  the  nurses' 
imaginations  and  spur  them  to  heroic  moments.  There  was 
only  continued,  patient,  monotonous,  exhausting  work. 

Colonel  Wadhams  wrote  of  the  base  hospitals  that  ''it  is  un- 
fortunate but  certain  that  the  Army  and  the  people  at  large  will 
never  be  able  to  realize  the  debt  of  gratitude  which  they  owe  to 
the  personnel  of  these  units.  .  .  .  Surgeons  and  nurses  literally 
dropped  at  the  operating-tables  from  fatigue."  ^^ 

And  the  morale  of  the  10,061  American  Army  nurses,  regu- 
lars and  reserves,  who  served  in  the  zone  of  the  base  with  the 
American  Expeditionary  Forces  in  France  ?  These  women 
had  gone  to  France  with  high  hopes  for  rendering  heroic  service 
but  with  extremely  vague  conceptions  of  what  this  service 
would  in  actuality  consist.  When  they  arrived,  they  were 
quietly  absorbed  in  the  Sanitary  Service  and  were  sent  to  bases 
far  behind  the  lines,  to  lonely  and  remote  French  villages  where 
living  conditions  were  primitive  and  social  customs  strange. 
Instead  of  the  assignimcnt,  immediate  or  later  for  most  of  them, 
to  the  fighting  zones  which  they  coveted,  the  zones  where  they 
had  imagined  themselves  as  rendering  spectacular  service,  they 
were  sent  to  the  rear  of  the  Armies  and  scrubbed  floors  in  dirty 
and  dilapidated  French  buildings  or  in  rude  wooden  barracks, 
set  up  wards,  made  beds  and  nursed  contagious  cases.  During 
1917  and  the  early  part  of  1918,  physical  discomfort,  manual 
toil,  loneliness  and  monotony  was  the  order,  not  the  exception, 
of  their  day.  In  addition  to  bearing  the  responsibility  of 
housework  which  should  have  been  done  by  orderlies  and  con- 
valescent patients  and  to  performing  comparatively  uninterest- 

"  "History  of  tlic  Xursiiiir  Activities.  A.K.F.,  on  the  Western  Front  dur- 
ing tile  War  Period,"  J.  C.  Stimson.  p.  8. 

**  '"Report  of  Colonel  Sariford  Wadlunns.  Chief,  Group  B.,  G.  4,  General 
Staff,  G.  H.  Q.,  A.  E.  F."  Suryeon  Cieneral's  Office,  U.  S.  A.,  Washington, 
D.  C. 


THE  EUROPEAN  WAR  517 

ing  professional  duties,  they  were  under  the  strain  of  endless 
inspections  and  criticisms  of  conditions  beyond  their  power 
to  remedy. 

A  last  straw  for  most  of  them  was  the  formation  of  forward 
professional  teams.  During  the  spring  and  summer  of  1918, 
nurses  to  the  numbers  of  2GG2  were  detached  from  the  staffs 
of  the  base  hospitals  and  sent  to  the  zone  of  the  advance,  leav- 
ing to  the  7000  nurses  remaining  in  the  bases,  greatly  increased 
duties  and  the  poignant  disappointment  of  not  having  been 
chosen  to  share  in  the  most  romantic  and  spectacular  phase  of 
war  nursing. 

Then  during  the  early  summer  of  1918,  the  pendulum  swung, 
even  in  the  zone  of  the  base,  to  the  other  extreme  and  the 
nurses  in  the  base  hospitals  were  called  upon  to  shoulder  a 
task  as  difficult  as  was  that  at  the  front,  a  task,  however,  which 
lacked  the  features  which  made  front  line  service  heroic  and, 
therefore,  more  easily  endurable.  American  troops  went  into 
action  at  Chateau-Thierry  and  the  wards  of  all  American  sani- 
tary formations  were  crowded  with  wounded  men.  I^urses, 
surgeons  and  orderlies,  as  has  been  stated  before,  worked  until 
they  could  work  no  more.  Discouraged  by  apparently  futile 
efforts  to  improve  conditions,  exhausted  by  the  herculean  labor 
demanded  of  them,  in  many  cases  harried  by  constant  bom- 
bardments and  bewildered  by  the  sight  and  suffering  of  the 
disfigured  men,  the  nurses  were  sobered  and  numbed  by  fatigue 
and  horror  into  silence  and  disillusionment.  War  no  longer 
appeared  to  be  a  fine,  a  brave,  an  heroic  thing. 

All  of  them  sobered,  many  of  them  silenced,  a  few  of  them 
embittered,  they  nevertheless  did  efficient  work  and  did  it  at 
least  as  gallantly  as  women  have  met  crises  before — and  even 
though  this  may  sound  contradictory  when  the  disillusionment 
and  bitterness  is  considered,  they  did  rise  spiritually  to  their 
task.  They  could  do  no  less,  for  they  had  only  to  look  about 
them  in  the  wards  to  find  examples  of  fortitude  and  cheerful- 
ness which  shamed  their  complaints  into  silence  and  sent  them 
alx)ut  their  work.  ^'The  wounded  are  so  brave,"  wrote  Sara 
Parsons,  herself  an  Army  nurse  as  well  as  a  veteran  in  nursing 
education  and  administration,  "that  no  woman  with  a  heart,  as 
long  as  she  has  strongtli  to  stand  on  hor  feet  and  keep  going, 
could  yield  to  discouragement  and  depression." 

Even  though  the  nurses  had  little  time  for  the  expression  of 
their  sympathy  and  admiration  for  the  woundt^d,  ev<>n  though 


518   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

many  of  them  may  have  been  short  at  times  in  patience,  even 
though  a  few  of  them  broke  under  the  strain,  none  who  know 
conditions  as  they  actually  existed,  may  say  with  truth  that 
their  work  was  not  bravely  and  well  done !  Much  has  been 
written  in  eulogy  of  the  war  nurse,  but  to  nurses,  the  thought- 
ful and  well-weighed  sentences  of  one  who  knew,  William  S. 
Thayer,  are  praise  enough : 

Only  tried  women  are  suitable  to  go  out  into  nursing,  and 
especially  into  army  nursing.  Xo  belter  proof  of  this  can  be 
found  than  tbe  prejudice  which  existed  in  1898  among  many 
excellent  medical  officers  of  the  Army,  against  the  introduc- 
tion of  the  trained  nurse  regularly  into  the  Army  service. 
Tliese  officers  could  not  conceive  the  presence  of  attractive 
young  women  among  the  someM-hat  rough  boys  of  tbe  Army 
without  complications  and  scandal.  This  prejudice  still  per- 
sisted among  some  Army  officers  after  twenty  years.  .  .  . 

I  remember  well  the  conditions  of  the  Spanish  War.  I 
remember  the  fine  work  done  by  nurses;  but  I  remember  also 
the  difficulties,  tbe  anxieties  and  the  obstacles  in  tbe  way  of 
those  who  endeavored  to  maintain  the  standards  of  tbe  service 
and  to  show  to  tbe  ^Medical  Corps  what  nursing  in  the  Army 
might  and  should  be. 

Twenty  years  later  .  .  .  nearly  eleven  thousand  regular 
and  reserve  nurses  served  in  France  alone.  The  anxieties 
and  the  danger  of  the  voyage  these  women  bore  as  calmly,  and 
often  more  so,  than  the  men.  To  their  work  in  France  I  can 
testify  as  one  who  was  among  them.  I  saw  them  under  all 
conditions.  In  the  hurriedly  improvised  camp  hospital  of  the 
crowded  base  port,  and  in  isolated  points  in  the  base  sections ; 
in  spots  removed  from  all  that  was  interesting  and  stimu- 
lating, where,  at  times,  refined  women  bad  to  sleep  crowded 
together,  twenty  or  thirty  in  a  rough,  open  ward,  without 
privacy,  with  tbe  crudest  and  most  insufficient  sanitary  ar- 
rangements, exposed  continually  in  damp  rainy  weather,  with 
mud  so  deep  tbat  one  could  navigate  only  in  rubber  boots.  I 
saw  them  in  balf-finishod  base  hospitals  in  tbe  Vosges,  under 
like  conditiojis.  in  tbe  Ijitter  northern  winter,  where  with 
fingers  and  toes  numb  and  l)Iancbed  with  cold,  one  nurse  had 
almost  to  care  for  a  ^\bo]e.  ill-heated  ward.  I  saw  them  work 
day  in  and  day  out  without  rest,  without  recreation,  in  the 
darkened  wards  by  night,  and  the  fog  and  rain  by  day,  and 
bear  the  strain  every  bit  as  well  as  men.  .  .  .  They  served 
without  fear,  without  flinching,  without  complaint.  But  one 
murmur  did  1  hear,  and  this  a  nnirmur  aiul  not  a  complaint. 


THE  EUROPEAN  WAR  519 

a  regret  that  it  miglit  not  be  given  to  them  to  share  more 
fully  the  duties  and  the  responsibilities  at  the  points  of  great- 
est danger.  Wherever  they  went  they  brouglit  order  and 
cleanliness,  and  system  and  contentment  and  peace.  Ask  the 
doughboy  what  it  meant  to  him  to  find  himself  at  last  in  a 
ward  presided  over  by  a  nurse.  Try  to  say  a  light  word  about 
a  nurse  to  a  doughboy  who  has  been  under  her  care !  *^ 


While  the  United  States  Medical  Corps  was  organizing  sani- 
tary units  in  the  zones  of  the  base  and  the  advance,  the  Ameri- 
can Red  Cross  Commission  for  Europe  was  setting  np  a 
supplementary  medical  and  nursing  service  to  take  care  of 
emergency  demands  which  the  less  flexible  structure  of  the 
Military  Establishment  could  not  meet.  The  American  Red 
Cross  in  France  served  as  an  emergency  arm  of  the  Medical 
Department  of  the  American  Expeditionary  Forces  and  the 
Nursing  Service  formed  a  vital  phase  of  this  service.  An  ac- 
count of  its  development  and  accomplishments  constitutes  a 
dramatic  and  complex  chapter  of  military  nursing  history. 

The  American  Red  Cross  Nursing  Service  in  France  may 
well  be  compared  to  a  small  and  sturdy  ship  in  strange  and 
troublous  waters,  a  ship  on  which  many  masters  strove  for  com- 
mand, a  ship  buffeted  about  by  changing  winds  of  European 
and  American  public  opinion,  threatened  by  perilous  shoals  of 
fundamental  professional  nursing,  military  and  lay  policy  and 
strained  by  emergencies  which  demanded  service  in  proportions 
such  as  have  never  before  been  demanded  of  women.  That 
this  ship  came  at  last  gallantly  to  port  speaks  well  indeed  for 
the  stamina  of  those  who  formed  her  crew. 

To  gain  a  true  understanding  of  the  nature  and  value  of  the 
nursing  service  rendered  by  the  American  Red  Cross  in  France, 
an  appreciation  is  necessary  of  French  nursing  progress,  of 
French  and  American  social  conditions,  of  American  Army  and 
American  Red  Cross  organization  and  of  the  military  situa- 
tion which  confronted  the  Alli(>s  in  1017  and  1918.  Each  of 
these  determining  factors  will  be  treated  in  turn. 

The  French  Red  Cross  unit(xl  the  prominent  women  of 
France  in  volunteer  work  in  time  of  war.     This  organization 

■""Xursiiif,'  and  tlic  Art  of  MciliciiU'" :  An  address  delivered  hy  Dr.  W.  S. 
Thayer,  late  T^ripadier  (ieneral,  Medieal  Corjis,  V.  S.  A.,  before  a  meeting 
hold  in  memory  of  .lane  A.  Delano,  Pliiladeljihia,  !May  7.  1!)1!>:  later 
published  in  the  Amcricnn   ,1ournal   of  Xurfiinij,  December,    ll'li*. 


620   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  divided  into  three  societies  as  follows:  (1)  Societe  Fran- 
gaise  de  Secours  aux  Blesses  Militaires;  (2)  Union  des  Femmes 
de  France;  (3)  Association  des  Dames  Frangaises. 

Each  of  these  three  societies  had  its  own  organization  and 
direction  and  arranged  for  its  own  financing.  The  Societe 
Frangaise  de  Secours  aux  Blesses  Militaires  was  directed  by 
a  committee  of  men,  but  the  other  two  societies  were  managed 
entirely  by  women,  with  men  serving  only  as  consultants  at 
board  meetings.  The  three  societies  were  united  through  a 
Central  Committee  which  alone  possessed  the  authority  to  main- 
tain official  relations  with  the  International  Committee  of  the 
Red  Cross  at  Geneva  and  with  foreign  Red  Cross  societies.^^ 

The  Societe  Frangaise  de  Secours  aux  Blesses  Militaires  was 
created  in  June,  18G4,  and  was  recognized  to  be  of  public 
utility  on  June  23,  1866.  It  was  estimated  that  in  April,  1917, 
this  society  was  maintaining  eight  hundred  hospitals  with  a 
total  capacity  of  seventy  thousand  beds."*^  The  nurses  for  these 
hospitals  were  all  members  of  the  Societe  Frangaise  de  Secours 
aux  Blesses  Militaires  and  had  received  instruction  in  nursing 
offered  by  the  society.  The  course  of  studies  was  given  at  a 
large  dispensary  school  in  the  Place  des  Peupliers,  covered 
five  months  and  led  to  the  first  diploma,  or  Diplome  Simple. 

During  the  summer  of  1916,  Miss  Maxwell  and  Miss  Irene 
Givenwilson  made  the  inspection  tour  of  sixty-seven  French, 
British  and  Belgian  military  hospitals,  which  has  been  de- 
scribed in  a  preceding  section.  A  report  of  this  tour  submit- 
ted in  October,  1916,  by  Miss  Givenwilson  to  Miss  Delano 
contained  the  following  statement : 

All  members  of  the  French  Eed  Cross  belong  to  the  upper 
and  middle  classes  and  the  whole  service  is  voluntary  for  the 
love  of  country  and  humanity.  There  are  about  thirty  thou- 
sand memljers  at  present  enrolled  as  nurses.  Some  of  these, 
owing  to  adverse  circumstances,  may  require  pecuniary  assist- 
ance and  this  is  graiited  out  of  the  funds  of  the  society,  but 
it  is  never  looked  upon  as  remuneration  for  services  rendered. 

The  Societe  de  Scours  aux  Blesses  Militaires  is  the  largest 
of  the  three  associations.  .  .  .  The  training  school  in  Paris  is 
known  as  the  IIoinial-Ecole  and  is  presided  over  by  ]\Ille. 

"  Spe  "Report  ui  tlio  Frcncli  Kod  Cross."  written  l)y  William  f!.  Sliarp, 
Ambassador  to  France,  to  tlie  U.  S.  State  Department,  April  27,  1917, 
filed   Librarv,  National   Headquarters,  Washington,  D.  C. 

"  Ibid. 


THE  EUROPEAN  WAR  521 

Genin.  Here  all  aspirants  to  membership  undergo  a  strict 
training  daily  for  five  months  before  they  can  present  them- 
selves for  examination  and  receive  the  first  diploma  which 
admits  them  to  the  society.  To  acquire  the  mental  attitude 
necessary  for  service  in  time  of  war,  three  principles  are 
strongly  impressed  upon  the  pupils  during  their  training: 
(1)  unity  of  action;  (2)  unity  of  thought;  (3)  unity  of 
submission.*^ 

The  training  offered  by  the  Societe  de  Secours  aux  Blesses 
MilUaires  was  described  as  follows  by  Mme.  Edouard  Krebs- 
Japy,  in  L'Infirmiere : 

Schools  for  Training  Eed  Cross  Nurses : 

A.    The  Society  for  Assistance  to  Wounded  Soldiers : 

I.  Hospital  School  in  the  Square  des  Peupliers,  Paris 
(XIII).     Directrice,  Mile.  Genin. 

Prerequisites  for  admission:  The  applicants  must  be 
twenty  years  of  age,  must  bring  responsible  references,  must 
belong  to  the  Society  for  Assistance  to  Wounded  Soldiers 
and  must  promise  to  serve  in  case  of  war  or  public  calamity. 

The  subjects  are  arranged  as  follows:  (a)  A  five  months' 
period  of  instruction,  entitling  the  applicant  to  appear  for 
examination,  for  the  purpose  of  obtaining  a  primary  diploma 
conferring  the  title  of  nurse  to  the  society.  The  nurse  is 
entitled  to  a  service  book  and  may  be  assigned  to  medical  or 
surgical  sanitary  units,  civil  or  military,  in  case  of  war. 
(b)  A  second  nine  months'  period  of  study  and  theoretical 
instruction  will  be  required  for  obtaining  the  second  degree. 
Only  nurses  having  the  primary  diploma  and  who  are  from 
twenty-five  to  forty-five  years  old  may  be  admitted  to  receive 
this  supplementary  instruction.  The  final  examination  will 
allow  the  applicant  to  obtain  a  second  degree  diploma,  en- 
titling her  to  be  known  as  a  head  nurse  or  supervisor.  .  .  . 

II.  In  the  provinces,  the  society  trains  its  nurses  in  its 
numerous  dispensary-sch  ooh^° 

Miss  Givenwilson's  diary  contained  the  following  comment 
regarding  a  visit  made  by  Miss  Maxwell  and  herself  to  the 
IIopital-Ecole : 

*■■' "Report  of  tlie  Voluntary  Xursiiifj  Services  of  Enjiland  and  France;" 
T.  ^I.  Givenwilson,  pp.  7-9 ;  Library,  National  Headquarters,  Washington, 
D.  C. 

*^  L'Infirmirre ;  ^Nfnie.  Edouard  Krebs-Japy,  pp.  CO-Gl,  Librairie  Armand 
Colin,  1921,  Paris,  France. 


522    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Maxwell  and  I  then  set  out  for  the  Red  Cross  Training 
Hospital  for  Nurses  in  the  Place  des  Feupliers,  of  which 
Mile.  Genin,  Chevalier  of  the  Legion  of  Honneur,  is  the 
directrice.  .  .  .  We  had  a  most  interesting  talk  with  Mile. 
Genin.  She  has  a  wonderful  personality  and  the  fine  com- 
manding head  and  features  of  a  leader. 

.  .  .  The  training  school  had  been  transformed  into  a 
military  hospital  of  about  seventy  or  eighty  beds.  We  were 
conducted  over  the  whole  building  by  an  infirmiere  major  and 
we  were  struck  by  the  perfect  cleanliness  of  the  whole  building 
and  its  equipment.  What,  however,  struck  us  disagreeably 
was  the  closeness  of  the  atiuosphere  and  the  number  of  flies 
which  worried  and  distressed  the  poor  wounded.  It  is  a 
characteristic  of  the  French  hospitals  to  keep  nearly  all  the 
windows  closed;  their  aversion  to  fresh  air  is  remark- 
able. .  .  .5° 

The  second  society,  Union  des  Femmes  de  France,  was  recog- 
nized to  be  of  public  utility  on  August  6,  1882.  It  was  esti- 
mated that  this  branch  of  the  French  Red  Cross  was  main- 
taining in  April,  1917,  3G3  hospitals  with  a  total  bed  capacity 
of  30,000."^^  The  official  circular  issued  by  the  Union  des 
Femmes  de  France  set  forth  the  following  information  regard- 
ing the  annual  courses : 

Assistant  hosirital-attendant's  certificate:  Pupils  desirous 
of  obtaining  this  certificate  must  take  the  theoretical  course  in 
anatomy,  minor  surgery,  hygiene,  care  of  the  sick,  pharmacy, 
bandages  and  practical  exercises,  in  one  of  the  different  train- 
ing centers,  and  pass  the  examination. 

Ilosintal-attendant's  certificate:  To  obtain  this  certificate, 
one  must  take  the  theoretical  courses  designated  above;  after 
reaching  the  age  of  18,  take  a  practical  probationary  term  of 
three  months  (three  attendances  per  week)  in  a  dispensary 
school  or  outside  consultation  office  of  a  civil  hospital;  and 
pass  the  examination.  (X.  B.)  A  term  either  in  a  consulta- 
tion office  for  babies,  in  a  day-nursery  or  in  a  baby  home, 
completed  by  practical  instruction  in  puericulture,  is  strongly 
rccommendcfl  to  pupils  until  it  becomes  obligatory. 

Diploma  for  liospital  allendant:  After  obtaining  the 
infirmarian's  certificate,  one  must  take  the  theoretical  courses, 

'""Diary  of  My  Visit  to  France,  June-August,  191G,"  I.  M.  Givenwilson, 
pp.  20-21;'  41. 

^' Soo  ""Report  of  the  Froneli  Red  Cross."  written  by  W'illiani  G.  Sharp, 
Ambassador  to  France,  to  liic  L'.  hi.  .State  IJepartmcnt,  April  27,  1917. 


THE  EUROPEAN  WAR  523 

and,  only  after  reaching  the  age  of  21,  take:  (1)  A  three 
months'  term  in  the  training  hospital;  (2)  A  three  months' 
term  in  theoretical  and  practical  massage;  {'S)  A  three 
montlis'  term  in  a  civil  or  military  hospital;  (4)  Take  the 
courses  in  military  administration  and  pass  the  different  tests 
in  each  hranch. 

The  third  society,  Association  des  Dames  Franqaises,  was 
recognized  to  be  of  public  ntility  on  April  23,  1883.  It  was 
reported  to  be  maintaining  in  April,  1917,  281  hospitals  with 
a  total  bed  capacity  of  17,207.  The  instruction  which  it  gave 
its  nurses  resembled  that  ofiered  by  the  two  other  societies  of 
the  French  I  fed  Cross. 

As  to  professional  nursing  service,  only  one  school  for  nurses 
organized  upon  British  and  American  standards  existed  in 
France :  L'Ecole  Frofessionale  des  Gardes-Malades  Ilospitali- 
eres  at  Bordeaux,  known  as  the  Nightingale  School^  (with  the 
sanction  of  ]\liss  ]S"iglitingale's  executors). 

As  to  the  nurses  in  French  civil  hospitals,  Miss  Givenwilson 
wrote  in  her  official  report  to  jSTatioual  Headquarters: 

The  professional  nurses  are  comparatively  few  and  do  not 
receive  the  same  exhaustive  training  as  our  own.  They  are 
drawn  for  the  most  part  from  the  ranks  of  the  religious 
sisters,  or  from  women  of  the  lower  classes  trained  in  the  ci\il 
hospitals  of  the  Assidance  Fuhlique.  .  .  .^- 

The  following  account  appeared  in  Miss  Givenwilson's  diary : 

July  18,  1910.  We  went  to  visit  the  old  civil  hospital  of 
St.  Louis  this  afternoon.  It  was  built  in  the  IGth  century  as 
a  hospital  for  the  plague  and  was  separated  from  the  city  by 
strong  turreted  walls  and  a  moat.  Some  of  the  ancient  build- 
ings still  remain,  hut  the  moat  has  disappeared  and  small 
buildings,  mean  streets  and  insignificant  houses  press  close 
upon  the  old  walls.  It  is  now  the  chief  hospital  in  the  city 
I  Paris  I  fur  skin  diseases  and  contains  a  famous  library  on  the 
sul)ject.  .  .  . 

The  French  nurses  are  seen  at  their  worst  liere.  ...  I 
think  that  this  war  will  impress  u])on  the  French  the  neces- 
sity of  training  nurses  of  higher  social  standing  and  greater 
intelligence   for   tfieir   hospitals.      The   part   of   the   hosj)ital 

""Report  of   the   \'olunteer   Nursing   Service   of   Englami    and    France," 
p.   12. 


624    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

which  looked  the  most  carefully  tended  was  the  beautiful  old 
garden  with  its  magnificent  trees  and  neat  flower  beds.  .  .  /^ 

Of  the  mobilization  and  service  of  the  nursing  members  of 
the  French  Red  Cross,  Miss  Givenwilson  wrote  in  her  report: 

On  the  declaration  of  war,  all  the  members  of  the  three 
societies  of  the  French  Red  Cross  were  immediately  mobilized 
and  dispersed  throughout  the  country  wherever  they  were 
needed.  And  to  their  honor  be  it  said  that  all  nobly  re- 
sponded to  the  call,  leaving  comfortable,  often  luxurious 
homes,  to  experience  the  rigid  discipline  and  heavy  responsi- 
bilities of  a  French  military  or  auxiliary  hospital  for  the 
duration  of  the  war.  For  it  has  to  be  remembered  that  very 
few  of  these  women  are  trained  nurses,  although  they  are 
often  given  the  supervision  of  a  ward  of  seriously  wounded 
soldiers  with  only  orderlies  to  assist  them.  This  is  the  great 
defect  of  the  nursing  system  in  France  .  .  .  and  this  war  has 
demonstrated  the  urgent  need  in  France  for  the  establishment 
of  training  schools  for  nurses  on  the  same  lines  as  those  that 
exist  in  England  and  America.  .  .  . 

The  training  of  the  French  Red  Cross  for  its  first  diploma 
.  .  .  renders  their  members  very  capable  "nurses'  aides." 
But  they  are  called  upon  to  accept  responsibilities  far  beyond 
their  knowledge  and  this  they  do  with  a  courage  and  devotion 
which  is  truly  admirable.  They  are  tireless  in  the  accom- 
plishment of  their  arduous  duties;  they  take  no  hours  off  for 
recreation  or  amusement;  their  free  time,  if  they  have  any,  is 
spent  in  making  their  wards  more  attractive  by  simple  deco- 
rations manufactured  by  their  deft  fingers  from  the  modest 
means  at  their  disposal.  They  are  full  of  cheerfulness  and 
compassion  and  in  the  eyes  of  the  wounded  under  their  care 
is  to  be  read  the  appreciation  of  these  noble  women,  wlio  have 
voluntarily  sacrifi(;ed  all  with  glad  heart  at  the  call  of  patriot- 
ism and  humanity.'^* 

Of  the  French  military  hospitals,  Miss  Givenwilson  wrote: 

Ilopitnl  Central  at  Bar-le-Duc:  This  hospital  accommo- 
dated tliree  thousand  beds  and  is  situated  in  some  barracks 
which  were  a])])roaching  completion  before  the  war  broke  out 
and  were  rapidly  transformed  into  a  hospital.  .  .  . 

We  first  visited  the  surgical  side,  whose  wards  appeared  to 

""Diary,"  T.  M.  fJivcnwilson.  pj).  72-73. 

""Report  of  tlie  Voluntary  Nursing  Service  of  England  and  France,"  pp. 
11-13. 


THE  EUROPEAN  WAR  525 

be  beautifully  kept,  altliough  there  is  only  one  nurse  to  each. 
This  is  one  of  the  ])oints  that  has  struck  me  forcibly;  the 
French  or  Belgian  nurse  accomplished  much  more  than  the 
Englisli  or  American  one,  in  sheer  majuial  labor.  Her  tech- 
nical knowledge  is  much  less  and  her  patients  suffer  in  conse- 
quence, but  she  had  a  far  larger  number  of  beds  under  her 
charge  without  auxiliary  heli)  and  yet  she  manages  to  keep 
her  wards  neat  and  clean.  Everything  in  French  hospitals  is 
on  a  simpler  scale  and  the  P'rench  poilu  is  neither  given  nor 
demands  as  much  as  the  Britisli  Tommy.  In  this  huge  hos- 
pital of  three  thousand  beds,  there  were  only  fifty  nurses  and 
about  one  hundred  orderlies  and  the  wounded  looked  well 
cared  for.  .  ,  . 

There  is  a  terrible  plague  of  flies  throughout  this  whole 
neighborhood,  in  spite  of  all  precautions  to  get  rid  of  them. 
They  swarm  in  thousands  everywhere  and  the  most  seriously 
wounded  have  to  be  protected  by  pieces  of  gauze  over  their 
heads.  There  are  camps  of  soldiers  and  horses  everywhere, 
so  it  seems  impossible  to  eradicate  the  pest.  .  .  .^^ 

Miss  Maxwell  and  Miss  Givenwilson  visited  the  French  mili- 
tary evacuation  hospital  at  Revigny.  Miss  Givenwilson  wrote 
in  her  report  to  National  Headquarters : 

The  work  of  this  great  hospital  was  in  full  swing  when  we 
arrived  early  in  the  morning.  The  establishment  consists  of 
an  evacuation  hospital  of  eight  hundred  beds  which  is  even 
now  being  increased  to  one  thousand.  The  wounded  are 
brought  liere  straight  from  Verdun  by  a  little  branch  line  of 
railway  and  it  is  here  that  the  triage  or  sorting  of  the 
wounded  takes  place.  Over  one  hundred  thousand  have 
passed  through  the  evacuation  hospital  since  the  beginning  of 
March. 

A  colony  of  huts  has  been  erected  in  a  convenient  situation 
adjoining  the  main  line  from  Paris  to  Bar-lo-Duc.  Toul  and 
Nancy.  The  evacuation  hospital  is  ]iractically  continuous 
with  the  stationary  hospital  but  is  a  complete  unit  in  itself 
and  possesses  its  own  kitchen,  oflices,  operating  and  dressing 
rooms. 

There  arc  four  categories  for  the  wounded:  (1)  Those 
seriously  wounded,  who  cannot  he  transported  further  witli- 
out  risk  of  life:  thes(>  are  carried  immediately  after  (lamina- 
tion to  the  adjoining  statioiuiry  hospital  (small  compared  to 
the  evacuation  h()S])ital  itself).     ('2)  Those  who  are  seriously 

"■'Report  of  the  \'oluntiiry  Xursing  Service  of  Knj,'laii(i  and  France,"' 
pp.  4.")-47. 


626    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

wounded  and  can  be  transported  are  taken  by  ambulance  cars 
to  the  hospitals  of  Jean  d'Heurs  or  to  the  British  hospital  of 
Faux  Miroir,  both  situated  a  few  kilometers  distant.  (3) 
Others  who  are  less  seriously  wounded  are  sent  by  ambulance 
train  to  Paris  or  hospitals  in  the  interior.  (4)  All  those  who 
are  only  slightly  wounded  are  sent  to  hospitals  within  the 
Army  Zone,  so  that  on  recovery  they  can  be  immediately  re- 
turned to  their  companies.  They  are  seldom  absent  for  more 
than  a  week  or  a  fortnight. 

The  town  of  Revigny  itself  is  a  mass  of  ruins  and  the 
hospital  is  situated  on  the  outskirts,  among  the  fields.^** 

The  following  description  of  the  evacuation  hospital  at  Re- 
vigny appeared  in  Miss  Givenwilson's  diary: 

August  4,  1916.  We  started  for  Eevigny  early  this  morn- 
ing. .  .  .  The  work  of  the  great  hospital  was  in  full  swing 
when  we  arrived.  .  .  ,  We  visited  all  the  huts  of  the  station- 
ary hospital  and  found  them  filled  with  very  sick  men.  The 
mortality  here  is  very  great.  .  .  . 

I  shall  never  forget  the  ghastly  sights  in  the  wards  in  which 
the  septic  and  gangrenous  cases  were  lying.  An  attempt  was 
being  made  to  treat  these  by  constant  irrigation,  but  the  awful 
discomfort  of  the  men  was  horrible  to  look  upon.  They  had 
no  proper  mattresses  and  those  parts  of  the  body  not  being 
irrigated  were  supported  only  by  pillows  and  sacks.  Yet  such 
is  the  heroic  endurance  of  these  men,  that  no  complaints  were 
to  be  heard,  only  the  restless,  moaning  delirium  of  those  who 
were  almost  past  help. 

The  nurses  were  a  nice  set  of  cheerful,  hard-working 
women,  though  their  life  is  full  of  hardship  and  toil.  .  .  . 

The  surgeon-in-chief  proposed  that  we  should  witness  the 
arrival  of  the  Yerdun  ambulance  train  which  was  shortly  due. 
We  went  to  the  little  roadside  station  to  find  that  tlie  train 
was  already  there  and  was  slowly  unloading  its  gliastly  bur- 
den. Skillful  arms  were  there  to  receive  the  shapeless  masses 
huddled  on  the  stretchers  and  they  were  swiftly  borne  to  the 
hospital. 

Soon  the  little  operating-room  became  a  shambles,  the  floor 
bloodstained,  the  pails  overflowing  with  soiled  dressings,  the 
atmosphere  thick  with  the  smell  of  blood,  disinfectants  and 
human  sweat.  Doctors  and  nurses  worked  without  pause,  the 
only  sounds  being  the  click  of  the  instruments  and  the  low 
moans  or  sharp  exclamations  of  pain  of  the  wounded.     One 

"'■Report  of   the  V'oluntarv   Nursintr   Service   of   England    and    France." 
p[..  -18-40. 


THE  EUROPEAN  WAR  527 

by  one  they  lay  exposed  to  the  keen  eye  of  the  surgeon, — men 
with  limbs  fractured  and  battered  to  a  pulp,  with  faces  man- 
gled beyond  recognition,  with  huge  rents  torn  in  their  bodies. 
.  .  .  And  in  the  faces  of  all  these  wounded  was  a  dumb  look 
of  wonderment  that  such  things  should  be  and  an  infinite 
trust  in  the  skill  of  those  in  whose  care  they  now  were.  .  .  .^^ 

From  the  report  and  diary  submitted  by  Miss  Givenwilson, 
which  bore  the  endorsement  of  Miss  Maxwell,  it  may  readily 
be  appreciated  that  in  a  modern  system  of  nursing,  the  French 
nation  was  far  behind  the  United  States,  where  practically 
every  town  of  over  ten  thousand  population  possessed,  at  the 
time  of  the  United  States'  entry  into  the  war,  a  hospital  main- 
taining a  professional  school  for  nurses  founded  on  the  Night- 
ingale System.  The  heroism  with  which  nurses  of  the  French 
Ked  Cross  cared  for  their  wounded  needs  no  further  eulogy 
here,  but  it  is  equally  self-evident  that  the  professional  attain- 
ments of  women  who  have  had  only  five  months'  theoretical 
instruction  gained  through  semi-weekly  lectures  and  dispensary 
training,  are  not  to  be  compared  with  those  of  women  who  have 
undergone  two  or  three  years'  training  as  nurses  while  resident 
at  a  modern  general  hospital.  In  addition  to  the  inhibitory 
influence  of  the  French  Red  Cross,  French  social  customs  were 
potent  factors  in  limiting  the  development  of  a  French  nursing 
profession  comparable  to  that  of  Great  Britain  and  the  United 
States.  To  give  a  man  a  bed-bath  was  considered  by  nurses  of 
the  French  Red  Cross  to  be  menial  labor  of  a  degrading  nature; 
to  remain  on  duty  all  night  was,  to  them,  an  unheard-of  breach 
of  convention.  Before  taking  up  in  detail  the  Paris  situation, 
it  must  be  understood  that  in  a  country  where  any  woman  who 
cared  for  the  sick  was  officially  rated  as  a  nurse,  public  opinion 
would  have  little  understanding  and  appreciation  of  the  mean- 
ing and  value  of  American  nursing  standards  and  ethics. 

A  second  determining  factor  of  the  nursing  situation  as  it 
developed  in  the  Paris  Head(|uarters  of  the  American  Red 
Cross  was  the  natural  zeal  of  American  laywomen  then  in 
France,  the  wives,  daughters  and  relatives  of  prominent  Red 
Cross  officials  and  other  influential  Am(>rican  women  who  ren- 
(l('r(>d  distinguislicd  service  to  the  Allied  and  American  troops 
in  France,  to  share  in  nursing  the  wounded.  The  point  of  view 
of  the  American  laywoman  was  natural  and  easy  to  understand. 

''"Diary.'"  I.  M.  Oivoiiwilson,  pp.  154-15G. 


528   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

It  may  be  said  that  since  the  beginnings  of  war,  women  have 
been  urged  by  sympathies  based  on  the  maternal  instinct  and 
the  tendency  of  womankind  to  venerate  that  which  is  strong 
and  courageous,  to  desire  to  minister  to  the  wounded.  This 
principle  may  certainly  be  called  one  of  the  foundation-stones  of 
the  Red  Cross  ideal  and  in  the  twentieth  century,  the  Red  Cross 
nurse  was,  to  the  general  public,  the  crowning  symbol  of  the 
Red  Cross  organization,  the  fullest  expression  of  this  ideal ; 
hence  the  desire  on  the  part  of  the  laywoman  to  serve  as  a 
Red  Cross  nurse.  Further,  American  laywomen  argued,  why 
was  it  so  necessary  for  a  woman,  before  she  could  go  into  the 
wards  of  a  military  hospital,  to  undergo  a  long  training  based 
on  some  elusive  idea  to  which  nurses  constantly  referred  as 
"professional  standards  ?"  Leaders  of  the  nvirsing  world  had 
admitted  that  the  number  of  trained  women  was  limited.  Better 
a  partially  trained  woman  in  a  ward  than  that  men  should  die 
unattended !  Why  should  not  they  themselves  be  allowed  to 
go  immediately  into  this  spectacular,  this  most  appealing 
branch  of  Red  Cross  endeavor? 

The  point  of  view  of  the  American  professional  nurse — and 
it  has  been  shown  that  the  American  Red  Cross  nurse  was  the 
highest  exponent  of  the  American  nursing  profession — was 
equally  natural  and  easy  to  understand.  It  has  been  stated  in 
a  preceding  chapter  that  one  of  the  basic  principles  of  the 
nursing  profession  was  that  "nursing  education  and  administra- 
tion must  be  directed  by  nurses."  The  welfare  of  the  patient 
was  the  fundamental  reason  for  this  principle.  ^N^urses  con- 
tended that  an  executive  nurse,  alive  to  the  opportunities  of 
nursing  service  by  reason  of  her  own  personal  familiarity  with 
nursing  theory  and  technique  and  her  knowledge  of  the  primary 
importance  of  discipline,  could  judge  the  needs  of  the  patient 
and  the  work  of  the  nurse  better  than  could  a  laywoman,  who 
knew  little,  if  anything,  of  this  theory,  this  technique  and  above 
all  this  discipline. 

In  addition  to  the  principle  of  the  welfare  of  the  patient, 
another  determining  social  factor  of  the  Paris  situation,  a  factor 
which  leaders  of  nursing  would  probably  not  have  admitted  at 
the  time,  was  the  natural  desire  of  the  professional  nurse  to 
reap  the  fruits  of  a  hard  won  struggle.  Previous  to  tlie  decla- 
ration of  the  European  War,  a  professional  nurse  did  not  hold 
so  enviable  a  position  as  was  accorded  her  immediately  after 
the  declaration  of  war,  when  to  nurse  the  soldiers  was  the 


THE  EUROPEAN  WAR  529 

romantic,  the  spectacular  service  to  render.  The  American 
Army  authorities  permitted  only  professionally  trained  women 
in  their  hospitals  and  the  American  nurses  in  these  instances 
reaped  the  reward,  in  this  opportunity  to  serve,  of  long  years 
spent  in  training  and  longer  years  spent  in  the  practice  of  their 
profession.  Through  the  American  Red  Cross  in  France,  how- 
ever, another  opportunity  for  war  nursing  presented  itself  and 
to  this  more  yielding  avenue  of  approach,  lay  women  flocked, 
there  to  come  up  against  the  bars  of  "professional  standards," 
the  only  bars  with  which  nurses  could  strive — for  nurses  in  the 
majority  have  not  wealth  and  social  position — to  hold  that 
which  they  considered  rightfully  their  own. 

Conditions  outside  the  Red  Cross,  as  well,  played  a  part  in 
this  controversy.  The  English  system  of  Voluntary  Aid  De- 
tachments; the  presence  of  untrained  helpers  in  the  wards  of 
hospitals  established  by  various  other  American  relief  agencies 
and  later  taken  over  by  the  American  Red  Cross,  notably  ]\Iili- 
tary  Hospitals  Xos.  1  and  2 ;  the  dictum  of  the  French  govern- 
ment that  any  woman  who  cared  for  the  sick  was  officially  rated 
as  a  nurse,  all  fanned  the  flame  of  volunteer  zeal  to  such 
heights  of  enthusiasm  that  an  American  Red  Cross  Xursing 
Service  established  in  France  on  a  professional  basis  seemed  in 
the  early  days  of  1917  likely  to  be  consumed  therein. 

The  organization  of  the  American  Red  Cross  in  France  con- 
stituted another  shoal  upon  which  the  Xursing  Service  threat- 
ened to  go  agi'ound.  On  May  9,  1917,  Henry  P.  Davison 
cabled  to  Herman  H.  Harjes,  of  the  banking  firm  of  Morgan, 
Harjes  and  Company,  Paris,  who  was  then  head  of  the  Ameri- 
can Red  Cross  in  France,  regarding  the  anticipated  appoint- 
ment and  persoiniel  of  the  War  Council  of  the  American  Red 
Cross.  After  outlining  the  proposed  campaign  for  the  first 
Red  Cross  War  Fund,  ^Ir.  Davison's  message  continued : 

We  now  contemplate  immediately  after  our  organization 
having  one  of  our  council,  Murphy,  jjrocood  at  once  with  a 
personal  stafT  to  I'aris.  where  he  will  go  with  full  autlK^rity 
from  the  War  Council  to  undertake  ami  do  such  things  as 
may  seem  to  hitn  wise,  ho  hciiig  necessarily  governed  by  con- 
ditions ot)taininir  hero  from  time  to  timo. 

(irayson  M-1'.  Murphy  is  a  West  Point  graduate,  was  in  the 
Army  aliout  nine  years,  retiring  to  go  into  husiiic-s.  and  is 
now  sciuor  \  icc-prcsident  of  the  Xew  York  (luaraiity  Trust 
Company,     lie  is  a  man  uf  ability  and  connnon  sense,  pet'U- 


530   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

liarly  free  from  personal  ambition,  ...  It  is  expected  he  will 
receive  the  line  commission  of  major  in  the  United  States 
Army.  He  understands  that  you  are  at  present  the  head  of 
the  American  Red  Cross  in  France  and  desires,  as  we  all  do, 
that  your  relations  to  this  organization  shall  not  only  be 
maintained  but  strengthened.^^ 

This  cable  went  on  to  outline  the  cooperation  of  the  American 
Red  Cross  with  Alexander  Ribot,  Premier  of  France,  and  with 
relief  organizations  then  in  France.  It  was  contemplated  that 
Major  Murphy  should  be  commissioner  for  Europe  with  his 
headquarters  in  Paris.  On  May  13,  Mr.  Harjes  cabled,  at  the 
suggestion  of  the  French  Ministry  of  Foreign  Affairs  and 
General  Retain,  that  "a  competent  man  be  sent  at  once,  invested 
with  the  necessary  avithority  as  high  commissioner  who  would 
be  the  effective  representative  of  our  Government  and  Army 
and  the  link  between  the  French  and  American  Governments 
so  as  to  make  known  at  once  and  accurately  what  our  friends 
here  desire." 

On  ^fay  10,  1917,  President  Wilson  announced  the  appoint- 
ment of  the  War  Council  of  the  American  Red  Cross.  A  few 
days  later,  this  body  "recommended  to  the  Executive  Commit- 
tee of  the  Central  Committee  that  Grayson  !M-P.  ]\[urphy,  a 
member  of  the  War  Council,  should  be  appointed  the  repre- 
sentative of  the  American  Xational  Red  Cross  in  Europe  and 
that  a  commission,  of  which  Major  ^furphy  would  be  the 
head,  should  accompany  him  to  Europe  for  the  purpose  of 
carrying  out  relief  work  in  France,  Belgium  and  other  Euro- 
pean countries  .  .  ."  This  action  was  later  formally  ratified 
by  the  Executive  Committee  at  a  meeting  held  June  15,  1!)17, 
and  was  spread  on  the  Minutes  of  the  War  Council  at  a  meet- 
ing held  August  10,  1917. 

In  the  meantime,  Afajor  Murphy  had  selected  a  strong  staff 
and  the  new  Commission  for  Europe  had  sailed  June  2.  Major 
Murphy  was  commissioner;  the  deputy  commissioners  wore 
James  H.  Perkins,  of  Xew  York  ;  William  Endicott,  of  Boston  ; 
Carl  Taylor,  of  Xew  York ;  George  B.  Ford,  of  New  York ; 
Ernest  ^IcCullough,  of  Boston ;  A.  W.  Copp,  and  Ernest  P. 
Bicknell,  Director  General  of  Civilian  Relief  of  the  American 
Red  Cross.  Others  who  accompanied  tlie  commission,  but 
whose  names  are  not  listed  as  deputy  commissioners  on  the 

"'See  Red  Cross  Arcliives,  File  No.  241. 


THE  EUROPEAN  WAR  531 

Minutes  of  the  War  Council  of  August  16,  1917,  were  Fred- 
erick S.  Hoppin,  Kcvercnd  Kobert  Davis,  Reverend  E.  D. 
Miel,  F.  K.  King,  Paul  Kainey,  Frederick  Hoffman,  Ralph 
Preston,  Phillip  Goodwin,  C.  G.  Osborne,  R.  J.  Daly,  John 
Van  Schaick  and  Thomas  H.  Kenny,  The  War  Department 
detailed  Dr.  Alexander  Lambert,  Major,  Medical  Reserve 
Corps,  U.  S,  A.,  to  join  the  commission  as  liaison  officer  be- 
tween the  American  Expeditionary  Forces  and  the  American 
Red  Cross. 

The  American  Red  Cross  Commission  for  Europe  arrived  in 
Paris  on  June  14,  1917,  and  set  up  the  headquarters  of  the 
organization  at  No.  5  Rue  Francois  1"".  Ten  days  later,  the 
War  Department  appointed  Major  Murphy  to  membership  on 
General  Pershing's  staff.  By  this  appointment,  members  of 
tli(>  Red  Cross  Commission  for  Europe  who  were  soon  to  become 
directors  of  important  branches  of  Red  Cross  service,  were 
placed  in  a  position  where  they  could  easily  consult  officers  of 
the  American  Expeditionary  Forces  who  were  heads  of  those 
departments  in  the  American  Armies  in  France  which  were 
particularly  affected  by  Red  Cross  operations. 

The  first  work  of  the  commission  was  accomplished  through 
the  generosity  of  relief  organizations  already  existing  in 
France.  Dr.  C.  C.  Burlingame,  then  Captain,  Medical  Corps, 
V.  y.  A.,  who  was  later  the  director  of  Hospital  Service, 
American  Red  Cross  in  France,  wrote : 

At  tlio  time  the  Eed  Cross  stepped  into  the  field,  the  Ameri- 
can Eeliof  Clearing  House  was  already  functioning  to  furnish 
efficient  relief  and  avoid  the  duplication  of  various  relief 
agencies.  The  director  general  of  this  organization  was  at 
the  time  IT.  O.  Beatty;  J.  H.  Jordian  was  the  chief  operating 
manager.  Atfiliated  with  the  Clearing  House  were  Ralph 
Preston.  Herman  Harjes,  J.  Ridgely  Carter.  James  R.  Bar- 
bour and  others.  Associated  with  tlie  Clearing  House  were 
such  organizations  as  the  Xorton-Harjes  AmhuUmce  Service 
and  tlie  American  l)istril)uting  Service,  organized  by  Mr.  and 
Mrs.  Robert  W.  Bliss,  of  the  United  States  Embassy  in 
Paris. •'^^ 

The  Committee  of  the  American  Relief  Clearing  House 
turned   over   to    the    American   Red   Cross   their   organization, 

''"Military  History  of  tlic  American  Ke(l  Cross  in  France,"  C.  C.  Bur- 
lingame. J).   '),   [{ed  Cross  Library. 


532   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

their  equipment  and  their  personnel,  which  immediately  gave 
to  the  commission  a  ''running  start"  for  its  new  task. 

In  September,  1917,  Major  Perkins  was  made  commissioner 
for  France;  Major  ^hirphv  was  forced  to  spend  much  of  his 
time  traveling  in  Belgium,  Italy  and  the  Balkans,  preparatory 
to  the  initiation  of  American  Red  Cross  activities  in  these 
places. 

The  early  days  of  the  summer  of  1917  were  spent  in  estab- 
lishing contact  with  the  American  Army  officers  then  in  France, 
with  the  organizations  already  existing  there  for  the  relief  of 
the  civilian  population  and  with  the  French  authorities.  The 
conferences  which  took  place  in  July,  August  and  September 
were  attended  by  high  officials  of  the  American  Army  and 
the  Red  Cross  Commission  for  Europe.  Among  the  consulting 
officers  were  General  Pershing,  Colonel  Bradley,  Colonel  San- 
ford  Wadhams,  Major  Murphy,  Major  Lambert  and  Captain 
Burlingame,  and  recogiiition  was  given  by  these  officials  to  the 
relationship,  already  provided  for  by  law  and  Army  regula- 
tions, that  the  American  Red  Cross  should  serve  as  an  emer- 
gency arm  of  the  ]\Icdical  Corps  in  the  field. 

Of  the  early  organization  of  the  American  Red  Cross  in 
France,  Major  Perkins  wrote: 

Within  a  few  weeks  after  our  arrival,  IMajor  IMurphy  and  I 
discussed  with  General  Pershing  the  work  which  lay  before 
us.  .  .  .  He  felt  that  it  would  be  many  months  before  his 
Army  would  1)0  an  effective  fighting  force  and  that  the  Eed 
Cross  must  during  those  months  carry  tlie  American  flag  in 
Europe. 

With  this  idea  in  view,  we  organized  two  departments ;  one, 
the  Department  of  Civil  Affairs,  whose  duty  it  was  to  take  \ip 
all  the  relief  work  in  France,  the  need  for  whicli  lun]  been 
created  by  the  war ;  the  otlier,  the  Department  of  ^lilitary 
Affairs,  should  iiandle  our  Ked  Cross  work  with  both  the 
French  and  American  Armies. "° 

Dr.  Alexander  Lambert  was  straightway  appointed  director 
of  the  Red  Cross  ^Medical  and  Surgical  Service,  under  the  De- 
partment of  ^lilitary  Affairs. 

American  Red  Cross  medical  and  surgical  service  to  Ameri- 
can and  Allied  troops  embraced  two  distinct  types  of  hospitals. 

'"■^  "Tlic  First  Year  of  tlie  Anu'rican  Red  Cross  in  France,"  p.  4. 


THE  EUROPEAN  WAR  533 

The  first  of  these  were  designated  as  American  Red  Cross 
military  hospitals  and  were  established  primarily  to  care  for 
American  soldiers.  Of  this  type  Commissioner  Perkins  wrote : 
''Where  the  hospital  is  known  as  a  Red  Cross  military  hospi- 
tal, it  means  that  we  have  installed  the  hospital  and  that  its 
business  aspects  are  managed  by  us,  but  that  its  medical  direc- 
tion is  turned  over  to  the  Army,  which  employs  its  own 
personnel." 

Captain  Burlingame  defined  American  Red  Cross  military 
hospitals: 


The  term  "American  Red  Cross  military  hospital"  was 
used  only  by  direction  of  the  Chief  Surgeon,  A.  E.  F.,  a 
number  being  assigned  only  by  his  office.  The  word  "mili- 
tary" in  the  title  of  a  Red  Cross  hospital  was  never  inserted 
except  upon  his  order.  It  was  for  this  reason  that  certain 
hospitals  known  as  American  Red  Cross  hospitals  were 
operated  under  the  same  general  plan  as  American  Eed  Cross 
military  hospitals  but  not  under  that  name. 

Again,  certain  personnel  organized  as  base  hospital  units 
were  moved  into  American  Red  Cross  hospitals  and  operated 
on  the  same  basis  as  the  American  Red  Cross  military  hospi- 
tals. It  seemed  unwise  to  change  the  name  of  a  base  hospital 
unit  even  when  operated  on  this  plan. 

American  lied  Cross  military  hospitals  were  operated 
jointly  by  the  l^ed  Cross  and  the  Medical  Corps.  In  each 
instance  there  was  some  reason  why  it  could  not  be  operated 
to  advantage  by  the  United  States  Army  independent  of  the 
American  Ked  Cross.  These  reasons  were  varied ;  for 
example,  when  America  first  entered  the  war,  Paris  and  its 
environs  were  not  opened  by  the  French  to  the  U.  S.  x\rmy  for 
hospitalization  purposes.  It  w'as  possible,  however,  for  the 
Red  Cross  through  various  agreements,  some  of  them  in- 
formal, to  take  over  or  establish  hospitals  in  and  about  Paris. 
Jt  should  he  remembered  that  Paris  was  then  out  of  the 
American  and  in  the  heart  of  the  French  Army  Zone. 

As  raj)i(lly  as  conditions  changed,  making  it  j)ossible  for 
the  I'ed  Cross  to  withdraw,  formations  operating  as  American 
Ped  Cross  military  liospitals  were  completely  turned  over  to 
the  ^Medical  Corps  to  be  operated  as  regular  Army  forma- 
tions. .  .  ."^ 

"  •■^lilitary  Tlistory  of  <ho  American   Rod  Cross  in   Franco,"'   pp.   2(!-27*, 
-ilirary.    Xnliotnil    llrdiliiiuirlcrK.    Wdshiw^Xou.    1).    C. 


534    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  a  letter  addressed  December  27,  1917,  to  the  Judge  Advo- 
cate General  of  the  Army,  the  Surgeon  General  of  the  Army 
asked 

.  .  .  for  the  opinion  of  the  Judge  Advocate  General  spe- 
cifically on  (a)  Base  Hospital  Xo.  39  "attached  to  and  render- 
ing service  to  the  French  Army;"  (b)  on  personnel  of 
"American  Red  Cross  Military  Hospitals,  Xos.  1,  2  and  3 
(formerly  the  American  Ambulance,  the  Hospital  Benevole 
21  bis — Blake's  Hospital  and  Mrs.  Reid's  Hospital),  the  per- 
sonnel of  which  are  partly  commissioned  or  enlisted  in  the 
U.  S.  Army  and  are  partly  civilian,  whether  American  or 
foreign  not  of  record;  and  (c)  on  personnel  of  Red  Cross 
hospitals  maintained  in  France  for  civil  relief  only.**^ 

The  Judge  Advocate  General  replied  on  December  29,  1917: 

When  American  Red  Cross  officials  have  been  accepted  by 
the  United  States  and  are  performing  in  France  service  for 
any  of  the  Allied  forces,  they  are,  to  use  the  words  of  Article 
of  War  2,  "persons  accompanying  or  serving  with  the  Armies 
of  the  United  States  in  the  field,"  and  hence  American  Red 
Cross  officials  with  the  hospital  described  in  paragraph  1, 
sub-paragraph  (a)  are  subject  to  the  military  jurisdiction  of 
the  United  States.  The  hospitals  described  in  sub-paragraphs 
(b)  and  (c)  are  not,  in  a  strict  sense,  military  hospitals,  as 
they  furnish  aid  to  civilians;  but,  nevertheless,  as  the  Army 
of  the  United  States  is  operating  quite  as  much  for  the  benefit 
of  the  civilian  population  of  France  as  for  the  benefit  of  the 
military  population,  the  personnel  of  these  hospitals  must  be 
held  to  be  subject  to  American  military  jurisdiction  in  case 
the  persons  in  question  have  been  in  some  formal  or  informal 
way  recognized  by  the  Army  of  the  United  States — otherwise 
not.  What  is  important  is  neither  what  these  persons  are 
doing,  nor  where  they  are  doing  it,  but  what  description  of 
persons  they  are.  If  they  are  "persons  accompanying  or 
serving  with  the  Armies  of  the  United  States  in  the  field'' 
there  is  military  jurisdiction  under  the  words  of  Article  of 
War  2.  (See  Geneva  Convention  of  190G,  Article  10,  and 
Rules  of  Land  Warfare,  pars.  133-136.)  ^^ 

American  Red  Cross  hospitals,  the  second  type  of  institu- 
tion established  by  the  Commission  for  France,  admitted  both 

"^  Lcfjal   Matters  Relating:  to  tlic  Aiticrican   Red   Cross:    Army  and  Navy 
Orders;  Appendix  No.  V[.  Document  102.     Library,  Xational  Headquarters. 
'"  Ihid.,  Document  No.    KCi. 


THE  EIROPEAN  WAR  535 

American  and  Allied  wounded.  They  were  defined  by  Major 
Perkins:  "In  what  arc  known  as  American  Red  (h-oss  hospitals 
we  supply  all  materials  and  install  the  hospital.  We  also 
furnish  nurses  and  pay  their  salaries.  Doctors  and  orderlies 
are  partly  loaned  by  the  Army  and  partly  supplied  by  us." 

In  working;  out  a  policy  of  coordination,  the  American  Red 
Cross  acquired,  during  the  summer  and  fall  of  11)17,  hospitals 
then  being  maintained  in  France  by  various  American  relief 
agencies.  The  first  of  these  was  the  American  Ambulance  at 
Neuilly.  Of  this  institution,  American  lied  Cross  Military 
Hospital  No.  1,  W.  S.  Patten,  then  director  of  the  Depart- 
ment of  ^lilitary  Aflfairs,  American  Red  Cross  in  France, 
wrote  in  his  report  of  the  medical  division  during  its  first  six 
months  in  France: 

American  Red  Cro.'-:s  Military  Hospital  Xo.  1  was  originally 
the  American  Ambulance  and  has  now  been  put  under  the 
United  States  Army  and  the  American  Eed  Cross.  This  hos- 
pital contains  between  five  and  six  hundred  beds,  which  are 
at  the  disposal  of  the  French  Army.  It  also  operates  a  com- 
plete dental  clinic  for  the  free  service  of  the  French  soldiers, 
members  of  the  United  States  Army  and  personnel  of  the 
American  Red  Cross.  Ui  connection  with  this  hospital,  we 
have  an  ambidanee  service  which  carries  the  wounded  for  the 
entire  Paris  district,  viz.,  it  evacuates  French  wounded  to  all 
the  hospitals  in  Paris,  a  very  valuable  service  in  itself  and  a 
useful  medium  through  which  to  help  our  Allies.  We  have, 
furthermore,  established  a  sanitary  train  for  the  French  which 
goes  to  tlie  Front  and  brings  back  the  wounded.  The  Ameri- 
can Red  Cross  has  the  entire  medical  and  surgical  manage- 
ment of  this  train.  An  agreement  under  which  the  hospital 
and  its  associated  undertakings  are  directed  gives  us  author- 
ity over  them,  but  an  American  Army  othcer  is  assigned  to  the 
directorship  of  the  hospital. 

American  Red  Cross  ^Military  Hospital  No.  1  was  the  first 
American  institution  in  France  to  be  operated  under  the  special 
relationship  which  has  been  defined  abov(^  by  the  Judge  Advo- 
cate Crcneral  and  others.  It  was  also  a  stronghold  of  lay  in- 
fluence. It  had  been  oruanized  early  in  liU4-  by  a  C(^mniittee 
of  Americans.  Airs.  (Jcorgc  Munroc,  the  wife  of  an  American 
banker  who  had  for  numy  years  made  his  home  in  Paris,  was 
one  of  the  principal  sponsors  for  and  contributors  to  its  maintc- 
nnncc. 


536  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  this  point  it  may  be  well  to  interpolate  a  word  as  to  the 
method  adopted  by  the  American  Red  Cross  in  developing  its 
foreign  activities.  When  a  commission  entered  a  foreign  coun- 
try, it  first  established  contact  with  the  members  of  the  Ameri- 
can Embassy  and  Americans  then  resident  there  who  had  al- 
ready won  the  confidence  of  the  local  authorities,  and  made 
them  the  spokesmen  for  the  American  Red  Cross  until  the 
officers  of  the  commission  had  won  local  confidence.  Mr. 
George  Munroe  was  born  in  France  and  both  he  and  Mrs.  Mun- 
roe  were  known  to  Parisians.  ]\Irs.  Munroe  spoke  fluent  French, 
knew  the  conditions  in  French  hospitals  in  and  about  Paris  and 
was  a  staunch  war  worker,  so  she  was  in  an  excellent  position  to 
advise  the  commissioner  about  the  development  of  women's 
service. 

The  American  Ambulance  had  been  developed  in  1914  and 
in  the  absence  of  American  nurses  in  Paris,  American  women 
resident  there  had  done  the  pioneer  work.  Mrs.  Munroe  was 
one  of  these ;  Mrs.  William  K.  Vanderbilt  was  another, ,  and 
she  made  the  first  bed  at  the  iSTeuilly  Ambulance  because,  as 
she  afterwards  stated  to  Miss  Boardman,  there  was  no  one  else 
to  do  it.  After  these  American  women  had  once  become  inter- 
ested in  the  work,  it  was  only  human  nature  that  they  would 
desire  to  continue  it.  An  incident  will  serve  to  show  the  abso- 
lute dearth  of  professional  nurses.  The  Duchess  of  Rohan 
converted  her  Paris  residence  into  a  military  hospital  for 
French  wounded  and  she  and  her  friends  did  the  nursing.  Thev 
had  neither  resident  surgeon  nor  chief  nurse  because  they  could 
not  get  either ;  a  single  doctor  came  in  once  a  day  to  make 
rounds.  The  Duchess  and  her  friends  had  had  only  the  most 
elementary  instruction  in  nursing,  yet  they  were  forced  by 
necessity  to  care  for  grands  blesses.  "The  anxiety  we  felt  in 
trying  to  care  for  these  gravely  wounded  men,  many  of  whom 
had  just  come  off  the  operating-table,"  the  Duchess  said  to  ]\riss 
Boardman,  "was  our  greatest  trial.  When  we  had  air  raids, 
they  begged  us  to  take  them  down  to  the  ahris  but  we  could  not 
tell  whether  the  moving  of  them  would  be  fatal  or  not.  If  we 
moved  them  and  they  died,  we  would  be  responsible,  yet  if  they 
were  not  moved,  they  might  be  struck  and  again  we  would  be 
responsible." 

As  the  work  at  the  Ambulance  got  under  way,  a  unit  of 
American  nurses,  among  them  many  Red  Cross  nurses,  was 
s(>nt  over  from  this  country  to  form  the  nursing  staff.     Margaret 


THE  EUROPEAN  WAR  637 

Dunlop,  of  the  Pennsylvania  School,  was  the  chief  nurse.  She 
and  several  of  the  original  unit,  however,  returned  in  1916  to 
the  United  States.  As  the  needs  for  the  Ambulance  were  in- 
creasing with  every  year  of  the  duration  of  the  war,  the  nurs- 
ing statf  was  enlarged  by  the  assignment  of  whatever  nursing 
personnel  was  available  in  Paris — several  British  nurses,  a 
number  of  the  American  Red  Cross  nurses  who  had  elected  to 
remain  in  foreign  service  after  the  recall  of  the  Mercy  Ship 
units,  and  especially  untrained  American  volunteers  who  were 
then  resident  in  Paris  and  who  were  zealous  to  serve. 

In  tlu^  simnner  of  1917,  the  American  Ked  Cross  took  over 
the  Ambulance,  enlarged  and  militarized  it  and  assigned  nu- 
merous American  Ived  Cross  nurses  to  duty  as  reserves  of  the 
Army  Xurse  Corps.  Differences  of  opinion  arose  between  the 
old  and  the  new  regime.  Esther  Y.  Hassan  was  the  first  super- 
intendent of  the  Xavy  Nurse  Corps.  Later  she  was  assigned 
as  head  nurse  of  a  hundred  Army  "casuals"  who  went  overseas 
in  June,  1!>17,  for  duty  in  various  American  and  British  hos- 
pitals then  in  need  of  reinforcements.  She  drew  a  significant 
comparison  between  conditions  existing  in  the  English  bases 
and  at  American  Red  Cross  Military  Hospital  No.  1 : 

The  fact  that  I  was  in  charge  of  the  unit  on  the  way  over 
and  during  those  wonderful  eight  days  in  London  came  nigh 
to  ruining  an  otherwise  perfectly  good  nurse,  for  to  be 
*'^ratron"  in  England  is  quite  the  most  blissful  experience 
that  has  ever  come  to  me.  I  never  knew  before  what  a  very 
important  person  "Matron"  is.  We  have  all  come  to  love  the 
British  mightily.  Their  hospital  administration  is  quite 
remarkable.  .  .  . 

We  found  the  British  officers  very  nice  also.  They  saluted 
whenever  they  came  into  the  wards  and  wlien  we  met  them 
outside  and  their  attitude  was  just  what  it  would  he  to  a 
brother  officer,  but.  alas  and  alack,  here  we  are  once  more 
eating  humble  })ie  with  our  own  countrymen  !  Tlio  woi'k  was 
hard  in  the  British  bases  but  always  interesting.  We  nurs(\s 
did  every  dressing  in  tlie  ward,  chest  cases,  knee  joints  and 
ani])utati()ns,  whereas  the  doctor  does  even  the  tiny  scratches 
here,  witli  f()i'ce])s  and  all  the  pomp  and  fuss  of  the  most 
extreme  civil  liospitals. 

Just  at  ])rcs(Mit  this  whole  hosjiital  is  being  reorganized  and 
you  will  have  to  iningine  what  that  means.  We  are  trembling 
for  the  nursing  standards.  l)ut  hope  that  things  will  turn  out 
better  when  the  smoke  of  battle  clears  awav.     1  would  like  to 


538   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tell  you  more  of  the  conditions  here,  but  upon  studying  the 
posted  rules  of  our  energetic  young  censor  I  have  decided  to 
follow  the  counsel  of  one  of  our  humorous  publications  which 
gave  as  advice  to  the  young  man  about  to  marry,  the  single 
word,  "Don't !"  Of  course,  you  must  expect  that  we  Ameri- 
cans, young  in  this  game  of  war,  would  go  to  many  extremes. 

Martha  St.  John  Eakins  was  chief  nurse  of  the  Ambulance 
Hospital  and  Frances  B.  Latimer,  one  of  the  nurses  of  the 
Mercy  Ship  Expedition,  was  her  assistant.  The  hospital  was 
of  one  hundred  and  fifty  bed  capacity.     Later  it  was  enlarged. 

The  second  institution  taken  over  by  the  Red  Cross  Commis- 
sion for  France  was  the  surgical  hospital  established  in  1915 
by  Dr.  Joseph  A.  Blake,  of  Xew  York  City.  This  hospital, 
which  was  subsequently  designated  as  American  Red  Cross 
Military  Hospital  Xo.  2,  was  used  largely  for  fracture  cases. 
Of  this  institution,  Mr.  Patten  wrote : 

Military  Hospital  Xo.  2  contains  three  hundred  beds,  of 
which  one  himdred  are  reserved  for  French  wounded  and  the 
remainder  for  members  of  the  American  Army  and  the  per- 
sonnel of  the  American  Ked  Cross.  In  this  hospital  is  situ- 
ated our  Researeli  Laboratory  Xo.  1,  where  a  corps  of  bac- 
teriologists are  making  valuable  records  for  the  benefit  of  the 
medical  profession  working  with  the  Army.  During  the  past 
months,  we  have  carried  on  in  this  laboratory  a  careful  inves- 
tigation of  some  of  the  causes  of  trench  fever.  By  means  of 
the  work  of  this  laboratory  we  are  making  it  possible  to  grasp 
more  thoroughly  the  original  causes  of  maladies  common  to 
soldiers.  There  has  been  no  lack  of  attention  given  to  the 
severely  wounded.  Through  such  information  as  our  re- 
search l;i})oratories  have  given  us,  injuries  and  sickness  which 
in  the  rush  of  war  seem  less  important  because  less  visible, 
can  be  watched  in  the  first  stages  when  they  are  more  quickly 
and  more  easily  cured. 

A  third  institution  which  the  commission  took  over  early  in 
the  summer  of  1917  was  tlie  officers'  hospital  established  in 
1015  by  Mrs.  Whitclaw  Roid  in  the  Rue  de  Chevreuso,  in  the 
building  which  had  formerly  boused  her  Club  for  Girls.  Miss 
Eleanor  R.  White,  a  reserve  nurse,  Army  Xurs(>  Corps,  was 
the  chief  nurse;  Miss  Agnes  F.  James,  Army  Xurse  Corps, 
was  her  assistant  and  was  also  chief  nurse  of  American  Red 
Cross  Military  Hospital  Xo.  112,  an  overflow  hospital,     Mrs. 


THE  EUROPEAN  WAR  539 

Reid's  hospital  was  designated  as  American  Red  Cross  Mili- 
tary Hospital  No.  3. 

Additional  hospitals  previously  maintained  by  individual 
Americans  were  also  taken  over  during  the  summer  and  fall 
of  1917  by  the  commission.     Of  these,  Mr.  Patten  wrote: 

In  the  interests  of  the  French,  the  Red  Cross  assists  four 
other  hospitals  situated  at  Annel,  Cugny,  fivreux  and  Sois- 
sons.  It  also  supplies  part  of  the  personnel  for  these  hospitals 
to  wliieh  we  have  given  ambulances,  beds,  instruments  and 
other  medical  and  surgical  materials.  The  hospitals  at  Annel, 
Cugny,  fivreux  and  Soissons  were  existing  institutions  and 
are  operated  for  the  French  soldiers. 

The  hospital  at  Evreux  was  staffed  by  nurses  of  the  original 
Yvetot  Unit  which  National  Head(piartcrs  had  sent  in  Febru- 
ary, 1915,  to  the  Alliance  Hospital.  Dr.  Ralph  Fitch  had 
been  director  and  Mary  M.  Fletcher,  supervising  nurse  of 
the  unit.  In  August,  1915,  Miss  Fletcher  had  resigned  to 
marry  an  Englishman  and  Mary  K.  Nelson  had  been  appointed 
in  her  place.  During  the  same  month,  the  Service  de  Sante 
had  requested  that  Dr.  Fitch  and  the  nurses  take  charge  of 
]\Iilitary  Hospital  No.  48'""  at  St.  Valery-cn-Caux. 

National  Headquarters  recalled  its  foreign  units  on  Octo- 
ber 1,  1915,  but  Dr.  Fitch,  Miss  Nelson,  Josephine  Clay, 
^Marion  M.  Rice,  Helen  Spaulding  and  Helen  Kerrigan  elected 
to  remain  as  volunteers  at  St.  Valerv  in  the  service  of  the 
French.  During  the  following  mouths  ]Miss  Nelson  built  up 
a  strong  nursing  staff,  com^posed  of  American  and  P]nglish 
nurses  and  nurses'  aides.  In  September,  1917,  the  French 
Government  moved  the  unit  from  St.  Valerv  to  Evreux  and 
placed  them  in  charge  of  I'Hopital  Complimentaire  No.  2,  of 
six  hundred  beds. 

When  the  American  Red  Cross  Commission  for  France 
adopted  its  policy  of  coordination  of  existing  relief  agencies,  it 
offered  financial  aid  and  supplies  to  Dr.  Fitch's  hospital.  The 
work  was  largely  orthopedic.  Doris  Petrola,  an  American  Red 
Cross  luirses'  aide  assigned  to  duty  at  Evreux,  wrote: 

The  two  wards  on  wliich  I  am  stationed  have  o8  French 
blesses  and  everything  looks  weird  at  night.  There  is  no 
li<jht  except  that  from  the  waning  moon  and  from  one  lantern 
covered  with  a  towel.      Arms  and  legs  are  strung  up  in   57. 


540    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

varieties  of  angles  and  one's  imagination  may  distort  them 
into  anything,  according  to  the  degree  of  indigestion  one  has 
from  the  cooking.  .  .  . 

Shortly  I  will  hear  a  blesse  calling  "Mees !"  It  is  almost 
time  to  give  the  "squirts"  as  they  call  Dakin  irrigations.  We 
do  everything  but  drink  Dakins  here.  ...  I  am  told  that  the 
wounds  here  are  very  bad.  I  have  no  means  of  comparison, 
but  I  do  know  that  a  man  injured  at  home  like  the  least 
seriously  wounded  here  would  be  considered  extremely  ill  and 
would  be  surrounded  by  doctors  and  nurses.  .  .  .  Aides  were 
badly  needed,  so  we  were  welcome  and  it  is  a  great  pleasure. 
Often  the  blesses  will  say  "That  makes  hcaucoup  travail  for 
you,  Mees";  and  I  can  always  say  and  mean  it  in  my  heart 
"Ce  nest-ce  pas  heaucoup  de  travail  parceque  c'est  un 
plaisir." 

The  assumption  of  financial  and  executive  responsibility  for 
these  hospitals  immediately  created  a  need  for  an  executive 
nurse  to  direct  from  the  Paris  headquarters  of  the  Commis- 
sion for  Europe  the  nursing  service  in  these  institutions.  At 
this  early  date  the  question  of  lay  control  of  professional  nurs- 
ing service  arose,  a  problem  to  persist  until  after  the  signing  of 
the  armistice.  The  Commission  for  France  desired  to  place 
Mrs.  Munroe  in  charge  of  American  Red  Cross  nurses  in 
France.  Through  the  efforts  of  two  influential  American  Red 
Cross  nurses  then  in  France  the  point  of  view  of  American 
Red  Cross  nurses  and  their  desire  for  professional  direction 
was  presented  to  the  commissioners  and  ^Mrs.  Munroe  was 
given  the  direction  of  the  nurses'  aides,  wdiich  were  known  in 
France  as  auxiliares.  Major  Murphy  cabled  Islr.  Davison  on 
July  10:  ''(Cable  No.  119).  Please  have  Miss  Delano  select 
a  trained  nurse  to  act  as  head  of  our  nursing  activities  in 
France.  This  woman  is  needed  immediately.  She  should 
have  tact  and  experience  and  be  thoroughly  subject  to  com- 
mand of  officers  in  charge." 

Miss  Delano  acknowledged  receipt  of  this  message  under 
date  of  July  13.  Among  the  nurses  of  the  oSTew  York  Hospital 
Unit,  U.  S.  Army  ]^as(^  Hospital  No.  9,  then  equipped  and 
ready  to  sail,  was  ^fartha  Russell.  ]\Iiss  Delano  on  July  17 
requested  her  to  come  to  National  Headquarters  and  upon  her 
arrival  offered  her  the  appointnuuit  as  chief  nurse  of  the 
commission.  Miss  Russell  accepted  the  position.  Miss 
Delano  wrote  on  July  18  to  Major  Murphy  as  follows  a  letter 


THE  EUROPEAN  WAR  541 

of  introduction:  ''This  letter  will  introduce  JNIartha  Russell, 
who  has  been  selected  at  your  request  to  act  as  a  n^presentative 
of  the  Nursing  Service  under  your  direction  in  France.  Miss 
Russell  has  had  a  good  deal  of  executive  experience  and  is,  I 
believe,  well  qualitied  for  the  work."  Similar  letters  were 
written  to  Colonel  Ireland  and  to  Colonel  Winter  and  full  in- 
formation concerning  Miss  Russell's  appointment  was  re- 
ported verbally  to  Mr.  Wadsworth,  then  acting  chairman  of 
the  Red  Cross  and  ex-officio  member  of  the  War  Council,  and 
to  other  interested  officials  at  Xational  Headquarters,  ^liss 
Noyes  wrote  on  July  21  to  !^[r,  Norton,  of  the  War  Council : 
''Will  you  kindly  cable  to  Major  Murphy  that  Martha  Russell 
is  leaving  New  York  to-day  as  the  representative  of  the  Nursing 
Service  in  France  ?" 

An  important  change  of  personnel,  which  was  to  have  direct 
bearing  upon  the  situation  relating  to  the  appointment  of  a 
chief  nurse,  American  Red  Cross  in  France,  had  taken  phice 
some  days  before  in  the  Department  of  Military  Relief.  The 
Minutes  of  the  War  Council,  meeting  July  11,  recorded  the 
fact  that  ''the  War  Council  has  been  informed  by  ^lajor  Gen- 
eral Gorgas  that  Colonel  fletlcrson  R.  Kean  has  been  placed  in 
charge  of  the  entire  ambulance  service  in  Franc(^  and  has 
therefore  been  withdrawn  from  the  Red  Cross."  The  same 
^Minutes  stated  that  the  War  Council  had  recommended  to  the 
Executive  Committee  that  John  D.  Ryan,  one  of  its  members, 
be  appointed  as  Director  General  of  ^Military  Relief.  On 
July  1-'},  Mr.  Ryan  wrote  to  General  Gorgas,  requesting  that 
^lajor  Winford  II.  Smith,  some  time  superintendent  of  fFohns 
Hopkins  Hospital,  who  was  then  on  duty  in  the  Surgeon 
GencraTs  office,  be  detailed  to  duty  at  National  Headquarters 
as  assistant  Director  General  of  ^Military  Relief.  General 
l>liss,  then  acting  Chief  of  Staff,  T".  S.  A.,  under  S})e('ial 
Orders  No.  KIT),  dated  July  18,  detailed  Major  Smith  to  Na- 
tional Headciuarters.*'^ 

!Major  Smith  arrived  at  National  Headquarters  at  a  time 
of  stress  and  because  of  the  mobilization  of  Red  Cross  base 
hospitals  into  active  service,  found  a  heavy  burden  of  work 
awaiting  him.  He  occupied  an  office  on  the  first  iloov  of  the 
main   building,   dii'ectiy   across   the   hall   from   that   wliicli    was 

"'Major  Smitli  was  appointcil  Dii^n'tor  Cionoral  of  ilie  lli'partnu'nt  oi 
Military  Relief  at  a  ineetiii<r  of  the  Executive  Committee  held  Aufzust  31, 
1917. 


542    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

used  by  Miss  Delano  and  Miss  Noyes.  After  hours,  on  the 
night  of  July  20,  while  Major  Smith  was  endeavoring  to  get 
his  work  in  hand,  the  following  cable  arrived  at  National  Head- 
quarters and  was  referred  to  him: 

7:40  P.M. 
July  20,  1917. 
19,686.    Please  communicate  the  following  to  H.  P.  Davi- 
son: 

Cable  No.  19G.  Please  communicate  the  following  to 
Annie  W.  Goodrich,  Teachers  College,  Columbia  University : 
quote :  Doctor  Lambert  says  necessary  to  have  someone  com- 
petent to  take  complete  management  of  Eed  Cross  nurses  in 
France  under  him.  You  must  undertake  this  and  report  at 
once  to  him  in  Paris.     End  quote. 

(signed)   Murphy-Harjes. 

Major  Smith,  apparently  not  realizing  the  importance  of  con- 
sulting the  Nursing  Service  before  taking  any  action  on  the 
above  cable,  that  night  sent  a  copy  of  it  verbatim  to  Miss  Good- 
rich, with  the  following  letter  of  transmittal : 

July  20,  1917. 
My  dear  Madam: 

Mr.  H.  P.  Davison,  chairman  of  the  \Yar  Council  of  the 
Eed  Cress,  is  in  receipt  of  the  following  cable.  What  shall 
we  reply  ? 

Very  truly  vonrs, 

(signed)   W.  H.  Smith,  Major,  M.R.C.,  U.S.A. 
Asst.  Director  General,  Mil.  Relief. 

Thus  at  the  beginning  of  the  war  period  the  personality  of 
Annie  Warburton  Goodrich  leaped  into  the  arena  of  Red  Cross 
nursing  history  and  remained  an  active  and  complex  factor 
throughout  the  tense  and  sometimes  hysterical  months  which 
followed.  Hitherto,  as  one  of  the  members  of  the  National 
Committee  on  Red  Cross  Nursing  Service,  she  had  from  the 
beginning  helped  to  shape  the  policies  of  the  service. 

Miss  Goodrich  came  from  pure  New  England  stock.  She 
was  of  slender' build,  quick  in  her  movements,  with  alert  gray 
eyes  and  a  highly  organized  nervous  temperament.  Her  bril- 
liant mental  powers  wove  expressed  in  instantaneous  reactions 
and  in  a  flashing,  rapier-like  wit  which  often  held  a  satiric 
flavor.      Ambition,    fervid    sinccritv    and    staunclmess   blended 


THE  EUROPEAN  WAR  543 

to  form  a  character  highly  complex  and  not  easy  to  under- 
stand. She  was  a  confirmed  pacifist.  Hers  was  a  practical 
idealism,  best  seen  in  the  working  out  of  difficult  problems.  She 
had  a  penchant  for  administration  which  amounted  almost  to 
genius. 

Her  professional  career  was  as  brilliant  as  that  of  any  Ameri- 
can nurse.  She  was  graduated  in  1892  from  the  New  York 
Hospital  School  for  Nurses.  For  seven  years,  she  was  super- 
intendent of  the  training  school  and  Matron  of  the  New  York 
Post-Graduate  Hospital.  In  much  the  same  way  that  a  strong 
administrator  is  called  from  one  high  post  to  another  in  the 
business  world,  Miss  Goodrich  was  called  first  to  reorganize  the 
training  school  at  St.  Luke's  Hospital,  New  York  City,  then 
to  the  New  York  Hospital  and  then  to  Bellevue  and  Allied 
Hospitals.  She  then  went  to  Albany,  to  be  inspector  of  train- 
ing schools  under  the  Board  of  Reg-ents  of  New  York  State. 
From  that  position  she  was  called  to  Teachers  College  to  in- 
struct in  the  theoretical  phases  of  public  health  nursing  affili- 
ated with  Henry  Street  Settlement.  In  1917,  at  the  request 
of  the  Surgf^on  General,  she  made  an  inspection  trip  through 
the  cantonments  in  the  United  States  and  returned  to  the  Sur- 
geon General's  office  in  Washington  and  organized  the  Army 
School  of  Nursing.  In  1905,  ]\Iiss  Goodrich  was  president  of 
the  Superintendent's  Society  and  from  1915  to  1918  was  presi- 
dent of  the  American  Nurses'  Association.  From  1912  to  1915, 
she  was  president  of  the  International  Council  of  Nurses. 

At  the  time,  July,  1917,  when  the  correspondence  between 
!Major  Smith  and  ^liss  Goodrich  took  place,  the  Nursing  Ser- 
vice was  receiving  an  overwhelming  number  of  telegrams  and 
cables  every  day.  In  due  course  of  office  routine,  a  copy  of 
the  Lamhert-Goodrich  cable.  No.  196,  was  sent  to  ]\Iiss  Noyes' 
desk.  She  interpr<>ted  the  cable  as  a  request  for  Miss  Good- 
rich's aid  in  obtaining  a  proper  chief  nurse  and  as  Miss  Rus- 
sell had  already  sailed  when  this  copy  of  Cable  No.  190  came 
to  her  desk,  she  laid  it  aside,  regarding  the  question  as  a  closed 
one  and  neither  she  nor  Miss  Delano  broached  the  subject  with 
^liss  (loodrich. 

]\Iiss  Delano,  as  she  later  stated,  did  not  then  see  a  copy  of 
Cable  No.  19<).  On  the  margin  of  a  copy  of  this  cabl(\  in  the 
Ked  Cross  Nursing  Service  files,  there  now  appears  in  Miss 
Delano's  handwriting  the  words  ''never  saw  this."  Xo  date  is 
given  as  to  th(>  time  when  Miss  Delano  wrote  this  phrase  upon 


544   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  copy,  but  from  events  which  later  took  place,  it  is  probable 
that  she  saw  it  for  the  first  time  in  October,  1917. 

Some  time  between  July  21  and  July  24,  during  one  of  the 
many  conferences  which  took  place  daily  between  Miss  Noyes 
and  Major  Smith,  Major  Smith  asked  Miss  !N^oyes  if  a  director 
of  nursing  for  the  Paris  office  had  yet  been  selected.  Miss 
Noyes  replied  that  Miss  Russell  had  sailed  on  July  21.  Most 
unfortunately  Major  Smith  did  not  mention  to  Miss  Noyes 
the  matter  of  his  letter  to  Miss  Goodrich,  either  then  or  later, 
else  the  sequel  might  have  been  different. 

On  July  24,  Miss  Goodrich  wrote  to  Major  Smith : 

I  beg  to  acknowledge  your  communication  of  July  20, 
relating  to  the  message  received  by  Mr.  Davison  from  Dr. 
Lambert.  This  letter  only  reached  me  this  morning,  owing 
to  my  absence  from  the  city. 

In  order  that  there  may  be  no  misunderstanding,  I  am 
writing  to  say  that  I  understood  you  to  tell  me  over  the  tele- 
phone that  Miss  Martha  Russell  had  already  been  sent  to  take 
the  management  of  Red  Cross  nurses  in  France  and  therefore 
the  matter  was  closed. 

Major  Smith  replied  on  July  27  to  Miss  Goodrich:  "Your 
letter  of  the  24th  is  at  hand,  in  which  you  say  you  understood 
Miss  Martha  Russell  has  already  been  sent  to  take  the  manage- 
ment of  Red  Cross  nurses  in  France  and  that  the  matter  is 
therefore  closed.     Your  understanding  is  correct." 

At  the  time  of  this  correspondence  between  Major  Smith  and 
Miss  Goodrich,  ]\Iiss  Russell,  in  complete  ignorance  that  she 
was  embarking  upon  a  task  for  which  another  woman  had  been 
requested,  had  already  sailed  for  France.  Martha  JMontague 
Russell  was  born  in  Pittsfield,  Massachusetts,  and  was  an 
alumna  of  Mount  Holyoke  College.  She  received  her  training 
as  a  nurse  at  the  iSTew  York  and  Sloane  Hospitals,  jSTcw  York 
City.  She  was  for  some  montlis  a  head  nurse  in  the  Alanhattan 
Hospital,  Xew  York  City,  and  later  in  the  Norton  Intirmary, 
Louisville,  Kentucky.  She  afterwards  did  public  health  nurs- 
ing at  Henry  Street  Settlement.  She  then  became  assistant 
superintendent  of  the  Providence  Lying-in  Hospital.  Provi- 
dence, Rhode  Island,  and  later  director  of  nurses  of  the  West 
Penn  Hospital,  Pittsburgh,  Pa.  She  then  went  to  the  Sloane 
Alaternity  Hospital,  Xtnv  York  City,  as  superintendent  of 
nurses  and  remained  there  fur  twelve  years,  until  she  accepted 


THE  EUROPEAN  WAR  645 

Red  Cross  service.  Her  enrollment,  however,  dated  back  to 
the  year  1908.  Her  nine  months'  service  in  the  pioneer  work 
of  establishing  the  American  Red  Cross  Nursing  Service  in 
France  brought  her  the  Florence  Nightingale  Medal  of  the 
International  Red  Cross. 

Miss  Russell  arrived  in  Paris  on  August  12,  1917.  The 
following  day  she  wrote  ]\Iiss  Delano: 

After  a  very  pleasant  interview  with  Major  Murphy,  he 
handed  me  over  to  Dr.  Lambert,  who  is  in  charge  of  the 
me<lical  and  surgical  work  of  the  Red  Cross,  including  the 
nursing.  Dr.  Lambert  said  the  French  ruling  was  that  any- 
one who  cared  for  the  sick  is  a  nurse.  1  do  hope  our  nurses 
will  be  able  to  show  that  our  Red  Cross  pins  mean  a  whole  lot 
more.  Dr.  Lamhert  said :  "Do  not  question  that  I  am  with 
you  in  upholding  the  standards  to  the  limit." 

Dr.  Lamhert  took  me  down  to  Army  Headquarters  and  I 
met  Colonel  Eradlcy,  Colonel  Ireland  and  Colonel  Winter. 
I  gave  your  letters  to  the  last  two  gentlemen,  and  they  were 
both  delighted  to  hear  from  you  and  spoke  with  cordial  appre- 
ciation of  the  work  your  courage  and  wisdom  has  accom- 
plished. 

In  this  section  will  be  set  forth  American  Red  Cross  nursing 
service  to  the  sick  and  wounded  of  the  American  Expeditionary 
Forces.  Red  Cross  nursing  service  to  the  civilian  population 
of  Europe  will  be  found  in  a  subsequent  chapter. 

Miss  Russell  first  undertook  a  survey  of  the  American  Red 
Cross  hospitals  then  (Existing  in  France.  She  found  that  the 
staffs  of  these  hospitals  were  all  in  need  of  additional  nurses 
and  that  the  standards  of  nursing  service  existing  in  each  was 
varied  and  dillVred  from  that  which  the  National  Committee 
demanded  sliould  (>xist  in  American  Red  Cr<)ss  hospitals.  She 
immediately  ])egan  an  elfort  to  standardize  these  services  and 
to  rer'iil'orcc  thcni  iy  the  assignnunit  of  nurses  fnun  the  United 
States.  CnchT  Commissioner  Murphy's  or  ^lajor  Perkins' 
code-signature,  she  ('al)h'(l  the  needs  to  Miss  Delano  at  National 
Ilea(l<iuiirters.      Miss  Xoycs'  division  supplied  the  nurses. 

After  the  nurses  ari'ived  in  France,  they  wvvv  assign(>d  to 
duty  singly  or  in  twos,  not  in  large  units  as  was  the  ])roee(!ure 
of  the  Army  in  reference  to  its  base  hosj)itals.  Thi^  lied  ( 'ross 
scale  of  sahiri(s  followed  that  of  the  Army  Xui'se  Corj)s.  Previ- 
ous to  duly  9,  191S,  statf  nurses  were  paid  lifty  didlars  a  month, 


546    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

with  ten  dollars  monthly  increase  for  foreign  service.  Chief 
nurses  received  thirty  dollars  in  addition  to  this  base  pay.  By 
Act  of  Congress,  July  9,  1918,  the  salaries  of  all  members  of  the 
Army  Xurse  Corps  were  increased  ten  dollars  a  month  and  the 
Red  Cross  followed  this  ruling  with  reference  to  the  nurses 
serving  directly  under  its  auspices  overseas. 

In  addition  to  pressing  demands  for  graduate  nurses,  Miss 
Russell  faced  an  insistent  demand,  from  Red  Cross  officials, 
for  nurses'  aides.  The  assignment  of  nurses'  aides  to  foreign 
service  offered,  however,  opportunity  for  many  differences  of 
opinion  in  the  War  Department,  at  National  Headquarters, 
among  the  members  of  the  Paris  office  and  among  physicians 
and  nurses  in  foreign  service.  The  decision  of  General  Gorgas 
rendered  immediately  before  the  mobilization  of  the  first  six 
base  hospital  units,  definitely  barred  untrained  women  from 
the  military  hospitals  of  the  American  Expeditionary  Forces. 
This  decision  was  repeated  in  a  second  ruling  transmitted 
September  20,  1917,  by  Colonel  G.  E.  Bushnell  to  Miss  Xoycs: 

The  Surgeon  General  directs  me  to  state  that  in  view  of  the 
large  number  of  graduate  nurses  available  and  the  additional 
large  number  which  are  now  being  trained,  it  is  not  thought 
necessary  to  inaugurate  any  measures  for  the  training  of 
volunteer  nurses  at  the  present  time. 

The  views  of  General  Bradley,  the  chief  surgeon  of  the 
American  Expeditionary  Forces,  seemed  to  correspond  with 
those  of  General  Gorgas  in  the  desire  to  exclude  nurses'  aides 
entirely  from  military  hospitals.  General  Ireland  had  faith 
that  their  services,  if  properly  directed,  might  result  in  great 
benefit  both  to  patient  and  nurse.  In  a  letter  written  Decem- 
ber 10,  1917,  Miss  Russell  reported  General  Winter's  attitude: 

Just  a  line  to  tell  you  that  at  a  meeting  of  the  medical 
committee  this  evening,  your  old  friend,  Colonel  Winter, 
quashed  the  plan  that  the  people  here  had  been  concocting  for 
getting  aides  for  convalescent  hospital  work  over  here.  He 
said  that  one  good  nurse  who  knew  her  business  was  worth 
twenty  aides  and.  with  the  orderlies  and  convalescent  patients 
to  help  her,  would  take  better  care  of  the  patients  than  the 
aides.  He  said  they  could  use  them  in  the  cantonments  if 
they  wanted  to.  but  that  they  did  not  want  them  in  France 
for  the  soldiers  unless  it  was  much  more  important  than  it 
appeared  at  present. 


THE  EUROPEAN  WAR  547 

The  first  important  development  of  the  aide  problem  ap- 
peared in  a  cable  (No.  450)  dated  August  21,  1917,  in  which 
Commissioner  Perkins  requested  that  a  bureau  to  pass  on  all 
auxiliarv  hospital  workers  to  be  assigned  to  overseas  service 
be  established  at  National  Headquarters  under  the;  director  of 
the  Woman's  Bureau.  On  September  12  Major  Perkins  cabled 
again  that  the  Nursing  Bureau  in  France  had  been  divided, 
''Miss  Kussell  taking  graduate  trained  nurses  and  Mrs.  Munroe 
auxiliarv  luirses  not  graduates  of  training  schools."  This  plan 
of  organization  contemplated  that  Mrs.  Munroe's  bureau  should 
be  a  sub-bureau  of  Miss  llussell's  department. 

The  responsibility  for  the  training  and  direction  of  nurses' 
aides  had  been  intrusted,  it  will  be  remembered,  to  the  National 
Committee  on  Ked  Cross  Nursing  Service.  Miss  Delano  and 
Miss  Noyes  therefore  considered  that  the  creation  of  this  sub- 
bureau  with  an  untrained  woman  as  director,  would  present 
opportunity  for  possible  division  of  authority  and  they  made 
vigorous  protest  against  it  to  the  War  Council.  After  some 
further  discussion  by  cable,  Mr.  Davison  on  September  17  sent 
the  following  message  drafted  by  Miss  Noyes : 

Bureau  Nursing  feels  strongly  inadvisability  separating 
hospital  au.xiliary  workers  from  Nursing  Service.  Establishes 
precedent  contrary  to  Eed  Cross  regulations  and  policy  of 
Surgeon  Generals.  Nursing  Service  recommends  Martha 
Eakins,  chief  luirse  of  American  Ambulance,  if  acceptiible  to 
Aliss  Russell,  as  iiead  auxiliary  bureau.  Believe  that  this  will 
accomplish  purpose  desired  and  insure  efficiency  of  hospital 
service. 

The  discussion  then  dragged  along  by  letter  and  cable  until 
]\rajor  Perkins  suggested  on  October  15  that  the  whole  vexa- 
tious question  be  "tabled"  for  the  present. 

In  the  meantime,  Miss  Russell  was  organizing  a  Local  Com- 
mittee on  Ked  Cross  Nursing  Service  in  Paris,  which  would 
undei'take  upon  antliorization  from  National  Headquarters  the 
enrollment  in  the  American  Bed  Cross  Nursing  Service  of 
American  nurses  then  in  Europe.  The  work  she  was  doing  in- 
cluded distribution  of  extra  winter  (Hjuipment  to  nurses  of  the 
Bed  Cross  base  hospitals,  then  militarized  and  in  service  with 
the  l^)ritish  and  American  Expeditionary  Forces:  tli(>  welcom- 
ing of  nurs(>s  coming  abroad  for  assignment  to  the  I".  S.  ^ledi- 
cal  Corps;  and  assistance  in  the  development  of  American  Bed 


548   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Cross  relief  to  the  civilian  population  of  France  and  Belgium. 
In  the  bulletin  published  on  I^ovember  13  by  the  Paris  com- 
mission appeared  a  notice  stating  that  fourteen  chief  nurses 
from  base  hospitals  of  the  British  Expeditionary  Forces,  the 
American  Expeditionary  Forces  and  the  Red  Cross  attended 
Miss  Russell's  conferences. 

In  addition  to  the  American  Red  Cross  military  hospitals 
and  American  Red  Cross  hospitals,  the  Commission  for  Europe 
also  established  and  maintained  dispensaries  to  serve  the 
American  Expeditionary  Forces.  As  United  States  troops 
were  landed  in  France  in  increasing  numbers,  they  needed  dis- 
pensary service  and  the  Medical  Department  requested  the 
commission  to  supply  it.  The  first  dispensaries  were  estab- 
lished at  the  ports  of  debarkation,  Bordeaux,  Brest,  Lorient 
and  St.  Nazaire  and  along  the  line  of  communications  at 
TsTantes,  Neuilly  and  Paris.  A  full  list  of  these  dispensaries 
may  be  found  in  the  Appendix. 

An  interesting  system  was  worked  out  at  Neufchateau 
whereby  traveling  dispensaries  attached  to  a  central  hospital 
served  United  States  divisions  then  in  training  centers  in  the 
surrounding  districts.  Of  this  service,  which  resembled  the 
extra-cantonment  work  of  the  Federal  Public  Health  Service  in 
the  United  States,  Mr.  Patten  wrote: 

Our  dispensary  service  is  one  of  the  most  valuable  services 
developed  by  this  division.  With  its  center  at  Xeufchateau, 
where  we  have  established  a  hospital  in  connection  with  it, 
the  work  has  been  planned  to  cover  the  surrounding  territory 
wherever  the  French  civil  population  required  medical  atten- 
tion, ^lost  of  the  French  doctors  are  in  the  service  of  the 
Army,  so  that  in  some  of  the  smaller  towns  there  is  ]io  native 
doctor  or  at  best  one  too  old  to  care  for  all  the  inhaljitants. 
Towns  wliere  there  were  sufficient  native  doctors  and  equip- 
ment were  passed  over  in  organizing  our  routes. 

Keeping  tliis  policy  in  mind,  we  drew  up  different  itin- 
eraries so  that  our  ambulances  could  visit  tlie  various  dispen- 
saries at  least  once  every  other  day.  We  have  now  forty  of 
these  dispensaries  and  a  corps  of  eleven  American  Red  Cross 
nurses  in  this  serxice.  I'he  doctors  are  assigned  by  the  United 
States  Army  and  \v(jrk  under  the  direction  of  tlie  American 
Red  Cross. 

Infirmaries  for  American  troops  at  rest  stations  and  at  two 
aviation  camps  were  also  established  and  maintained  by  the 


THE  EUROPEAN  WAR  549 

Commission  for  France.  Convalescent  and  rest  homes  com- 
prised another  type  of  American  Red  Cross  medical  service  to 
American  troops.  At  these  homes,  officers,  enlisted  men  and 
Army  nurses  fonnd  agreeable  surroundings  and  healthy  recrea- 
tion. One  of  these  was  established  in  the  Hotel  Regina  at 
Biarritz,  overlooking  the  sea.  Here  there  was  golf,  tennis  and 
bathing  and  owners  of  neighboring  villas  extended  tlunr  hos- 
pitality to  convalescents,  or  to  war-weary  men  and  women  on 
their  precious  fourteen  days'  leave. 

As  the  American  Red  Cross  in  France  developed  this  exten- 
sive military  program  and  the  even  more  elaborate  program  of 
civilian  relief  and  child  welfare  work  to  be  described  later,  the 
officials  at  Paris  headquarters  grew  more  and  more  insistent 
in  their  demands  for  nurses.  If  large  numbers  of  graduate 
nurses  were  not  available,  they  argued,  then  send  us  the  par- 
tially trained  aides  we  have  already  recommended.  They  had 
already  in  many  cases  cabled  directly  to  these  women.  On 
November  18,  ]\lajor  Perkins  cabled  to  Xational  Headquarters 
for  thirty  aides  to  be  sent  over  as  rapidly  as  possible,  to  be  used 
in  connection  with  Red  Cross  civilian  relief  in  France.  Again 
j\riss  Delano  and  Miss  Xoyes  tried  to  strengthen  ]\Iiss  Russell's 
position  and  sent  the  following  reply.  Cable  6099,  which  was 
transmitted  by  Mr.  Davison  to  Major  Murphy : 

Nursing  Service  asks  that  Red  Cross  nurses  and  nurses' 
aides,  paid  or  volunteer,  be  requested  through  ]\[artha  Eus- 
sell  as  needed.  In  cooperation  with  prominent  public  health 
nurses,  groups  of  public  health  workers  have  already  been 
organized.  We  maintain  list  of  selected  and  carefully  prepared 
aides. 

It  will  be  remembered  that  the  aides  trained  for  the  first 
fifty  Red  Cross  base  hospitals  were  enrolled  at  Xational  Ilc^ad- 
quarters.  1'he  decision  of  the  War  Department  not  to  utilize 
their  services  had  already  brought  much  derogatory  criticism 
upon  the  Xursing  S(>rvice.  Should  Xational  Head<iuarters 
decide  to  accept  auxiliary  helpers  in  Red  Cross  hospitals,  those 
iuirs(^s'  aides  should  in  justice  hv  the  first  to  be  sent  out.  ^Fem- 
bers  of  the  Ccunmission,  however,  cabled  insistently  for  indi- 
viduals wh(un  they  personally  knew.  Mr.  Daviscui  att(Mnpt(Hl  to 
clear  up  this  and  other  aspects  of  the  situation  in  a  cable 
(Xo.  0114)  of  Xoveniber  19,  drafted  by  Miss  Xoyes: 


550    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  are  receiving  cables  from  you  for  nurses  and  nurses' 
aides  requested  through  various  sources.  Highly  important 
that  these  should  be  secured  through  Red  Cross  Xursing 
Service  at  Washington  or  their  representative  in  Paris.  In 
connection  with  base  hospitals  here  and  in  France,  a  large 
number  of  women  have  been  prepared  who  meet  established 
Red  Cross  requirements  and  are  available  for  duty  if  needed. 
Agreement  with  State  Department  confines  requests  for  pass- 
ports to  Red  Cross  workers  who  have  been  fully  investigated. 
As  we  are  held  responsible  for  all  workers,  it  seems  hardly 
fair  to  them  or  to  nurses'  aides  whom  we  have  enrolled  to  ask 
for  passports  unless  we  make  selection  through  our  Xursing 
Service.  If  Miss  Russell  is  not  capable  of  assuming  this 
responsibility,  she  could  be  replaced.  We  have  been  assured 
that  she  is  worthy  of  your  entire  confidence.  Mrs,  Munroe 
and  others  who  have  been  doing  splendid  work  in  France 
could  no  doubt  be  helpful  as  an  advisory  committee. 

The  office  of  the  chief  nurse  now  became  the  subject  of  a 
cross-firG  of  cables  and  letters.  Miss  Russell,  instead  of  being 
a  member  of  Major  ^Murphy's  immediate  staff  and  a  member  of 
the  Commission  for  Europe,  a  position  which  would  have  given 
her  administrative  freedom  and  access  to  all  bureaus  and  de- 
partments of  the  commissions  for  France,  Italy  and  other  coun- 
tries, had  been  assigned  to  Major  Lambert's  staff,  in  the  De- 
partment of  Military  Affairs  of  the  Commission  for  France. 
However,  she  was  expected  to  provide  nursing  service  for  ci- 
vilian as  well  as  military  relief  in  all  parts  of  Europe,  yet  her 
contact  with  the  commissioner  and  with  directors  of  the  other 
departments  was  through  the  chief  of  her  department,  ]\[ajor 
Lambert.  Miss  Delano  and  Miss  I^oyes  at  National  Head- 
quarters had  direct  personal  contact  with  the  members  of  the 
War  Council  and  heads  of  important  services  and  they  natu- 
rally thought  that  their  representative  in  France,  ^liss  Rus- 
sell, had  similar  freedom  and  prerogatives.  They  held  ^liss 
Russell  responsible  for  the  dov^clopment  of  a  service,  for  which 
she  lacked  the  authority  to  make  such  a  dcvelo])nient  possible. 
The  organization  of  the  Xursing  Service  at  Paris  h(>adquarters 
in  1017  was  thus  manifestly  unsound,  and  on  December  1.3 
Miss  Russell  recommended  to  ]\Iajor  Lambert  that  a  reorgani- 
zation he  effected  wherein-  t^ie  Nurses'  Bureau  would  be  trans- 
ferred from  the  Department  of  ^Military  iVff'airs  to  the  admin- 
istrative staff"  of  the  Commissioner  for  France,  where  it  would 
be  in  a  position  to  serve  all  departments  and  bureaus.     Fnfortu- 


THE  EUROPEAN  WAR  651 

nately,  Major  Lambert  was  on  receipt  of  this  letter  on  the  point 
of  starting  on  a  field  trip,  bnt  he  assured  Miss  Kussell  that  on 
his  return  her  recommendation  would  be  put  into  effect.  "On 
his  return,"  wrote  Miss  Russell  to  Miss  Noyes,  "his  power  was 
gone."  Dr.  Lambert  in  January,  1018,  became  director  of 
the  Medical  Department  of  the  commission  and  Dr.  C.  C. 
Burlingame,  with  Dr.  W.  E.  Clark  as  his  assistant,  succeeded 
Major  Lambert  as  chief  of  the  medical  and  surgical  divisions 
of  the  Military  Affairs  Department. 

The  entire  situation,  both  in  Washington  and  Paris,  was 
swiftly  approaching  serious  misunderstanding,  as  may  be  seen 
in  a  letter  written  December  IG,  1917,  by  ]\Iajor  Lambert  to 
Dr.  R.  M.  Pearce,  then  chairman  of  the  National  Medical 
Board  at  Red  Cross  Headquarters. 

...  If  I  ask  for  nurses  Xovember  9  and  six  weeks  later 
find  the  national  department  in  Washington  still  asking 
questions  as  to  what  1  want  nurses  for,  it  strikes  me  that 
something  is  wrong  with  the  Washington  end.  Will  you  not 
use  your  endeavor  to  make  them  realize  that  we  are  not  ask- 
ing for  people  here  unless  we  need  them  and  we  are  not  asking 
for  nurses  unless  we  need  them  as  nurses  to  do  nursing  work  ? 

It  is  a  growing  conviction  with  Commissioner  Perkins, 
myself  and  all  concerned  that  we  must  have  a  reserve  of 
nurses  to  supply  those  who  are  sick  and  convalescing  and  to 
meet  various  demands  that  we  cannot  foresee.  Therefore, 
please  make  a  serious  request  to  the  national  department  in 
Washington  that  they  cease  to  block  the  supply  of  nurses  that 
come  here. 

The  first  urgent  need  of  the  commission,  as  it  has  been  said 
before,  was  for  nurses  to  undertake  the  many  projects,  both 
civil  and  military,  of  the  American  Red  Cross  in  France.  The 
pioneer  American  Red  Cross  pediatric  unit  which  had  sailed 
for  France  early  in  August,  1917,  had  included  in  its  personnel 
only  one  nurse,  Elizabeth  Ashe,  who  later  became  chief  nurse 
of  the  American  I^ed  C^ross  Children's  13ureau.  The  second 
pediatric  unit  had  included  among  its  personnel  ten  American 
Red  Cross  nurses  especially  trained  in  cliild  welfare  work;  it 
embarked  in  September  for  France.  A  third  unit  of  about 
fifteen  public  health  nurses  had  sailed  early  in  Xov(Mnber  and  a 
fourth  unit  of  approximately  twenty-five  child  welfare  nurses 
was  under  process  of  organization  in  Xovcniber,  at  the  time  when 


552   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Major  Lambert's  letter  to  Doctor  Pearce,  as  quoted  above,  was 
received  at  National  Headquarters.  Miss  Noyes  and  her  co- 
workers were  then  combing  the  country  for  nurses  to  supply 
these  and  the  military  needs.  The  Army  alone  was  asking  for 
nurses  to  staff  fifty  additional  base  hospitals  over  and  above  the 
nurses  of  the  first  fifty  base  hospitals,  was  calling  for  hospital 
units  and  emergency  detachments  and  large  numbers  of  "casu- 
als" ;  the  Navy  and  the  United  States  Public  Health  Service 
were  looking  to  the  Red  Cross  for  their  reserves. 

An  extremely  important  responsibility  confronted  the  Red 
Cross :  If  nurses  should  be  recklessly  drawn  into  military  service 
from  civilian  hospitals  and  public  health  nursing  organizations, 
these  civilian  hospitals  and  public  health  nursing  organizations 
would  be  forced  to  close  their  doors  and  to  discontinue  their 
visiting  nursing,  with  the  result  that  the  health  of  the  civilian 
population  would  suffer.  War  conditions  were  already  taxing 
the  strength  of  the  civilian  population,  yet  upon  them  depended 
the  manufacture  of  war  supplies,  the  financing  of  war  loans 
and  the  general  economic  stability  of  the  United  States  and 
Europe.  Unfamiliarity  with  nursing  conditions  in  the  United 
States  led  Major  Lambert  to  use,  in  his  letter  to  Dr.  Pearce, 
the  words  "please  make  a  serious  request  to  the  national  de- 
partment in  Washington  that  they  cease  to  block  the  supply  of 
nurses  that  come  here,"  but  the  words  brought  a  certain  ironical 
amusement  to  Miss  Delano  and  Miss  Noycs  when  the  letter  was 
referred,  to  them.  In  a  letter  addressed  November  22  to  Miss 
Russell,  Miss  Noyes  had  already  protested  against  the  extrava- 
gant demands  for  luirses  which  the  Paris  office  was  making: 

We  realize  that  you  will  have  a  great  deal  of  work  to  do  in 
organizing  your  forces,  and  please  do  not  hesitate  to  call  upon 
us  for  assistance  wlien  needed.  We  are  securing  nurses  and 
nurses'  aides,  selecting  them  from  the  base  hospitals  which 
had  prepared  groups  for  service,  as  rapidly  as  possible.  I 
ho])C  tlie  Red  Cross  Commission  for  France  is  not  expecting  us 
to  supply  nurses  for  all  the  French  civil  liospitals,  for  there  is 
no  nursiiig  service  in  the  world  which  could  meet  such  a 
demand  as  that.  We  can,  however,  as  we  told  you  before  you 
left,  meet  the  military  needs  in  France  and  in  this  country 
and  supply  public  healtli  and  welfare  workers,  organizing 
nurses  and  those  for  base  liospitals,  but  I  do  not  see  how  we 
could  possibly  supply  an  unlimited  number  of  nurses  to  civil 
hospitals. 


THE  EUROPEAN  WAR  553 

May  I  state  here  that  wo  liave  thirty-two  cantonment  hos- 
pitals in  this  country,  each  one  calling  for  a  stall"  of  from 
sixty-five  to  one  hundred  nurses,  and  these  we  are  supplying 
at  the  present  time.  In  addition  we  have  all  the  regular 
Army  posts  and  the  hase  hospitals  on  tiie  horder.  The  more 
you  know  ahout  conditions  over  here  and  the  strengtli  of  our 
Ked  Cross  Nursing  Service  at  home,  the  better  prepared  you 
will  be  to  meet  conditions  abroad. 

On  December  26,  Major  Perkins  cabled  Mr.  Davison: 
^^Sitnation  makes  it  imperative  Miss  Goodrich  of  Nursing 
Service  be  sent  to  France  as  soon  as  possible." 

Two  months  before,  ^liss  Delano  had  learned  for  the  first 
time  and  under  embarrassing  conditions  that  Miss  Goodrich's 
services  had  been  requested  as  chief  nurse  of  the  American 
Red  Cross  overseas.  During  a  meeting  of  the  National  Com- 
mittee on  Red  Cross  Nursing  Service  held  on  October  20,  1917, 
at  the  Atlantic  Division  headquarters  in  New  York  City,  ]\Iiss 
Maxwell  brought  up  a  leading  question  regarding  the  appoint- 
ment of  the  chief  nurse,  American  Red  Cross  in  France.  Miss 
Delano  replied  that  this  appointment  was  a  Red  Cross  ad- 
ministrative matt(>r,  not  a  problem  of  policy  which  belonged 
to  the  National  Committee.*^^  Brisk  discussion  followed,  dur- 
ing the  course  of  which  one  member  asked  why  ]\Iiss  Goodrich 
had  not  been  sent,  especially  in  view  of  the  fact  that  her  services 
as  chief  nurse  had  been  specifically  requested  by  Dr.  Lam- 
bert. ^Miss  Delano  and  Miss  Noyes  looked  at  each  other  in 
blank  bewikha-nicnt.  Miss  Delano  was  in  complete  ignorance 
of  the  entire  situation.  Miss  Noyes  had  wholly  failed  to 
identify  (^ible  No.  1!)6  as  a  request  for  Miss  Goodrich's  per- 
sonal services  as  chief  nurse.  Further,  she  had  not  seen  a  copy 
of  the  cable  until  after  ^liss  Russell  had  sailed. 

Miss  Lillian  Wald  remarked  that  it  was  sc^lf-evident  that 
neither  ^AFiss  Delano  nor  ]\[iss  Noyes  knew  anything  about  a 
request  for  JNliss  Goodrich's  services,  or  ]\Iiss  Goodricirs  and 
Major  Smith's  corresjjondence,  and  she  accordingly  told  them 
the  various  facts  in  tlu^  case.  ^Nfiss  Goodrich  h"rself  stat(>d 
at  this  meeting  that  slie  had  first  interpreted  the  cable,  just  as 
^liss  Noyes  did,  to  be  a  request  for  her  help  in  nominating  tli(> 
chief  nurse,  not  a  recpiest  for  her  personal  services.  S1h> 
later  wrote  that  ".   .   .   as  I  recall  the  discussion  at  the  com- 

"  For    this    reason,   no    record   of  tliis   discussion    is  to   be   found   in   the 
^Minutes  of   tlie    Niitional   Committee   on  this  meeting'. 


554   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

mittee  meeting  referred  to,  the  question  was  not  so  much  as  to 
why  I  was  not  appointed,  but  why  the  selection  of  the  appointee 
for  this  important  overseas  position  was  not  brought  to  the 
Red  Cross  committee  on  nursing  for  suggestions  .  .  ."  ^^  But 
it  may  be  stated  that  the  wording  of  Cable  No.  119  was  so  per- 
emptory that,  even  if  Miss  Delano  had  agreed  that  the  ap- 
pointment was  a  matter  for  the  National  Committee,  she  would 
have  hesitated  to  delay  it  long  enough  to  get  in  touch  with  the 
membership  of  this  body.  The  Advisory  Committee  of  the 
National  Committee  was  not  organized  until  two  days  after 
Miss  Russell  had  sailed.  However,  Miss  Delano  and  lEiss 
Noyes,  had  they  previously  been  in  possession  of  all  this  in- 
formation, would  have  had  little  reason  to  believe  that  Miss 
Goodrich  would  be  interested  in  a  more  or  less  subordinate 
administrative  position  with  the  American  Red  Cross  in  France. 
She  was  then  director  of  nurses  at  Henry  Street  Settlement, 
associate  professor  in  the  Department  of  Nursing  and  Health, 
Teachers  College,  and  president  of  the  American  Nurses'  As- 
sociation. 

Miss  Delano  and  Miss  Noyes  had  returned  to  National  Head- 
quarters, considerably  chagrined  that  nurses  outside  the  Red 
Cross  organization  should  have  known  more  about  Red  Cross 
administrative  correspondence  than  did  they.  After  some 
deliberation,  Miss  Delano  on  November  20  wrote  !Miss  Good- 
rich and  asked  her  if  she  would  consider  going  to  France  as 
chief  nurse  of  the  American  Red  Cross.  Under  date  of 
December  11,  Miss  Goodrich  wrote  Miss  Delano: 

It  seems  to  me  important  that  you  should  have  as  clear  a 
statement  as  possible  of  my  attitude  towards  the  matter 
concerning  Avhich  you  wrote  me  November  20,  and  that  I 
discussed  with  yourself  and  Mr.  [George]  Scott  [then 
director  of  division  orirani/ation  at  National  Headquarters] 
in  Washington  last  week. 

I  beg  you  to  believe  that  I  deeply  appreciate  the  honor  of 
being  asked  ])y  the  Ked  Cross  to  go  to  France  in  this  capacity, 
but  as  I  consider  tlic  matter,  and  I  am  sure  you  will  under- 
stand that  1  have  given  it  the  deepest  consideration,  I  cannot 
feel  that  I  should  be  justified  in  severing  lines  of  work,  the 
important  bearing  of  which  on  the  present  situation  I  do  not 
believe  I  exaggerate,  to  assume  for  an  indefinite  period  the 

"^'So,.  k'ttcr  written  December  17,  1921,  by  A.  W.  Goodrich  to  Clara  D. 
Noyes. 


THE  EUROPEAN  WAR  555 

work  in  France  as  you  present  it  in  your  letter,  or  even  in  its 
wider  aspects  as  ])resente(l  by  Mr.  Scott.  I  appreciate  that  a 
survey  of  the  situation  is  important  to  enable  a  wise  dcternii- 
nation  of  the  policies  of  tlie  lied  Cross  relating  to  the  nursing 
care  to  be  rendered  by  our  women  in  France,  but  such  a 
survey,  I  am  convinced,  would  be  of  limited  value  if  it  did 
not  include  a  study  of  the  nursing  situation  in  our  hospitals 
on  the  other  side  as  well  as  the  public  health  field.  I  believe 
that  only  under  the  highest  governmental  authority  would  the 
task  be  possible.  If  the  survey  could  be  made  under  such 
authorization  and  it  is  felt  that  I  am  the  person  to  be  en- 
trusted with  so  important  and  difficult  mission,  I  should,  of 
course,  be  ready  to  go. 

Upon  receipt  of  Major  Perkins'  request  of  December  26 
for  ]\Iiss  Goodrich's  assignment  to  the  Paris  ofHce,  ^liss  De- 
lano immediately  submitted  to  ^Ir.  Scott  Miss  Goodrich's 
letter,  quoted  above.  To  a  general  statement  of  the  situation, 
Miss  Delano  added  the  fallowing  recommendation :  "I  would 
suggest  that  a  letter  be  sent  the  Surgeon  General,  including  this 
statement  of  ^liss  Goodrich's,  thus  placing  upon  him  the  re- 
sponsibility for  a  decision." 

However,  the  Jlod  Cross  did  not  ask  the  Surgeon  General 
to  empower  ^Ihs  Goodrich  with  governmental  authority  to  make 
a  surv(\v  of  military  and  Ived  (Voss  hospitals  in  France.  Miss 
Delano  stated  the  following  reasons  in  a  memorandum  prepared 
January  1),  1918,  for  Mr,  Scott: 

Some  time  ago  I  requested  ^liss  Goodrich  to  accept  service 
in  France  as  tlie  representative  of  the  American  IJed  Cross 
])ei)artment  of  Nursing.  At  the  time  she  stated  to  me  that  if 
she  were  to  go  she  would  not  wish  to  assume  ]\Iiss  KusselTs 
resj)onsibilities  and  should  desire  that  either  she  or  someone 
else  remain  in  the  Paris  ollit'e.  She  ex])resse(l  herself  as 
willing  to  go  ()\('r  to  make  a  survey  of  the  nursing  situation 
generally,  including  the  military  hos])itals. 

I  requested  Miss  (Joodrich  to  send  me  a  statement  in  regard 
to  the  nuitter  and  am  sendiiig  with  this  her  letter.  1  have 
conferred  with   Dr.  Ward"'  and  Mr.  Swan""*  concerning  the 

•"  Dr.  Kdwin  St.  John  Ward,  an  assistant  surfrcdn  in  tlic  Department  of 
Military  AtTairs  of  the  Anieriean  Red  Cross  C'oinniission  for  France,  then 
in  the  I'nittnl  States;   later  ajipointed  eoniniissioner  for   Palestine. 

"■''Major  .Joseph  K.  Swan,  director  of  tiie  I'aiis  Hureau  of  Sii]i|)lies  and 
an  oxeentiv(>  in  various  administrative  capacities  in  the  Department  of 
Militarv  Atfairs  of  the  (umniission   fur    France. 


556   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

duties  required  of  the  representatives  of  the  United  States  in 
Paris,  and  they  both  agreed  that  supervision  or  inspection  of 
the  nursing  service  in  inilitary  hospitals  was  not  contem- 
plated. I  have  also  consulted  with  Dr.  Pearce  as  to  the 
desirability  of  suggesting  such  supervision  to  the  Surgeon 
GeneraFs  office  and  he  too  thinks  that  it  would  be  undesirable 
at  this  time. 

Under  these  circumstances  and  in  view  of  Miss  Goodrich's 
evident  unwillingness  to  go  to  France  for  Red  Cross  work 
alone,  I  would  suggest  that  a  cable  be  sent,  stating  Miss 
Goodrich's  position  in  the  matter. 

We  have  recently  sent  Blanche  E.  Eldon  to  act  as  Miss 
Russell's  assistant.  Tliis  fact  might  also  be  noted  in  the 
cablegram.  I  feel  sure  that  both  ]\Iiss  Russell  and  Miss  Eldon 
would  be  willing  to  accept  any  decision  reached  by  the  Red 
Cross. 

I  have  hesitated  to  select  another  nurse  in  this  country  for 
service  in  France,  as  I  know  of  no  one  at  the  moment  who 
would  be  in  any  way  familiar  with  the  situation.  I  am 
wondering  if  you  might  not  think  it  desirable  to  suggest  to 
Major  Perkins  that  he  request  Mary  Nelson's  release  from 
Dr.  Fitch''s  hospital.  She  has  been  there  since  1914  as  chief 
nurse  and  is  spoken  of  very  highly  by  people  returning  from 
France.  Mr.  Swan  has  met  her  and  can  give  you  further 
information  regarding  her  ability.  It  is  possible  that  Miss 
Russell  or  Miss  Eldon  might  be  acceptable  to  Dr.  Fitch  as  her 
substitute. 

Mr.  Davison  cabled  to  Major  Perkins  January  11,  1918: 
"I^ursing  Service  suggest  you  obtain  release  if  acceptable  to  you 
of  Mary  Nelson  of  Dr.  Fitch's  hospital  to  relieve  ]\Iiss  Russell 
who  might  be  acceptable  to  Dr.  Fitch  to  replace  Miss  Nelson. 
Unable  to  obtain  services  of  Annie  Goodrich." 

To  Miss  Goodrich,  ]\Hss  Delano  wrote  January  12: 

I  have  had  several  conferences  with  members  of  the  Red 
Cross  commission  who  have  recently  returned  from  France, 
in  regard  to  the  special  matter  in  connection  with  our  work 
there. 

It  does  not  sc(>m  (losiral)le  at  this  time  for  the  Red  Cross  to 
ask  the  Surgeon  (ieiH-rars  office  to  confer  upon  their  repre- 
sentative in  France  defhiite  authority  in  regard  to  the  mili- 
tary hospitals. 

i  greatly  regret  that  you  do  not  feel  justified  in  going  to 
Eur()])e   for  the    Red    Cross  alone,  but  the  members  of  the 


THE  EUROPEAN  WAR  657 

commission  who  have  recently  been  here  assure  me  that  the 
duties  which  they  have  in  mind  for  this  position  do  not 
involve  any  authority  in  connection  with  the  military  hospi- 
tals and  that  aJiy  attempt  to  secure  such  authority  would 
probably  not  be  acceptable. 

Eegretting  that  it  has  not  been  possible  to  make  satisfactory 
arrangements  and  appreciating  greatly  your  interest  in  the 
matter,  believe  me,  etc. 

On  January  19,  1918,  Dr.  Lambert  cabled  directly  to  Miss 
Goodrich  :  "Have  repeatedly  cabled  for  you  in  last  three  months. 
Is  there  anything  to  prevent  your  coming?  Answer  me  per- 
sonally." 

Miss  Goodrich  cabled  to  Dr.  Lambert  on  January  21 :  ''Work 
here  for  civilians  and  soldiers  too  important  to  justify  abandon- 
ment unless  given  government  authority  to  inquire  into  and 
report  upon  nursing  situation  there  military  as  well  as  Red 
Cross.  In  November  expressed  willingness  to  go  under  these 
conditions." 

On  January  22,  Miss  Goodrich  wrote  to  Miss  Delano: 

I  had  dictated  a  brief  letter  of  acknowledgment  to  your 
communication  of  January  12,  but  in  the  interim  between  the 
dictation  and  transcription  of  the  letter,  a  message  has  come 
from  the  other  side  that  seems  to  indicate  that  my  services 
are  still  desired.  I  am  loath  indeed  to  refuse  to  go,  but  I  am 
also  firmly  convinced  that  I  can  only  effectively  render  the 
service  tliey  have  in  mind  through  a  governmental  recognition 
that  will  clearly  define  my  position  and  make  my  opinions  in 
matters  relative  to  nursing  authoritative.  1  appreciate  that 
this  is  a  great  deal  to  ask,  but  I  believe  that  my  experience  in 
nursing,  the  importance  of  the  work  I  shall  be  forced  to 
relinquish  and,  above  all,  the  problems  I  may  be  called  upon 
to  solve,  justify  this  request. 

In  order  that  there  shall  be  no  confusion  or  misunder- 
standing I  aju  writing  to  ^liss  Thompson  and  ^Trs.  Higbee 
and  am  enclo-iiig  a  cojiy  of  my  letter.  1  am  also  enclosing 
co])ies  of  my  letter  of  December  11  and  this  letter  to  them. 

I  am  leaving  to-night  for  Cincinnati  and  shall  hope  to  be 
back  by  Sunday.  If  for  any  reason  you  thought  it  desirable,  I 
could  return  by  tbe  way  of  Washington  if  you  telegraph  me  to 
do  so.  .  .  . 

The  following  letter  was  sent  the  same  day  to  Miss  Thomp- 
son bv   ^^iss  Goodrich : 


558   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Some  time  ago  I  was  asked  by  the  Red  Cross  to  go  to 
France.  I  expressed  my  willingness  to  do  so  under  certain 
conditions  that  are  set  forth  in  a  letter  dated  December  11 
that  I  am  enclosing.  The  matter  hung  for  some  time  in 
abeyance,  was  closed,  but  may  possibly  be  reopened  for  the 
reason  that  my  letter  to  Miss  Delano  of  January  23  will 
explain.  As  head  nurse  of  the  Army,  I  desire  you  to  know 
exactly  how  I  feel  in  the  matter  in  order  that  you  may  be  in  a 
position  to  express  your  opinion  upon  the  question  should  it 
come  to  your  attention.  May  I  add  that  I  am  sending  a  simi- 
lar letter  to  Mrs.  Higbee. 

The  !N^ursing  Service  files  show  no  record  that  Miss  Delano 
replied  to  this  letter  from  Miss  Goodrich. 

It  will  be  readily  appreciated  that  an  assumption  on  the 
part  of  the  American  Red  Cross  of  any  responsibility  in  con- 
nection with  the  conditions  existing  in  and  the  conduct  of 
United  States  Army  hospitals  would  lie  far  outside  its  charter 
obligations  and  would,  moreover,  be  contrary  to  all  precedents 
and  regulations  of  the  highly  organized  and  sharply  disciplined 
Military  Establishment. 

In  this  serious  and  unfortunate  controversy,  one  of  the  most 
regrettable  which  appears  in  connection  with  the  nursing  his- 
tory of  the  war,  both  ]\riss  Delano  and  ]\Iiss  Goodrich  were 
motivated  by  high  though  opposing  ideals  of  duty  to  the  sick. 
It  is  to  be  doubted  if  elements  of  personal  interest  were  guid- 
ing factors  on  either  side  of  the  case,  for  both  Miss  Goodrich 
and  Miss  Delano  were  at  this  time  holding  positions  which  set 
them  above  the  need  of  self-seeking.  ]\riss  Goodrich  earnestly 
believed  that  only  through  complete  comprehension  of  the  entire 
situation  both  in  military  and  Red  Cross  hospitals  could  she 
formulate  sound  policies  for  the  Red  Cross  Nursing  Service 
abroad. 

Miss  Delano  had  seen  the  failure  of  the  Volunteer  Corps 
which  the  vSurgeon  General  had  tried  to  organize  in  11)05.  She 
felt  that  the  Red  Cross  Reserve  was  the  only  practical  instru- 
mentality through  which  a  large  group  of  nurses  might  be  held 
in  readiness  for  the  Army.  However,  her  one  aim  was  to 
serve  the  Army,  even  though  it  meant  the  total  eclipse  of  the 
Red  Cross  Nursing  Service.  ''The  chief  aim  of  the  Nursing 
Service,"  IMiss  Delano  had  said  again  and  again  to  ]\riss  Noyes 
and  her  other  co-workers,  "is  to  serve  the  Army."  For  the 
Red  Cross  to  put  itself  in  the  position  of  asking  of  the  Army 


THE  EUROPEAN  WAR  559 

any  authority  over  the  military  hospitals  in  France  would  have 
been  an  offense  to  Aliss  Delano's  sense  of  clean-cut  organiza- 
tion. Moreover,  her  knowledge  of  the  Army,  gained  through  the 
years  when  she  was  head  of  the  Array  Nurse  Corps,  had  taught 
her  the  futility  of  asking  for  such  authority,  even  if  she  her- 
self had  been  in  sympathy  with  !Miss  Goodrich's  point  of  view. 
Miss  Delano  regarded  this  seething  Paris  situation  as  essentially 
an  administrative  problem  and  consequently  saw  no  reason  for 
taking  it  up  with  the  National  Committee.  Differences  in  the 
outward  expression  of  fundamental  war  nursing  principles 
undoubtedly  existed  among  the  other  members  of  the  National 
Committee  on  Ked  Cross  Nursing  Service,  as  well  as  between 
Miss  Delano  and  ]\Iiss  Goodrich. 

While  the  controversy  was  still  going  on,  Miss  Russell  con- 
tinued her  efforts  to  maintain  a  professional  nursing  service  in 
France  in  face  of  the  persistent  tendencies  toward  lay  control. 
On  January  23,  1918,  she  wrote  Miss  Noyes: 

I  think  that  it  is  desired  to  have  a  laywoman  in  charge  of 
the  women's  activities,  including  nursing  with  the  canteens, 
etc.  This  is  ratlier  vague  and  I  trust  will  not  materialize, 
but,  between  military  and  lay  control,  we  have  some  reason  to 
wonder  how  nurses  can  manage  to  hold  the  position  they  need 
in  order  to  fulfill  their  responsibilities.  I  do  not  want  to 
write  discouraged  letters.  War  is  a  savage  state  of  society 
and  it  strikes  at  many  things  we  have  cherished.  I  really 
have  faith  in  the  ultimate  outcome,  though  I  think  that  we 
must  be  ready  to  go  through  a  black  period  at  first. 

Of  lay  control,  ]\riss  Russell  alluded  again  in  a  letter  to  ]\riss 
Delano,  January  21),  1918:  "I  confess  to  a  very  strong  feeling 
that  our  standing  as  professional  women  is  hard-pressei  these 
days.  They  icant  our  hands  hut  not  on?'  heads  for  the  work. 
Perhaps  I  am  too  tired  to  be  hopeful  to-day  and  I  am  ashamed 
to  speak  to  you,  who  have  labored  so  valiantly  for  years." 

After  ^liss  Goodrich  had  refused  to  go  to  France  as  chief 
nurse  of  the  American  Red  Cross  alone,  ^liss  Delano,  as  has 
be(Mi  stated,  had  nominated  ^larv  K.  Xelson,  then  chief  nurse 
of  American  Red  Cross  Hospital  Xo.  109  at  I^^vreux,  of  which 
Dr.  Fitch  was  in  connnand,  as  a  possible  successor  to  ^liss 
Russell.  Since  August,  1915,  when  Miss  Nelson  had  succeeded 
Mary  Fletciier  as  chief  nurse  of  Dr.  Fitch's  hos])ital.  Ameri- 
can Red  Cross  nurses  and  lay  assistants  had  worked  together 


660   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

both  at  St.  Valery-en-Caux  and  at  fivreux  in  great  harmony 
under  Miss  I^Telson. 

In  February,  1918,  Miss  Morgan  and  Dr.  Lambert  requested 
that  Miss  Nelson  come  to  Paris  for  a  personal  interview.  Miss 
Nelson  described  the  conference  at  the  Paris  headquarters : 

.  .  .  The  date  was  between  the  18th  and  the  28th  of  Feb- 
ruary. .  .  .  Dr.  Burlingame  telephoned  our  Chief  and  gave 
him  to  understand  my  experience  with  nurses'  aides  was  the 
reason  why  I  was  needed  in  Paris  to  do  it  on  a  bigger  scale. 
That  same  day  Miss  Morgan  wrote  me  a  very  casual  note  in 
which  she  assumed  I  was  seeking  another  position  and  invited 
me  to  lunch  with  her  where  we  might  talk  over  some  work  in 
which  she  thought  I  would  be  interested.  .  .  . 

Immediately  Dr.  Fitch  by  telephone  to  Dr.  Burlingame 
demanded  an  explanation.  Then  it  was  arranged  that  I 
report  in  Paris  to  Major  Lambert  and  Dr.  Fitch  was  assured 
that  he  was  releasing  me  for  a  more  important  need. 

On  entering  Major  Lambert's  office,  where  I  found  with 
him  Miss  ]\lorgan  and  Dr.  Burlingame,  the  atmosphere  did 
not  seem  clear.  They  gave  me  the  impression  of  not  being 
quite  ready  for  me.  I  was  surprised  to  find  Miss  ^Morgan 
assuming  direction  of  the  conference.  The  first  question, 
after  the  usual  greetings,  was  something  to  this  effect: 
"Tell  us  just  how,  when  everyone  else  is  having  so  much 
difficulty  with  aides,  you  seem  to  have  no  trouble?" 

Very  quietly  I  went  over  the  gradual  growth  of  our  group, 
— how  each  aide  knew  from  the  beginning  which  nurse  was 
responsible  for  her  work  and  how  with  the  spirit  of  the  work 
paramount,  it  just  worked  well  and  seemed  most  natural. 
To  this  ^liss  ^lorgan  shook  her  head.  My  methods  were  too 
simple;  they  would  not  serve  for  Paris.  Then  followed  a 
brief  discussion,  where  1  calmly  insisted  on  the  necessity  of 
clear  lines  of  responsibility.  Dr.  Burlingame  appeared  to 
agree  with  me;  he  liad  visited  us  in  ^Svreux  and  had  seen  it 
all  in  operation. 

It  was  then  ^liss  ^Morgan's  turn  to  describe  ^Irs.  ]\Iunroe's 
difficulties  and  how  they  had  hoped  I  might  have  come  to  help 
her.  but  with  sucli  definite  ideas  of  professional  relations,  it 
would  perhaps  be  wiser  to  think  the  whole  matter  over  before 
going  any  furtlier. 

Whereupon  I  found  myself  being  ushered  out  with  some 
hazy  plan  of  a  future  meeting  which  even  then  seemed  a  mere 
pretext.  ...  1  never  dreamed  of  anyone's  even  thinking  of 
considering  my  rei)]acing  Miss  Russell.*'^ 

•"See  letter  written  September  23,  1921,  by  M.  K.  Nelson  to  the  author. 


THE  EUROPEAN  WAR  561 

The  situation  came  to  a  climax  on  February  20.  Miss 
Russell  wrote  Miss  Delano: 

The  responsibility  that  I  feel  for  the  standards  and  the 
accomplishment  of  our  profession  are  so  involved  with  condi- 
tions here  and  at  home  that  I  am  afraid  I  have  not  heen  ahle 
to  keep  as  clear  a  head  as  is  needed  for  the  situation  and  evi- 
dently from  your  letter  you  are  bewildered  as  to  our  needs : 

First :  1  will  tell  you  about  the  demands  brought  to  me 
yesterday  and  that  may  help  you  to  see  why  the  requests  I 
send  seem  indefinite.  Part  of  it  is  the  'Svar"  atmosphere  and 
the  way  we  nuist  expect  to  work.  I  had  told  you  they  were 
discussing  convalescent  plans,  but  I  had  no  definite  request 
till  yesterday.  They  then  told  me  that  they  would  want  ten 
or  twelve  nurses  to  do  visiting  nursing  in  two  cities,  Biarritz 
and  Royen,  where  they  had  taken  rooms  in  hotels  for  con- 
valescent men,  one  hotel  for  fifty  to  one  hundred  ofTicers  and 
beds  in  each  city  for  one  to  two  hundred  men.  Their  plan  is 
to  have  the  nurses  live  by  themselves  in  some  hotel  and  visit 
the  patients  when  necessary.  They  said  they  wanted  the 
nurses  to  go  in  about  ten  days.  It  seems  to  me  that  this  calls 
for  women  of  unusual  dignity  and  character  and  I  tremble 
lest  they  demand  that  aides  be  placed  there  to  help. 

Then  a  little  later,  a  telephone  call  came  asking  for  four  or 
six  nurses  to  be  sent  to  help  in  some  of  the  French  Army 
hospitals  at  the  front.  1  begged  that  a  conference  be  held 
before  embarking  on  such  a  new  departure,  as  I  did  not  feel 
that  we  could  accept  an  obligation  like  that  without  consid- 
eration. The  Commissioner  said  that  they  must  be  sent  at 
once.  1  suppose  I  did  not  protest  wisely,  but  while  I  wish 
we  could  take  care  of  all  the  sick,  I  wish  we  could  also  have  a 
little  clearer  idea  of  our  responsibility  before  we  embark  upon 
so  new  an  undertaking.  However,  we  have  Florence  Bullard, 
who  can  lead  the  expedition,  and  we  will  see  who  else  can 
help.  You  will  note  that  we  asked  in  a  cable  for  thirty  nurses 
who  could  be  here  on  call  for  emergencies. 

Second  :  The  question  of  the  use  of  aides  is  very  acute,  as 
I  have  previously  written.  It  is  ])robable  that  the  situation 
will  not  be  allowed  to  remain  in  our  hands  as  comjiletely  as 
we  wish. 

War  conditions  in  Paris  were  at  this  time  grave.  Air  raids 
by  night,  shelling  by  the  long  range  giin  by  day  and  the  ])r('S('n('o 
of  the  German  troops  sev(>nty  miles  away  were  conditions  hardly 
conducive  to  calnnu^ss.  The  Allies  were  well  aware  that  the 
(icrniau  High  ("onunautl  was  meditating  a  tremendous  spring 


562  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

offensive,  using  the  troops  and  supplies  released  by  the  collapse 
of  Russia  from  the  eastern  theater  of  war. 

On  February  20,  Major  Perkins  cabled  Mr.  Davison: 

Cable  2414 :  Our  whole  relationship  to  Nursing  Service 
here  dependent  upon  competent  leadership.  We  are  losing 
our  position  with  nursing  profession,  which,  as  you  know,  is 
one  of  our  greatest  assets.  Believe  head  of  our  service  should 
be  possessed  of  great  personality,  character  and  recognized 
leadership.  This  one  position  so  vital  that  no  job  at  home 
should  stand  in  way.  Xeither  Miss  Delano  nor  Miss  I^oyes 
considered  just  the  person.  Please  select  new  head  for  our 
service,  but  before  deciding  finally  wire  name  for  our  con- 
firmation. 

To  this  cable  Mr.  Gibson,  of  the  War  Council,  responded  (Cable 
'No.  6979) : 

Dr.  Clarke  '°  .  .  .  just  sailing  has  long  story  which  desire 
you  to  consider,  either  cabling  us  further  thereafter.  If 
question  so  vital  impossible  [to]  wait  his  arrival,  cable  us 
more  in  detail  regarding  just  requirements  of  position. 
Strongly  advise  however  seeing  Clarke  first. 

Miss  Russell  in  the  meantime  was  continuing  her  work  as 
best  she  could.     She  wrote  Miss  Delano,  March  4 : 

A  lease  has  been  signed  for  Pension  Galilee,  for  use  as  a 
nurses'  club  for  the  duration  of  the  war.  The  French  pro- 
prietaire  continues  to  run  it  as  her  own  business  proposition, 
the  Red  Cross  undertakes  to  back  the  scheme  by  paying  rent 
and  a  certain  bonus  to  hold  the  house  and  each  nurse  will 
probably  pay  eleven  francs  without  lunch,  or  fourteen  francs 
with  lunch.  Before  the  price  is  absolutely  settled,  further 
conference  with  Colonel  Winter  is  necessary.  This  amount 
will  be  covered  for  any  nurse  on  detailed  duty  and  that 
seemed  a  fair  standard  to  me. 

The  house  is  in  the  pleasantest  residential  district  of  Paris, 
near  the  Alma  and  Etoile  stations  of  the  "metro,"  and  is  a 
most  attractive  building  with  light  rooms,  each  with  hot  and 
cold  water,  a  fair  number  of  baths  and  numerous  balconies. 
One  of  its  great  charms  is  a  garden  opening  from  the  saloon, 
where  tea   (if  there  is  any)   may  be  served.     This  will  be  a 

'"Dr.    William    E.    Clarke    sailed    April    13,    1918,    with    rank    of    major, 
American   Red   Cross  Coininission   for    France. 


THE  EUROPEAN  WAR  563 

restful,  pleasant  spot  when  one  comes  in  after  work.  1  think 
the  nurses  who  come  on  leave  will  enjoy  it  very  much.  We 
do  not  plan  to  try  for  much  emphasis  on  the  social  side,  as  the 
nurses  always  want  to  spend  most  of  their  time  here  sight- 
seeing and  resting. 

The  Pension  Galilee  was  entirely  self-supporting.  !N"iirses 
wore  accommodated  there  at  the  rate  of  14  francs  a  day  and 
for  this  reasonable  charge  were  given  among  other  things 
sugar,  butter  and  plenty  of  hot  water  and  heat,  luxuries  almost 
impossibh'  to  obtain  at  the  average  hotel  in  Paris  during  1918. 

To  Kuth  Morgan,  a  member  of  the  Finance  Committee  of  the 
CoTumission  and  a  woman  of  unusual  business  acumen,  nurses 
owe  the  establishment  of  the  Pension  Galilee.  Miss  Morgan 
was  the  daughter  of  ]Mr.  and  Mrs.  William  D.  ]\rorgan,  of  Xew 
York  City,  and  had  for  many  years  taken  a  prominent  part  in 
philanthropic  work  there.  She  had  served  on  the  training 
scliool  and  social  service  committees  at  Bellevue  Hospital 
and  had  shown  keen  interest  in  hospital  and  civic  reform.  For 
many  years  she  was  president  of  the  Xew  York  Colony  Club. 
81ie  spoke  fluent  French  and  was  familiar  with  conditions  exist- 
ing in  Paris.  As  she  was  the  only  woman  to  serve  on  the  Finance 
Committee,  she  held  a  position  of  much  influence  and  authority 
at  Paris  hoad(}uarters. 

Early  in  March,  1U18,  the  nursing  situation  at  Paris  head- 
quarters came  to  the  crisis  which  had  been  imminent  for  some 
months.  On  March  d,  Miss  Ilussell  wrote  personally  to  Miss 
Delano : 

Since  I  wrote  you  March  6,  matters  are  practically  in 
st((tu  quo.  1  have  learned  tliat  the  plan  is  to  have  a  depart- 
ment of  hospital  women,  witli  ^liss  Euth  ^lorgan  at  the 
head,  and  that  they  have  cal)lcd  for  ^liss  Goodrich  to  head  the 
nursing  part  of  it.  I  do  not  know  if  slie  will  come  or  whether 
they  would  give  even  to  her  adequate  authority  to  accomjjjish 
things. 

When  I  came  1  was  told  ])y  several  of  the  commission  that 
nurses  ^\cre  ready  to  tell  how  much  they  could  do,  but  never 
ready  really  to  work.  I  f<'lt  that  it  was  wise  to  go  quietly  and 
unostentatiously  about  the  business  of  learning  what  the 
nursing  needs  were  and  what  could  be  done  to  fill  them. 
Evidently  I  overdid  it,  for  the  ]iowers-that-be  liavc  of  late 
completely  igiinri'd  me.  Of  course,  that  does  not  matter 
l)ersonally,  but  it  is  not  as  it  should  be  for  our  profession.     So 


564    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

many  fine,  intelligent  women  are  here.  But  defeat  of  one 
person  is  not  necessarily  disaster  for  the  whole  profession,  and 
I  still  have  hope  for  you  and  them,  through  the  devoted 
determination  among  the  nurses  that  they  will  let  no  personal 
grievances  hinder  them  from  giving  our  men  the  care  they 
need.  I  shall  continue  to  do  what  I  can  unless  I  am  ordered 
to  vanish. 

In  a  personal  cable  sent  on  March  13  to  Miss  Delano,  Miss 
Russell  reported :  ' 'Resignation  given  by  request  of  Commis- 
sioner." 

National  Headquarters  responded  under  date  of  March  19 : 
''Sending  successor  to  Russell  on  first  available  steamer."  On 
the  following  day,  however,  Major  Perkins  wrote  to  General 
Bradley,  then  chief  surgeon,  A.  E.  F.,  requesting  the  assign- 
ment of  Julia  Catherine  Stimson,  then  chief  nurse  of  General 
Hospital  No.  9,  British  Expeditionary  Forces,  as  chief  nurse 
of  the  American  Red  Cross  in  France.  He  did  not,  however, 
advise  Miss  Delano  of  this  fact.  On  the  same  day  Miss  Delano 
offered  Miss  Russell  foreign  assignment  in  Italy  or  elsewhere 
in  Europe,  but  Major  Perkins  answered  on  March  25 :  ''Miss 
Russell  will  report  to  you  about  April  fifteen.  Lay  control 
desired  here."  On  the  following  day,  he  cabled  again :  "Suc- 
cessor to  Miss  Russell  selected  here.  Miss  Julia  Stimson  has 
been  assigned  by  the  Army  for  this  purpose." 

Major  Perkins  cabled  National  Headquart'Crs  April  2  of  the 
reorganization  of  the  American  Red  Cross  Nursing  Service 
in  France:  "Further  modification  of  organization  of  Military 
Affairs  Department  takes  Nursing  Service  out  of  this  Depart- 
ment and  makes  it  separate  bureau  under  administrative  bureaus 
for  general  service  to  entire  organization." 

This  cable  meant  that  the  Nursing  Service,  instead  of  being 
an  independent  department  such  as  existed  at  National  Head- 
quarters, was  to  be  a  sub-bureau  of  the  Women's  Bureau  of 
Hospital  Service,  of  which  Miss  Morgan  was  the  director. 

Information  as  to  Miss  Morgan's  position  may  be  gained 
from  the  following  personal  letter  written  by  her  on  March  27 
to  Miss  Russell: 

There  seems  to  he  an  impression  in  your  mind  that  there 
was  a  usurpation  intended  by  mc  of  nurses'  functions, — in 
fact,  that  you  liavo  already  registered  a  protest  in  this  belief. 

1  am  taking  on  direcrt  lied  Cross  responsibility  and  author- 


THE  EUROPEAN  WAR  565 

ity  precisely  as  Major  Fosl)urgli  [Director  General,  Army  and 
Navy  l)ej)urtnient,  American  Ked  Cross  Commission  for 
France]  and  ]\Irs.  Whitelaw  Keid  [a  member  of  the  Ked 
Cross  Commission  for  (ireat  Britain]  have  done  and  this 
authority  could  be  transferred  at  any  moment  to  a  Ked  Cross 
man  if  it  was  the  sentiment  of  nurses  in  general  that  no 
woman  should  represent  the  Ked  Cross  to  them.  1  think  the 
general  cause  of  women  would  suffer  by  this  view. 

As  1  have  said  to  you,  1  consider  that  the  chief  nurse  of 
the  Ked  Cross  has  been  unduly  hampered  in  two  respects: 
One,  because  she  was  subordinated  to  one  section  of  one  de- 
partment of  the  Ked  Cross;  and  the  other,  that  she  had  no 
relation  or  means  of  communicating  with  the  Army, 

This  being  her  position,  I  think  the  whole  position  of  the 
nursing  profession  is  suffering,  and  considering  that  it  is 
giving  the  biggest  service  rendered  by  women  in  the  war  and 
is  only  second  to  the  men  in  the  fighting  line,  tins  is  a  matter 
of  deep  regret.  ^ly  plan  purposed  a  more  independent  nurs- 
ing bureau  in  the  Ked  Cross  with  connection  through  me  to 
the  Commissioner  and  direct  relation  through  the  chief 
nurse  to  the  Army. 

I  have  already  put  up  the  greatest  effort  of  which  I  am 
capable  to  bring  these  things  about,  but  have  no  personal 
interest  in  the  matter  so  long  as  it  is  accomplished.  I  have 
deeply  appreciated  your  ditliculties  and  your  disinterested 
patience. 

The  Paris  interpretation  which  put  the  Nursing  Bureau 
in  the  Women's  Bureau  of  Hospital  Service  had  one  general 
theoretical  argument  in  its  favor,  i.e.,  luirses  were  women  and 
therefore  nursing  service  belonged  in  the  Bureau  of  Women's 
Hospital  Service.  This  intca-pretation  was  in  reality,  how- 
ever, a  direct  blow  at  fundamental  principles  held  bv  the  nursing 
profession  that  professional  "nursing  education  and  adminis- 
tration should  he  directed  by  nurses."  True,  the  organization 
provided  that  Miss  Stimsou  should  be  chief  nurse,  but  that  ^liss 
Morgan  shouhl  be  director  of  the  department  in  whicli  Miss 
Stimsou  and  her  bureau  functi(Uied.  This  faulty  organization 
brought  al)out  a  condition  of  aifairs  in  which  nurses,  on  their 
{)ai't,  were  not  prepared  to  take  kindly  the  etl'orts  of  Miss  ^lor- 
gan  on  their  behalf,  and  in  which  all  layworkers  interested  in 
the  nurses,  among  them  ^liss  ^lorgan,  on  their  part,  might 
regard  the  whole  nursing  personnel  as  unappreciative  and  un- 
iii'ateful. 


666  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

When  these  questions  of  policy  and  administration  were  sub- 
mitted at  a  later  date  to  Miss  Morgan,  she  wrote : 

The  position  occupied  by  the  chief  nurse  before  the 
organization  and  formation  of  the  independent  nurses' 
bureau  caused  her  to  be  dominated  by  the  whole  hierarchy  of 
the  Medical  Department  and  Military  Affairs,  including  the 
subordinate  of  these  departments. 

No  doubt  there  is  a  series  of  protests  in  the  records  of  the 
Washington  Bureau  of  Nursing  against  this  domination. 

The  profession  of  nursing  is  the  greatest  of  women's  pro- 
fessions and  was  founded  by  a  woman.  It  was  my  opinion 
that  there  was  danger  that  the  professional  dignity  would  go 
unrecognized  and  the  professional  opportunities  for  service  be 
lost.  I  am  quite  content  that  any  judgment  in  the  matter  be 
left  to  a  history  of  the  results. 

The  reorganization  of  the  Nursing  Bureau  in  France  pre- 
sented opportunity  for  a  general  analysis  of  the  misunderstand- 
ing existing  between  the  Paris  office  and  National  Headquar- 
ters, and  Miss  Noyes  wrote  on  April  4,  1918,  a  strong  letter  to 
Mr.  Case,  of  the  War  Council,  a  letter  which  enumerated  in 
detail  the  six  problems  upon  which  confusion  had  resulted. 
All  of  these  problems  were  of  an  administrative  nature.  A 
copy  of  this  letter  was  immediately  sent  by  j\Ir.  Case  to  Com- 
missioner Perkins  and  resulted  in  a  much  better  understand- 
ing between  the  two  offices. 

The  office  and  authority  of  the  chief  nurse,  American  Red 
Cross  Commission  for  France,  was  finally  outlined  by  Major 
Perkins  in  a  cable  sent  April  IG  to  National  Headquarters: 

Bureau  of  Hospital  Service  is  new  bureau  in  American 
Red  Cross  which  is  responsible  directly  to  general  manager 
[Paris  office  I  and  commissioner.  It  concerns  itself  only 
witli  nurses  and  nurses'  aides  and  includes  plans  for  their 
holiday,  convalescent  care,  hotel  and  club  accommodations, 
equipment,  recreation,  etc.  IJuth  ^Morgan  is  director  of  [this] 
bureau.  This  ])ureau  has  separate  budget  and  power  to 
requisition.  Julia  C.  Stimson  is  newly  appointed  cliief  nurse 
of  the  American  I^ed  Cross  in  France,  assigned  to  this 
position  by  Surgeon  Oeneral  of  the  American  Expeditionary 
Forces,  and  will  in  addition  perform  all  duties  heretofore  per- 
formed by  cliiof  nurse  of  American  l^ed  Cross  in  France, 
includiniT  enrollment,  assiiriinient  ami  direction  of  Red  Cross 


THE  EUROPEAN  WAR  567 

nurses.    She  will  report  directly  to  Bureau  of  Nursing  Service 
of  American  Keel  Cross  in  Washington. 

Julia  Stimson's  first  letter  to  ^fiss  Delano,  written  April  16, 
1918,  explained  the  circumstances  which  led  to  her  appoint- 
ment: 

A  little  over  a  month  ago,  ^lajor  Alexander  Lambert,  chief 
Burgeon  of  the  American  Red  Cross  in  France,  telegraphed  to 
mo  to  go  to  I'aris  for  a  conference.  I  came  and  one  of  the 
first  questions  that  1  was  asked  was,  could  I  explain  what  was 
Wrong  with  the  j)resent  position  of  the  chief  nurse  of  tiie 
American  lied  Cross.  1  told  him  that  there  was  a  very  great 
dilHculty  which  had  been  obvious  to  many  of  us  for  a  great 
many  months  past,  and  that  was  that  they  expected  the  chief 
nurse  of  the  American  Ked  Cross  to  undertake  very  difficult 
duties  with  her  hands  tied  behind  her.  They  asked  me  what  I 
meant  by  such  a  statement  and  I  said  that  so  long  as  the 
position  of  chief  nurse  had  no  official  relation  to  the  Army 
Xurse  Corps,  it  would  never  have  the  authority,  responsibility 
and  dignity  that  it  should  have.  After  a  considerable  talk 
with  Major  Lambert  and  Miss  Morgan  and  Commissioner 
Perkins,  they  asked  me  to  put  in  writing  my  ideas  on  the 
subject.  1  prepared  them  at  night  and  presented  them  the 
following  morning,  in  the  form  expressed  on  the  accompany- 
ing sheet.  ...  I  left  that  paper  with  them  and  returned  to 
Eouen. 

I  must  say  that  it  was  explained  to  me  that  Miss  Eussell 
was  returning  to  America  and  1  was  asked  what  1  thought  of 
the  position  foi  myself.  I  told  them  very  frankly  that  1  was 
an  Army  nurse  and  under  Army  orders  and  that  the  scheme 
that  1  was  proposing  for  the  position  was  not  made  in  refer- 
ence to  myself  in  any  way.  as  I  could  consider  nothing  that 
did  not  come  as  an  Army  order.  I  have  since  learned  that 
the  scheme  which  1  had  left  with  them  was  entirely  approved 
by  the  l?ed  Cross  officials  and  was  taken  at  once  to  Army 
headquarters  and  accepted  by  Ccaeral  Bradley  and  Colonel 
Ireland  and  Miss  Bell,  the  chief  nurse.  Four  or  five  weeks 
later.  1  received  an  order  from  the  office  of  the  Surgeon 
General  as  follows:  ":\riss  J.  C.  Stimson,  TJ.  X.,  A.  X.  C.  is 
relieved  from  further  duty  with  Base  Hospital  Xo.  21  and  is 
ordered  to  re]iort  to  the  Chief  Surgeon  of  the  American  Bed 
Cross  in  Baris  for  duty  as  chief  nurse  of  the  American 
Bed  Cross  in  France."  Since  1  have  been  here  1  have  learned 
that  both  ^liss  (loodrich  and  yourself  have  had  similar  ideas 
about  a   dclinite   relati(uiship  between   this   position  and  the 


568   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Army  Nurse  Corps.  It  is  too  soon  to  know  how  the  arrange- 
ment is  going  to  work,  or  what  snags  we  shall  meet,  but  I  am 
perfectly  sure  that  the  way  is  opened  for  a  far  greater  co- 
operation and  understanding  than  was  possible  before. 

I  wish  very  much  that  1  might  have  seen  Miss  Eussell 
before  she  left  and  could  have  explained  to  her  my  under- 
standing and  sympathy  with  her  in  the  difficulties  she  encoun- 
tered and  my  admiration  of  the  spirit  she  showed  in  circum- 
stances that  made  her  position  intolerable.  She  has  been 
through  a  most  difficult  time  and  gave  of  her  very  best,  and 
anything  that  I  am  able  to  do  will  be  but  building  on  the 
foundation  that  she  has  laid. 

Herewith  is  quoted  Miss  Stimson's  conception  of  the  position 
as  referred  to  above,  a  conception  which  was  prepared,  it  must 
be  remembered,  after  twenty-four  hours'  study  of  the  situation 
from  a  point  of  view  outside  the  Paris  office : 

I.  The  chief  nurse  of  the  American  Red  Cross  (in 
France)  should  be  nominated  by  the  lied  Cross  and  approved 
by  tlie  Army.  She  should  be  given  by  the  Army  (if  not 
already  so  graded)  the  grade  of  army  chief  nurse  in  charge  of 
the  American  Ked  Cross  Nursing  Service  in  France. 

II.  She  should  be  subordinate  to  the  chief  nurse  of  the 
American  Expeditionary  Forces. 

III.  Duties.  Supervision  and  control  of  all  nursing  activi- 
ties which  have  beeii  or  may  be  assigned  by  the  Army  to  the 
American  Ked  Cross. 

A.  Present  activities:  (1)  assistance  of  nurses  on  leave; 
(2)  supply  of  equipment;  (3)  assistance  of  nurses  ordered 
back  to  tlie  United  States;  (4)  establishment  and  control  of  a 
bureau  of  American  Ped  Cross  nurses  not  in  tlie  Army. 

B.  Pr()])()sed  activities:  (1)  formation  of  plans  for  the 
estal)lishnient  and  control  of  an  American  Ped  Cross  nurses' 
aide  service  in  France;  (2)  establishment  of  an  autboritative 
information  l)ureau  for  nurses,  authoritative  because  it  repre- 
sents the  chief  nurse  of  the  A.  E.  F. 

Peason  for  the  need  of  an  Army  chief  nurse  in  charge  of  the 
American  IJed  Cross  Nursing  Service  in  France:  that  a  more 
efficient  relation  may  be  made  possible  by  having  in  authority 
a  chief  nurse  recognized  by  the  Army  and  cognizant  of  Army 
nursing  matters  and  conditions  in  military  hospitals. 

In  her  answer  written  May  8  to  Miss  Stimson,  Miss  Delano 
said : 


THE  EUROPEAN  WAR  569 

There  are  certain  points  which  to  me  seem  absolutely 
essential  in  \vorkin<i^  out  any  basis  of  cooperation  with  Na- 
tional Headquarters.  .  ,  . 

The  llrst  is  that  the  representative  of  the  Department  of 
Nursing  should  be  defhiitely  in  charge  of  Ked  Cross  nurses 
and  nurses'  aides,  responsible  for  their  assignment  to  duty  in 
France  and  for  their  supervision.  She  should  make  recom- 
mendations in  regard  to  their  release  from  duty  and  other 
complications  which  might  arise  concerning  their  health  and 
conduct. 

This  insistence  that  an  executive  nurse,  subject  to  the  joint 
policies  of  the  American  lied  Cross  and  of  the  nursing  profes- 
sion, as  represented  by  the  National  Committee  on  lied  Cross 
Nursing  Service,  should  control  the  destinies  of  American  lied 
Cross  nurses  on  active  service,  was  the  old  contention,  it  will 
be  remembered,  over  which  the  supervising  nurses  of  the  !Mercy 
Ship  Expedition  had  struggled  in  1914.  jMoreover,  it  was  the 
keystone  upon  which  the  Nursing  Service  had  been  erected.  The 
American  nursing  profession  had  in  1909  accepted  affiliation 
with  the  American  Hod  Cross  upon  the  definite  understanding 
that  the  National  Committee  on  Ked  Cross  Nursing  Service, 
which  was  to  be  composed  of  a  majority  representation  of  nurses 
and  was  to  have  a  nurse  as  chairnum,  should  ])ossess  advisory 
powers  in  the  determination  of  the  policies  governing  the  serv- 
ice. This  basic  understanding  implied  a  guarantee  of  profes- 
sional leadership  to  all  nurses  who  might  enroll  in  the  service 
and  ]\Iiss  Delano  and  ^[iss  Noves  had  explained  this  organiza- 
tion and  indirectly  implied  this  professional  guarantee  when 
they  had  urged  nurses  to  enroll.  This  was  another  powerful 
reason  why  they  both  felt  under  undeviating  obligation  to 
protest  against  lay  control  of  the  American  Red  Cross  Nursing 
Service  in  France. 

In  the  same  letter,  Miss  Delano  wrote: 

I  was,  however,  greatly  surprised  at  your  appointniont 
without  conference  with  this  office.  Fortunately  1  am  entirely 
satisfied,  hut  I  can  imagine  circumstances  under  which  1 
would  not  have  hceu  willing  to  place  in  the  hands  of  a  person 
who  had  neither  been  nominated  nor  selected  by  me.  the 
welfare  and  direction  of  the  large  groups  of  nurses  we  are 
sending  over.  I  am  telling  you  this  jiot  with  an  idea  of 
raising  ditliculties  now.  hut  to  ex])lain  to  you  th;it  tlie  Vwd 
Cross  ollieials  here  at  lleadcjuarters  recognize  tlie  Department 


570  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  Nursing  as  definitely  in  charge  of  Red  Cross  nursing  activi- 
ties wherever  we  are  located  and  would  have  naturally  ex- 
pected that  no  formal  appointment  would  be  made  without 
consultation  with  me. 

I  had  not  anticipated  that  the  chief  nvirse  of  a  base  hospital 
unit  released  for  this  service  would  have  continued  in  the 
grade  of  Army  cliief  nurse,  receiving  her  salary  from  the 
Government.  I  can  see  no  objection  to  this,  however,  if  it 
seems  more  acceptable  to  the  Army. 

In  commenting  on  Miss  Stimson's  outline,  Miss  Delano  con- 
tinued : 

I  shall  be  very  glad  of  further  information  in  regard  to  the 
duties  designated  and  the  reason  for  omitting  ^^  from  these 
duties  all  reference  to  the  nurses'  aides  which  we  have  from 
time  to  time  sent  to  France.  The  selection  of  nurses'  aides 
for  service  has  been  placed  definitely  under  the  Department 
of  Xursing  at  Red  Cross  Headquarters.  It,  therefore,  seems 
inconsistent  that  requests  for  nurses'  aides  should  come  to  us 
through  others  than  the  representatives  of  the  Department  of 
Nursing,  or  that  we  should  be  expected  to  assign  nurses' 
aides  through  any  other  channel,  either  to  hospitals  or  directly 
under  the  Ked  Cross. 

IMore  than  five  vears  ago,  the  instruction,  preparation, 
selection  and  supervision  of  women  desiring  to  volunteer  as 
nurses'  aides  in  case  of  war  was  placed  under  the  Department 
of  Nursing  and  all  correspondence  relative  to  such  appoint- 
ments came  to  this  office.  T  understand  the  complications  in 
France  and  realize  that  as  far  as  the  American  Ambulance  is 
concerned,  ^Mrs.  ^lunroe  has  for  some  time  been  in  charge  of 
the  selection  of  aides  for  this  hospital  and  could  appreciate 
]\[iss  Russell's  unwillingness  to  interfere  with  a  plan  wliich 
had  actually  been  in  existence  for  so  long.  If  this  arrange- 
ment cannot  he  modified  for  Army  Hospital  No.  1,  I  should 
certainly  tliiuk  it  most  undesiralde  that  the  plan  be  extended 
to  other  hospitals  or  positions  and  that  a  dual  responsibility 
should  be  created. 

We  shall,  therefore,  expect  that  in  sending  requests  for 
nurses  and  nurses'  aides  to  Headquarters,  cablegrams  should 
indicate  that  these  requests  meet  with  your  approval.  It 
also  seems  desirable  that  as  far  as  possible,  a  definite  stnte- 
ment  should  he  made  in  regard  lo  the  special  service  for 
which  the  nurses  or  nurses'  aides  are  desired. 

"In   writinir  tliis  Idler.   Miss   Delano  overlooked    Point   B,   TIT,   of  Miss 
Stimson's  outline  of  duties. 


THE  EUROPEAN  WAR  571 

Miss  Delano  summarized  the  criticism  which  the  Red  Cross 
Nursing  Service  was  then  meeting: 

It  naturally  leads  to  dissatisfaction  to  send  a  nurse  to 
France  with  a  good  deal  of  experience  along  certain  lines 
and  find  that  she  is  assigned  to  some  routine  duty  without 
special  reference  to  her  qualifications.  There  is  a  good  deal 
of  op])osition  throughout  tlie  whole  United  States  to  the  with- 
drawal of  so  many  experienced  nurses  from  important  posi- 
tions, both  in  hospital  work  and  public  liealth  service.  The 
Red  Cross  must,  therefore,  consider  the  needs  of  the  whole 
country  as  well  as  the  military  service  and  our  work  in 
France.  We  cannot  afford  to  tear  down  existing  organiza- 
tions and  ruthlessly  withdraw  nurses  from  communities  un- 
less we  can  justify  ourselves  by  a  convincing  statement  that 
the  nurses  are  needed  for  a  more  important  piece  of  work. 

Miss  Delano's  letter  closed  with  a  characteristic  personal  mes- 
sage to  her  new  representative : 

I  am  much  pleased  over  the  news  in  the  morning  papers 
of  General  Ireland's  appointment  as  Chief  Surgeon  General 
in  France.  I  feel  sure  you  can  rely  on  his  sympathetic 
interest  and  cooperation,  for  I  have  found  him  at  all  times  a 
tower  of  strength,  with  great  ability  and  absolute  sincerity 
of  purpose. 

Please  be  sure  that  you  have  my  u;iqnalifun  l^lcssing  and 
the  assurance  that  I  shall  do  every. '.ing  pu.sjibic  to  make  the 
work  in  France  a  success. 

Miss  Delano  wrote  ]\riss  Noyes  on  Jauuarv  18,  1010,  after 
a  careful  study  of  the  Paris  office,  when  sli(>  was  on  that  foreign 
inspection  tour  which  was  her  last  work  for  the  service  which 
she  had  built  up  and  loved : 

There  is  no  doubt  that  ^liss  ^Morgan  was  the  nominal  head 
of  the  Xursing  Service  in  France.  Apparently  the  question 
of  assignmtMit  to  (hity  of  tlie  nurses  and  their  rcK^asc  was 
left  to  the  nurs(^  in  charge,  but  theoretically  there  is  no  doubt 
that  their  lin(>  of  coinnninication  with  the  higher  autliorities 
was  throuirh  Miss  Morgan. 

I  do  not  know  whether  this  situation  existed  wb(>n  Miss 
Pussell  was  b.ere.  as  the  civilian  relief  was  not  so  cK-arly 
se])arated  frtini  the  military  service.     A[)par(Mitly  the  separa- 


len- 


572   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tion  is  still  quite  distinct,  although  nominally  under  the  same 
jurisdiction. 

Miss  Noyes  wrote  regarding  the  organization  of  the  Ann 
can  Red  Cross  Nursing  Service  in  France: 

The  jSTursing  Service  at  National  Headquarters  consisted 
of  an  independent  department  which  supplies  nurses  for  all 
branches  of  military  and  public  health  nursing  service,  both 
within  the  Government  and  the  Ked  Cross.  Miss  Delano 
and  I  had  personal  contact  with  the  various  members  of  the 
War  Council  and  we  could  make  recommendations  directly 
to  them  regarding  the  conduct  of  the  service. 

The  organization  of  the  Paris  office  consisted  of  a  Nurses' 
Bureau  within  the  Women's  Bureau.  Miss  Stimson  had  the 
title  of  chief  nurse,  American  Red  Cross  in  France;  how- 
ever, the  organization  made  Miss  Morgan  the  official  channel 
of  communication  between  the  Nurses'  Bureau  and  the 
Commissioner. 

Miss  Delano  interviewed  Dr.  Lambert  while  he  was  on  a 
trip  to  this  country  during  the  spring  of  1918,  regarding  the 
nursing  situation  in  France.  I  was  present.  Dr.  Lambert 
denied  that  the  Nursing  Bureau  was  under  the  direction  of  a 
laywoman.  I  asked :  "Did  Miss  Stimson  have  the  power  to 
make  recommendations  to  the  Commissioner  for  the  conduct 
of  the  Nursing  Service  in  France,  or  did  these  recommenda- 
tions have  to  go  through  Miss  Morgan's  hands  ?"  He  replied : 
"They  had  to  go  through  ]\Iiss  ^lorgan." 

Why  a  nursing  service,  wholly  different  from  that  which 
existed  at  National  Headquarters,  should  have  been  set  up 
in  Paris,  was  not  clear  to  National  Headquarters  or  to  nurses 
in  foreign  service  and  it  caused  great  anxiety  and  consider- 
able criticism  among  the  Ped  Cross  nurses  overseas,  thus 
lowering  their  morale  to  an  appreciable  degree.  The  nurses 
themselves  fully  understood  that  the  Nursing  Service  in 
Washington  was  directed  by  nurses  who  had  easy  access  to 
the  members  of  tbe  War  Council  and  needed  no  intermediary. 
They  were  suspicious  of  the  Paris  organization  and  many 
personal  letters  and  personal  protests  to  that  effect  were  re- 
ceived by  us.  Tbey  well  knew  that  the  organization  at  Na- 
tional Headquarters  had  already  proven  itself  capable  of 
administering  the  problems  arising  from  the  mobilization 
and  equi])nu'nt  of  many  tbousands  of  nurses,  whereas  the 
Paris  office  at  tliis  tiine  dealt  only  with  a  few  Innidreds. 
Why  sbould  not  an  able  nurse  in  tbe  Paris  office,  they  argued, 
have  attended  to  the  business  details  of  tbe  Nursinfj  Service 


THE  EUROPEAN  WAR  573 

in  France,  just  as  the  Department  of  Nursing  at  National 
Headquarters  attended  to  the  business  details  of  the  Nursing 
Service  in  the  United  States,  even  to  the  expenditure  of 
thousands  of  dollars  for  equipment  alone? 

Nurses  were  quite  willing  to  concede  that  a  women's  bu- 
reau with  a  laywoman  in  charge,  was  essential  in  Paris,  in 
order  that  the  groups  of  non-professional  workers  might  have 
full  consideration.  But  they  contended  that  a  iiurscs'  bu- 
reau, quite  independent  and  on  an  equal  plane  should  also 
have  existed  so  that  plans  and  recommendations  involving  the 
work  and  welfare  of  nurses  might  be  presented  directly  to  the 
commissioner  through  their  representative,  the  chief  nurse 
of  the  American  Ked  Cross  in  France. 

While  information  regarding  the  organization  of  the 
American  Ked  Cross  Nursing  Service  was  in  their  hands,  it 
is  possible  that  in  the  pressure  of  the  time,  the  commission 
did  not  appreciate  that  they  were  setting  up  an  organization 
in  Paris  which  was  directly  contrary  to  that  which  had  ex- 
isted for  many  years  at  National  Headquarters.'^ 

The  last  word   in  this  controversy  belongs  in  chronological 
sequence  to  Miss  Stimson,  who  thus  defined  her  own  position : 

After  the  reorganization  accomplished  by  ^liss  ^Morgan, 
Miss  Stimson's  position  was  entirely  different  from  that 
occupied  by  iliss  Kussell.  ^liss  Stimson  was  not  in  any  way 
subordinate  to  the  ^ledical  Department  or  the  Department  of 
Military  Affairs  and  she  did  have  direct  access  to  the  Com- 
missioner, it  must  be  remembered  that  Miss  Kussell  had 
been  responsible  to  the  Chief  Surgeon  and  his  assistant  and 
also  to  the  Director  of  Military  Affairs.  At  the  time  ^liss 
Stimson  was  appointed  chief  nurse.  Miss  Morgan  was  actu- 
ally the  liaison  officer  between  the  nursing  activities  and  the 
connnission,  as  a  member  of  the  Fiiumce  and  Fxecutive 
committees  and  later  of  the  commission.  She  was  not  known 
as  tiie  head  of  the  nursing  bureau  but  held  a  somewhat  un- 
official position. 

The  chief  nurse's  responsibility  through  a  member  of  the 
commission  freed  her  from  the  domination  of  tlie  Medical 
Dei)artnu'nt  and  assured  her  the  backing  of  the  t'ommissioii 
and  of  the  Chief  Surgeon  of  the  Army  and  did  not  in  any 
way  prevent  her  direct  access  to  the  Commissioner  when  slic 
desired  it.  Any  nunil)er  of  instances  can  be  enumerated  to 
prove  that  fact.      For   example,   there   was   no   intermediary 

"  ^roiiiorandum  written   by  Clara   D.  Noyes,   September   12,    1921,  to  the 
autlior. 


674    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

between  her  and  the  Chief  Surgeon  of  the  American  Expe- 
ditionary Forces,  a  thing  unheard  of  under  the  former  regime 
and  a  fact  which  should  also  prove  (if  any  proof  other  than 
her  word  is  necessary)  her  freedom  of  access  to  the  Com- 
missioners.'^ 

While  this  much  discussed  reorganization  of  the  Nursing 
Service  in  France  was  taking  phicc,  the  enemy  had  hiunched 
the  first  of  their  five  major  offensives  of  1918  and  during  the 
entire  spring  and  early  summer,  the  fate  of  Paris  hung  in  the 
balance.  With  the  constant  air  raids  and  the  shelling  as  well, 
it  was  not  a  time  conducive  to  cool  and  judicious  deliberation. 
When  she  first  accepted  the  appointment.  Miss  Stimson  knew 
little  if  anything  of  the  standardized  organization  of  the 
Nursing  Service  in  the  United  States,  which  Miss  Delano  had 
been  building  up  for  eight  years.  Later  the  military  situation 
gave  her  little  opportunity  to  try  to  bring  the  organization  of 
the  Nursing  Service  in  France  in  line  with  the  organization 
of  the  Nursing  Service  at  National  Headquarters.  Thus  it  may 
be  stated  that  she  accomplished  her  work  not  because  of  the 
organization  but  in  spite  of  it,  for  fortunately  she  and  Miss 
Morgan  worked  well  together  and  she  found  Miss  Morgan  at 
all  times  an  enthusiastic  and  sympathetic  helper. 

This  whole  subject  of  organization  may  be  compared  to  an 
imperfect  tool.  jNIiss  Russell  tried  to  reshape  the  tool  to  the 
pattern  upon  which  she  knew  Miss  Delano  and  Miss  Noyes 
were  insistent;  Miss  Nelson  stated  her  opinions  about  the  tool 
so  definitely  that  it  was  not  offered  to  her ;  Miss  Stimson  took 
up  the  tool  and  worked  with  it  as  it  was  as  well  as  she  could 
and  with  her  nurses  accomplished  a  brilliant  piece  of  work. 

Miss  Russell  was  at  this  time  returning  to  the  United  States, 
greatly  discouraged  and  in  almost  complete  physical  exhaustion. 
However,  it  may  be  seen  that  her  nine  months'  work  in  France 
was  not  without  far-reaching  results.  Miss  Russell  had  or- 
ganized, upon  authority  from  National  Headquarters,  a  Local 
Committee  for  the  enrollment  in  the  American  Red  Cross  Nurs- 
ing Service  of  American  nurses  then  overseas.  She  had 
furnished  extra  articles  of  equipment  to  nurses  serving  with 
the  pioneer  Red  Cross  base  hospitals  of  the  British  and  Ameri- 
can Kxpeditionarv  Forces.  She  had  secured  long  needed  ac- 
commodations  in    Paris   for   American   nurses.      Further,    the 

'M-cUlt  written  ^Nlurcli  8,  11)22,  by  J.  C.  Stinibon  tu  C.  D.  Noyes. 


THE  EUROPEAN  WAR  575 

development  of  a  mobile  service  by  which  American  Red  Cross 
nurses  could  be  sent  immediately  upon  call  from  the  American 
Expeditionary  Forces  to  any  emergency,  and  the  first  plans 
for  later  Ked  Cross  cooperation  with  the  French  Hervice  de 
Sante  had  been  initiated  during  her  term  of  office. 

This  situation  has  been  set  forth  in  some  detail,  not  only 
in  justice  to  the  persons  and  principles  concerned,  but  to  show 
to  the  nursing  profession  that  the  Ked  Cross  Nursing  Service 
was  not  without  its  internal  problems. 

To  Miss  Stimson  and  her  associates  during  the  summer  of 
1918  came  the  opportunity  to  develop  brilliant  projects  of 
military  nursing  service.  Her  first  work  was  the  establishment 
of  a  more  complete  system  for  supplying  nurses  with  equip- 
ment. The  first  step  was  to  secure  and  distribute  to  all  the 
nursing  stalls  of  the  American  base  hospitals  then  in  France 
such  articles  as  had  been  omitted  from  their  initial  equipment. 
A  second  important  step  was  to  supply  nurses  who  had  been 
enrolled  in  Europe  with  the  standard  Red  Cross  equipment. 
A  third  step  was  the  establishment  in  Paris  of  an  organization 
through  which  nurses  both  of  the  American  Red  Cross  and  of 
the  Army  and  Navy  Nurse  Corps  could  replace  at  cost  worn-out 
articles  of  equipment.  Another  phase  of  the  equipment  problem 
which  devolved  upon  the  Nurses'  Bureau  was  to  supply  the 
norfolk  suit,  after  the  Army  Nurse  Corps  had  adopted  it  as  its 
regulation  outdoor  uniform,  to  the  nurses  who  had  been  equipped 
with  the  serge  dress,  the  original  type  of  outdoor  uniform  sup- 
plied by  the  Red  Cross. 

Marie  B.  Rhodes  reported  April  22,  1918,  to  the  Chief 
Nurse  of  the  Commission  to  France  and  was  temporarily  placed 
in  charge  of  nurses'  equipment.     Of  her,  ^liss  Stimson  wrote : 

One  day  Miss  Ehodes  appeared  at  the  office  and  asked 
how  she  could  get  into  the  Army  Nurse  Corps,  stating  that 
slie  was  a  Kod  Cross  nurse  and  bad  come  to  France  with  a 
women's  unit  which  liad  been  disorganized.  She  was  told 
how  to  a])ply  for  admission  to  the  Army  Xurse  ror])s  and  her 
papers  were  forwarded  to  the  office  of  the  Chief  Surgeon  at 
Tours.  In  the  meantime,  while  awaiting  action  on  her  appli- 
cation, she  asked  if  she  could  be  of  any  use  and  was  told  that 
she  certainly  couhl.  right  there  in  the  Ked  Cross  ollice.  She 
said  she  would  he  glad  to  do  anything,  so  we  gave  her  piles 


576    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  correspondence  and  reports  on  the  subject  of  nurses' 
clothing. 

She  started  to  put  them  in  shape,  making  tables  of  the 
equipment  the  nurses'  units  had  already  received  and  what 
they  were  asking  for,  to  show  what  each  unit  should  have  to 
meet  the  minimum  standard  equipment  which  had  then  been 
worked  out.  The  way  in  which  Miss  Rhodes  undertook  this 
extremely  complicated  task  and  compiled  accurate  tables  and 
statements  from  which  the  Red  Cross  Commission  could  order 
thousands  of  dollars  worth  of  contracts  for  clothing,  proved 
her  efficiency  to  such  an  extent  that  before  her  papers  came 
through  from  the  Chief  Surgeon's  office  at  Tours,  the  Chief 
Nurse  of  the  Red  Cross  telegraphed  to  Tours,  asking  that  Miss 
Rhodes  be  assigned  to  the  Red  Cross  office  in  Paris. 

From  that  time  until  May,  1919,  Miss  Rhodes  did  a  mag- 
nificent piece  of  work  in  charge  of  the  equipment  bureau 
and  therefore  made  possible  the  efficient  functioning  of  liter- 
ally thousands  of  nurses,  because  through  her  efforts  these 
nurses  all  over  France  were  supplied  with  equipment  which 
was  an  absolute  necessity  for  their  physical  welfare. 

A  graphic  description  of  the  pleasing  manner  in  whicli 
Miss  Rhodes  met  nurses  and  supplied  their  needs  was  given  by 
Sophia  M.  Burns,  chief  nurse  of  Mobile  Hospital  No.  9 : 

I  have  always  believed  that  an  efficient  operating-room 
nurse  would  make  a  good  business  woman  and  in  the  Red 
Cross  office  I  found  proof  that  I  was  right.  At  her  desk, 
Miss  Rhodes  was  directing  three  orderlies,  speaking  French 
to  a  rather  trying  maid,  answering  an  insistent  telephone  and 
dexterously  meeting  the  demands  of  many  visitors. 

She  spoke  to  me  briskly:  "So  you  all  are  Mobile  No.  9? 
That  completes  our  chain  of  medical  organizations.  Have  a 
chair  and  tell  me  what  equipment  you  have  and  what  you 
need." 

The  result  of  our  conference  was  that  each  nurse  was 
completely  outfitted  with  a  trench  coat,  two  jersey  uniforms, 
rain  hat,  rubber  boots,  sweater,  mittens  with  wristlets,  two 
suits  of  genuine  all-woolen  underwear,  black  jersey  tights, 
hose,  woolen  kimono,  trench  cap  or  bonnet  de  police,  set  of 
dishes  consisting  of  cup,  saucer,  plate,  folding  knife,  fork 
and  spoon,  cot  pillow,  four  blankets,  bed  socks,  wash  cloths, 
bath  and  hand  towels,  duffle  bag  with  padlock  (trunks  were 
forbidden)  and  the  sleeping  bag  which  we  had  brought  from 
New  York. 


THE  EUROPEAN  WAR  577 

In  Miss  Rhodes'  report  of  the  Nurses'  Equipment  Shop  ap- 
peared a  paragraph  with  which  many  nurses  and  many  men  in 
all  branches  of  the  service  will  sympathize,  in  that  it  reflects 
their  own  experiences : 

We  were  very  busy  and  happy,  but  I  felt  that  1  would  like 
to  be  at  my  own  woriv.  A  great  many  requests  for  anes- 
thetists came  into  headquarters.  I  offered  my  services  at 
night  and  for  two  months  went  into  the  different  hospitals  iu 
Paris  where  they  needed  help.  At  two  o'clock  in  the  morn- 
ing the  commanding  officer  sent  me  home  by  ambulance  so 
that  I  got  to  bed  by  three-thirty.  This  was  the  reason  why  I 
never  got  down  to  the  office  in  the  morning  before  ten 
o'clock.  I  met  so  many  people  in  the  hospitals  whom  I  knew 
and  liked  helping  our  boys  directly  so  much  that  I  found  it 
hard  to  stick  to  Jersey  dresses  and  trench  coats,  but  every 
time  I  said  anything  about  leaving,  my  Big  Chief  was  kind 
and  yet  positive  that  1  must  jersey  dress  and  trench  coat  a 
while  longer.  We  had  so  many  hurry  calls  for  them  that  we 
got  the  idea  that  these  jersey  dresses  and  trench  coats  were 
winning  the  war ! 

The  dress  was  made  of  gray  jersey  and  in  style  resembled  the 
gray  cotton  ward  uniform ;  it  was  warmer  and  could  be  worn 
for  a  longer  period  without  being  laundered.  It  was  issued 
by  the  Nurses'  Bureau  in  Paris,  without  consultation  with 
National  Headquarters  and  was  not  in  conformance  with  Army 
regulations,  but  because  of  its  practicability,  no  objections  were 
raised. 

Of  conditions  at  the  line,  Miss  Rhodes  wrote: 

We  had  many  demands  from  the  front.  The  only  way  to 
get  them  there  was  to  deliver  the  things  myself,  by  camion. 
I  made  many  trips  up  the  line.  It  always  seemed  one  of  the 
most  wortb-wliilo  tilings  J  could  have  done,  ^lany  of  tiie 
nurses  wore  up  there  witliout  their  luggage;  others  had  never 
seen  theirs  since  thi\v  left  the  States.  One  time  I  remember 
particularly  was  at  Kvacuation  lTos])ital  No.  L")  at  \'erdun. 
Here  were  twenty  nurses  witli  only  hand  luggage,  caring  for 
thousands  of  patients.  Tt  was  very  cold  and  living  condi- 
tions were  most  uncomfortable.  When  we  fitted  up  those 
nurses  from  our  camion,  they  almost  cried  for  jov  ! 

T  visited  all  the  hosjiitals  in  the  forward  areas  several 
times,  on  each  occasion  tinding  nurses  badly  in  need,  either 
due  to  fire  or  loss  of  bac:<ra<re.     On  mv  wav  out  one  morning 


578   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  Mobile  Hospital  No.  8,  where  I  had  an  emergency  call,  I 
met  a  hospital  train  on  which  were  three  nurses.  I  never 
have  been  so  welcome  anywhere.  One  of  the  coaches  had 
burned,  including  most  of  their  clothes,  and  we  were  able  to 
fit  up  those  nurses  right  there  on  the  track. 

From  May  1, 1918,  to  December  31,  1918,  the  Nurses'  Equip- 
ment Shop  supplied  articles  free  of  charge  to  9,300  regular  and 
reserve  nurses,  Army  Nurse  Corps,  800  Red  Cross  nurses, 
100  American  aides,  75  French  aides,  and  130  officers  and 
clerical  workers  of  various  Red  Cross  foreign  commissions. 

The  staff  of  the  Paris  Nurses'  Equipment  Shop  numbered  ten 
people  in  October,  1918.  A  Red  Cross  captain  was  in  charge 
of  the  buying  and  cash  sales.  Besides  Miss  Rhodes  and  her 
two  nurse  assistants,  there  were  shippers,  packers  and  a  chauf- 
feur for  their  camionettes.  This  division  continued  to  sell  re- 
equipment  articles  during  the  spring  of  1919  until  their  records 
show  transactions  amounting  to  over  7,500,000  francs  before 
the  Quartermaster's  Corps  assumed  these  responsibilities.  A 
statistical  summary  is  as  follows : 

Donations  (May  1,  1918-May  1,  1919) 3,401,189.85  frs. 

Cash  sales       "  "       "  "      166.286.00    " 

Stock  on  hand,  May  1,  1919 218,060.15    " 

Purchases  (May  1,  1918-May  1,  1919) 3,445,472.50    " 

Stock  purchased  prior  to  May  1,  1918 292,200.00    " 


Now  during  the  spring  and  summer  of  1918  came  the  crucial 
days  of  the  European  War,  days  and  weeks  when  the  German 
High  Command  struck  again  and  again  on  the  Western  Front 
and  the  Allies,  united  at  last  under  Marshal  Foch,  resisted 
savagely  until  the  fury  of  the  five  German  drives  on  Paris  had 
been  spent.  Then  on  July  18,  the  Allied  Armies  took  over 
the  offensive  and  during  the  following  months  drove  the  enemy 
out  of  France  and  Belgium. 

The  first  German  offensive  of  1918,  it  will  be  remembered, 
had  been  launched  on  ]\[arch  21  at  the  junction  of  the  French 
and  British  lines  near  Cambrai.  Of  this  engagement,  the 
Second  Battle  of  Picardy,  Colonel  Ayres  wrote: 

The  campaign  of  1918  opened  with  the  Germans  in  pos- 
session of  the  offensive.     In  a  series  of  five  drives  of  unpre- 


THE  EUROPEAN  WAR  679 

cedented  violence,  the  Imperial  Great  General  Staff  sought  to 
break  the  Allied  lino  and  end  the  war.  .  .  .  The  first  drive 
opened  on  March  :;il  on  a  fifty-mile  front  across  the  old  hattle- 
field  of  the  Somme.  In  seventeen  days  of  fighting  the  Ger- 
mans advanced  their  lines  beyond  Noyon  and  Montdidier  and 
were  within  twelve  miles  of  the  important  railroad  center  of 
Amiens  with  its  great  stores  of  British  supplies.  In  this 
battle,  also  known  as  the  Picardy  offensive,  approximately 
twenty-two  hundred  American  troops  serving  with  the  Brit- 
ish and  French  were  engaged.'^* 

Immediately  after  the  Germans  struck  near  Cambrai  in  this 
Second  Battle  of  Picardy,  Oeneral  Pershing  offered  the  small 
number  of  American  troops  then  in  France  to  the  iVllied  Armies, 
to  be  used  either  as  an  independent  unit  or  to  be  broken  up  and 
brigaded  with  the  French  and  British  Armies.  The  latter 
method  of  using  these  soldiers  was  employed  and  they  were 
brigaded  all  along  the  Western  Front.  When  these  soldiers 
became  sick  or  wounded,  they  were  cared  for  by  the  British 
and  French  sanitary  services  in  exactly  the  same  manner  as 
if  they  had  been  British  or  French  soldiers. 

One  of  ^liss  Ivussell's  last  reports  to  Miss  Delano,  that  writ- 
ten February  20,  1918,  had  mentioned  the  possible  assignment 
of  American  Red  Cross  nurses  to  military  hospitals  of  the 
French  Service  de  Sanfe,  to  care  for  American  sick  and  wounded 
who  had  been  sent  back  to  these  units.  The  d(>mand  for  nurses 
to  render  service  of  this  type  increased  in  proportions  dependent 
upon  the  numbers  of  American  troops  brigaded  with  the  French 
and  the  military  activities  which  occurred  during  A})ril,  ^lay, 
June  and  July.  This  type  of  assignment  finally  formed  one 
of  the  most  brilliant  and  appealing  phases  of  military  nursing 
servic(>  during  the  European  War. 

Of  the  position  held  by  American  Bed  Cross  supply  units 
at  the  beginning  of  the  Second  Battle  of  Picardy,  ^fajor  James 
B.  A.  Fosburgh,  Director  General,  Army  and  Navy  Department, 
American  lied  Cross  in  France,  wrote: 

As  is  well  known,  all  the  plans  of  our  Army  wore  jirodi- 
cated  upon  the  occupation  by  the  American  Ivxpoditionary 
Forces  of  the  sector  lying  roughly  between  Toul  and  Tjolfort 
(1!)1T).  The  lino  of  conununicatioiis  was  taken  ()V(m-  iinnio- 
diatoly  and  dovolo])ed  to  extoihl  from  Bordeaux  and  St. 
Xa/.airo  to  Dijon  and  Is-Sur-Lille,  and  from  there  radiating 
•'   'Tlu'  W  ar  witli  (uTinany,"  p.    10(i. 


580  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

up  through  the  area  established  for  division  training  in  the 
country  about  Neufchateau  and  adjacent  to  the  Toul-Belfort 
sector.  The  hospitalization  provided  by  the  American  Expe- 
ditionary Forces  was  entirely  located  along  this  line  of 
communications.  Large  units  were  located  at  Bazoilles, 
Vittel,  Contrexeville  as  forward  bases,  and  at  Dijon  and 
points  further  toward  the  interior.  In  the  entire  area  from 
Toul  to  the  Channel,  however,  the  other  Allied  authorities 
had  specifically  excluded  all  American  hospitals. 

With  the  knowledge  of  the  divisional  training  and  hospi- 
talization plans  of  the  Army,  the  American  Eed  Cross  lo- 
cated the  bulk  of  their  warehouses  in  the  Toul-Belfort  area, 
at  Dijon,  Xeufchateau,  Langres,  Chatillon,  to  serve  the  di- 
visional area,  and  at  Bar-le-Duc,  Toul,  Xancy,  Rambervillers 
and  Belfort,  to  serve  the  troops  actually  in  the  line.  Fortu- 
nately as  it  subsequently  developed,  the  bulk  of  our  stores  was 
centered  in  Paris. 

On  March  21,  the  first  of  the  series  of  German  offensives 
started  in  the  neighborhood  of  Noyon  and  Xan  and  with 
great  rapidity  the  German  forces  overran  the  country  lying 
to  the  south  as  far  as  Montdidier,  sweeping  aside  the  French 
and  British  forces  occupying  that  sector.  This  resulted  in 
the  appointment  of  ^Marshal  Foch  as  Generalissimo  of  the 
Allied  Forces.  General  Pershing  .  .  .  turned  over  to  Gen- 
eral Foch  certain  American  divisions  with  the  understanding 
that  they  would  in  all  respects  be  cared  for  by  the  French. 

On  or  about  ^May  1,  the  First  Division  was  movefl  across 
country  from  Toul  to  a  point  in  the  line  just  to  the  east  of 
Montdidier,  about  forty  kilometers  north  of  Beauvais.  While 
the  division  was  on  the  move,  we  were  advised  in  a  general 
way  of  their  destination  and  immediately  took  steps  to  secure 
a  warehouse  at  Beauvais.  We  were  told  that  they  were  mov- 
ing with  only  their  field  hospital  equipment  and  that  even 
this  material  was  lacking  in  certain  essential  requirements. 
We  therefore  sent  in  advance  to  Beauvais  two  large  double- 
walled  Bessonneau  tents  with  all  the  equipment  for  a  small 
field  hospital,  also  two  Ked  Cross  nurses  and  other  personnel 
with  diet  kitchens,  etc. 

From  long  experience  with  French  hospitals,  we  knew  that 
those  institutions  to  which  our  men  would  be  sent  would  lack 
many  items  of  equipment  and  supplies  which  American  prac- 
tice considered  essential  for  the  proper  care  of  tiie  wounded. 
Before  tbe  arrival  of  the  division,  our  French  bospital  sup- 
ply service  had  sent  their  inspectors  to  visit  each  French 
hospital  in  the  area  around  Beauvais  to  see  that  they  were 
provided  with  needed  sujtjilies.   .   .   , 


THE  EUROPEAN  WAR  681 

Another  provision  was  the  assignment  of  American  Red 
Cross  nurses  and  interpreters  to  these  hospitals.  Within  a 
weeiv  after  the  First  Division  had  gone  into  tlie  line,  Ameri- 
can wounded  ap])earod  in  fourteen  French  liospitals.  Had 
not  American  Ked  C^ross  nurses  gone  immediately  into  these 
institutions,  some  of  those  boys  would  have  died  without  ever 
being  able  to  speak  to  anyone  who  understood  them.^'^ 

On  May  6,  1918,  Miss  Stimson  made  a  supervisory  tour 
of  the  Beanvais  area,  which  served  the  Noyon-Montdidier 
sectors.     Of  this  tour  she  wrote : 

About  half-past  nine  that  night  we  arrived  in  the  pouring 
rain  at  Beauvais.  Some  Ked  Cross  men  took  us  to  a  little 
hotel,  one  of  the  gloomiest  places  I  have  ever  seen  in  my  life. 
All  the  electric  lights  had  been  painted  dark  blue,  so  that  no 
one  could  possibly  read.  The  hall  and  little  salon  were 
crowded  with  officers  of  all  sorts,  wandering  disconsolately 
about.  Our  room  upstairs  was  so  dark  we  lit  candles.  Even 
the  glass  in  the  windows  was  painted  deep  blue  against  Hun 
avions. 

The  next  day  we  visited  nine  hospitals,  some  with  our 
American  niirses  and  aides,  others  with  no  English-speaking 
persons  except  the  few  American  soldier  patients.  In  every 
case  where  there  was  one,  I  talked  to  the  iiifirmiere  major. 
Each  one  said  how  glad  she  was  to  have  the  American  nurses. 
Our  women  told  us  they  were  receiving  every  consideration. 
They  all  spoke  of  the  wonderful  devotion  of  the  French  nurses 
and  nuns  and  were  deeply  touched  by  the  eagerness  of  the 
French  to  learn  American  methods.  Our  nurses  appreciate 
that  the  years  of  voluntary  self-sacrificing  service  which  these 
French  women  have  given  deserve  great  respect.  If  they, 
our  nurses,  are  tactful  and  gracious  enough  in  their  dealings 
with  the  French  nurses  to  be  asked  to  teach  these  splendid 
women  some  results  of  the  professional  advantages  so  freely 
given  us,  then  indeed  no  greater  reward  nor  higher  tribute 
could  be  ours. 

Our  nurses  looked  shadowy-eyed  and  white-faced  from  their 
long  hours.  The  Americans  were  pitifully  glad  to  have  tliem. 
The  surgical  care  which  our  men  get  in  these  hospitals  is 
excellent. 

During  the  second  week  of  ^fay,  1918,  the  following  per- 
mission for  and  instructions  regarding  the  assignment  of  teams 

"Report  of  ^lajjor  Foshurpli  to  H.  P.  Davison;   Red  Cross  Arcliivos. 


582    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  one  American  Red  Cross  nurse  and  one  nurses'  aide  to  go 
into  every  French  military  hospital  where  American  troops 
were  being  cared  for,  were  issued : 

From:  The  Under-Secretary  of  State  for  the  Service  de 
Sante  Militaire. 

To:  The  Chief  of  the  Service  de  Sante  of  the  First 
Army  by  order  of  the  General  Commander-in- 
Chief. 

I  have  received  from  the  American  Eed  Cross  acting  in 
connection  with  the  Medical  Department  of  the  American 
Expeditionary  Forces,  a  request  for  permission  to  detail 
American  Eed  Cross  nurses  to  French  hospitals  of  the  Zone 
of  the  Interior  and  of  the  Army  Zone  which  have  admitted 
for  treatment  sick  and  wounded  of  the  American  Army. 

I  consider  that  our  desire  to  make  it  possible  for  our  Allies 
to  find  English-speaking  personnel  in  our  hospitals  makes  us 
accept  this  proposition. 

I  have,  therefore,  decided  that  nurses  of  the  American  Eed 
Cross  in  groups  of  two  may  be  sent  to  all  hospitals  where 
French  nurses  are  already  present  and  which  will  have  been 
reported  to  us  as  having  received,  or  as  expecting  to  receive, 
sick  or  wounded  of  the  American  Expeditionary  Forces. 

To  carry  out  these  instructions,  you  will  notify  me  at  once 
by  telegram  sent  to  my  central  office  Service  de  Concours 
Etran/jers  as  soon  as  the  hospitals  placed  under  your  au- 
thority have  received  or  expect  to  receive  soldiers  of  tbe 
American  Army.  You  will  notify  me  also  in  the  same  man- 
ner when  the  services  of  these  nurses  are  no  longer  required. 

All  nurses  on  duty  in  the  Army  Zone  will  be  militarized ; 
that  is,  they  will  possess  the  "red  workers'  permit"  granted 
by  the  Adjutant  General  of  the  American  Expeditionary 
Forces.  In  addition  to  this,  the  laws  regulating  the  admission 
of  this  personnel  into  the  Army  Zone  and  as  well  as  its  stay 
there  are  those  set  forth  in  the  Instruction  3993.SBA.1  of 
the  28d,  1917. 

During  their  stay  in  French  hospitals,  the  nurses  will  be 
placed  under  the  direct  orders  of  the  medecin  chef  who  will 
assign  them  to  duty  with  their  countrymen  or  with  the  French 
wounded,  if  the  emergency  arises.  The  nurses  will  not  he 
under  the  orders  of  the  inflrmiercs  principdJes,  hut  they  will 
live  with  the  other  infirniieres  under  the  same  conditions  and 
Avill  conform  to  the  same  rules  and  regulations  which  govern 
the  Frencli  personnel. 

In  case  of  serious  disregard  of  rules,  you  will  notify  me  hy 
wire  in  order  that  1  may  communicate  with  the  American  Eed 


THE  EUROPEAN  WAR  583 

Cross  and  request  the  urgent  removal  of  the  nurse  who  has 
become  undesirable  and  arrange  for  the  detailing  of  a  nurse 
to  take  her  place. 

In  a  report  of  May  28,  Miss  Stimson  wrote: 

The  Service  de  Sante  has  asked  [allowed]  us  to  organize 
twenty-five  teams  of  nurses  and  nurses'  aides.  I  have  ap- 
pointed Alice  Fitzgerald  to  prepare  and  supervise  these  units. 
She  speaks  fluent  French  and  is,  as  perhaps  you  remember, 
a  Hopkins  nurse  of  wide  executive  experience. 

Now  that  the  offensive  has  commenced  with  renewed  fierce- 
ness, this  part  of  our  work  is  bound  to  increase  tremendously. 
We  have  had  to  take  nurses  from  the  Department  of  Civil 
Affairs  as  it  is  impossible  to  get  Army  nurses  for  this  work. 
The  Army  officials,  though  heartily  in  favor  of  our  work  with 
the  Service  de  Sante,  state  that  their  nurses  are  needed,  or 
soon  will  be,  in  the  places  to  which  they  have  been  assigned. 
Among  the  last  group  of  nurses  many  possessed  very  special- 
ized training,  but  when  they  heard  of  the  real  military  neces- 
sity they  were  eager  to  be  used  wherever  needed.  Heads  of 
Eed  Cross  departments  have  been  equally  fine  about  giving 
over  to  this  work  nurses  assigned  to  their  specialized  services. 

Alice  Louise  Florence  Fitzgerald's  first  executive  work  with 
the  American  Red  Cross  was  in  the  development  of  this  service. 
The  daughter  of  an  American  scholar  who  made  his  home  in 
Florence,  Italy,  Miss  Fitzgerald  early  gained  knowledge  of  the 
language  and  peoples  of  France,  Italy  and  Germany.  This 
international  background,  coupled  with  her  wide  professional 
experience,  commanding  presence  and  native  charm  of  person- 
ality have  made  her  a  romantic  figure  in  American  Red  Cross 
nursing  history. 

Miss  Fitzgerald  was  graduated  in  190G  from  the  Johns  Hop- 
kins School  of  Xursing.  Two  years  later  during  the  earthquake 
which  devastated  Messina,  Italy,  she  did  emergency  relief 
nursing  in  that  city.  In  1911,  when  a  reorganization  of  the 
operating-room  system  at  Bellevue  Hospital  was  effected,  ^riss 
Xoyes,  then  superintendent  of  nurses,  had  chosen  ^liss  Fitz- 
gerald as  head  nurse,  a  post  requiring  the  exercise  of  unusual 
tact  and  executive  ability.  After  the  new  system  had  been 
firmly  established,  !Miss  Fitzgerald  left  j^ew  York  to  become 
superintendent  of  nurses  at  the  City  Hospital,  Wilk('s-I>arre, 
Pennsylvania.     She  later  became  superintendent  of  the  liobert 


584.    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Long  Hospital,  University  of  Indiana.  In  1913  she  enrolled 
in  the  American  Red  Cross  Nursing  Service.  She  was  sent 
overseas  in  February,  1916,  as  the  Edith  Cavell  Memorial 
Nurse  from  Massachusetts  and  she  served  as  a  member  of  the 
Queen  Alexandra's  Imperial  Military  Nursing  Service  Reserve 
at  Boulogne-sur-Mer  and  at  the  British  Front.  In  December, 
1917,  Miss  Fitzgerald  desired  to  join  the  American  forces, 
so  the  committee  of  prominent  Bostonians  which  had  sent  her 
overseas  provided  a  substitute  and  Miss  Fitzgerald  reported  on 
December  13  to  Miss  Russell  at  Paris  headquarters  of  the 
American  Red  Cross.  She  was  immediately  assigTied  to 
answer  an  emergency  call  for  nurses  at  Rimini,  Italy. 

In  February,  1918,  she  was  recalled  to  Paris.  She  wrote  of 
her  subsequent  work: 

On  February  18  I  was  sent  down  to  Bordeaux  where  I  was 
attached  to  zone  headquarters.  My  work  consisted  chiefly 
of  supervising  the  existing  American  Red  Cross  activities 
and  of  looking  around  for  possible  sites  for  future  projects. 
Among  other  duties,  1  took  over  that  of  meeting  the  incoming 
boats  and  welcoming  our  nurses  as  they  landed  in  France.  I 
have  heard  many  of  them  say  that  it  was  a  great  relief  for 
them  to  see  a  fellow-nurse  standing  on  the  dock  waiting  for 
them. 

On  May  IG  I  was  recalled  to  Paris  and  given  charge  of  the 
work  with  the  Service  de  Sante.  This  type  of  service  con- 
sisted of  placing  American  nurses  in  French  hospitals  to  care 
for  American  sick  and  wounded ;  it  had  begun  in  a  very  small 
and  unofficial  way  as  far  back  as  ]\[arch,  1918,  when  nurses 
were  sent  to  Soissons  to  care  for  our  men  in  French  hospitals. 
.  .  .  The  formal  agreement  with  the  Service  de  Sante  had 
just  been  signed  when  I  took  charge  of  the  service  in 
May 

Florence  ^l.  Patterson  assisted  Miss  Fitzgerald  in  this  phase 
of  American  Red  Cross  nursing  service.  Born  in  Wisconsin, 
Miss  Patterson  received  her  A.B.  from  Northwestern  University 
and  was  gi'aduated  in  1907  from  the  Johns  Hopkins  School  of 
Nursing.  She  was  for  some  time  assistant  superintendent  of 
nurses  of  the  Allegheny  General  Hospital,  Pittsburgh,  Penna. 
After  extensive  j)ost-graduate  instruction  at  Teachers  College, 
New  York,  and  at  the  Chicago  School  of  Civics  and  Philan- 
thropy, she  did  medical  social  service  work  and  public  health 
nursing  in  Chicago  and  Boston.     In  June,  1917,  she  joined  the 


THE  EUROPEAN  WAR  585 

staff  of  Miss  Noyes  at  National  Headquarters,  but  was  released 
the  following  month  to  act  as  chief  nurse  of  the  American 
Red  Cross  Commission  for  Roumania.  The  Roumania  unit 
was  recalled  from  the  Balkans  in  June,  1918,  and  ^liss  Patter- 
son was  then  assigned  to  the  Paris  headquarters  to  assist 
Miss  Fitzgerald. 

Of  the  conditions  which  confronted  the  first  American  nurses 
who  were  assigned  to  French  hospitals,  Miss  Stimson  wrote 
Miss  Delano  on  May  28,  1918: 

You  already  know  that  American  troops  have  been  placed 
with  the  British  and  the  French  forces.  It  has  followed  that 
when  they  were  sick  or  hurt,  they  have  been  cared  for  exactly 
as  were  the  British  and  French  troops.  With  the  British, 
this,  of  course,  was  a  very  simple  matter ;  the  American 
wounded  were  sent  right  down  through  the  British  bases. 
With  the  French,  the  problem  has  been  quite  different  because 
of  two  things;  the  difference  in  standards  of  nursing  and  the 
difference  in  language. 

In  one  hospital  I  saw  a  French  sign  in  the  corridor  which 
said  "All  volunteer  nurses  will  please  leave  their  names  and 
addresses  in  the  office."  In  this  institution,  I  was  told  there 
was  no  head  nurse.  I  should  tell  you  further  details,  were  it 
not  that  I  think  it  unfair  to  put  in  writing  observations  about 
women  whose  self-sacrifice  and  endurance  have  been  so  do- 
voted  but  whose  professional  opportuuities  so  limited. 

As  for  language  difficulties,  a  large  number  of  American 
boys  soon  came  to  French  hospitals,  where  there  was  not  one 
English-speaking  person.  When  this  was  discovered,  the  Hed 
Cross  received  })ermission  to  put  a  few  American  nurses  into 
these  hospitals.  Since  so  few  of  our  nurses  speak  French,  a 
French-speaking  nurses'  aide  was  sent  with  her  in  almost 
every  instance.  Thf^  reports  that  came  back  on  the  work  of 
these  teams  were  most  satisfactory.  1  wish  I  had  time  to  t<'ll 
you  individual  stories  of  our  boys,  who  until  an  American 
nurse  spoke  to  them,  had  thought  they  might  he  in  the  bands 
of  the  Germans,  aiul  of  cases  where  am]uitalions  had  to  he 
done  when  it  was  impossible  to  ex])lain  to  the  hoy  hcforeliand 
what  was  going  to  take  place.  .  .  . 

Some  (lay  the  story  will  be  written  of  the  spirit  of  tliesf 
few  nurses  who  went  out  into  bomhod  areas,  into  crowded 
French  bosi)itals  where  they  shared  quarters  with  French  vol- 
unteer nurses,  or  found  rooms  for  themselves  in  slu>llcd  vil- 
lages as  best  they  could.  Too  high  praise  i-annot  he  gi\(Mi 
them.      Some  day   i)erbaps   those   American    hoys   themselves 


586   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

will  tell  what  it  meant  to  them  to  have  an  American  nurse 
when  they  were  so  badly  hurt,  and  were  in  the  midst  of  stran- 
gers with  whom  they  could  not  communicate  and  under  con- 
ditions the  misery  of  which  they  cannot  exaggerate. 

Miss  Delano  commented  in  the  Red  Cross  Bulletin  of  August 
26,  1918,  upon  the  heart-appeal  of  this  service: 

The  sound  of  the  mother  tongue  in  a  strange  land  has 
always  been  considered  the  sweetest  sound  on  earth.  A  letter 
from  a  Ked  Cross  nurse  in  Koumania  tells  of  being  assigned 
to  a  ward  containing  a  Hungarian,  a  German,  a  Bulgarian,  a 
Prussian  and  a  Turk.  "The  Turk  had  his  leg  in  a  Kussian 
splint  but  he  certainly  did  smile  when  I  asked  him  for  the 
first  time  if  something  was  T^hoke  ginsel'  (Turkish  for  'very 
good'),"  the  letter  reads,  "and  was  equally  delighted  when  1 
counted  for  him  in  his  own  language.''  If  the  unspeakable 
Turk  can  smile  with  delight  at  the  sound  of  his  own  lan- 
guage, what  must  it  mean  to  our  American  boys  to  have 
someone  near  who  understands  when  he  refers  to  "Dad"  as  a 
"good  old  scout;"  Xew  York  as  the  "Big  Town;"  who  knows 
that  a  "cop"  is  a  policeman ;  a  "hobo"  a  tramp ;  that  "Howdy" 
means  "how  do  you  do ;"  and  "look  out !"  means  "be  careful !" 
Medical  men  call  it  the  striking  of  a  normal  balance,  the 
destroying  of  the  abnormal  condition  produced  by  unusual 
complexity  of  emotion  and  the  sudden  acquisition  of  almost  a 
lifetime  of  experience  in  a  few  months. 

Sara  R.  Addison,  an  American  Red  Cross  nurse  assigned  to 
duty  in  a  French  hospital,  wrote  of  her  service : 

Morale  does  not  apply  to  the  fighting  men  alone,  but  to 
the  soldier  who  has  fought,  is  wounded  and  is  "down  and 
out"  for  the  present.  I  firmly  believe  that  many  a  man  would 
have  felt  it  easier  to  die  than  to  try  to  make  his  wants  under- 
stood. I  remember  one  incident,  amusing  after  it  was  over, 
but  intensely  painful  to  the  lad  while  it  lasted.  He  had  had 
both  legs  and  one  arm  broken  by  an  Army  truck  which  had 
struck  him.  When  he  came  to  the  French  hospital  where  1 
was  assigned,  I  liappened  to  be  off  duty.  As  I  came  on  again 
I  was  met  by  a  P^rench  patient  gesticulating  wildly  toward 
"le  hiesse  Americain."  I  was  distinctly  alarmed  to  find  six 
Frenchmen  and  one  Frencli  nurse  surrounding  his  bed. 
Hemorrhage,  collapse,  death  entered  my  mind.  The  real 
facts  were  that  he  had  sneezed  while  asleep  and  in  some  way 


THE  EUROPEAN  WAR  587 

twisted  one  of  his  broken  legs.  The  French  nurse  immedi- 
ately ran  to  him  and  succeeded  in  getting  the  leg  in  a  more 
comfortable  position  but  he  could  not  make  her  understand  it 
teas  easier.  She  continued  to  change  its  position,  with  ex- 
cruciating results.  To  understand  his  relief  u})on  my  arrival, 
one  liad  to  see  his  face.  His  only  exclamation  was:  "For 
God's  sake,  tell  them  I'm  comfortable !" 

Of  the  nature  of  this  service,  nurses'  letters  speak  for  them- 
selves.    Annie  8.  Kathbone  wrote : 

I  was  one  of  a  group  of  nurses  assigned  in  June,  1918,  to 
February  3,  1919,  to  the  care  of  American  soldiers  in  French 
hospitals.  The  presence  of  American  women,  as  well  as  the 
more  familiar  methods  of  nursing,  seemed  to  sootln  them 
greatly.  One  boy,  weak  and  near  his  end,  said:  "Xo,  I  don't 
want  anything.  Please  talk  to  me.  1  like  to  hear  you  talk 
American." 

Particular  scenes  stand  out  vividly,  but  it  is  sometimes  the 
simple  and  less  romantic  details  that  one  loves  best  to  re- 
member. Perhaps  my  most  precious  memory  in  all  those 
stirring  times  was  that  of  half-delirious,  dying  boys  calling 
me  "Mother."  This  was  by  no  means  merely  a  nickname ; 
but  it  occurred  so  often  in  isolated  cases  as  to  quite  astonish 
me,  for  in  my  nursing  work  at  home  it  had  never  happened. 
I  heard  two  other  Red  Cross  nurses  say  that  their  experiences 
had  been  the  same  and  they  treasured  the  remembrance 
as  I  do. 

Of  course  as  nurses  in  the  war  zone,  we  had  the  usual 
bombing  raids.  Sometimes  (as  at  Creve-Coeur-le-Grand)  it 
seemed,  when  bombs  dropped  all  around  our  hospital,  quite 
by  itself  in  the  open  fields,  and  wlien  window  ghiss  was  sliat- 
tered  over  the  patients'  beds,  that  the  enemy  was  really  using 
the  hospital  as  a  target.  We  nurses  generally  found  these 
raids  more  endurable  when  it  was  our  turn  to  be  on  night  duty 
with  tlie  patients  tlian  when  we  hatl  to  sit  passively  through 
long  hours  in  tlio  slielter  of  a  cave. 

The  American  Kcd  Cross  supplied  many  articles  of  equip- 
ment and  numerous  luxuries  to  American  sick  and  wounded  in 
French  hospitals.  Miss  Fitzgerald  wrote  of  this  phase  of  the 
service : 

Our  nurses  did  not  simply  go  out  to  give  the  patient  tlio 
nursing  care  he  required.    They  went  to  look  alter  his  general 


588    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

welfare.  They  provided  for  him  the  food  which  was  not 
obtainable  in  the  hospital,  the  companionship  which  he  missed, 
the  small  luxuries  which  our  men  were  very  apt  to  call 
necessities  and  in  other  words,  anything  or  everything  which 
the  Red  Cross  could  give.  As  soon  as  nurses  left  for  a  par- 
ticular hospital,  I  put  in  a  request  for  certain  standard  sup- 
plies such  as  pajamas,  socks,  cigarettes,  chocolate,  games, 
writing-paper,  magazines,  books  and  newspapers.  Wherever 
the  hospital  was  not  too  far,  I  have  taken  these  supplies  out 
by  motor. 

The  average  French  hospital  has  very  little  equipment  and 
it  is  surprising  that  the  results  are  as  good  as  they  are.  In  all 
cases,  we  have  been  given  all  that  there  was  to  give  and  if  any 
partiality  has  been  shown  by  the  French,  it  was  in  favor  of 
the  Americans.  It  has  been  necessary  to  greatly  supplement 
the  food,  clothing,  bedding  and  equipment  in  order  to  ap- 
proach the  standards  which  we  have  set  for  ourselves  in 
America. 

In  one  particular  instance  in  a  French  hospital  in  Betz 
when  I  arrived  there  on  a  tour  of  inspection  shortly  after  the 
nurses,  I  found  that  a  room,  in  which  ordinarily  we  would 
have  placed  two  beds,  then  contained  ten  beds.  In  eight  of 
these,  very  seriously  wounded  men  were  lying.  In  the  other 
two  beds,  men  had  died  but  a  short  time  before.  The  beds 
were  so  close  together  that  you  could  not  have  stood  between 
them.  The  nurses  were  absolutely  at  a  loss  through  lack  of 
equipment  and  the  men  were  so  sick  that  even  then  it  seemed 
impossible  for  many  of  them  to  survive  the  night.  I  made  a 
list  of  the  supplies  that  they  needed  and  at  the  same  hour 
the  next  day,  I  had  all  these  supplies  out  there  and  the  grati- 
tude of  the  nurses  and  indirectly  of  the  patients  was  a  joy  to 
behold.  .  .  . 

]\liss  Fitzgerald  made  many  trips  of  inspection.  The  fol- 
lowing extracts  w'ere  taken  from  reports  written  by  her  after 
these  trips : 

June  18.  191S :  I  left  Tours  for  Saumur.  Here  I  found  our 
nurses  ou  duty  in  a  <-ontagious  hospital  in  a  wonderful  old 
chateau  overlooking  the  Loire.  Xeither  moat  nor  drawbridge 
were  lacking.  .  .  .  The  nurses  are  living  in  a  private  house 
just  outside  tlic  cliateau  walls  and  are  very-  happily  situated. 
Our  ])atieiits  seemed  contented  and  well  cared  for.  .  .  . 
June  "^0:  Miss  Ethel  Swope  [Connecticut  School  for  Nurses, 
New  Haven.  Conn.]  is  working  in  the  irojni-nl  Au-ffredi.  the 
oldest  hospital    in   France   except  the  original   Hotel  Dieu. 


THE  EUROPEAN  WAR  589 

She  is  caring  for  the  contagious.  On  arrival  there,  she  found 
a  colored  man  suffering  from  a  very  severe  case  of  small-pox 
and  his  condition  was  so  desperate  and  repulsive  that  he  had 
practically  been  abandoned  to  his  fate.  Many  were  afraid  to 
go  near  him.  His  joy  at  seeing  an  American  who  could  un- 
derstand him  was  quite  pitiful.  The  first  thing  which  he 
asked  the  nurse  to  do  was  to  write  to  his  people  that  they 
would  never  see  him  again  and  that  his  one  regret  was  that 
he  was  dying  before  even  having  been  in  battle.  Miss  Swope 
cared  for  him  until  the  end  and  the  man  was  given  a  most 
impressive  and  dignified  military  funeral,  his  coffin  draped 
with  the  Stars  and  Stripes. 

June  28:  Argentan-sur-Orne :  Some  of  the  patients  were 
in  another  hospital  in  the  city  and  the  surgeon  had  them 
brought  to  the  Ildjntal  Murte  in  order  to  have  them  all  to- 
gether. This  removal  caused  much  flutter  among  the  French 
Red  Cross  nurses  who  are  very  anxious  to  keep  our  men.  .  .  . 
A  very  ill  patient  is  now  being  cared  for  in  this  hospital. 
He  is  lying  on  a  hammock  suspended  to  a  wooden  frame  and 
with  the  help  of  many  pillows  is  being  made  comfortable. 
A  water  mattress  has  been  asked  for  him  and  was  shipped 
immediately.  IVIiss  Adeline  Rowland  [Johns  Hopkins  School 
of  Nursing],  wlio  has  charge  of  this  case,  has  been  extremely 
devoted.  She  has  bought  food  and  dainties  and  the  patient 
himself  told  me  of  a  delicious  chicken  which  lasted  three  days 
and  of  which  he  often  thinks.  It  is  a  question  if  his  life  can 
be  saved.  I  asked  him  what  I  could  send  him  and  his  answer 
was  "pies !"  I  fear  it  will  be  difficult  to  fulfil  his  desire,  as 
there  are  no  canteens  nearer  than  Angers,  but  I  will  send 
tinned  fruits  and  other  delicacies  from  Paris.  .  .  . 

Of  the  pressure  under  which  the  French  hospitals  operated 
during  the  last  gTcat  German  offensive,  Katherine  Williams, 
a  St.  Luke's  (Xew  York  City)  graduate  assigned  to  VHopital 
Militaire,  Chalons-sur-]\rarne,  wrote: 

Paris,  July,  191S:  .  .  .  Tliat  memorable  holiday,  July  14, 
I  had  dinner  with  some  of  the  canteeners  and  went  to  a  con- 
cert afterwards,  returning  home  and  getting  to  bed  about 
9  :30.  Twelve  midnight — Bang — with  so  great  a  concussion 
that  it  practically  threw  us  botli  out  of  bed,  and  we  Averc  sure 
a  bomb  had  struck  the  house.  The  sky  was  blazing  from 
horizon  to  horizon  and  the  thundering  roar  of  guns  was  so 
close  and  terrific  that  it  made  my  blood  run  cold.  That  first 
bang  on  the  dot  of  midnight  was  a  long  range  gun  that 
planted   a   shell   very  close  to  our  house  every  five   minutes 


590    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

regularly  for  two  cla3's  and  nights.  ...  By  the  time  this  let- 
ter reaches  you  it  will  be  no  secret  that  the  Huns  had  their 
eyes  and  plans  fixed  to  drive  through  Chalons  again. 

When  it  began,  one  of  the  first  things  we  did  was  to  pack 
up  everything,  ready  to  flee  at  a  moment's  notice.  Of  course 
we  dressed  and  went  over  to  the  hospital  and  about  6  :30  A.M. 
the  first  French  grands  blesses  began  to  arrive.  I  shall  never 
forget  the  sight  of  that  hall,  litters  from  end  to  end,  men 
blown  to  atoms  but  still  pitifully  hanging  to  a  thread  of  life ; 
no  noise,  a  sickening  silence  as  the  ambulances  were  unloaded, 
a  litter  lifted  down  to  the  ground,  only  to  find  that  the 
journey  had  been  too  much  and  that  in  that  lonely,  ghastly 
ride  one  more  soul  had  been  released. 

We  both  turned  to  at  once,  to  cut  the  clothing  off  the  men 
and  get  them  ready  to  go  to  the  operating-room.  In  the 
midst  of  this,  the  chief  surgeon,  M.  Tardary,  asked  me  if  I 
would  operate  with  him;  they  were  short  on  doctors  and  his 
assistant  must  work  another  room  so  that  they  could  keep 
going  two  at  a  time.  The  French  surgeons  are  marvelous. 
He  asked  me  during  the  day  if  I  were  fond  of  surgery  and 
added  "But  this  is  not  surgery;  it  is  butchery." 
.  .  .  About  noon  that  day  we  were  told  that  we  were  going  to 
receive  Americans;  there  had  been  a  dandy  little  field  and 
mobile  hospital  unit  establislied  nearer  the  line,  but  they  had 
been  bombed  and  shelled  almost  out  of  existence  and  were 
forced  to  move  back.  .  .  .  Four  barracks  on  the  lawn  were 
set  aside  for  the  American  unit  when  it  should  arrive  and 
about  2  A.M.  the  patients  began  to  arrive.  .  .  .  Sister 
Jean  and  M.  Houlie,  the  eye,  ear,  nose  and  throat  doctor,  who 
was  not  very  busy  at  the  time,  picked  out  the  worst  cases  and 
pumped  them  full  of  camphor  or  morphine.  ^liss  Robins  '^" 
too  was  splendid;  how  tliankful  I  was  to  have  an  aide  v.'ho 
had  had  sixteen  months  of  war  work,  who  was  possessed  of  a 
level  head  and  a  tactful  French  tongue ! 

About  five  that  afternoon,  two  American  surgical  teams, 
four  doctors,  two  anestlietists,  five  nurses  and  several  order- 
lies arrived.  .  .  .  We  established  a  triage,  as  the  French  call 
it,  or  a  sorting-out  hospital  on  the  lawn  and  as  the  ainbulances 
arrived,  one  doctor  was  stationed  to  keep  those  men  who  were 
in  so  shocked  a  condition  they  could  not  go  further  (eight 
kilometers  on  was  a  large  American  hospital  ready  for  a  large 
number  of  men)  and  to  send  the  rest  on.  The  new  arrivals 
were  put  in  one  barrack  and  as  soon  as  possible  vrere  carried 
over  to  the  main  hospital  building  for  operation  and  then  back 

'"  Margaret    Robins,    of    Pliiladclpliia,    an    American    Rod    Cross    nurse's 
aide  who  served  witli  !Miss  Williams  at  Chalons. 


THE  EUROPEAN  WAR  691 

to  a  post-operative  barracks.  All  this  went  on  under  Boche 
bombs  tumbling  from  airplanes,  that  five  minute  long  range 
shell  and  anti-aircraft  shrapnel  falling  like  hail  all  over  the 
place  and  much  the  most  dangerous  thmg  of  all.  Surely  God, 
in  his  protecting  divineness,  must  have  seen  and  felt  our 
sufferings  that  week,  for  hajjpily  no  one  was  hurt  or  killed  in 
our  particular  hospital  all  those  terrible  days.  I've  saved  the 
piece  of  shrapnel  that  glanced  off  my  tin  lid. 

During  nights  such  as  these,  the  French  and  American  nurses 
repeatedly  came  face  to  face  with  death  and  the  memory  of  the 
agony  which  attended  the  last  struggle  burned  itself  into  their 
consciousness  and  left  scars  which  were  to  remain  there  for 
many  nights  and  days  to  come.     Miss  Williams  wrote : 

Miss  Eobins,  two  of  the  Sisters  and  myself  stayed  in  the 
barracks  on  the  lawn.  There  were  five  nurses  in  the  aperat- 
ing-room.  I  could  never  tell  you  about  that  night, — it  is 
burned  into  my  memory  as  a  horror  never  to  be  forgotten. 
Men  died,  it  seemed  to  me,  every  five  minutes ;  every  case  was 
either  abdominal  or  head  and  therefore  practically  hopeless. 
I  did  not  know  death  could  be  so  pitiful.  All  I've  ever  seen 
of  death  has  really  been  a  merciful  release  for  some  soul 
struggling  against  disease  when  the  course  of  life  was  nearly 
complete,  but  God  !  how  hard  it  was  for  these  strong  young 
lives  to  give  up,  such  a  ghastly  waste  of  human  vitality, 
thought,  happiness,  everything  worth  having,  snuffed  out 
under  the  most  exquisite  suffering!  And  nothing  to  be  done 
about  it  but  try  and  make  it  bearable  and  thank  God  few 
knew  they  were  going  to  die.     That  is  the  worst  of  all.  .  .  . 

Friday  night  enemy  aviators  came  again,  so  the  patients 
were  taken  down  to  a  cave  which  served  as  an  ahri.  Miss 
Williams  described  the  bombing: 

At  nine-thirty  the  Iluns  arrived.  They  boml)ed  until  3:45 
A.  M,  around  and  around  the  hospital,  blew  open  every  iron 
shutter  on  the  windows,  came  within  ten  yards  of  the  conta- 
gious building  so  that  all  the  contagious  patients  were  forced 
to  come  over  to  our  cave  and  halls.  The  concussion  of  one 
])oml)  was  so  terrific  tliat  it  broke  tlie  leg  of  (^iptain  M..  one 
of  our  oldest  patients,  whose  two  breaks  had  nicely  knitttnl. 

The  terror  of  the  patients  was  simply  ])itiful;  those  brave 
lads  who  had  gone  over  the  top  so  unthinkingly,  found  it 
almost  impossible  to  bear  the  racket  when  tliev  were  bmuul 


692    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

helplessly  to  a  bed.  I  kept  thinking  the  next  will  surely  get 
us,  but  evidently  they  were  just  warning  us  to  get  out,  for 
their  aim  was  perfect  and  they  just  went  around  and  around 
us  all  night.  We  started  at  4  A.M.  to  evacuate  (that  was 
Saturday)  and  after  all  the  patients  had  gone  we  went  over 
and  packed. 

We  started  for  Paris  at  5  :30  P.M.  Saturday  and  it  wasn't 
until  we  got  into  that  train  that  we  realized  we  had  not  been 
undressed,  to  bed,  or  off  duty  since  Sunday  at  midnight  when 
the  fracas  began,  and  during  the  whole  week  I  counted  up 
four  and  a  half  hours  sleep  [in  137  hours'  duty].  We  got  to 
a  little  town  about  midnight,  where  we  had  to  change.  There 
we  had  sometliing  to  eat  and  although  we  were  half-starved 
we  would  fall  asleep  between  mouthfuls.  After  that  we  sat 
on  our  bags  on  the  platform  until  G  A.M.  waiting  for  the 
train  to  Paris,  which  was  supposed  to  come  through  about 
2  A.M.  We  reached  Paris  at  1 :30  P.M.,  Sunday,  went  to  the 
Pension  Galilee,  had  a  grand  lunch  in  our  rooms  and  by  2  :30 
we  were  sound  asleep  and  never  woke  up  until  the  following 
morning  around  5  A.M. 

Of  each  day's  routine  in  those  French  hospitals,  a  nurse 
wrote : 

Some  years  ago,  a  wild  youth,  the  son  of  a  titled  family  in 
Brittany,  ran  off  to  America.  He  had  no  money  and  helped 
to  unload  bananas  at  the  docks  in  New  York  as  his  first  job. 
Ijater  ho  was  a  waiter  and  almost  everything  else.  In  the 
course  of  twenty  years  he  became  very  prosperous  in  iron  and 
steel  and  was  completely  Americanized. 

Then  when  tlie  war  broke  out,  he  volunteered  in  the  French 
Army.  For  months  he  seemed  to  bear  a  charmed  life.  But 
after  a  while  in  one  of  his  dare-devil  voluntary  services,  he 
lost  a  leg  near  the  thigh.  The  surgery  was  skillful  but  gan- 
grene had  made  headway.  There  was  just  one  thing  to  do, 
long  frightful  baths  of  iodine.  Those  baths  were  my  severest 
duty  in  this  war.  The  agony  afterwards,  too !  With  his  face 
drawn  and  ghastly,  he  would  joke  in  American  slang.  His 
strength  was  so  wasted  that  his  surgeon  told  him  he  must 
conserve  it  even  to  the  extent  of  not  changing  his  position. 
Watching  the  clock,  he  would  lie  on  one  side  for  five  minutes, 
the  extreme  duration  possible,  then  on  the  other  for  five 
minutes.  With  such  a  mighty  force  of  will  to  live,  he  per- 
formed for  a  while  the  miracle  of  living. 

They  told  his  mother  from  Brittany,  whom  he  had  not  seen 
for  tM'cnty  years,  that  she  could  come  if  she  would  smile  all 


THE  EUROPEAN  WAR  693 

the  time  she  was  there.  The  frail  little  gentlewoman  bowed. 
"I  will  come  smiling,"  she  said.  She  did.  And  in  the  days 
that  followed,  through  the  dressings,  through  the  iodine  baths, 
she  sat  near  him,  knitting  and  smiling. 

Then  one  day  we  brought  him  other  news,  the  two  su- 
preme messages  of  Iiis  life.  This  French-American  or  this 
American-Frenchman,  had  been  cited.  ...  At  the  appointed 
time,  the  doctors,  the  nurses,  the  directors  came  in.  Then 
the  General  entered  with  his  staff,  to  which  were  attached 
military  drummers.  The  ceremony  begins  with  the  drums 
rolling  a  certain  beat,  never  used  except  to  announce  this 
decoration.  We  stood  at  attention,  the  patients  of  the  wards 
held  themselves  at  salute,  the  General  touched  with  his  sword 
the  shoulder  of  the  trembling,  uniformed  man  in  bed,  sa- 
luted his  cheeks  and  attached  the  Medaille  Militaire  on  his 
breast.    The  drums  rolled  thunderously. 

The  surgeons  didn't  talk  for  a  while.  They  knew.  And 
we  nurses  dropped  things  and  were  awkward  for  the  rest  of 
the  day.  And  the  frail  little  mother  kept  smiling,  with  ener- 
getic nods  over  her  knitting.     She  knew. 

Miss  Fitzgerald  had  ample  opportunity  to  see  the  French 
hospital  and  nursing  service  in  operation.  The  reports  of  her 
inspection  trips  mention  again  and  again  the  courtesy  of  the 
French  surgeons  and  the  willingness  of  the  French  nurses, 
handicapped  by  inadequate  training,  to  do  what  they  could  for 
the  Americans.     j\liss  Fitzgerald  wrote: 

August  3:  T  visited  the  PI.  0.  E.  18  at  Meaux.  Here  I 
found  one  of  our  nurses  in  charge  of  the  triage,  or  sorting- 
station.  In  one  corner  of  this  great  admission  tent,  she  liad 
established  a  little  diet  kitchen  of  her  own  and  in  her  odd 
time  she  made  broth,  porridge  and  such  diets  for  the  j)a- 
tients  in  that  hospital  and  in  the  other  hospital  at  Mcaux 
whom  she  thought  would  be  benefited  by  such  food. 

In  {\w  hospital,  the  mfdccin  chef  spoke  in  great  admira- 
tion of  the  nurses.  The  thing  that  struck  him  especially  was 
the  fact  that  our  nurses  actually  washed  and  cleaned  the  pa- 
tients themselves  and  that  they  said  they  enjoyed  doing  this. 
This  remark  might  seem  strange  to  anyone  wlio  did  not  un- 
derstand the  French  methods  of  nursing,  which  consist  purely 
in  making  surgical  dressings,  in  taking  tem})eratures.  in 
giving  the  medicines  aiul  carrying  out  the  treatments  ordered 
by  the  doctor, — and  here  the  nursing  ceases.  The  actual 
care  and  cleanliness  of  the  ])atient  and  of  the  l)edding  falls  to 


694   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  lot  of  the  servant  class,  no  matter  how  ill  the  patient  is. 
The  result  is  that  a  patient  goes  unM'ashed  until  he  is  well 
enough  to  get  up  and  ambitious  enough  to  do  this  for 
himself.  .  .  . 

August  22  :  Went  to  the  H.  0.  E.  13  at  Chateau-Thierry  and 
found  one  of  the  nurses  had  been  called  for  by  a  French 
General  in  his  own  car  to  go  and  care  for  an  American  lad 
in  a  French  formation  nearby,  who  was  not  expected  to  live. 
Time  proved  this  to  be  true  and  the  man  died  very  much 
the  happier  for  having  had -an  American  nurse  with  him  who 
was  able  to  take  his  messages  and  send  them  to  his  people  at 
home.  The  courtesy  of  this  French  General  should  be  much 
appreciated ;  it  was  a  very  humane  act  on  his  part  to  go  him- 
self and  get  the  nurse  whom  he  knew  would  provide  the  care 
and  consolation  which  the  boy  needed. 

Molly  B.  Smith,  an  American  Eed  Cross  nurse  transferred 
from  the  Children's  Bureau  to  a  French  hospital,  wrote : 

We  found  ten  severely  wounded  American  boys  at  the 
Hospital  Betz.  The  French  moved  them  into  a  separate  ward 
and  put  them  entirely  in  the  care  of  my  aide  and  me.  Four 
of  the  boys  were  delirious  and  two  died  almost  immediately, 
the  other  two  a  few  days  later.  The  French  at  once  sent 
four  very  ill  poUus  to  fill  the  four  vacant  beds.  At  first  we 
could  not  understand  this,  as  there  were  still  vacant  beds  in 
the  French  hospital,  but  we  learned  that  they  had  sent  us 
their  worst  cases  because  they  had  noticed  the  nursing  care 
which  we  had  been  giving  our  boys  and  realized  what  it  might 
accomplish  with  their  own  desperately  wounded  cases. 

We  in  turn  marveled  at  the  kindness  and  the  attention 
which  the  French  doctors  gave  ever}-  man,  regardless  of  his 
rank  and  the  nature  of  his  wound.  And  the  hours  that  they 
were  able  to  keep  going,  in  a  work  which  to  them  was  already 
a  very  old  story !  This  was  also  true  of  the  poilu  orderly,  so 
polite  and  so  efficient. 

In  September,  1918,  Miss  Fitzgerald  inspected  twenty-six 
French  hospitals  to  which  American  Ked  Cross  nurses  had 
been  assigned.     She  wrote: 

Most  of  the  formations  that  I  visited  at  this  time  were 
barrack  forniati(jiis  and  some  of  them  were  extremely  well 
organized  and  administered.  1  found  several  of  them  being 
taken  over  by  the  Americans,  who  naturally  were  each  day 


THE  EUROPEAN  WAR  695 

taking  over  more  in  this  particular  region.  The  situation 
in  a  hospital  which  is  changing  hands  is  really  rather  curious: 
the  medecin  chef  finds  himself  very  much  at  a  loss  because 
he  has  no  idea  of  his  own  personal  status.  All  he  knows  is 
that  he  has  lost  a  hospital  and  that  the  Americans  have  gained 
one  and  as  our  methods  are  so  very  different  from  the  French, 
he  does  not  quite  understand  at  what  stage  of  the  game  he  is. 
The  Americans  arrive  rather  suddenly  with  a  great  many 
cars  and  conveyances  and  apparently  need  more  space  than 
the  poor  French  ever  had  in  four  years  of  war,  but  after  a 
while  things  settle  down  and  nothing  could  interfere  with  the 
perfectly  good  feeling  between  the  French  and  the  Americans. 
I  found  that  the  American  formations  did  not  have  any 
nurses  with  them.  Upon  asking  the  reason  for  this,  1  was  told 
that  an  Army  order  had  forbidden  the  presence  of  any  woman 
in  this  area  until  the  first  gun  should  l)e  fired,  as  the  white 
cap  and  white  uniform  were  considered  to  be  too  conspicuous. 
The  roads  presented  an  endless  stream  of  convoys  going  in  a 
direction  north  of  Verdun  and  this  endless  stream  continued 
for  twenty-four  hours  out  of  the  twenty-four.  It  did  not  seem 
possible  that  so  many  Americans  could  be  in  France ! 

Two  hundred  and  five  American  Rod  Cross  nurses  and 
nurses'  aides  wore  assigned  during  the  spring,  summer  and 
autumn  of  1918  to  the  French  hospitals  of  the  Service  de  Sante. 
Miss  Fitzgerald  wrote: 

Our  nurses  have  been  in  151  French  hospitals.  The  total 
number  of  the  American  Expeditionary  Forces  cared  for  is 
difficult  to  estimate,  because  the  American  wounded  came  in 
in  such  varying-sized  groups,  from  4  patients  to  as  many  as 
600  patient:-.  A  fair  average  group,  I  think,  would  be  about 
20  patients  to  one  hospital.  At  least  3000  American  sick  and 
wounded  have  been  cared  for  in  all  l)y  the  American  Red 
Cross  nurses.  When  tliere  were  not  enougli  of  the  American 
Expeditionary  Forces  to  need  all  of  a  nurse's  time,  she  helped 
amoniT  the  French  wounded. 


Perhaps  the  most  spectacular  service  which  the  American 
Ked  CVoss  in  France  reiid(M'ed  to  the  I'nited  Staters  Medical 
(\irps  and  to  the  wounded  American  soldier  in  j-'rance  was  the 
estai)lishinent  of  einergcMicy  hospitals  during  tlie  spring  and 
summer  of  lOUS  for  the  American  Expeditionary  l-'oi-ccs.  At 
the  beginning  of  the  (lernian  oiFensive  of  March   Jl,   1018,  it 


596   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

will  be  remembered  that  the  sanitary  formations  of  the  U.  S. 
Medical  Corps  were  located  behind  the  Toul  sectors  in  the 
eastern  and  southeastern  part  of  France.  In  the  third  offensive, 
the  German  High  Command  chose  to  strike,  however,  at  the 
French  trenches  along  the  center  of  the  Western  Front.  Of  this 
blow,  Colonel  Ayres  wrote:  "For  their  next  attack  (May  27) 
the  Germans  selected  the  French  Front  along  the  Chemin  des 
Dames  north  of  the  Aisne.  The  line  from  Rheims  to  a  little 
east  of  Xoyon  was  forced  back.  Soissons  fell.  .  .  ."  The  First 
Division  was  at  this  time  brigaded  with  the  French  in  the 
Noyon-Montdidier  trenches.  On  May  28  the  Americans  cap- 
tured and  held  the  town  of  Cantigny  and  the  casualties  were 
sent  back  to  Beauvais  for  evacuation  to  Paris.  How  the 
American  Red  Cross  medical  service  fitted  into  this  emergency 
is  shown  in  Major  Fosburgh's  report: 

We  consulted  with  the  Army  authorities  and  found  that 
by  agreement  the  French  had  promised  hospitalization  of  our 
men  and  that  for  diplomatic  reasons  it  would  then  be  impos- 
sible for  our  ^[edical  Corps  to  establish  an  American  evacua- 
tion hospital  back  of  our  own  troops  in  the  French  sector. 
If  the  American  Eed  Cross  could  accomplish  this,  however, 
it  would  be  welcomed  by  the  Army. 

The  French  Service  de  Sante  was  approached  on  the  sub- 
ject. The  American  Red  Cross  proposed  that  they  establish 
and  operate  an  Allied  hospital  at  Beauvais  with  the  under- 
standing that  if  American  troops  were  in  the  neighborhood, 
their  wounded  would  be  sent  here.  The  proposal  was  imme- 
diately accepted  and  the  French  hospital  located  in  L'Ecoh 
Profcssionclle  at  Beauvais  was  turned  over  to  the  American 
Eed  Cross.  It  was  our  understanding  with  the  French  Ser- 
vice de  Saiitc  that  the  hospital  would  be  transferred  to  us  fully 
equipped.  Our  inspectors  reported,  however,  that  the  existing 
equipment  was  deficient,  so  we  made  arrangements  prior  to 
the  actual  assumption  of  the  hospital  to  re-equip  it.  expecting 
in  tbe  meantime  to  use  temporarily  the  equipment  of  the 
French. 

Of  the  organization  of  the  nursing  staff  for  this  hospital, 
later  designated  as  American  Red  Cross  Hospital  No.  104, 
Miss  Stimson  wrote: 

A  special  meeting  was  held  May  29  in  the  office  of  the 
general  manager  who  in  the  absence  of  the  commissioner  for 


THE  EUROPEAN  WAR  59T 

France  called  the  acting  head  of  the  Department  of  Civil 
Affairs,  the  chief  nurse  of  the  Children's  Bureau,  the  di- 
rector of  the  Women's  Bureau  of  Hospital  8ervi(;e  and  the 
chief  nurse  of  the  American  Red  Cross  in  France.  After 
the  discussion  of  the  need  for  nurses  to  take  care  of  Ameri- 
can soldiers  not  only  in  Paris  but  in  hospitals  nearer  the 
line,  this  meeting  voted  that  the  Department  of  Civil  Affairs 
should  immediately  call  in  at  least  forty  nurses  for  re- 
assignment by  the  chief  nurse  to  the  Department  of  Military 
Affairs.    This  number  was  later  raised  to  sixty. 

By  three  o'clock  the  next  afternoon  twenty  nurses,  most  of 
them  specialists  in  baljy  welfare,  tuberculosis  and  other 
forms  of  public  health  nursing,  left  for  Beauvais  while  twenty 
others  were  sent  to  ])repare  the  hospital  at  Auteuil.  Three 
doctors,  the  nurses  and  two  orderlies  were  crowded  with  many 
supplies  into  two  trucks. 

We  reached  Beauvais  after  10  P.^I.  The  town  was  so  dark 
that  we  could  hardly  keep  the  road;  French  sentinels  at  in- 
tersecting streets  were  the  only  human  beings  visible.  Two 
American  military  police  guided  us  to  Red  Cross  headquar- 
ters. On  the  way,  they  pointed  out  the  wrecked  ])uildings  in 
which  many  of  the  sixty  civilians,  killed  the  night  before, 
had  met  death. 

Red  Cross  headquarters  was  in  total  darkness.  When  I 
told  Captain  Jackson  that  twenty  nurses  and  Bishop  Mc- 
Cormick  had  arrived,  we  got  vigorous  response.  Tb.rough  the 
streets  now  dark  and  congested  by  Army  trucks  heavily 
laden  with  troops,  we  threaded  our  way  to  L'Ecole  Pro- 
fesmcmelle.  As  we  drove  into  the  courtyard  we  saw  the  dim 
outline  of  a  quadranglc^-shaped  building.  Some  voices  were 
heard  and  several  ])eo)de  came  out  with  exclamations  of 
welcome.  By  this  time,  the  siren  was  sounding  and  the  guns 
boomed  their  reply. 

We  nurses  wert^  hurried  across  a  cloister-like  corridor  into 
a  pitch  black  room.  It  was  impossible  to  see  the  faces  of  the 
people  who  were  speaking  and  not  even  a  lighted  cigarette 
was  ])ermitted.  We  soon  got  the  situation:  two  huiulred 
American  patients  ;ind  some  French  cases  left  in  a  wholly 
unequi))|>(Ml  hospital.  Th(^  severe  raid  of  tlie  day  before  had 
completely  (lemorali;^ed  the  French  civilian  (Mnployees.  (ias. 
electricity  and  water  mains  bad  been  ])ut  (Mit  of  conimission. 
A  large  number  of  patients,  after  twentv-f(Mir  houi's.  still  lay 
on  the  stretchers  on  which  they  had  comi^  in  from  the  fii^ld. 
fSix  AmiM'icnn  nurses.  gathere(l  up  from  surrounding  places, 
hail  been  toiling  night  and  day  but  were  still  as  game  as  the 
.\merican  otlicers  in  charire. 


598   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

They  asked  for  eight  volunteers  from  among  the  new 
arrivals.  Every  one  of  the  twenty  moved  forward.  The  first 
eight  whom  we  touched  in  the  darkness  were  put  to  one  side 
and  the  rest  groped  their  way  to  an  empty  ward  containing 
nothing  but  bed  frames  with  metal  slat-springs.  In  spite  of 
tw©  air  raid  alarms,  they  went  immediately  to  bed.  One 
adventurous  soul  happened  to  look  out  of  the  window  at  2 
A.M.  and  saw  in  tlie  courtyard  our  other  truck  containing 
their  baggage.  Out  she  went  for  bags  and  holdalls  and  those 
nurses  at  least  had  uniforms  in  which  to  go  on  duty. 

The  eight  nurses  took  off  their  hats  and  coats  and  went 
into  the  unlighted  wards  filled  with  heavily  wounded  men. 
What  a  tired  group  they  were  next  morning,  with  their  hair 
disheveled,  without  caps,  with  their  faces  and  dresses  covered 
with  dust  from  their  trip,  with  stained  towels  pinned  up 
across  the  front  of  their  cloth  dresses ! 

One  of  the  eight  nurses  who  were  selected  for  night  duty  was 
Anna  J.  Johnson.     She  wrote  of  her  experience : 

Miss  [Dorothy]  Turnbull,  the  chief  nurse,  led  the  way 
through  the  darkness  and  we  followed  as  best  we  could. 
Miss  []\Iargaret  F.]  McLeod  and  I  were  taken  to  wards  on 
the  top  floor;  we  thought  we  would  never  reach  the  top,  as 
we  had  to  feel  our  way  up  winding  stairs  and  through  dark 
halls.  We  were  told  that  there  were  about  sixty  new  operative 
cases  and  were  instructed  to  watch  for  shock  and  hemorrhage. 
"Do  not  strike  a  match  or  turn  on  a  flashliglit,"  were  Miss 
TurnbulFs  parting  words. 

The  barrage  continued  throughout  the  night,  the  Boche 
planes  hovering  above  us  and  the  shrapnel  falling  like  rain 
on  the  roof.  When  there  was  a  lull,  we  could  hear  our  pa- 
tients moaning  but  we  could  not  always  find  them.  At  3  :00 
A.M.  the  moon  came  out  and  wc  could  see  after  a  fashion.  At 
dawn,  we  discovered  that  we  had  liad  patients  and  beds  and 
dirt,  but  practically  nothing  else.  We  had  oidy  one  centi- 
grade thermometer,  three  glasses,  one  basin,  no  towels,  no 
wash-clothes.  .  .  . 

Miss  Turnbull  took  us  to  breakfast  in  a  huge  hall  where 
Italian  and  French  orderlies  were  screaming  at  each  other. 
There  were  a  number  of  long  dark  marble  tables.  Breakfast 
consisted  of  French  military  bread,  date  1915  on  the  loaf. 
Each  person  cut  his  or  her  chunk  ofP ;  there  was  a  streak  of 
mold  running  through  it.  but  one  picked  off  tlie  good  bread 
and  ate  it.     There  were  large  granite  ])itchers  of  coffee.  .  .  . 


THE  EUROPEAN  WAR  699 

The  capacity  of  the  Beauvais  hospital,  originally  two  hun- 
dred and  fifty  beds,  was  immediately  expanded  by  the  use  of 
Bossonneau  tents  to  four  hundred,  a  number  large  enough  to 
make  necessary  the  establishment  of  a  special  evacuation  train 
service  running  between  Beauvais  and  an  emergency  base  hos- 
pital established  on  the  Auteuil  race  course  near  Paris.  During 
the  entire  time  that  the  First  Division  was  in  the  ]\[ontdidier 
sector,  American  Red  Cross  Hospital  No.  104  received  and 
evacuated  American  wounded.  ^liss  Stimson  reported  the  con- 
ditions on  the  morning  following  the  arrival  of  the  emergency 
imit : 

Patients  were  immediately  evacuated  and  others  admitted. 
Nurses  in  charge  of  the  wards  soon  began  to  bring  com- 
parative order  out  of  chaos.  Boxes  of  supplies  were  opened 
and  equipment  of  all  sorts  distributed.  A  number  of  the 
members  of  the  Smith  College  Unit  were  flying  about  on  all 
kinds  of  errands.  Some  made  beds,  some  went  in  their 
camions  for  food,  others  washed  dishes.  The  kind  of  work 
they  had  been  doing  for  days  has  been  beyond  all  praise. 
Left  alone  in  wards  full  of  seriously  injured  men,  they  had 
nothing  but  instinct  and  common  sense  to  guide  them  in 
their  care. 

In  leaving  the  hospital,  the  French  had  taken  a  great  deal 
of  their  equipment.  Eed  Cross  supplies  from  the  warehouse 
in  Beauvais  were  rushed  over  within  a  few"  hours.  A  Eed 
Cross  plumber  and  electrician  appeared.  Soon  all  the  depart- 
ments of  a  smoothly  running  evacuation  hospital  were  getting 
into  line. 

"Tell  them  in  Paris,"  said  the  Army  ^Major  in  charge, 
"that  we  are  marching  on." 

"Tell  them,"  said  the  nurses,  "this  is  what  we  have  come 
for,  this  is  exactly  what  we  have  had  all  our  preparation  and 
all  our  training  for,  and  we  can't  say  how  glad  we  are  to  be 
here !" 

Back  in  Paris  on  the  Champs  dc  Course  at  Auteuil,  just  as 
splendid  a  piece  of  work  was  being  done  in  the  emergency 
erection  of  a  Red  Cross  base.  Dr.  (\  C.  liurlingame,  director 
of  hospital  administration  of  tlu^  commission,  rc^ported  c(^n- 
cerning  the  establishment  of  this  hospital,  American  Ked  Cross 
^lilitary  Hospital  Xo.  ."> : 

On  April  S.  1918,  Colonel  S.  P.  Wadhams.  :\redical  Corps, 
presented  to  the  Ped  Cross  the  {wssible  need   for  additional 


600   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospital  beds  in  Paris;  that  the  Army  was  forbidden  to  ac- 
quire them;  and  asked  for  a  tent  hospital  in  the  Bois  de 
Boulogne.  This  request  was  later  confirmed  in  writing  in  the 
name  of  the  Chief  Surgeon. 

The  Eed  Cross  undertook  the  establishment  of  a  hospital 
capable  not  only  of  caring  for  convalescents,  but  to  be  used 
for  general  medical  and  surgical  work.  The  construction  was 
commenced  on  May  6.  Twenty-one  working  days  later,  on 
Memorial  Day,  this  hospital  received  its  first  convoy  of  one 
hundred  and  sixty-nine  patients.  At  the  beginning  it  was  a 
five  hundred  bed  hospital,  but  grew  rapidly  to  twenty-five 
hundred  beds.  This  tent  hospital  became  the  great  sponge 
which  absorbed  all  the  overflow  patients  during  the  German 
drives  toward  Paris. 

American  Eed  Cross  nurses  composed  the  entire  original 
nursing  force.  When  the  emergency  arose,  they  were  swiftly 
withdrawn  from  the  Children's  Bureau,  the  Tuberculosis 
Bureau  and  other  Ked  Cross  civilian  relief  activities.  Xever 
was  there  a  better  demonstration  of  the  resourcefulness  of 
American  women  than  in  this  instance.  Perfectly  green  in 
the  military  game,  they  filed  in,  formed  a  nursing  force  of  an 
extremely  active  military  hospital  and  accomplished  their 
task  as  if  they  had  been  there  all  their  lives. 

Harriet  L.  Leete,  of  the  Red  Cross  Children's  Bureau  in 
Paris,  an  American  public  health  nurse  of  ripe  experience  and 
great  native  ability,  was  chief  nurse  of  the  Auteuil  Tent  Hos- 
pital, American  Red  Cross  Military  Hospital  No.  5.  Miss 
Leete  was  a  graduate  of  the  Lakeside  Training  School  for 
iSI^urses,  Cleveland,  Ohio,  and  was  for  many  years  superin- 
tendent of  the  Babies'  Hospital  disponsarv  of  that  city.  Her 
first  afiiliation  with  the  American  Red  Cross  came  in  1907, 
when  she  volunteered  through  the  Rochester  Cliapter  for  service 
as  a  nurse.  She  was  one  of  the  charter  members  of  the  iSTational 
Committee  on  Red  Cross  Xursing  Service  and  was  an  enthusias- 
tic sponsor  of  the  service  during  the  early  days  of  organization 
and  throughout  the  period  of  w'ar  and  demobilization.  She 
went  overseas  as  a  member  of  the  U.  S.  Army  Base  Hospital 
Xo.  4  (Lakeside),  but  was  transferred  from  her  unit  on  Sep- 
tember 15,  1917,  for  duty  with  the  American  Red  Cross  Chil- 
dren's Bureau  of  the  Department  of  Civil  Affairs,  Red  Cross 
Commission  for  Franco.  In  her  work  with  tli(>  Cliildren's  Bu- 
reau, she  rendered  brilliant  service  until  her  transfer  to  military 
duty  as  chief  nurse  of  Xo.  5. 


THE  EUROPEAN  WAR  601 

Miss  Leete  had  as  her  assistants  at  the  Tent  Hospital,  Susan 
Apted*  Blanche  Gilbert  and  Grace  Kellerhouse.  To  Mrs. 
Apted  (Connecticut  Training  School,  New  Haven,  Connecti- 
cut) was  entrusted  responsibility  for  setting  up  and  equip- 
ping the  various  tent  wards,  as  the  hospital  was  expanded 
during  the  summer  to  meet  em(>rgency  needs.  Blanche  Gilbert 
(Lakeside)  had  charge  of  the  placement  of  nurses  in  the  different 
divisions  of  the  big  base.  Grace  Kellerhouse  (Methodist  Episco- 
pal Hospital,  Brooklyn,  New  York)  was  the  head  nurse  of  a 
unit  of  twenty  Navy  nurses  which  was  assigned  in  August, 
1918,  from  Navy  Base  Hospital  No.  1  at  Brest  to  Auteuil,  to 
relieve  the  nursing  shortage  at  the  Tent  Hospital.  Miss  Keller- 
house was  placed  in  charge  of  the  training  of  the  orderlies  at 
No.  5.  She  was  given  authority  over  the  sergeants  and  by 
reason  of  this  imj)ortant  concession,  as  well  as  because  of  her 
native  tact  and  ability  and  her  previous  experience  in  the  Navy 
Nurse  Corps — for  one  of  the  chief  duties  of  Navy  nurses  is  the 
instruction  of  hospital  attendants — Miss  Kellerhouse  did  bril- 
liant work  at  American  Red  Cross  Military  Hospital  No.  5. 

At  the  height  of  the  sunnner  offensives,  the  nursing  staff"  of 
the  Auteuil  Hospital  numb(n*ed  nearly  three  hundred  nurses. 
The  hospital  occupied  a  position  of  great  strategic  importance. 
Nurses  who  had  arrived  in  France  without  any  experience  in 
military  nursing  were  assigned  to  temporary  duty  at  No.  5 
and  were  there  instructed  in  war-time  surgery  by  Inez  Cadell 
(Johns  Hopkins),  a  surgical  nurse  familiar  with  the  most 
modern  phases  of  war  nursing  technique.  After  this  intro- 
duction to  military  nursing  in  the  Tent  Hospital,  where  con- 
ditions somewhat  resembled  those  to  be  encountered  later  in 
the  field,  the  nurses  wvrc  sent  on  up  the  line  to  forward  Ameri- 
can Red  Cross  and  Medical  Corps  units. 

Of  the  recreational  phases  of  American  Red  Cross  ^Military 
Hospital  No.  5,  Dorothy  Lewis  Kitchen,  who  had  aided  !Miss 
Delano  in  the  preparation  of  nursing  publicity  at  National 
Headquarters  until  her  assignment  overseas  as  a  hospital  re- 
creation hut  worker,  wrote : 

American  Red  Cross  ^lilitary  Hospital  Xo.  5  is  a  large 
tent  hospital  on  the  race  course.  The  recreation  hut.  also 
under  can\as.  contains  writing  tal)les,  a  })iano  and  victrola 
and  a  canteen  where  cigarettes,  etc.,  are  sold.  W'e  came 
through  the  mud  and  ])ools  of  water  with  a  i;uii(]i  of  hoy< 
dressed    in    hath    rol)es.    iroinir   to    hear   a    Y..M.('.A.    concert 


602    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

there.  The  gassed  cases  are  the  hardest.  Any  man  would 
prefer  a  heavy  wound.  These  boys  have  a  queer  yellow-white 
color,  are  very  thin  and  cough  in  a  peculiarly  rasping  voice 
when  they've  had  it  in  their  lungs. 

The  tent  was  jammed  with  soldiers.  The  concert  singer, 
one  I'd  heard  in  vaudeville  in  the  States,  got  them  to  singing. 
It's  queer  that  they  seem  to  adore  the  rather  sad,  sentimental 
songs  like  "Just  a  Baby's  Prayer  at  Twilight"  and  "Home- 
ward Bound."  She  singled  out  a  little  darkey  from  Tennessee 
who  ragged  the  piano,  another  doughboy  who  also  played  and 
several  who  whistled  excellently.  The  audience  really  bright- 
ened up  to  hear  one  of  their  own  crowd  perform. 

Going  back  we  passed  the  windows  of  the  tent  wards ;  heads 
came  popping  out  and  they  called: 

"Gee,  real  American  girls !" 

"Anybody  there  from  Missouri?" 

"Ain't  California  swell?" 

Some  inside  who  couldn't  lift  their  heads  smiled  at  us 
through  the  windows. 

Elizabeth  Crcadick,  an  American  Red  Cross  nurse  who  wa3 
at  one  time  assigned  to  duty  at  No.  5,  wrote : 

The  little  comforts  and  luxuries  furnished  the  boys  at 
Auteuil  made  a  tremendous  impression  upon  them.  One 
night  while  on  duty  in  a  stalile  which  had  been  improvised 
into  a  semi-hospital,  I  overheard  a  boy  say  he  hoped  he  would 
go  to  Ked  Cross  Hospital  No.  5  in  Paris  because  "you  got 
ice  cream  there  and  it  was  some  hospital,  besides !"  The 
other  boys,  all  grievously  wounded  and  lying  on  blood-soaked 
stretchers,  forgot  their  suffering  for  a  moment  to  dispute  such 
a  fairy  tale.  The  lad  got  his  wish  because  I  went  to  see  him 
at  Hospital  No.  5  a  month  later. 

During  the  first  six  months  after  its  establishment,  Ameri- 
can Red  Cross  ]\Iilitary  Hospital  No.  5  received  11,401  Ameri- 
can patients  and  maintained  18^},7'}-3  hospital  days. 

The  Beauvais  and  Auteuil  hospitals  were  created  out  of  the 
dire  emergency  caused  by  the  enemy's  possession  of  the  Soissons 
Line.  The  need  for  Red  Cross  emergency  hospitalization  for 
American  troops  continued.  Colonel  Ayres  reported  the  con- 
tinuation of  the  third  great  offensive  of  the  German  divisions 
massed  on  the  Western  Front: 

.  .  .  Soissons  foil  and  on  ^lay  31  the  enemy  had  reached 
the  Marne  Valley,  down  wliich  lu'  was  advancing  in  the  direc- 


American  Red  Cross  Military  Hospital  Xo.  5,  at  Auteuil.  near  Paris.     To 
the  riglit  appear  tlie  old  betting-booths  under  the  trees. 


The   interior  of  a   tent    ward   at  Autriiil 


THE  EUROPEAN  WAR  603 

tion  of  Paris.  At  this  critical  moment,  our  Second  Division 
together  with  elements  of  the  Third  and  Twenty-eighth 
Divisions  were  thrown  into  the  line.  By  blocking  the  gen- 
eral advance  at  Chateau-Thierry,  they  rendered  great  assist- 
ance in  sto{)ping  perhaps  the  most  dangerous  of  the  German 
drives.  The  Second  Division  not  only  halted  the  enemy  on 
its  front  but  also  captured  from  him  the  strong  tactical  posi- 
tion of  Bouresches,  Belleau  Wood  and  Vaux. 

Major  Fosbiirgh  summarized  the  sanitary  situation  of  the 
Second  Division  as  it  moved  into  the  line  at  this  grave  crisis: 

It  was  reported  to  us  that  in  the  expectation  that  the 
French  would  provide  all  hospitalization,  the  Second  Division 
had  left  in  the  Toul  area  everything  except  their  regimental 
medical  chests.  Furtliermore,  because  of  the  suddenness  of 
the  drive  between  Soissons  and  Kheims,  the  French  had  been 
unal)le  to  salvage  any  of  the  hospitalization  in  that  area  and 
had  lost  in  excess  of  55,000  beds.  They  were  totally  unable 
to  make  provision  for  the  needs  of  the  Second  Division. 

The  day  after  their  arrival  in  the  Meaux  area,  Red  Cross 
inspection  cf  their  equipment  found  their  entire  hospitaliza- 
tion to  consist  of  two  field  hospitals.  One  of  these,  located  in 
a  cow  barn,  had  five  stretchers  and  a  small  assortment  of 
drugs  and  dressings.  The  second  one,  located  in  a  small 
schoolhouse,  luid  twelve  stretchers  and  a  larger  collection  of 
dressings  and  equii)nient.  Back  of  these  so-called  field  hos- 
pitals, the  divisional  surgeon  was  attempting  to  establish  at 
Meaux.  a  distance  of  twenty  miles  behind  the  lines,  in  a 
wrecked  chateau,  an  evacuation  hospital,  using  tentage  and 
equipment  previously  loaned  to  the  division  by  the  American 
Eed  Cross.  Back  of  ^leaux,  not  a  single  bed  was  in  readiness 
for  the  recej)tion  of  wounded,  liourly  expected,  until  Paris 
could  be  reached  at  a  further  distance  of  approximately  thirty 
miles. 

The  divisional  medical  otTicers  and  consultants  ap])oaled  to 
the  Ped  Cross  for  assistance.  It  was  apparent  that  a  hospital 
for  evacuation  ])urposes  must  be  established  at  once  and  ar- 
rangements w(M'('  concluded  over  night  for  taking  over  the 
hos])ital  at  douilly.  Scine-et-^Iarne.  which  liad  been  o])('ratc(l 
since  liil4  by  Mrs.  11.  P.  Whitney.  At  tliat  tinie  it  had  a 
capacity  of  '^'A-'y  beds.  Additional  buildings  and  tentage 
immediately  brought  this  up  to  eight  hundred  and  lit^forc  the 
^Marines  and  other  detachments  of  the  Second  Division  made 
their  great  fight  in  Belleau  Wood,  this  hospital  was  in  full 
o])eration.     The  Ped  Cross  also  furnisiied  tentage.  drcs.-ings, 


604     HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

instruments,  drugs  and  other  supplies  to  the  division  for 
their  field  hospitals.  Everyone  of  the  eighty-five  hundred 
casualties  in  a  single  week  in  Belleau  Wood  were  brought 
down  through  American  Red  Cross  beds  to  Paris.'^ 

Colonel  Burlingame's  report  included  the  following  com- 
ment upon  the  work  accomplished  by  the  little  unit  at  Jouilly, 
Seine-et-Marne : 

Colonel  Morrow,  chief  surgeon  of  the  Second  Division, 
suggested  tliat  the  l?ed  Cross  take  over  the  Jouilly  hospital 
and  tliat  transportation  of  patients  be  made  by  ambulance 
from  ]\Ieaux  to  this  point.  With  no  formality  at  all,  the 
hospital  was  taken  over  and  on  the  same  night,  June  3,  it 
was  filled.  Within  a  few  days  its  capacity  was  increased  from 
two  hundred  and  eighty  to  one  thousand  beds.  On  June  8 
the  Eed  Cross  personnel  was  augmented  by  the  assignment 
to  duty  at  this  formation  of  personnel  from  United  States 
Army  Evacuation  Hospital  Xo.  8. 

During  the  days  of  its  enlargement,  installation  of  electric 
lights,  etc.,  it  received  a  continuous  stream  of  supplies  from 
Paris  and  at  the  same  time  was  caring  for  its  maximum  ca- 
pacity of  patients.  On  July  6  and  7,  1700  patients  were 
handled  by  tbi'S  small  unit  and  1183  were  evacuated  to  Paris. 
The  personnel  of  iMacuation  Hospital  Xo.  8  was  withdrawn 
and  for  a  time  some  of  tlie  personnel  from  a  newly-arrived 
Army  base  hospital  were  assigned  to  duty  there. 

The  removal  of  American  troops  from  this  sector  resulted 
in  the  witlidrawal  of  the  ^Medical  Corps  from  this  formation 
and  this  unit  was  therefore  discontinued  as  an  American 
Bed  Cross  military  hospital  to  function  as  American  Red 
Cross  Hospital  No.  105  for  the  French  wounded. '^^ 

The  hospital  at  Jouilly,  Seine-et-]\Iarne,  was  used  as  a  medi- 
cal and  surgical  center  throughout  the  summer  of  1018,  while 
American  troops  were  in  the  vicinity  of  Chriteau-Thierry. 
Anna  Johnson  was  assigned  to  diity  there  on  August  22.  She 
wrote : 

This  hosjiital  is  located  in  an  old  college  and  the  buildings 
have  been  used  at  three  different  times  in  history  as  military 

"  A  furthor  iiccount  of  tlie  work  at  Jouillv,  Soine-et-Miirm>,  appears  in 
Chapter   VIII. 

""Military  History  of  tlie  American  Red  Cross  in  Franee,"  p.  44. 
Library,  National    Ileadcjuarters. 


THE  EUROPEAN  WAR  605 

hospitals.  ...  I  was  put  on  night  duty;  influenza  patients 
were  coming  in  very  fast  from  a  veterinary  camp  at  Jouilly. 
I  had  two  tents  about  one  half  a  block  a])art.  One  orderly 
was  on  duty  in  one  tent  and  another  in  the  other  tent  and  all 
night  long  in  the  pouring  rain  I  plowed  l)ack  and  forth 
through  the  mud  between  the  two  tents. 

The  men  were  desperately  sick.  On  the  fourth  niglit,  the 
theater  of  this  old  college  was  opened  to  acconnnodate  the 
great  numbers.  There  were  03  new  patients  that  night,  be- 
sides the  ones  in  my  two  tents  and  in  the  theater.  1  was  told 
that  at  midnight  more  nurses  would  arrive  to  iielp  me.  Four 
of  the  doctors  stayed  on.  The  men  were  the  sickest  I  have 
ever  seen.  They  looked  like  gassed  patients  but  none  of  them 
had  ever  been  near  the  front  and  they  had  only  been  in 
France  three  weeks,  taking  care  of  gassed  horses.  If  ever 
doctors  worked  with  patients,  those  from  Base  Hospital  No. 
57  certainly  did,  but  those  boys  in  spite  of  all  our  efforts 
simply  died.  One  night  13  were  carried  out  of  my  ward. 
It  was  discouraging  beyond  all  words  to  see  those  splendid 
specimens  of  manhood  just  pass  out  without  a  struggle.  They 
were  all  big  Western  fellows;  many  of  them  had  never  had  a 
sick  day  in  their  lives  before. 

The  last  week  in  INFay,  1918,  found  General  Lndcndorff  in 
possession  of  two  wedges  thrust  toward  Paris,  that  in  the 
northeast  with  its  point  at  Cantigiiy  and  Montdidier  and  that 
in  the  southeast  with  its  tip  at  Chateau-Thierry.  In  his  fourth 
great  offensive,  he  sought  to  smooth  these  wedges  out  into  a 
single  continuous  front.  Of  the  threatened  blow  which  fell  in 
June  upon  the  French  and  American  troops  holding  the  Noyon- 
Montdidier  trenches,  Colonel  Ayres  wrote : 

The  enemy  had  by  his  offensive  established  two  salients 
threatening  l^iris.  He  now  sougiit  to  convert  them  into  one 
by  a  fourth  terrific  blow  delivered  on  a  front  of  twenty-two 
miles  between  Montdidier  and  Noyon.  The  reinforced 
I'rencli  Army  resisted  firmly  and  the  attack  was  halted  after 
an  initial  advance  of  about  six  miles.  Throughout  this  ojiera- 
tion  (June  1-15)  the  extreme  left  line  of  the  salient  was  de- 
fended by  our  First  Division. 

During  the  first  week  of  June,  1018,  American  Ived  Cross 
^lilitarv  Hospital  No.  107  was  organized  at  .Iduy-sur-Morin. 
Of  its  establishment.  Colonel   Ihirlinaanic  wr<»tc: 


606   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

It  will  be  remembered  that  in  the  first  week  in  June,  1918, 
two  American  Divisions  were  in  action  around  Chateau- 
Thierry.  Action,  and  quick  action,  was  necessary  for  hospi- 
talization. Fifty  thousand  hospital  beds  had  previously  been 
captured  from  the  French  in  the  German  drive.  It  had  early 
become  evident  that  the  greatly  diminished  hospital  resources 
of  the  French,  combined  with  their  own  urgent  need  for 
beds,  would  make  it  impossible  for  them  to  carry  out  the 
agreement  to  hospitalize  wounded  from  American  divisions 
loaned  to  and  lighting  with  the  French. 

Word  concerning  the  conditions  was  received  from  Colonel 
Paul  C.  Hutton,  Medical  Corps,  who  was  representing  the 
Chief  Surgeon  of  the  Army  east  of  Montdidier  where  Ameri- 
can troops  had  been  brigaded  with  the  French.  A  camion 
train  of  supplies,  together  with  personnel,  was  started  on  the 
road  in  the  general  direction  of  Montmirail.  The  Director 
of  the  Bureau  of  Hospital  Administration  and  the  Chief 
Nurse  preceded  this  convoy,  getting  in  touch  with  Colonel 
Hutton.  Hurried  conference  between  the  head  of  the  ^Medical 
Service  of  the  French  Army  and  Colonel  Hutton  resulted  in 
the  Eed  Cross  taking  over  a  chateau  at  Jouy-sur-Morin,  which 
had  just  been  evacuated  by  the  withdrawal  of  a  French  for- 
mation. Watchers  along  the  road  diverted  the  camion  train 
to  the  point  which  was  to  become  American  Eed  Cross  hos- 
pital No.  107. 

Though  never  designated  as  an  American  Eed  Cross 
military  hospital,  No.  107  was  operated  as  such,  with  per- 
sonnel furnished  jointly  by  the  Army  and  the  Eed  Cross. 

In  a  letter  addressed  June  5  to  her  family,  Miss  Stimson 
wrote  of  the  difficulties  which  the  nurses  faced  in  establishing 
the  hospital  at  Jouy-sur-Morin : 

It  is  no  small  job  to  take  over  a  French  institution  to- 
gether with  part  of  its  force  and  man  it  with  two  teams  of 
officers  who  have  before  seen  each  other  and  a  group  of  nurses 
who  had  never  worked  together  cither  with  each  other  or 
with  the  doctors  in  command.  ^lost  of  them  speak  no  French 
and  all  of  tliem  are  Jiurses  specialized  in  child  welfare  or 
tuberculosis  or  social  service  work.  Fortunately  they  are  all 
Eed  Cross  nurses,  wliich  means  that  once  upon  a  time  before 
they  specialized  in  welfare  work,  tiiey  had  had  good  general 
trainmg,  so  tbey  are  instantly  transformed  back  to  surgical 
nurses. 

Tbe  nurse  in  cbargo,  Linda  K.  Meirs.  liad  never  seen  most 
of  her  staff  Ijcfore.     Slio  bad  rccentlv  come  back  from  work 


THE  EUROPEAN  WAR  607 

in  Roumania  and  liad  been  in  Paris  only  a  few  days  before 
I  sent  her  to  this  hospital. 

Everything  out  at  Jouy  looked  so  impossible  to-day  that 
after  much  talk  we  got  a  good  many  arrangements  about 
servants,  rations,  su})])lies  and  relation  to  the  French  and 
American  oflicials  straightened  out  and  then  Dr.  Burlingame 
decided  that  the  sooner  we  disappeared  the  sooner  would  they 
work  out  their  own  salvation,  so  we  returned  to  Paris.  .  .  . 

Miss  Meirs'  Red  Cross  service  had  begun  on  the  Mercy  Ship, 
had  extended  through  assignment  to  Kief  and  later  to  the 
American  Red  Cross  Commission  (1917)  for  Roumania ;  it 
finally  brought  her  the  Florence  Nightingale  ^fedal.  Of  her 
conduct  at  Jouy-sur-Morin,  Miss  Stimson  wrote  Miss  Noves 
(July  19)  : 

Miss  Meirs  has  done  splendid  work  here  at  American  Red 
Cross  Hospital  Xo.  107.  The  commanding  officer  tells  me 
that  on  the  night  of  the  heavy  raid  (July  15)  she  could  not 
have  been  finer.  It  was  a  terrible  experience.  One  of  the  hos- 
pital corps  men  was  killed  outright;  another  man  had  his  leg 
so  badly  hurt  that  immediate  amj)utation  was  necessary. 
Several  other  orderlies  as  well  as  patients  were  wounded. 

I  stayed  at  the  hospital  during  a  raid  on  the  following 
night.  After  what  they  had  had  the  night  before,  the  terror 
among  tlie  jiatieiits,  ])articularly  those  suffering  from  shell- 
shock,  we  shall  never  forget. 

^liss  Patterson,  formerly  chief  nurse  of  the  Commission  for 
Roumania  and  in  1918  assistant  to  !Miss  Stimson  and  Miss 
Fitzgerald  in  the  Paris  hcad(iuarters,  wrote  of  ^liss  Meirs: 

.  .  .  Her  commanding  ofHeer  has  said  that  she  is  the 
finest  nurse  lie  knows  and  her  nurses,  her  aides  and  every 
person  connected  with  the  place  have  been  unstinted  in  their 
praise.  Her  corjtsnien  call  her  "Colonel"  and  would  do  any- 
thing for  her.  In  short,  lier  wonderful  spirit  has  dominated 
always — her  absolute  unselfishness  and  keenness  to  serve  at 
any  place  or  anybody  who  needs  hel]).  It  is  not  such  tre- 
mendous executive  al>ility  which  she  has,  but  she  is  so  tre- 
mendously sincere  and  energetic  that  every  persou  about  her 
works  with  the  same  spirit  as  far  as  it  is  in  him.'.   .  . 

At  Jouy-sur-^rorin,  on  the  night  of  July  1,"),  Jane  Jefferv, 
an  Anicrii'iM!   Kcd  Ci-oss  nurse  transferred  from  the  Children's 


608    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Bureau,  was  severely  wounded.     A  French  dispatch  contained 
the  following  comment : 

Located  in  a  quiet,  remote  spot  three  kilometers  from  the 
railroad,  the  hospital  at  Jouy-sur-Morin  not  only  bears  the 
distinctive  marks  of  the  sanitary  service,  but  on  a  nearby 
grass  plot  there  has  been  spread  a  huge  cross  made  of  white 
towels,  its  arms  measuring  thirty  meters.  Shortly  after  the 
inauguration  of  the  hospital,  one  of  the  Allied  planes  flew 
over  the  spot  taking  photographs  to  show  that  the  cross  was 
plainly  visible  from  a  height  of  many  thousand  meters. 

During  the  night  of  July  15,  two  German  aviators  flew 
above  the  American  hospital;  volplaning,  they  descended  to 
within  a  few  hundred  meters  of  the  buildings  and  dropped 
four  bombs.    It  was  midnight. 

In  the  operating-room,  the  surgeons  were  at  work.  At  the 
moment  when  the  first  bomb  struck,  Major  McCoy  held  in 
his  forceps  the  femoral  artery  of  the  patient  on  the  table. 
The  lights  went  out,  two  more  bombs  fell,  the  third  failing  to 
explode.  In  one  room,  an  orderly  was  killed  as  he  was  giving 
a  drink  of  water  to  a  patient.  Nine  were  wounded,  .  ,  .  one 
of  whom  was  an  American  Eed  Cross  nurse. 

We  remember  that  recently  sixty  German  prisoners  were 
treated  in  this  hospital  at  Jouy-sur-]\Iorin.  where  they  re- 
ceived from  perhaps  the  very  nurse  whom  they  have  wounded 
the  same  care  and  attention  which  she  was  giving  our 
soldiers.'^ 

Miss  Stimson  wrote  Miss  Noyes  on  July  19 : 

Miss  JefPery  was  on  night  duty  attending  her  patients 
when  a  fragment  of  shell  struck  her.  She  showed  great  spirit 
and  was  only  concerned  because  she  felt  she  was  causing  more 
trouble  to  the  already  overworked  stafl^  of  doctors  and  nurses. 
When  T  told  her  the  next  day  we  were  going  to  bring  her  into 
a  hospital  lu-ro  in  Paris,  she  was  greatly  disappointed.  She 
had  hoped  to  be  able  to  go  on  duty  again  in  a  few  days. 

On  July  31  the  Paris  Bureau  of  Nursing  rushed  twelve  new 
arrivals  u])  to  Jony-sur-Morin  to  rccnforco  ^liss  Moirs'  staif. 
Among  these  nurses  was  Edith  Ambrose,  a  nurse  especially 
trained  in  psychiatric  work.     Of  her  experiences,  she  wrote: 

'"Translated  hv  tlie  Aniorif-an   Rod  Cross  Department  of  PuLlicity,  from 
Tablcttrs  (Iff!  Dcux-Churenie,  July  23,   1918. 


THE  EUROPEAN  WAR  609 

Upon  our  arrival  at  10:30  P.M.  three  of  us  went  immedi- 
ately on  night  duty.  Just  as  we  were  ahout  to  go  to  our  tent 
assignments,  Fritz  was  announced  by  a  siren.  We  happened 
to  be  in  the  corridor  of  the  chateau  whicli  is  headquarters  for 
the  staff  and  operating-rooms  for  the  hospital.  .Fritz's  calling 
cards  roared  as  they  struck  and  bang !  bang !  bang !  came  our 
welcoming  response.  Our  exchange  of  amenities  lasted  for 
perhaps  half  an  hour.  When  it  was  over,  I  tried  to  analyze 
my  sensations,  chiefly  disappointment  at  not  being  outside 
to  see  what  was  going  on  and  certainly  amusement  at  our 
different  attitudes.  A  timid  voice  whispered  out  of  the  dark- 
ness that  she  "wouldn't  be  so  afraid  if  someone  would  -only 
hold  her  hand !"  Every  one  must  have  grabbed  for  it,  for  I 
found  both  of  mine  firmly  held  until  after  the  last  gun  was 
fired. 

They  led  us  out  in  tlie  darkness  to  the  tents  where  each  of 
us  were  given  a  candle  and  explicit  instructions  to  shield  it 
carefully.  The  tents  had  no  floors,  but  by  morning  we  had 
ever}'  bed  full.  In  an  evacuation  hospital  like  this  we  did  as 
much  as  we  could  to  make  the  boys  comfortable  for  a  few 
hours  before  they  go  on  to  the  base.  IMorphine  of  necessity 
became  the  standing  order.  We  tried  to  give  them  a  bath, 
something  hot  to  eat  and  fresh  dressings. 

In  my  tent  was  a  lad  from  Xorth  Carolina  with  both  lungs 
pierced.  As  he  was  hemorrhaging  quite  frequently,  we  moved 
his  bed  outside  to  give  him  all  the  air  possible.  He  said  to 
me:  "Would  you  tell  me  a  fib  if  I  asked  you  if  1  was  going  to 
die?''  I  answered,  "Well,  you  are  a  good  enough  soldier  to 
know  what  a  fighting  chance  means  and  you  mustn't  tliink 
for  a  minute  you're  going  to  lose."  He  groped  for  my  hand 
in  fear  that  1  should  leave  him  alone  to  face  the  weakness 
coming  over  him.  Presently,  T  asked  him  if  he  would  like 
me  to  write  to  his  mother.  "Xo,"  he  said,  "she's  so  scared 
now  she'd  die  to  s(>o  a  strange  handwriting."  After  a  little 
while  he  said  again,  "You  all  are  certainly  next  to  having  her 
here  herself." 

A  hospital  wliicli  had  previously  hocn  maintained  in  part 
by  private  American  philanthropists  and  in  part  l)v  subsidies 
from  the  American  Tvcd  Cross,  was  taken  over  entirely  by  the 
commission  in  duly,  liUS,  oxpand(Ml  and  operated  as  an 
American  Ked  (^ross  hospital  ;  this  formation  was  Or.  Fitch's 
TFospital  at  Kvrcux,  Vllnjufnl  Comjil'uncntdirc  Xo.  J.  which  the 
French  Scrrire  de  Smile  had  tnriu'd  ov(^r  to  liini  on  September 
4,   1917,   after  he   and    Miss   Xclson   and   other   nurses  of  the 


610    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

original  Yvetot.Unit  had  been  transferred  from  St.  Valery-en- 
Caiix.  Dr.  Fitch's  hospital  at  fivreux  was  given  on  July  21, 
1918,  the  designation  of  American  Red  Cross  Hospital  No. 
109,  was  greatly  enlarged  and  was  run  by  the  commission 
until  after  the  Armistice.  The  nursing  staff  was  reenforced 
from  time  to  time  by  additional  nurses  from  Paris  headquar- 
ters. Leila  Halverson,  an  American  Red  Cross  nurse  trans- 
ferred from  the  Children's  Bureau  to  Dr.  Fitch's  hospital, 
wrote : 

About  May  1,  the  hospital  had  a  capacity  of  300,  but  soon 
four  fifty-bed  barracks  were  built  and  afterwards  ten  tents, 
containing  from  ten  to  fifty  beds  each,  were  put  up.  Most  of 
the  wounded  were  French,  but  we  also  had  Americans,  Eng- 
lish, Colonials  and  Boche  prisoners.  .  .  . 

The  work  done  in  this  hospital  was  almost  entirely  ortho- 
pedic, with  a  great  deal  of  bone  plating  and  bone  grafting. 
We  were  terribly  rushed  at  times  and  were  very  short  of 
nurses  and  aides.  After  the  arrival  of  one  American  convoy, 
the  surgical  staff  worked  steadily  for  42  hours,  stopping  only 
long  enough  to  eat  the  meals  that  were  served  in  the  steriliz- 
ing room,  then  slept  for  four  hours,  then  operated  again  for 
20  hours.  .  .  . 

From  September  4,  1917,  the  date  on  which  Dr.  Fitch  and  Miss 
Nelson  first  took  over  VHopital  Complimentaire  No.  2  at 
£vreux  until  January  1,  1919,  2194  patients  had  received  care 
there  from  American  Red  Cross  surgeons  and  nurses. 

Early  in  June,  1918,  the  use  of  gas  by  the  Germans  was 
increased  to  a  considerable  extent ;  this  increase  brought  about 
the  need  for  a  hospital  in  Paris  which  could  be  used  exclusively 
for  the  treatment  of  gassed  patients.  The  Red  Cross  Commis- 
sion for  France  accordingly  leased  the  Pavilion  BeUevue,  at 
beautiful  St,  Cloud,  near  Paris,  and  on  June  18,  1918,  opened 
a  hospital  of  600  beds,  which  was  designated  as  American  Red 
Cross  ^lilitary  Hospital  No.  0.  This  institution  was  originally 
intended  as  a  center  where  both  French  and  American  physicians 
might  study  gassed  cases,  but  the  acute  military  need  for  beds 
for  Americans  wounded  in  the  German  offensives  of  June  and 
July,  1918,  and  the  subsequent  Allied  offensives  resulted  in  the 
use  of  the  Bellevue  Hospital  solely  by  the  American  Expedition- 
ary Forces. 

American  Red  Cross  ^Military  Hospital  No.   0  was  staffed 


THE  EUROPEAN  WAR  611 

wholly  by  forty  American  Hod  Cross  nurses  and  twelve  nurses' 
aides,  who  had  becni  recalled  from  hospitals  of  the  Cliildren's 
and  Trberculosis  Bureaus  and  reassigned  to  help  meet  the  mili- 
tary needs.  Lily  B.  Crighton  (Illinois  Training  School  for 
Nurses)  was  chief  nurse  of  this  hospital.     She  wrote: 

On  July  10,  1  was  assigned  to  a  new  gas  hospital  wliich  the 
Eed  Cross  started  at  liellevue,  St.  Cloud.  It  was  a  very  beau- 
tiful place  and  conunaiulod  a  bird's-eye  view  of  Paris.  .  .  . 

Our  hospital  was  Mipposed  to  be  of  50U  bed  capacity  but 
during  the  rush,  we  had  well  over  (JOG  patients.  The  Red 
Cross  sent  us  generously  sup])lies  of  all  kinds,  so  we  could  put 
cots  in  the  halls  on  short  notice.  .  .  ,  We  were  also  equipped 
with  an  electric  blower  ajul  "amberine''  sprays.  .  .  .  The 
men  would  come  in  with  hideous  blisters  extending  from 
their  shoulders  down.  The  nurses  would  clip  away  all  this 
blistered  skin,  i-lcan  the  then  raw  surface  with  antiseptic 
solution,  dry  it  with  the  electric  blower  and  spray  on  the 
"amberine."  Burns  treated  in  this  manner  healed  in  an 
incredibly  short  time.  .  .  . 

Colonel  Burlingamc  stated  that  American  Red  Cross  Military 
Hospital  Xo.  (J  during  the  six  months  ending  December  31, 
11)18,  maintained  (Jl, ;')<)()  hospital  days  and  admitted  3052 
patients. 

Paris  was  the  receiving  base  for  American  soldiers  wounded 
in  the  German  otl'ensives,  but,  as  has  been  stated  before,  the 
sanitary  units  of  the  U.  S.  Medical  l)e])artnient  were  not  then 
admitted  to  the  French  Army  Zone,  of  which  Paris  was  the 
center.  Thus  all  American  Ked  Cross  hospitals  in  and  near 
the  citv  were  crowded  to  capacitv  during  the  sunnner  of 
1918. 

The  American  Ambulance  which  was  greatly  enlarged  and 
two  smaller  sp(;cial  hospitals  which  had  been  established  in 
connection  with  it.  were  utilized  for  the  wounded.  I'^iirly  in 
11)18,  a  need  had  arisen  for  hos])italization  facilities  to  care  for 
sick  personnel  of  the  American  Ued  Cross  and  of  other  Anu^ri- 
can  welfare  organizations  tlu'U  o{)erating  in  Kurope  and  of 
women  employees  of  the  American  Armies  in  and  al)()Ut  Paris. 
The  Commission  for  France  took  over,  re('.(iui])ped  and  main- 
tained a  small  private  hospital  at  Xeuilly  which  they  designated 
American  Red  Cross  Hospital  No.  101.  Later  a  sepai'ate  hos- 
pital,    also    at     .\euilly.     was    secui'ecj     and    oi»erateil     by     the 


612    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

American  Red  Cross  for  auxiliary  personnel  of  the  American 
Expeditionary  Forces.  It  was  designated  as  American  Red 
Cross  Hospital  No.  103.  When,  in  June,  1918,  the  military 
situation  became  acute  and  the  Germans  seized  Soissons,  with 
the  subsequent  loss  of  French  hospitalization,  the  beds  of 
American  Red  Cross  Hospitals  Nos.  101  and  103  were  used 
to  care  for  overflow  patients  from  the  Ambulance,  Military 
Hospital  No.  1.  Thus  during  the  six  months  ending  Decem- 
ber 30,  1918,  Red  Cross  Military  Hospital  No.  1,  with  its 
allied  hospitals  Nos.  101  and  103,  admitted  7437  patients  and 
maintained  175,873  hospital  days;  5553  operations  were  per- 
formed during  this  period. 

Red  Cross  Military  Hospital  No.  2  admitted  during  the 
period  from  July  1,  1918,  to  December  31,  1918,  2283  patients, 
performed  1294  operations,  and  maintained  64,478  hospital 
days. 

American  Red  Cross  Military  Hospital  No.  3  during  the 
last  six  months  of  1918,  admitted  1524  patients,  of  whom  27 
died.  The  hospital  maintained  during  this  period  31,491 
hospital  days. 

The  operation  of  this  emergency  hospital  service  in  the  zone 
of  the  base  in  such  places  as  Paris  and  Evreux,  and  in  for- 
ward areas  such  as  Beauvais,  Jouilly-Seine-et-!Marne  and  Jouy- 
sur-Morin  called  for  extensive  Red  Cross  organization  to  furnish 
personnel  and  supplies  to  the  units.  To  meet  the  calls  which 
they  had  reason  to  expect  would  continue  throughout  the  sum- 
mer as  the  Allied  offensive  was  developed,  the  Red  Cross  Com- 
mission for  Europe  had  built  up  by  June,  1918,  an  organization 
similar  to  that  existing  in  the  United  States.  In  January, 
Major  ]\Iurphy  had  resigned  from  the  American  Red  Cross 
War  Council  to  nndcrtake  service  in  the  American  Army  and 
on  February  5,  ^lajor  Perkins  was  appointed  commissioner  for 
Europe.  llai'vcy  1).  (iibsoii,  fornici'ly  general  manager  at 
National  H(;ad(inart('rs  and  later  a  member  of  the  War  Council, 
succeeded  .Major  Perkins  as  eoinniissioner  for  France.  Com- 
missioner (lii)son  divided  France  into  nine  zones,  with  head- 
quarters at  Paris,  Honh^aux,  lirest,  St.  Nazaire,  Havre,  Mar- 
seilles, Lyons,  Tones  and  Xenfchatean.  The  Paris  otHee  acted 
in  relation  to  these;  zones  in  much  the  same  way  as  did  National 
Headquarters  in  Washingtcjii  to  its  divisions.  The  twenty 
a(;tivities  of  the  commission  wen;  administered  by  seven  de- 
partments : 


THE  EUROPEAN  WAR  613 

I.  Department  of  Requirements,  wliich  dealt  with  supplies, 
transportation,  manufa(.'tures,  personnel,  jxjrmits  and  passes, 
construction. 

J  I.  Medical  and  Sur<?ical  Department,  which  dealt  with 
hospital  administration,  nursing,  tuberculosis  and  public 
health,  the  C'hildren's  Bureau,  reconstruction  and  re- 
education. 

III.  Medical  Research  and  Intelligence  Department,  which 
dealt  with  research,  medical  information,  the  library  bureau 
and  publications. 

IV.  Department  of  Army  and  Navy  Service,  which  dealt 
with  canteen,  home  and  hospital,  outpost  and  xVrmy  field 
service. 

V.  Department  of  French  Hospitals,  which  dealt  with 
requisitions  from  and  supplies  for  French  hospitals,  the 
bureau  of  visiting. 

VI.  Department  of  General  Eelief,  which  dealt  with  refu- 
gees, soldiers'  families,  war  orphans,  agriculture. 

VII.  Department  of  Public  Information,  which  dealt  with 
news  service,  photographs  and  motion  pictures  descriptive  of 
Red  Cross  activities  overseas. 

During  the  summer  of  1918,  the  Nurses'  Bureau  established 
and  maintained  numerous  homes  in  and  near  Paris  and  at 
other  hospital  centers  where  Army  and  Red  Cross  nurses  who 
were  being  held  on  temporary  assignment  in  these  centers,  who 
were  on  leave  or  who  were  convalescent  from  sickness  incurred 
in  line  of  duty,  were  entertained.  Of  these  homes,  Carrie  ^I. 
Hall,  who  in  November,  P.)18,  followed  J\liss  Stiinson  as  chief 
nurse  of  the  American  Red  Cross  in  France,  wrote : 

The  convalescent  home  at  Le  Croisic,  which  was  opened 
in  July,  1018,  offered  accommodations  for  100  nurses  on 
convalescence  or  on  leave.  T^e  Croisic  is  an  attractive  little 
fishing  village  on  tlie  Brittany  coast  and  the  coinaleseent 
home  overlooked  the  ocean  on  a  stretch  of  sandy  bea(  h.  it 
made  an  ideal  r(\<ting-place  for  nurses  and  workers  worn  with 
the  strain.  The  rates  of  ten  francs  a  day  were  most  reason- 
able. The  good  food,  the  fresh  bracing  air.  the  fine  bathing 
and  the  pictures(|ue  Breton  peasant  life  conibiiieil  to  make 
T^e  Croisic  a  most  desirable  resort.  The  place  was  closed  in 
November,  1!>18.  and  steps  were  innnediately  taken  to  lind  a 
suital)le  substitute  in  the  south  of  b'rancc.  A  location  at 
Cap  d'Antibes,  near  Cannes,  on  the  I''r(Micb  Kivicra.  was  se- 
cured  and    on   Januarv   f!.    IIUO.   tlu^   hotel    was   taken   over. 


6U   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Plans  were  made  to  receive  200  convalescent  women  personnel 
of  the  Red  Cross  and  five  nurses  were  sent  to  assist  the  nurse 
in  charge,  Mrs.  Katherine  Hough.  The  Convalescent  Bureau 
provided  all  information  and  secured  transportation  and 
reservations.  The  personnel  who  were  sent  down  on  conva- 
lescent leave  by  advice  of  a  doctor,  were  kept  there  free  of  all 
expense.  The  personnel  on  leave  were  charged  reasonable 
rates,  which  they  could  not  have  obtained  at  any  other  hotel 
in  this  very  fashionable  neighborhood. 

Miss  Morgan  took  a  vivid  interest  in  the  establishment  of  the 
convalescent  home  at  Le  Croisic  and  did  much  to  secure  the 
funds  necessary  for  maintaining  it  and  the  other  nurses'  homes 
in  and  near  Paris.  A  list  of  these  nurses'  homes  may  be  found 
in  the  Appendix. 

The  later  weeks  of  June  were  comparatively  quiet  while 
General  lAidendorff  massed  his  forces  for  what  proved  to  be 
his  last  offensive.     Colonel  Ayres  wrote : 

On  July  15,  the  enemy  attacked  simultaneously  on  both 
sides  of  Eheims,  the  eastern  corner  of  the  salient  he  had 
created  in  the  Aisne  Drive  (May  27).  To  the  east  of  the  city, 
he  crossed  the  ]\Iarne  but  made  slight  progress.  His  path 
was  everywhere  blocked.  In  this  battle,  eighty-five  thousand 
American  troops  were  engaged,  the  Forty-second  Division  to 
the  extreme  east  of  Champagne,  and  the  Third  and  Twenty- 
eighth  to  the  west,  near  Chateau-Thierry. 

The  turning-point  of  the  war  had  come.  The  great  Ger- 
man offensive  had  been  stopped.  The  initiative  now  passed 
from  Ludendorff  to  ]\Iarshal  Foch  and  a  series  of  Allied 
offensives  began,  destined  to  roll  .back  the  German  armies  be- 
yond the  French  frontier.  The  moment  chosen  by  Marshal 
Foch  for  launcliing  the  first  counter-offensive  was  July  18, 
when  it  was  clear  that  the  German  Champagne-l\Iarne  drive 
had  spent  its  force.  Tlie  place  chosen  was  the  uncovered  west 
flank  of  the  German  salient  from  the  Aisne  to  the  Marne, 
The  First.  Seeoud,  Third,  Fourth,  Twenty-sixth,  Twenty- 
eighth,  Thirty-second  and  Forty-second  American  divisions, 
togotlier  with  selected  French  troops,  were  employed. 

At  the  initiation  of  the  counter-offensive  of  July  18,  the 
Medical  Corps  had  received  permission  from  the  French  to 
bring  up  their  own  evacuation  hospitals,  so  that  the  Red  Cross 
hospitals  subsequently  developed  acted  in  a  supplementary 
capacity  to  Army  formations.     A  small  unit  at  Chantilly  was, 


THE  EUROPEAN  WAR  G15 

however,  an  exception  and  was  described  by  Colonel  Burlin- 
game  as  follows : 

Just  before  the  great  counter-offensive  on  July  15  the 
American  First  and  Second  divisions  were  withdrawn  from 
the  Beauvais  sector.  It  was  generally  believed  that  their  des- 
tination was  to  be  Meaux,  where  they  were  to  have  a  much- 
needed  period  of  rest.  Less  than  twenty-four  hours  before 
the  actual  attack  began  on  the  morning  of  July  18,  it  was 
learned  that  the  destination  of  these  divisions  had  been 
abruptly  changed  and  they  were  beingfswung  toward  the  line 
south  of  Soissons. 

On  the  line  of  evacuation  from  this  sector  existed  no 
American  hospitalization.  It  so  happened  that  the  Ambu- 
lance St.  Paul,  then  being  operated  in  cooperation  with  the 
Eed  Cross,  was  then  located  at  Chantilly  on  this  very  line. 
With  but  twenty-four  hours,  the  Ambulance  St.  Paul  was 
selected  as  the  meeting  place  and  an  emergency  formation 
created  to  function  as  an  annex  to  this  little  one  hundred 
and  fifty  bed  French  unit.  Fight  surgeons,  sixteen  nurses 
and  twelve  enlisted  men  were  detached  from  American  Ked 
Cross  Hospital  No.  104  at  Beauvais  and  directed  to  proceed 
to  Chantilly,  where  they  were  met  by  additional  Red  Cross 
personnel  from  I'aris.  Tents,  operating  equipment  and  all 
things  necessary  for  a  three  hundred  bed  evacuation  hospital 
were  rushed  from  Beauvais  and  Paris  to  meet  at  Chantilly. 

The  nursing  staflF  at  Chantilly  was  made  up  of  fifteen  nurses 
who  were  withdrawn  from  American  Kcd  Cross  Hospital  Xo. 
104  at  Beauvais  and  twenty  Army  nurses  who  were  sent  up  from 
Paris. 

Mary  A.  Burgess,  formerly  in  service  with  the  Red  Cross 
Children's  Bureau,  was  chief  nurse.  One  of  the  nurses  with- 
drawn from  Beauvais,  Elizabeth  E.  Cherry,  wrote : 

On  July  18,  !Major  ^Moorehead  heard  from  Paris  Headquar- 
ters that  nurses  and  supplies  were  needed  at  Chantilly,  that 
many  French  and  American  wounded  were  expected  there  at 
any  time.  In  less  than  twcdve  hours,  he  had  split  our  per- 
sonnel, leaving  a  part  in  Beauvais.  With  the  remainder  of 
the  personnel  and  with  what  sup])lies  could  be  spared,  we 
started  for  Chantilly.  The  Ked  Cross  was  also  sending  us 
more  nurses  and  su])plies  from  Paris. 

When  we  arrived,  we  found  that  the  tents  had  already 
been  put  up.     Mile.  St.  Paul  [founder  of  the  Anihulanee  St. 


616    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Paul]    had    managed    to    save    them   in    the    retreat    from 

Soissons.  .  .  . 

This  unit  remained  at  Chantilly  for  thirteen  weeks  and  during 
this  time  received  1364  patients,  many  of  them  wounded  men 
from  the  United  States  Marine  Corps.  The  unit  cared  also 
for  French  wounded. 

One  of  the  largest  of  the  Red  Cross  evacuation  hospitals  to 
be  established  for  care  of  the  wounded  of  the  American  Expe- 
ditionary Forces  was  set  up  early  in  August  at  Coincy,  north 
of  Chateau-Thierry  in  the  Vesle  sector.  Colonel  Burlingame 
wrote : 

When  the  Americans  were  near  Fere-en-Tardenois  and 
Fismes,  urgent  need  existed  for  an  evacuation  hospital. 
American  Red  Cross  representatives  went  over  the  devastated 
area,  found  a  pump  capable  of  furnishing  the  water  supply, 
ordered  materials  from  five  different  points  to  be  assembled 
at  this  pump,  with  a  piece  of  charcoal  designated  it  "Ameri- 
can Red  Cross  Hospital  jSTo.  110"  and  stationed  a  man  to 
guard  it.  Within  three  days  materials  were  on  the  spot  and 
within  a  week  patients  were  being  received. 

Of  special  interest  was  the  method  in  which  the  supplies  of 
this  emergency  evacuation  hospital  were  assembled  at  Coincy. 
Colonel  Burlingame  stated : 

A  part  of  this  equipment  was  taken  from  the  American 
Red  Cross  hospital  at  Beauvais,  a  part  from  the  American 
Red  Cross  formation  at  Chantilly,  a  part  from  the  American 
Red  Cross  hospital  at  Jouy-sur-Morin,  with  other  articles 
from  Paris  wareliouses.  At  one  time,  these  materials  met  at 
Coincy  and  became  American  Red  Cross  Hospital  Xo.  110, 
a  permanent  and  complete  mobile  unit. 

An  extract  from  the  report  of  the  commanding  officer, 
Lieutenant-Colonel  John  J.  Moorehead,  gave  a  vivid  picture 
of  this  evacuation  center : 

The  location  was  chosen  primarily  because  of  the  water, 
because  the  road  passing  our  doors  was  the  main  artery  to  the 
not  distant  front  and  beca\ise  a  railroad  soon  to  be  repaired 
was  not  far  from  us.  The  farm  buildings  used  for  offices 
and  store-rooms  were  wrecks,  the  ground  on  which  we  pitched 
our  tents  was  full  of  shell  holes,  discarded  ammunition  and 


THE  EUROPEAN  WAR  617 

other  accoutrements  of  war.  Great  piles  of  refuse  and 
debris  made  it  a  breeding  place  for  myriads  of  flies.  Not  far 
away,  enemy  dead  lay  unhuried.  The  only  pleasing  outlook 
was  the  view  from  the  hill-top,  a  wide  sweep  ending  in  a 
range  of  hills  beyond  which  the  sounds  of  war  told  us  that  the 
line  was  not  far  distant,  told  us  also  that  in  this  sector  there 
was  need  of  a  hospital. 

To  this  forbidding  site  we  brought  from  Chantilly  nine 
surgeons  and  twenty-nine  nurses.  Soon  we  were  provided 
with  an  ambulance  com})any  with  one  hundred  and  ten 
enlisted  men  and  the  actual  preparation  for  our  new  home 
began. 

After  the  American  troops  moved  out  of  this  sector,  the  Chief 
Surgeon,  American  Expeditionary  Forces,  ordered  No.  110  to 
Villers-Daucourt  for  the  Argonne  offensive.  During  the  four 
months  ending  Xovembcr  30,  1918,  this  hospital  admitted 
17,446  patients  and  maintained  23,179  hospital  days. 

Another  emergency  evacuation  hospital  was  American  Red 
Cross  Hospital  Xo.  Ill,  of  which  Lieutenant-Colonel  J.  C. 
McCoy  was  commanding  officer.  Colonel  Burlingame  wrote 
of  its  establishment: 

At  the  request  of  the  Army,  American  Red  Cross  Hospital 
Xo.  Ill  was  estal)lished  in  the  Hotel  Dieu  at  Chateau-Thierry 
in  August,  li)l<S.  The  building  was  for  the  most  part  still 
intact,  though  at  first  ricrnian.  then  French  and  lastly  Ameri- 
can shells  liad  somewhat  pounded  it  to  pieces.  For  a  few 
days  it  had  itccii  the  lionie  of  a  medical  formation  of  the 
United  States  Army  division  which  had  withdrawn.  As  the 
hospital  at  Jotiy-snr-Morin  was  no  longer  active.  ])ractically 
all  the  personnel  from  that  formation  was  moved  to  this  new 
hospital.  It  was  maintnincd  after  American  troops  had  h'ft 
that  area,  serving  as  insurance  against  a  jiossihle  return  to 
that  sector.  During  the  four  months  ending  Novenih(>r  .'in, 
191S,  it  admitted  -jn!!.-)  patients  and  maintained  St.Sl  l.os])ital 
days. 

The  following  report  regarding  the  cTnorgeiicv  assignment  nf 
Red  Cross  nursc^s  to  hospitals  caring  for  wonndc^l  of  the  Ameri- 
can Expeditionary  Forces  during  the  military  crisis  of  ^lay, 
June  and  July,  191S,  was  submitted  by  Miss  Stimson: 

All  the  following  requests  were  met  witliin  forty-eight 
hours  and  in  manv  cases  within  twentv-eiirht  hours. 


618   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Beauvais :  Since  April  12,  59  nurses  and  aides  have  been 
sent  to  Beauvais  and  the  vicinity.  The  first  groups  were 
assigned  under  the  Red  Cross  representative  to  French 
hospitals  where  there  were  American  men.  On  May  29, 
seven  of  these  were  assigned  to  the  hospital  which  had 
just  been  put  under  the  care  of  the  American  Red  Cross 
and  on  May  30  twenty  more  were  sent  to  relieve  the 
urgent  condition  in  that  hospital.  All  the  nurses  and 
aides  in  this  area  can  be  moved  about  from  hospital  to 
hospital  as  the  need  for  their  services  varies  from  day 
to  day. 

Jouy-sur-Morin :  On  June  4,  twelve  nurses  and  aides  were 
sent  up  to  get  this  hospital  ready  for  patients  who  were 
received  within  three  days  after  the  nurses'  arrival.  On 
June  18,  eight  more  were  sent  up  to  help  in  the  hospital, 
which  is  now  running  as  an  active  evacuation  hospital  of 
300  beds. 

Auteuil :  To  American  Red  Cross  Military  Hospital  Xo.  5, 
40  nurses  and  aides  have  been  assigned  to  take  care  of 
patients  who  have  varied  in  number  from  100  to  712. 
The  first  patients  arrived  on  May  31.  The  Army  nurses 
who  were  asked  for  did  not  arrive  until  June  14. 

Service  de  Sarite:  Beginning  May  25,  21  teams  of  one  nurse 
and  one  aide  have  been  sent  out  at  the  request  of  the 
Service  de  Sante,  which  has  given  us  not  more  than 
twenty-four  hours'  notice  at  any  time. 

A.  R.  C.  Hospital,  44  Rue  Chauveau,  Xeuilly,  asked  for  tem- 
porary aid  to  assist  in  the  care  of  American  soldiers 
beginning  ]\Iay  30.  Five  nurses  have  been  sent  for  vary- 
ing periods  of  time. 

A.  R.  C.  Military  Hospital  Xo.  2  :  Five  nurses  have  been 
sent  here. 

fivreux :  Major  Fitch  asked  for  help  and  on  April  27  ten 
nurses  and  aides  were  sent  there. 

Ris  Orangis :  A  nurse  and  an  aide  were  sent  in  response  to  an 
emergency  call. 

Etc.,  Etc.',  .  . 

In  a  report  written  bv  Miss  Hall,  later  chief  nurse  of  the 
American  Red  Cross  in  France,  appeared  the  following  com- 
ment regarding  the  work  of  Miss  Eldon : 

During  tlie  Cbateau-Tliierry,  the  St.  ^lihiel  and  the  drive 
north  of  Verdun,  all  feverish  times  at  Paris  Headquarters, 
the  Xursing  Bureau  owed  much  of  its  stability,  its  apparent 
facility  in  answering  urgent  calls  for  help  and  its  good  judg- 


THE  EUROPEAN  WAR  619 

ment  in  sfelectiiifif  nurses  and  aides  to  the  assistant  to  the 
Chief  Xurse  |Miss  I01don|.  ...  It  was  no  unusual  thing  to 
find  her  at  her  desk  in  the  morning  with  a  blank  list  of 
waiting  nurses  and  aides  in  one  hand  and  a  request  for 
perhaps  twenty  or  thirty  for  immediate  assignment  in  the 
other.  This  meant  the  necessity  of  checking  up  every  hospital 
in  the  neighborhood  and  asking  for  the  release  of  as  many 
nurses  as  it  was  possible  to  get,  and  before  evening  the  neces- 
sary number  would  generally  be  produced.  ...'*" 

Of  the  intense  strain  under  which  the  American  Expedi- 
tionary Forces  and  the  American  Ked  Cross  were  then  laboring, 
Major  Fosbiirgh  wrote  Mr.  Davison : 

The  work  referred  to  was  done  at  the  most  critical  period 
of  the  war,  when"  Paris,  it  would  seem,  was  almost  in  the 
grasp  of  the  enemy  and  when  everyone  was  working  under 
the  greatest  pressure,  both  physically  and  mentally.  For 
periods  as  long  as  three  weeks  our  offices  were  closed  neither 
day  nor  night.  Divisional  representatives,  messengers  from 
division  surgeons,  headquarters  medical  consultants  of  tlie 
Army  were  coming  in  at  all  times  to  beg  additional  help  or 
report  progress.  During  one  night  between  the  hours  of 
midnight  and  eight  a.  :m.  over  fifty  requisitions  were  received 
and  the  goods  sent  out. 

To  Dr.  Burlingame  (IT.  S.  A.  Medical  Corps)  is  due  a 
major  portion  of  tlie  credit  for  what  was  done.  His  assist- 
ant, ^liss  I'reston,  by  her  unquenchable  good  spirit  and 
enthusiasm,  kept  the  whole  organization  going.  Captain  A. 
A.  Pice,  supply  otTicer,  unknown  probably  outside  the  depart- 
ment, worked  williout  thought  of  food  or  sleep,  ^liss  Stim- 
son,  Chief  Xurse,  who  used  and  re-used,  shifted  and  changed 
our  small  personnel  in  such  a  way  as  to  meet  every  real 
emergency,  made  })ossit)le  the  establishment  and  operation  of 
all  these  hospitals.  Drs.  ^loorehead.  Tarnowsky  and  ^IcCoy, 
in  charge  of  individual  emergency  hospitals,  cqui])ped  and 
operated  ellicient  hospitals  with  probably  more  limited  mate- 
rial and  in  a  sliorter  space  of  time  than  had  perluips  been 
done  in  this  war.  Dr.  ^IcCoy,  during  the  ])ombing  of  his 
hospital  at  Jouy-sur-Morin,  standing  above  a  serious  abdomi- 
nal operation  (iilmly  holding  with  forceps  a  severed  artery 
until  candles  could  be  ])rought  by  which  to  coin])lete  the 
operation,  is  no  more  striking  than  numerous  otlu'r  instances 
of  this  kind,  performed  by  our  personnel  during  this  jiast 
great  sunmier. 

""Report  of  the  Xursinir  l?uroau":   Carrie  M.  TIall :    l\t'<l  Cross  Archives. 


620   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  difficulties  under  which  the  entire  Paris  headquarters' 
staff  were  laboring  were  indeed  very  great.  Forty  desks  ex- 
tended down  a  large  central  office  space  and  at  each  desk,  the 
harried  officials  of  each  service  administered  their  particular 
duties  among  the  pandemonium  of  typewriters,  dictation,  local 
and  long  distance  telephone  calls  and  always  outside  the  inter- 
mittent roar  of  Big  Bertha  as  the  shells  exploded.  There  was 
no  time  for  protracted  conferences.  "It  was  as  if  each  of  us 
was  working  in  an  isolated  tank,"  Miss  Stimson  once  said. 
"In  the  interior  of  our  particular  tank,  we  were  cut  off  from 
the  other  tanks  and  we  were  working  under  tremendous 
individual  pressure  and  strain,  yet  we  were  all  forging  ahead 
in  the  same  general  attack  and  toward  the  same  general  goal." 

Of  this  mobile  nursing  service  operating  for  the  American 
Expeditionary  Forces  from  the  Paris  headquarters  of  the 
American  Red  Cross,  Miss  Stimson  first  wrote  Miss  Noyes, 
June  12 : 

I  wish  it  were  possible  for  you  to  be  here  even  for  one  day 
to  get  a  glimpse  of  how  we  are  trying  to  meet  the  calls  for 
nurses  constantly  coming  to  us.  These  demands  come  for 
nurses  to  care  for  American  soldiers  not  only  here  in  Paris, 
where  the  already  established  hospitals  are  overflowing  and 
to  whom  we  are  sending  every  possible  kind  of  nurse  or  aide 
we  can  secure,  but  also  to  the  new  hospitals  the  Red  Cross  is 
opening  in  order  to  relieve  this  urgent  military  situation. 
High  x\rmy  officials  come  here  every  day  to  confer  with  the 
Commissioner  about  new  ways  in  which  the  Red  Cross  can 
assist  the  Army.  These  requests  in  almost  every  instance 
imply  the  help  of  nurses  who  can  easily  be  moved  from  place 
to  place  and  can  be  brought  up  to  meet  emergencies  behind 
the  lines  more  quickly  than  Army  nurses  can  be  moved. 

Later  in  the  summer,  the  moving  of  any  personnel  other  than 
that  of  the  American  Army  become  so  difficult  and  took  so 
long  to  accompli sli,  that  this  situation  was  almost  entirely 
rev(>rsed.  Army  nurses  could  then  be  moved  more  readily  and 
with  less  delay  than  Red  Cross  nurses,  so  many  nurses  who 
had  been  serving  before  under  the  Commission  for  France,  were 
enrolled  as  reserves  of  the  Army  Nurse  Corps,  but  continued 
to  serve  in  American  Vied  Cross  sanitary  units, 

\a\\o  in  July,  the  American  Red  Cross  Commission  for 
France  submitted  the  following  estimate  of  personnel  needed 
bv  the  Nursing  Bureau  between  August   and  Januarv,   1019: 


THE  EUROPEAN  WAR  621 

Nurses  and  nurses'  aides  are  used  for  two  purposes:  First, 
they  are  the  only  nursing  personnel  available  to  take  charge  of 
Eed  Cross  emergency  hospitals  until  they  become  the  re- 
sponsibility of  the  Army;  also  they  are  placed  in  French 
hospitals  under  the  Sen'ice  de  Sanle  in  order  that  our  sol- 
diers in  those  hospitals  may  have  the  care  of  some  one  who 
can  speak  their  language.  Second,  they  are  used  in  connec- 
tion with  the  emergency  work  being  done  for  the  civilian 
population  of  France,  particularly  the  children  and  the 
tuberculous. 

Up  to  the  present  time  there  have  been  about  four  hun- 
dred and  seventy  nurses  and  nurses'  aides  brought  to  France. 
They  constitute  an  emergency  force  that  can  be  moved  from 
place  to  place  as  the  need  exists.  In  order  to  carry  out  our 
program  of  being  able  to  assist  the  Military  Establishment  in 
whatever  emergency  may  arise  and  in  order  to  discharge  the 
responsibility  wiiich  we  have  assumed  toward  the  civilian 
population  of  France,  it  will  be  necessary  to  import  up  to 
January  1,  1919,  the  following  personnel:  Nurses,  250; 
nurses'  aides,  300. 

Dietitians  are  used  for  organizing  diet  plans  in  American 
Eed  Cross  hospitals,  for  assistance  to  American  Expedition- 
ary Forces'  hospitals  and  for  general  use  as  mess  officers. 
The  Red  Cross  assigns  them  to  such  work  and  pays  their 
salaries.  They  are  also  used  to  teach  and  work  with  the 
French  civilian  population  and  in  French  military  hospitals. 
At  the  present  time,  notwithstanding  the  great  use  that  could 
be  made  of  the  services  of  dietitians,  only  two  have  been 
brought  from  America  and  there  is  no  supply  of  them  to  be 
secured  in  France. 

On  July  31  Miss  Stimson  wrote  Miss  Noyes: 

The  Red  Cross  is  constantly  being  asked  to  take  new  hospi- 
tals for  the  Army.  Into  some  of  these.  Army  nurses  are  sent 
at  once;  in  a  good  many  instances,  however,  we  have  to  take 
care  of  the  emergency  before  the  Army  nurses  arrive.  8omo 
of  these  nurses  assigned  by  the  Red  Cross  are  often  left  on 
the  staff  with  the  Army  nurses.  You  will  be  interested  to 
know  that  the  Chief  Surgeon,  American  Ivxpeditionary 
Forces,  has  assigm^d  iifty  Army  nurses  to  the  Red  Cross  be- 
cause of  this  very  need  for  moving  nurses  quickly  in  just 
such  emergencies.  When  Army  nurses  are  assigned  to  the 
Red  Cross,  it  is  possible  for  me  to  move  tlieni  within  a  couple 
of  hours.  We  could  use  three  times  as  many  more,  if  the 
Arniv  could  siiare  them.     The  Chief  Suru'cou  and  his  assist- 


622    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ants  are  continually  in  our  office  and  in  the  past  two  or  three 
months  they  and  the  Bed  Cross  officials  have  worked  together 
as  though  they  were  one  organization. 

The  last  Red  Cross  hospital  to  be  organized  for  American 
troops  in  action  at  the  front  was  American  Red  Cross  Hospital 
No.  114,  which  was  established  at  Luxembourg,  Toul,  in  the 
Asile  Caserne  J  a  former  hospital  and  orphanage  which  had  been 
maintained  since  December,  1917,  by  the  American  Red  Cross 
Children's  Bureau  for  French  refugee  children.  The  build- 
ings consisted  of  typical  French  wooden  military  barracks.  The 
children  were  evacuated  in  August  to  Neufchateau,  Nancy  and 
Lyons,  the  hospital  was  enlarged  from  ninety  beds  for  chil- 
dren to  fifteen  hundred  beds  for  American  wounded  expected 
from  the  St.  Mihiel  drive.  Martha  S.  Clark,  an  American  Red 
Cross  nurse  sent  up  from  Paris  to  help  reequip  the  Asile 
Caserne  as  a  military  hospital,  wrote : 

...  On  September  11,  a  Eed  Cross  mobile  unit  of  about 
100  doctors  and  45  nurses,  with  Major  McCoy  as  command- 
ing officer  and  Linda  Meirs  as  chief  nurse,  arrived  and  we 
began  to  set  up  the  wards  for  patients  from  St.  Mihiel.  That 
day  we  made  twelve  hundred  beds  and  almost  within  twenty - 
four  hours  they  were  filled;  a  few  days  later  we  had  1800. 
As  this  was  an  evacuation  hospital,  we  only  kept  them  for  a 
few  hours'  rest  after  re-dressing  their  wounds.  .  .  . 

Henrietta  R.  Reed,  another  Red  Cross  nurse  on  duty  at  the 
Asile  Caserne,  wrote : 

On  the  night  of  September  12,  our  first  wounded  arrived. 
By  dawn  about  1000  men  had  come  in  and  Major  McCoy's 
unit  had  twelve  operating-tables  running  at  full  speed.  .  .  . 
My  first  assignment  was  to  a  ward  containing  63  wounded 
Boches,  both  officers  and  privates.  They  were  covered  with 
filth  from  head  to  feet  and  almost  all  of  them  were  badly 
wounded.  They  were  all  undressed,  bathed,  given  new 
pajamas  and  put  to  bed  between  the  clean  Eed  Cross  sheets 
and  new  blankets.     They  stayed  with  us  five  days.  .  .  . 

The  hospital  consisted  of  sections  which  were  lettered  from 
A  to  K.  Each  section  was  made  up  of  seven  wards  containing 
twenty  men  each.  There  were  four  private  rooms  to  each 
section ;  men  who  were  dying  or  who  could  not  live  for  48 
hours  were  placed  in  these  rooms,  thus  sparing  the  other 
wounded  the  sight  of  a  dying  comrade  and  giving  to  the 
unfortunate  man  himself  quiet  and  privacy  to  the  end. 


f^iiiiinnl    in   Rid    Crvss   .Vhm  iuu 

A  I'dstcr  l)y  luibci-t  IJcid.  i)laniir(!  iiv  tlio  Aiiu'ricaii  Itcd  C'rciss  to  -tiinn 
!:itc  tlif  .■iirollinciit  (if  niir-r^  tdi-  military  scrvicr  lint  withheld  Inmi  di-- 
frilniti.iii   at   the   rtMjucst    of  the   War    Depart mnit. 


THE  EUROPEAN  WAR  623 

American  Red  Cross  Evacuation  Hospital  No.  114  was  in 
operation  at  the  Asile  Caserne  de  Luxembourg  from  September 
12  to  September  23.  The  American  troops  then  advanced  north 
of  Verdun,  so  Major  McCoy's  unit  was  ordered  to  follow  them 
as  far  as  Fleury-sur-Aire.  United  States  Army  Base  Hospital 
No.  82,  which  had  recently  arrived  from  the  United  States 
with  surgeons  and  corpsmen  but  without  nurses,  was  ordered  to 
duty  at  the  Asile  Caserne  de  Luxembourg  and  the  original  child 
welfare  nurses,  "casuals"  who  had  been  sent  up  from  Paris  and 
several  of  Miss  IMeirs'  original  unit  remained  there  to  con- 
stitute the  nursing  staff.  Colonel  Burnham  was  commanding 
officer  of  Base  Hospital  No.  82  and  Sarah  M.  Morgart  (Cone- 
maugh  Valley  Memorial  Hospital,  Johnstown,  Pa.)  was  ap- 
pointed as  chief  nurse ;  she  had  formerly  been  Miss  Meirs' 
assistant.  Henrietta  Reed,  who  had  remained  at  the  Asile 
Caserne,  wrote : 

On  September  23,  Base  Hospital  No.  82,  with  Colonel 
Burnham  in  command,  arrived  and  the  following  day  the 
ambulances  began  rolling  in  again,  this  time  with  500  gassed 
and  "flu''  cases  from  the  Fourth,  the  Seventh,  the  Ninety-first 
and  other  divisions.  At  one  time  I  had  charge  of  176  men 
with  mumps,  pneumonia  and  influenza.  .  .  . 

Gladys  H.  Porter,  a  public  health  nurse  who  had  been  at  the 
Asile  Casei^ie  since  its  establishment  in  December,  1917,  and 
who  remained  there  through  its  metamorphosis  as  Evacuation 
Hospital  No.  Ill  and  finally  as  U.  S.  Army  Base  Hospital 
No.  82,  wrote: 

After  !Major  McCoy's  unit  had  moved  up  to  Fleury,  we 
suddenly  found  ourselves  being  entirely  reequipped  by  the 
American  Ked  Cross  and  converted  into  a  base  hospital  of 
2000  beds.  ]\Iedical  and  surgical  cases  came  so  quickly  that 
we  had  to  resort  to  cots  in  the  corridors  and  finally  tents  on 
the  grounds.  Our  surgical  wards  had  so  many  frames  and  so 
much  fracture  apjiaratus  that  the  boys  called  them  F»arnum 
and  Bailey  circus  lings,  or  "trolley-cars"  and  urged  all 
visitors  to  take  stock  in  the  new  corporation. 

In  the  meantim(\  ^lajor  ]\lc(\)v's  unit  had  cone  on  to 
Fleury-sur-Aire.  Bessie  A.  Copelin,  one  of  the  nurses,  de- 
scribed the  trip  up : 


624    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  traveled  in  35  ambulances,  each  one  running  twenty 
minutes  apart.  No  one  was  allowed  to  stick  her  head  out,  as 
we  were  in  constant  danger  of  being  bombed  or  shelled. 

On  our  arrival  at  Fleury,  we  found  that  our  corpsmen,  who 
had  gone  on  two  days  before,  had  everything  in  readiness. 
On  September  25,  the  wounded  began  to  come  in  and  we 
evacuated  from  1200  to  2000  a  day. 

At  Fleurj,  Major  McCoy's  unit  was  taken  over  by  the  Army. 
Colonel  Burlingame  wrote : 

This  transfer  of  No.  114  to  Fleury  was  largely  a  move- 
ment of  personnel  with  but  a  small  unit  of  equipment.  Al- 
though financed  for  a  time  by  the  Ked  Cross,  they  were 
largely  equipped  by  the  Army.  On  their  arrival  at  Fleury, 
the  formation  became  known  as  Evacuation  Hospital  Xo.  114 
and  was  eventually  taken  over  entirely  by  the  Medical  Corps, 
with  the  exception  of  certain  Red  Cross  nursing  personnel, 
who  continued  with  the  formation  until  the  end.  To  quote 
from  a  letter  of  September  24  from  the  Red  Cross  (addressed 
to  the  Army)  :  "In  view  of  the  fact  that  the  movement  of 
this  unit  is  one  of  personnel  alone,  it  seems  to  be  a  hindrance 
rather  than  a  help  to  the  Army  to  operate  it  as  an  American 
Red  Cross  unit  and  we  therefore  propose  to  turn  the  per- 
sonnel of  the  unit  to  the  United  States  Army."  A  few 
weeks  after  its  designation  as  American  Red  Cross  Evacua- 
tion Hospital  Xo.  114,  it  disappeared  from  Red  Cross  history. 

For  the  thirty-two  days  of  its  Red  Cross  existence,  the  hos- 
pital received  14,771  and  evacuated  13,809  patients. 

Another  hospital,  formerly  maintained  by  the  Children's 
Bureau  of  the  Department  of  Civil  Affairs  but  later  trans- 
ferred to  the  Department  of  ^lilitary  Affairs  to  serve  the  Ameri- 
can Flxpeditionarv  PV)rces,  was  the  Hospital  Violet,  at  Lyons. 
It  had  been  established  in  the  spring  of  1918  as  a  contagious 
hospital  for  refug'0(;  children  but  when  the  influenza  epidemic 
broke  out  among  American  soldiers  in  camps  near  Lyons,  the 
children  were  evacuated  from  it  and  the  medical  and  nursing 
staff  cared  entirely  for  American  soldiers  tak(m  sick  with  the 
influenza.  Susanne  Hoskins,  an  American  l{ed  Cross  child 
welfare  nurse,  wrote : 

In  October,  1018,  I  was  transferred  to  the  Hospital  Violet, 
which  had  just  been  taken  over  for  the  care  of  American 
boys.     ^ly  first  week  there  was  most  unhappy;  we  lost  three 


THE  EUROPEAN  WAR  625 

of  our  finest  boys  with  the  flu.  It  broke  one's  heart  to  think 
of  all  that  these  boys  had  been  through  at  the  front, — some 
of  them  had  seen  nine  months  in  the  trenches, — and  then  to 
have  them  come  back  of  the  lines  to  rest  and  die  like  that. 
Our  first  patients  were  all  from  La  Valbonne,  an  officers' 
training  camp  just  outside  Lyons.  Most  of  them  were  ser- 
geants in  line  for  commissions.  Later  on,  we  had  many 
"casuals,"'  boys  passing  through  Lyons  and  getting  sick  in  tiie 
hotels  and  even  the  railroad  stations.  Hospital  Violet  was 
also  used  to  evacuate  the  boys  from  French  hospitals.  .  .  . 
The  American  Red  Cross  hospitals  seem  to  give  the  boys  the 
touch  of  home  they  crave. 

!N^o  incidents  illustrate  the  flexibility  of  Red  Cross  organiza- 
tion better  than  do  these  transfers  of  American  Red  Cross  Hos- 
pital No.  114  and  of  the  Hospital  Violet.  Hospital  No.  114 
was  formerly  a  mobile  unit  but  when  need  arose,  it  was  estab- 
lished at  the  Asile  Caserne  de  Luxembourg  as  an  evacuation 
hospital  to  serve  the  wounded ;  Hospital  Violet  had  been  a 
children's  hospital,  but  it  too  was  commandeered  for  the  care 
of  sick  American  troops.  Through  the  summer  of  1918,  efiicient 
fulfillment  of  the  needs  of  the  American  and  Allied  Military 
Establishments  became  the  primary  aim  of  the  Paris  head- 
quarters, even  though  this  meant  in  large  part  a  loss  of  identity 
of  the  American  Red  Cross  Nursing  Service  in  France.  It 
has  already  been  shown  that  nurses  who  had  come  over  to  work 
primarily  with  the  civilian  population  were  ^'militarized"  as 
necessity  arose.  ]Miss  Stimson  explained  some  of  the  reasons 
for  this  transfer: 

At  the  time  when  tlie  Red  Cross  nurses  in  France  who 
came  for  work  with  the  civilian  pojjulation  were  plated  in 
hospitals  under  military  control  during  the  great  emergency 
of  the  sunnner  of  11)18,  they  were  all  given  an  opportunity  to 
become  definitely  attached  to  the  military  service.  A  nuinlier 
of  them  were  sworn  in  as  reserve  nurses.  Army  Xurse  Corps, 
and  were  paid  by  the  Army.  .  .  .  It  is  doubtful  whether  at  the 
time,  wliich  was  one  of  great  confusion,  it  was  explained  to 
these  nurses  that  if  they  did  not  become  a  part  of  the  Aimy 
they  would  not  be  entitled  to  compensation  and  licncllts 
should  they  become  disabled.  At  that  time  such  henelits  were 
not  generally  known,  if  they  had  been  authori/.ed. 

Oiu^  of  the  important  reasons  for  urging  the  so-calle(I 
"militarization""  of  IJed  Cross  nurses  was  the  greater  ease  and 
speed   in  nioxing  th-'ui  from  jjlace  to  place  according  to  the 


626    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

need,  than  was  made  possible  through  Army  orders.  It  fre- 
quently required  ten  days  to  secure  the  necessary  papers  to 
move  Red  Cross  nurses  not  in  the  Army.  Permission  to 
move  all  non-Army  personnel  had  been  obtained  through  the 
French,  but  American  Army  transfers  could  be  made  in  a  few 
hours. 

This  absorption  into  the  Military  Establishment  of  nurses 
as  assigned  under  the  American  Red  Cross  involved  an  impor- 
tant question  of  Red  Cross  policy.  Miss  Stimson  wrote  Miss 
Nayes : 

I  am  very  sorry  if  in  our  work  in  Paris  we  embarrassed  you 
in  any  way  by  allowing  Red  Cross  nurses,  i.e.,  nurses  as- 
signed to  the  Red  Cross  Commission  to  France,  to  join  the 
Reserve  Army  Xurse  Corps.  We  did  not  urge  them  to  do  so, 
but  we  felt  that  when  they  wished  to  we  had  no  right  not  to 
allow  them.  Many  of  them  said  they  had  not  had  an  oppor- 
tunity to  join  in  the  States  and  were  even  so  misinformed  as 
to  think  that  when  they  signed  up  for  the  Red  Cross  Xursing 
Service  they  were  joining  the  Army  Nurse  Corps.  I  did  not 
realize  the  difference  in  paper  work  in  preparing  the  two 
groups.  As  a  matter  of  fact,  the  total  number  of  Red  Cross 
nurses  who  joined  the  Reserve  Xurse  Corps  over  here  did  not 
exceed  forty-five.  At  the  present  time  most  of  these  are  being 
given  permanent  assignment  with  various  x\rmy  formations, 
as  the  emergency  needs  to  which  the  Red  Cross  devoted  their 
services  no  lunger  exist. ®^ 

Here  lay  the  crux  of  a  situation  which  caused  both  Miss 
Delano  and  ^liss  Xoyes  embarrassment  because  of  the  position 
in  which  it  placed  the  Red  Cross  in  regard  to  the  group  of 
nurses  who  served  with  great  loyalty  and  self-sacrifice  in  the 
cantonment  hospitals  in  the  United  States  throughout  the  war. 
Miss  Xoyes  answered  this  point  as  follows: 

There  was  no  nursv^  who  left  this  country  who  did  not  have 
a  formal  communication  from  me  saying  that  it  was  definitely 
understood  that  she  was  accepting  service  under  the  Red 
Cross  and  that  transfer  to  the  Army  would  not  be  permitted. 
Some  of  these  nurses  stood  out  against  accepting  service  in 
the  military  camps  in  this  country,  this  being  a  preliminary 
preparation  for  overseas  duty  with  the  Army.  I  should  never 
have  assigned  some  of  these  women  to  France  at  all,  except 
*^  Miss  Stimson  to  Miss  Xoves.  Deecmbrr  2,   1018. 


THE  EUROPEAN  WAR  627 

that  the  need  for  nurt^es  was  so  great  that  we  could  not  ignore 
any  source  of  supply,  but  we  considered  them  unpatriotic. 

If  military  training  in  this  country  for  oflicers  and  soldiers 
in  the  cantonments  was  a  prerequisite  for  overseas  duty  in 
the  Army,  then  no  patriotic  nurse  should  have  held  out 
against  the  assignment  to  a  military  camp  in  this  country. 
In  their  anxiety  to  get  overseas  in  the  shortest  possible  space 
of  time,  they  would  accej)t  service  directly  with  the  Red 
Cross.  It  was  made  plain,  however,  to  these  women,  not  only 
by  me  but  invariably  by  Miss  Johnson  in  Xcw  York,  that  this 
service  was  not  for  the  Army.  I  fear  the  same  traits  whicli 
many  of  them  showed  in  refusing  service  in  the  camps  have 
been  the  controlling  factor  in  leading  you  to  believe  that  they 
were  not  informed  concerning  the  military  service. 

There  is  one  thing  I  cannot  quite  understand,  whether,  for 
instance,  ^liss  Eldon  and  others  need  have  gone  into  the 
Army  Nurse  Corps  when  they  were  to  be  left  in  the  Paris 
office,  which  vas  a  Red  Cross  office.  I  mention  this  point,  as 
many  of  the  nurses  who  are  returning  to  tliis  country  are 
speaking  critically  of  the  militarization  of  the  Paris  office  and 
resent  what  they  call  the  elimination  of  the  Ked  Cross. ^'^ 

The  Nursing  Service  in  France  has  already  been  compared 
to  a  small  ship  in  strange  and  tronblons  waters.  If  lay  control 
in  Ked  Cross  administrative  matters  may  be  called  the  Scylla 
which  threatened  her  on  the  one  quarter,  then  the  absorption 
of  the  Nursing  Service  by  the  Army,  as  set  forth  above,  may 
surely  be  called  the  Charvbdis !  This  interesting  and  vital 
point  of  policy,  bearing  directly  on  the  relationship  of  the  Red 
Cross  to  the  Army,  may  thus  be  summarized :  Many  persons 
might  hold  that  by  proclamation  of  the  President  and  by  regu- 
lations of  the  War  Department,  every  enrolled  Red  Cross  nurse 
is  a  reserve  nurse  of  the  Army  Nurse  Corps,  provided  she  is 
willing  to  serve.  When  such  a  nurse  has  been  detailed  by  the 
Ked  Cross  to  a  militarized  establishment  such  as  the  Red  Cross 
Commission  for  France,  operating  in  the  theater  of  war  undcu* 
an  Army  chief  nurse,  it  becomes  a  matter  of  interpretation  of 
Article  10  of  the  Revised  Treaty  of  Ceneva,  July  G,  100»),  as 
to  whether  she  is  "assimilated  to  the  personnel  charged  with  the 
removal,  transportati(Ui  and  treatnu^nt  of  the  sick  and  wounded." 

Before  sunmiarizing  Red  Cross  emergency  hospital  and  nurs- 
ing service  to  the  American  Expeditionary  Forces,  it  is  well  to 
include  at  this  point  a  statement  of  Miss  Stimson's  appointment 

'^.Miss  Novcs  to  Miss  Stiinsnii.   DcrcmlHT  21,   THIS. 


628    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

as  director  of  the  Nursing  Service,  American  Expeditionary 
Forces.  As  early  as  July  31,  1918,  her  report  to  Miss  ISToyes 
mentioned  the  over-lapping  of  her  duties  as  chief  nurse,  Ameri- 
can Red  Cross,  with  those  of  the  Chief  Nurse,  American  Expe- 
ditionary Forces : 

During  the  great  activity  of  our  forces,  we  have  placed 
almost  the  entire  emphasis  of  our  work  on  the  military 
phases.  My  own  position  as  an  Army  chief  nurse,  directly 
representing  the  Chief  Surgeon,  has  had  to  be  greatly  devel- 
oped. Xot  only  are  there  countless  numbers  of  Army  nurses 
coming  to  our  office  for  various  kinds  of  assistance,  but  the 
Chief  Surgeon  has  asked,  since  the  Eed  Cross  supplies  free 
transportation  by  automobile,  that  I  inquire  into  the  welfare 
of  Army  nurses  at  the  front.  It  is  very  easy  for  me  to  com- 
bine my  visits  to  the  two  groups  of  nurses  and  I  have  been 
able  to  be  of  considerable  assistance  to  x4,rmy  nurses  in  evacu- 
ation hospitals  and  on  surgical  teams.  I  am  able  to  see  that 
needful  equipment  from  the  Bed  Cross  is  supplied  quickly 
and  I  can  also  be  helpful  by  acting  as  a  go-between  with 
groups  of  nurses  to  their  own  chief  nurses  at  the  bases,  or  with 
the  Chief  Xurse  of  the  American  Expeditionary  Forces.  I 
am  also  able  to  communicate  very  quickly  with  these  nurses 
through  our  ambulances  and  automobiles  which  are  con- 
stantly going  between  Paris  and  the  front  and  this,  since  the 
mail  service  is  so  slow  and  difficult,  is  useful. 

It  is  because  of  the  increasing  importance  of  such  duties  as 
these  that  I  have  cabled  to  ask  if  Florence  Johnson  can  be 
sent  over  to  assist  me.  It  is  very  necessary  that  I  visit  all  the 
base  hospitals  to  explain  to  the  nurses  what  the  Eed  Cross  is 
doing  and  what  it  stands  ready  to  do  for  them.  I  feel  that  I 
could  do  no  more  important  piece  of  work  than  to  explain  to 
the  large  numbers  of  Army  nurses  now  in  France  the  details 
of  the  work  of  the  Eed  Cross  here.  I  was  utterly  ignorant 
myself  until  I  was  appointed  to  this  office  and  I  feel  sure  that 
many  of  the  nurses  in  France  are  as  unknowing  as  I  was. 
You  will  remember  that  ]\Iiss  Johnson  was  a  class-mate  of 
mine  at  the  Xew  York  Hospital  and  is  a  very  close  friend. 
She  would  be  exactly  the  person  to  under-study  me  and  to 
share  some  of  the  tremendous  burden  and  responsibility  of 
the  Paris  office.  1  would  not  ask  to  have  so  valuable  a  person, 
were  it  not  almost  impossil)le  to  find  her  equal  here. 

When  !Miss  Johnson  was  approached  upon  the  subject,  she 
decided  to  remain  in  New  York.  National  Headquarters  cabled 
to  ^liss  Stimson : 


THE  EUROPEAN  WAR  629 

[Cable  No.  10.027  j  ^fiss  Johnson  is  doing  most  impor- 
tant work  in  New  York.  Enjoys  very  close  and  harmonious 
relations  with  chief  nurses  stationed  there  representin<(  the 
Surgeon  (ieneral's  oilice.  Has  full  charge  of  equipi)ing,  in- 
terviewing and  directing  all  Army  and  Red  ('ross  nurses 
sailing  from  Kcw  York.  Looks  after  their  comfort  and 
morale,  advises  them  of  their  duties  and  responsibilities  and 
we  feel  that  her  removal  at  this  time  would  result  in  serious 
dislocation  of  the  entire  service. 

This  cable  recommended  other  nurses  then  serving  in  the 
Paris  office  who  were,  in  Miss  Delano's  opinion,  well  fitted 
for  this  work.  Carrie  ]\I.  Hall,  at  that  time  chief  nnrse  of 
the  American  Red  Cross  in  Great  Britain,  was  finally  trans- 
ferred to  Paris  to  assist  Miss  Stimson. 

Miss  Stimson's  duties  during  August  and  September  brought 
her  in  more  and  more  close  touch  with  the  nursing  service  of 
the  American  Expeditionary  Forces.  In  her  last  official  letter 
to  Miss  Delano,  written  on  jSTovember  6,  Miss  Stimson  an- 
nounced her  appointment  as  Director  of  Nursing,  American 
Expeditionary  Forces: 

By  this  time,  you  probably  know  that  General  Ireland  has 
appointed  me  director  of  the  xVrmy  Xurse  Corps.  I  am  not 
definitely  taking  up  the  work,  however,  until  Xovember  15. 
I  do  not  know  liow  to  explain  to  you  how  all  this  develop- 
ment has  taken  place,  for  the  situation  is  so  absolutely  dif- 
ferent from  what  anyone  so  far  away  can  imagine,  or  from 
what  any  of  us  have  experienced  before.  General  Ireland  will 
be  able  to  explain  to  you  better  than  anyone  else  why  he 
thought  I  could  be  of  more  use  in  this  position  than  I  am 
here.  Miss  Hall  has  a  very  complete  understanding  of  the 
situation  here. 

I  caimot  tell  you  bow  strongly  we  all  feel  over  here  that  you 
shoidd  conic  and  se(>  just  what  is  happening.  At  the  j)eriod 
of  our  great  cnicrgcncies.  we  had  no  time  for  thinking  out 
policies;  but  n<iw  as  we  face  another  winter  of  hard  work  we 
are  greatly  in  need  of  inspiration. 

In  her  report   as  director  of  the   Xursing  Service,   A.    E.   F., 
Miss  Stimson  wrote: 

On  October  "i'v*.  the  Chief  Surgeon  received  a  \vt\ov  dated 
October  s,  from  the  Acting  Surgeon  (ieiieral  stating  that 
"autboritv    was   received    from   the    Secretarv   of   War,   dateil 


630    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

September  5,  1918,  for  the  appointment  of  one  director  and 
two  assistant  directors  of  Xursing  Service  in  France  and  the 
same  in  England."  Miss  Stimson  reported  to  the  Chief 
Surgeon  in  Tours,  T^ovember  15,  1918.  Miss  Bell  returned 
to  the  United  States,  December  2,  1918,  and  became  assistaiit 
to  the  Superintendent  of  the  Army  Xurse  Corps  in  Wash- 
ington. 

During  its  first  eighteen  months  in  France,  the  American 
Red  Cross  established  nine  American  Red  Cross  military  hos- 
pitals in  France ;  these  institutions  had  an  estimated  bed  capac- 
ity of  6727.  During  the  same  period,  the  commission  also 
established  twelve  American  Red  Cross  Hospitals  to  serve  the 
American  and  Allied  Military  Establishments ;  these  institu- 
tions had  an  estimated  bed  capacity  of  4331.  Other  formations 
included  L'Hdpital  des  Allies,  at  the  Chateau  d'Annel,  near 
Campeigne;  Ambulance  Chirurgical  St.  Paul,  the  temporary 
formation  at  Chantilly ;  the  Daly  Unit ;  and  the  L'Ecole  de 
Legion  d'Honneur  at  St.  Denis.  All  these  units  were  assisted 
by  American  Red  Cross  funds,  personnel  and  supplies.  A  list  of 
all  sanitary  units  organized  by  the  commission  to  serve  the 
American  and  Allied  Military  Establishments  may  be  found  in 
the  Appendix. 

Colonel  Burlingame's  report  of  the  work  accomplished  in 
twenty-four  of  the  twenty-eight  military  hospitals  operated  by 
the  Red  Cross  for  the  twenty  months  ending  February  28,  1919, 
summarized  American  Red  Cross  medical  and  nursing  service 
to  the  American  Expeditionary  Forces : 

Hospital  days 1,154,854 

Patients  admitted    91,356 

Patients  died    1,457 

Of  the  89,539  patients  admitted  to  Red  Cross  hospitals 
during  the  last  six  months  of  1918,  86,787  were  from  the 
American  Expeditionary  Forces. 

It  should  be  borne  in  mind  that  the  Chief  Surgeon  of  the 
American  Expeditionary  Forces  intended  that  this  coopera- 
tive effort  of  hospitalization  between  the  Ped  Cross  and  the 
other  parts  of  the  rNfedical  Corps  should  he  primarily  an 
emergency  measure.  How  well  the  intent  of  the  Chief  Sur- 
geon was  carried  out  a])pears  in  the  graphic  chart  attached, 
which  sliows  a  drop  of  two-thirds  of  the  total  days  of  hospi- 
tali/cation  care  within  one  month  after  the  signing  of  the 
Armistice. 


THE  EUROPEAN  WAR  631 

On  November  11,  11)18,  the  American  Red  Cross  Nursing 
Service  in  France  had  ()04  of  its  nurses  at  work  directly  under 
its  own  auspices  in  both  military  and  civilian  activities  of  the 
American  Red  Cross  Commission  for  Europe.  Five  hundred 
and  fifty-three  American  Red  Cross  aides  were  also  in  active 
service  at  this  time.  Of  this  number,  233  were  sent  to  France 
from  the  United  States ;  320  others  were  women  who  had  been 
trained  for  service  as  aides  with  the  first  fifty  base  hospitals 
organized  by  the  Red  Cross  for  the  Army.  When  the  Surgeon 
General  debarred  them  from  active  service  in  hospitals  of  the 
Military  Establishment,  they  volunteered  for  Red  Cross  service 
overseas  as  canteen,  recreation  hut  and  surgical  dressings 
workers  and  were  sent  to  France  in  these  capacities.  During 
the  military  crisis  of  the  summer  of  1918,  with  the  attendant 
acute  shortage  of  nurses,  these  aides  registered  with  the  Bureau 
of  Nursing  at  the  Paris  Office  and  were  assigned  to  duty  in 
French  hospitals  of  the  Service  de  Sante  and  to  emergency 
hospitals  of  the  American  Red  Cross. 

How  well  the  American  Red  Cross  in  France  served  as  an 
emergency  arm  of  the  United  States  Medical  Corps  may  be  seen 
by  a  brief  statistical  summary.  The  total  number  of  battle 
casualties  of  the  American  Expeditionary  Forces  during  the 
European  War  was  280,330.  Of  this  number  34,180  were  killed 
in  action ;  14,72!)  died  of  wounds ;  230,074  were  wounded  in 
varying  degrees;  21>13  were  reported  ''missing  in  action";  and 
4434  were  taken  prisoner. '^^  During  the  twenty  months  ending 
February  28,  1910,  twenty-four  of  the  twenty-eight  military 
hospitals  which  were  operated  in  France  by  the  American  Red 
Cross  cared  for  80,787  patients  of  the  American  Expeditionary 
Forces.  These  men  were  largely  wound  cases  because  the  hos- 
pitals where  they  were  treated  were  organized  for  the  specific 
purpose  of  caring  for  American  soldiers  wounded  in  the  prin- 
cipal German  and  Allied  offensives.  '  Thus  the  American  Red 
Cross,  in  addition  to  organizing  and  equipping  the  fifty  base 
hospitals  which  formed  the  skeleton  of  the  hospitalization  of  the 
Medical  Department  in  France,  may  also  be  said  to  have  pro- 
vided, through  this  emergency  hospital  service  as  developed 
by  the  Americnn  Red  (^ross  Commission  for  Europe,  hospital- 
ization to  more  than  one  third  of  the  American  battle  casualties 
of  the  European  War. 

"'•'Jlic  War  with  ( lirinany."  L.  P.  Ayrc?,  p.  122. 


632   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  greater  flexibility  of  the  Red  Cross  organization  as  com- 
pared to  the  necessary  stability  of  the  Military  Establishment, 
the  tremendous  resources  placed  at  the  immediate  and  complete 
disposal  of  the  American  Red  Cross  in  France  through  the  gen- 
erosity of  the  American  public  as  compared  to  the  governmental 
routine  of  Congressional  appropriation  and  expenditure,  and 
the  unofficial  position  which  the  society  occupied  in  relation 
to  the  French  Government,  permitted  the  American  Red  Cross 
in  France  to  render  this  signal  service  to  the  wounded  of  the 
American  Expeditionary  Forces.  Thus  the  early  policy  which 
had  been  adopted  by  the  American  Army  and  the  Commission 
for  France  that  the  American  Red  Cross  in  France  should  serve 
as  an  emergency  arm  of  the  Medical  Corps  was  developed  be- 
yond even  the  most  earnest  and  enthusiastic  hopes  entertained 
by  the  society  for  the  alleviation  of  the  suffering  of  sick  and 
wounded  American  soldiers. 

With  the  exception  of  the  Red  Cross  evacuation  hospitals 
described  in  the  preceding  section,  the  Medical  Corps  of  the 
American  Expeditionary  Forces  organized  all  American  sani- 
tary formations  operating  in  the  immediate  zone  of  the  ad- 
vance. In  these  formations,  however,  many  reserve  members 
of  the  Army  Xurse  Corps  served  at  the  front  during  the  iillied 
offensive  of  the  summer  of  1918.  To  appreciate  as  a  whole 
the  general  type  of  service  of  these  nurses,  a  brief  summary  at 
this  point  of  the  forward  operations  of  the  American  Expedi- 
tionary Forces  will  throw  liulit  upon  the  fragmentary  accounts 
of  their  experiences  given  later  by  nurses. 

Immediately  following  the  failure  of  the  German  offensive 
of  j\Iarch-July,  1018,  ^Marshal  Foch  launched  his  first  counter- 
attack on  July  18  upon  the  uncovered  west  flank  of  the  German 
salient  from  the  Aisno  tf)  the  ]\Iarne.  By  this  operation,  com- 
pleted August  6,  the  Allied  line  ran  from  Soissons  to  Rheims 
along  the  Vesle.  A  few  days  later,  the  British  Armies  began 
their  offensive  on  the  kSouime  salient,  which  lasted  until  the  date 
of  the  Armistice.  With  these  troops  were  elements  of  three 
American  divisions.  Of  the  next  movement,  Colonel  Ayres 
wrote : 

In  the  meantime,  siniultanooup  assaults  were  in  progress  at 
other  })()i]its.  Oil  \u,i:iist  IS,  (ieneral  ]\Iangin  began  the 
Oise-Aisuo  ])haso  of  the  great  Allied  offensive.  A  day  later, 
the  British   launched  the   first  of  a  series  of  attacks  in  the 


THE  EUROPEAN  WAR  633 

Ypres  sector,  which  continued  with  some  interruptions  to  the 
time  of  the  Armistice.  [With  tliese  troops  were  four  Ameri- 
can divisions.  ] 

With  the  organization  of  the  American  First  Army  on 
August  10  under  the  personal  command  of  General  Pershing, 
the  history  of  the  American  Expeditionary  Forces  entered  a 
new  stage.  The  St.  Mihiel  (September  12-1(5)  and  the 
Meuse-Argonne  (September  2()-November  11)  offensives  were 
major  operations  planned  and  executed  by  American  generals 
and  American  troops.  .  .  . 

Two  comparisons  between  this  operation  at  St.  Mihiel  and 
the  Battle  of  Gettysburg  emphasize  the  magnitude  of  the 
action.  About  five  hundred  and  fifty  tliousand  Americans 
were  engaged  at  St.  Mihiel;  the  Union  forces  at  Gettysburg 
numbered  approxinuitely  one  hundred  thousand;  St.  ^lihiel 
set  a  record  for  concentration  of  artillery  fire  by  a  four-hour 
artillery  prcparatio!i.  consuming  more  than  one  million 
rounds  of  ammunition.  In  three  days  at  Gettysburg,  Union 
artillery  fired  thirty-three  thousand  rounds.  The  St.  ]\Iihiel 
offensive  cost  only  about  seven  thousand  casualties,  less  than 
one-third  of  the  Union  losses  at  Gettysburg.  ...**■* 

The  j\reuse-Arg(ninc  campaign  saw  the  collapse  of  the  German 
Fifth  Army.     Of  this  engagement,  Colonel  Ayres  wrote: 

"The  object  of  this  offensive,"  said  General  l^ershing  iji  his 
report  of  November  "^0,  1918,  "was  to  draw  the  best  German 
divisions  to  our  front  and  to  consume  them."'  This  sentence 
expresses  better  than  any  long  description  not  oidy  the  object 
hut  also  the  outcome  of  the  battle.  Iilvery  available  American 
division  was  thrown  against  the  enemy.  Every  available 
German  division  was  thrown  in  to  meet  them.  At  the  end  of 
forty-seven  days  of  continuous  battle,  our  divisions  had  con- 
sumed the  (icrnian  divisions. 

Tiie  goal  of  the  American  attack  was  the  Sedan  ^[czicrcs 
railroad,  the  main  line  of  supply  for  the  German  forc(^s  on 
the  major  part  of  tlu'  Western  Front.  If  this  line  were  cut.  a 
retirement  on  the  whole  front  would  be  forced.  This  retire- 
ment woulil  include,  moreover,  evacuation  of  the  liricy  iron 
fields,  which  the  (lerinans  had  be»Mi  using  to  great  a(l\antage 
to  su])plenient  their  iron  supply.  The  defense  of  the  positions 
threatened  was  therefore  of  such  imjiortaiU'c  as  to  wai'i-ant  the 
most  desperate  ineasures  for  resistanc(\  When  the  engage- 
ment w;is  eviijently  impending,  the  commander  of  the  Ger- 
man fifth  Army  sent  word  to  his  forct'S,  calling  on  them  for 
»*"The  War  willi  (i.T!iiaii\ ,"  pp.   109-110. 


634,    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

unyielding  resistance  and  pointing  out  that  defeat  in  this 
engagement  might  mean  disaster  for  the  Fatherland.  .  .  . 

On  the  first  day  of  American  action,  the  2Gth  of  September, 
and  the  next  day  or  two  after  that  the  lines  were  considerably 
advanced.  Then  the  resistance  became  more  stubborn.  Each 
side  threw  in  more  and  more  of  its  man  power  until  there 
were  no  more  reserves.  Many  German  divisions  went  into 
action  twice  and  not  a  few  three  times,  until  through  loss 
they  were  far  under  strength.  All  through  the  month  of 
October  the  attrition  went  on.  Foot  by  foot  the  American 
troops  pushed  back  the  best  of  the  German  divisions.  On 
November  1,  the  last  stage  of  the  offensive  began.  The 
enemy  power  began  to  break.  American  troops  forced  their 
way  to  the  east  banks  of  the  Meuse.  Toward  the  north,  they 
made  even  more  rapid  progress  and  in  seven  days  reached  the 
outskirts  of  Sechm  and  cut  the  Sedan  Mezieres  railroad, 
making  the  German  line  untenable. 

In  the  meantime  (October  2  to  28)  our  Second  and  Thirty- 
sixth  divisions  had  been  sent  west  to  assist  the  French  who 
were  advancing  in  Champagne,  beside  our  drive  in  the  Ar- 
gonne.  The  liaison  detachment  between  the  two  Armies  was 
for  a  time  furnished  by  the  Ninety-second  Division. ^^ 

From  Cluiteau-Thierry  to  the  Sedan-Mezieres  railroad,  the 
forward  sanitary  formations  of  the  ]\redical  Corps,  American 
Expeditionary  Forces,  followed  the  advancing  American  armies. 
From  the  Chief  Surgeon's  office,  moved  in  flanuarv,  1918,  from 
Chaumont  to  Tours,  ]\Hss  Bell  directed  the  nursing  service  of 
the  American  Expeditionary  Forces,  assisted  until  June  13, 
1918,  l)v  Anna  E.  Coftey,  Army  ISTursc  Corps.  Upon  this  date 
Miss  Coffey  was  transferred  to  another  station  and  Xina  Shel- 
ton  was  ordered  from  Base  Hospital  I^o.  24  to  assist  j\[iss  Bell 
until  Aliss  kStimson's  appointment  took  effect  on  November  15. 

Three  types  of  assignment,- — (1)  to  hospital  trains;  (2)  to 
evacuation  and  mobile  hospitals;  (8)  to  professional  teams — 
characterized  the  nursing  service  of  the  zone  of  the  advance. 
The  following  sections  deal  separately  with  these,  the  most 
forward  positions  held  by  any  American  women  during  the 
European  War. 

Linking  the  front  with  the  base  were  the  hospital  trains  of 
the  U.  S.  Army  ]\ledlcal  Corps.  In  her  definition  of  this  branch 
of  the  nursing  service  of  the  American  Expeditionary  Forces, 
Miss  Stimson  wrote: 

""Tlic  War  Willi  Ccrmany,"  p.  111. 


THE  EUROPEAN  WAR  636 

Hospital  trains,  not  originally  intended  for  operative  or 
other  treatment,  are  designated  for  evacuation  of  the  sick 
and  wounded.  Each  train  is  a  complete  unit  under  the 
command  of  a  selected  medical  officer.  The  regular  staff 
consists  of  two  medical  officers,  three  nurses  and  thirty-six 
enlisted  men,  including  a  registered  pharmacist,  a  clerk,  a 
mechanic,  two  cooks,  two  assistant  cooks,  two  men  for  each 
ward  car  and  one  man  detailed  to  the  staff  coach. 

Of  the  assignments  of  women  nurses  to  this  branch  of  the 
service,  Miss  8timson  wrote: 

For  the  most  ])art,  those  groups  of  two  officers  and  thirty- 
six  men  were  organized  in  tlio  United  States  as  hospital  train 
units.  On  Trains  Xos.  50  and  51  they  were  formed  from 
casuals  of  the  American  Expeditionary  Forces.  None  of  these 
units,  prior  to  the  summer  of  1918,  included  women  nurses. 
On  July  13,  1918,  three  nurses  were  detailed  from  Base 
Hospital  No.  27  for  temporary  duty  on  Hospital  Train  No.  37 
and  a  trial  trip  was  made  by  them  a  few  days  later.  Several 
officers  of  the  Medical  Department  were  present  on  this  first 
trip  to  observe  tlieir  work  and  to  judge  the  advisability  of 
having  them  assigned  permanently  to  this  service.  Three 
nurses  of  Base  Hospital  No.  47  were  sent  on  August  4  to 
Train  No.  52  and  three  others  to  Train  No.  Gl.  Base  Hospital 
No.  8  supplied  others  on  August  5  for  Trains  Nos.  53  and  54, 
while  Base  Hospital  No.  9  sent  forward  three  to  Train  No.  55. 
As  new  trains  came  into  the  service  additional  nurses  were 
assigned. 

Because  of  the  unusual  nature  of  this  service,  General  In- 
structions issued  to  the  officers  of  trains  are  herewith  given, 
although  they  belong  rather  in  a  history  of  the  Armv  Xurse 
Corps  than  in  tluit  of  its  Reserve: 

Duties  of  trained  nurse:  The  senior  of  the  three  nurses 
assigned  to  the  train  will  act  as  matron.  Nurses  will  carry 
out  the  orders  of  the  medical  officers  and  are  to  Ije  obeyed 
next  after  them. 

(Quarters:  Xurses  will  have  quarters  assigned  them  witliin 
the  staff  coiicli  and  they  will  not  use  other  coni])artments.  No 
visitors  save  women  will  enter  tlieir  quarters.  Only  the 
necessary  personal  articles  will  be  kept  on  trains:  all  heavy 
baggage  will  be  k(>pt  at  the  nurse's  home. 

Leave:  Nui'st>s  are  never  to  be  absent  without  the  permis- 
sion of  the  coiunianding  otlicer  of  tlie  train.     Tliev  are  not 


636   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

allowed  more  than  two  hours  away  from  the  train  and  per- 
mission to  be  absent  is  never  given  within  the  zone  of  the  ad- 
vance. One  trained  nurse  must  always  be  present  with  the 
train,  whether  it  is  halted  at  a  station  or  garaged  on  a  siding. 
When  trains  are  laid  up  for  prolonged  repairs  or  are  other- 
,wise  delayed  for  a  considerable  period,  nurses  will  not  be 
kept  on  the  train,  but  will  be  reported  to  the  senior  matron 
of  the  section,  who  will  make  use  of  their  services  temporarily. 
They  will  be  returned  upon  the  request  of  the  commanding 
officer  of  the  train. 

Helen  T.  Biirrey,  reserve  nurse,  Army  Nurse  Corps,  a 
graduate  of  St.  Francis  Hospital,  Pittsburgh,  Pa.,  and  a  mem- 
ber of  the  nursing  staff  of  U.  S.  Army  Base  Hospital  ^N^o.  27, 
was  one  of  the  iirst  three  nurses  to  be  assigned  to  hospital 
trains  of  the  American  Expeditionary  Forces.     She  wrote : 

Base  Hospital  27,  located  at  Angers,  France,  received  the 
first  official  order  dated  July  14,  1918,  to  supply  Army  nurses 
for  this  service.  Until  this  time,  the  Medical  Corps  attached 
to  hospital  trains  were  caring  for  the  wounded.  Through 
Miss  Blanche  Eulon,  chief  nurse  of  Base  Hospital  27,  Edna 
Cooper,  Grace  O'Donnell  and  I  were  detailed  to  Hospital 
Train  57. 

When  told  that  we  were  to  leave  the  next  day  to  board  this 
train  which  was  then  stationed  at  Port  Boulet,  France,  we 
were  certainly  filled  with  a  spirit  of  adventure.  We  arrived 
at  Port  Boulet  July  15,  found  our  train  and  made  ourselves 
known  to  the  commanding  officer,  Captain  Goodwin,  who 
had  knowledge  of  our  coming.  He  received  us  very  kindly 
and  immediately  showed  us  to  our  quarters. 

We  were  agreeably  surprised  at  the  modern  equipment.  In 
our  coach  there  were  three  compartments  which  consisted  of 
a  dining  room  and  two  sleeping  rooms  and  a  lavatory  (tri- 
angular in  shape)  containing  a  small  wash  bowl  and  com- 
mode. Tlie  sleeping  rooms  were  made  up  of  a  private  room 
consisting  of  one  berth  and  a  wardrobe  and  a  second  room 
which  contained  a  lower  berth  and  an  upper  berth.  Of  course, 
we  all  wanted  the  private  room,  but  since  it  could  not  be 
private  among  three,  we  resolved  to  take  "turns  about"  and 
rotate  from  upper  berth  to  private  room.  The  rule  was  one 
week  in  the  private  room  and  the  next  week  in  the  lower 
bertli  and  tlio  tliird  week  in  the  upper  berth.  As  we  had  five 
months  of  this  life,  we  had  plenty  of  time  for  the  private 
room.     Tlio  dining  room,  wliich  was  also  used  as  a  living 


A  U.  S.  Army  Hospital  Train. 


Phdtns.    hi/   Slijna!    Cnrpa.    I'.    S.    A. 


THE  EUROPEAN  WAR  637 

room,  contained  a  table  and  two  chairs  and  a  side  seat  fitted 
to  the  wall. 

Miss  Burrey  described  the  accommodations  of  Hospital  Train 
No.  57: 

The  rest  of  the  train  consisted  of  sixteen  coaches,  including 
one  infectious  car  which  carried  eighteen  beds;  one  staff  car 
which  carried  eight  beds ;  one  kitchen  and  sitting  sick  offi- 
cers' car  which  carried  three  beds  and  twenty  seats;  eight 
ordinary  lying  ward  cars  which  carried  288  beds;  one  phar- 
macy car;  one  infectious  case  sitting  car  which  carried  fifty- 
six  seats  and  fourteen  upper  berths;  one  kitchen  and  mess 
car  with  three  beds  for  cooks;  one  personnel  car  with  thirty 
beds  and  one  train  crew  and  store  car;  the  total  capacity  of 
the  train  was  thus  400  beds. 

Each  moving  hospital  was  equipped  with  electric  lights, 
steam  heat,  electric  fans,  lavatories  and  racks  for  personal 
belongings  and  even  ash  trays  for  the  patients'  indulgence. 
There  were  eight  ordinary  ward  cars  for  patients  containing 
thirty-six  beds  arranged  in  tiers  of  three.  These  could  easily 
be  converted  into  seats  to  accommodate  patients  who  were 
able  to  sit  up;  they  (ould  also  be  used  for  stretchers  in  emer- 
gency cases  or  folded  against  the  sides  of  the  coach  when  the 
cars  required  cleaning. 

Miss  Biirrey  wrote  of  the  trial  trip  of  Train  No.  57,  when  for 
the  first  time  American  Army  nurses  were  officially  assigned 
to  train  service : 

Our  first  trip  was  to  evacuate  patients  from  different  hospi- 
tals who  were  able  to  be  moved  to  a  point  of  embarkation  for 
the  United  States.  Since  we  were  the  first  nurses,  Colonel 
Howard  Cfark,  who  was  then  in  charge  of  the  train  service, 
made  the  first  trip  to  these  different  hospitals;  this  was  also 
the  first  trij)  for  transporting  badly  wounded  patients  from 
the  hospitals  near  the  front  to  the  hospitals  near  the  point  of 
embarkation. 

We  started  July  17.  passed  through  Tours,  Bourges.  Xovers, 
Dijon,  Chaumont,  Neufchateau,  Contrexeville,  Toul  and 
Savenay,  stop])ing  at  several  base  hospitals  and  filling  our 
train  with  wounded  who  were  to  be  taken  to  Base  Hospital 
No.  8  at  Savenay.  After  seeing  our  work.  Colonel  Clark  con- 
gratulated us  and  recommended  that  all  the  trains  be  supplied 
with  three  nurses. 

We  worked  day  and  night  with  those  patients:  the  ])atlietic 
condition  of  our  bovs  who  were  verv  badlv  wounded  made  us 


638   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

realize  that  being  wounded  was  hard  enough  to  bear,  without 
the  jolts,  noit^e  and  dirt  connected  with  traveling  on  a  train. 
These  patients  were  in  our  care  for  two  nights  and  three  days 
before  they  were  unloaded  at  Base  Hospital  Xo.  8.  I  remem- 
ber two  patients  who  had  broken  backs  and  had  horrible  be  1 
sores.  You  can  picture  the  special  care  such  a  case  would 
require,  but  our  time  with  each  patient  was  limited  and  we 
gave  the  best  attention  possible.  We  also  had  many  patients 
who  had  amj)utations  of  legs,  or  arms,  and  many  other 
wounds  that  caused  much  pain  and  constant  attention  from 
doctors  and  nurses. 

One  of  the  chief  discomforts  which  we  noticed  that  the 
patients  met  was  caused  by  the  tightening  of  bandages  due 
to  the  restless  position  of  the  patient  and  by  the  moving  and 
stopping  of  the  train.  This  condition  was  also  aggravated  by 
the  infected  wounds  and  the  patients  were  constantly  calling 
for  relief  from  the  bandages, 

Anne  P.  Ilill  (nco  Peck),  reserve  nurse,  who  was  assigned 
in  August,  1918,  from  U.  S.  Army  Base  Hospital  No.  9  to 
hospital  train  service,  described  the  routine  of  taking  on  pa- 
tients : 

Our  first  trip  was  one  which  we  would  have  chosen, — to 
Chateau-Thierry.  We  arrived  aljout  ten  o'clock  that  night, 
took  on  four  hundred  and  fifty  l)adly  wounded  and  gassed 
patients  and  at  midniglit  started  back  for  Chatelguyon.  .  .  . 

Hot  soup,  coffee,  beans  and  bread  were  prepared  for  the 
patients  while  tiiey  were  being  assigned  to  various  cars  ac- 
cording to  their  condition.  The  commanding  othcer  tried  to 
arrange  all  serious  cases  in  the  car  adjoining  the  pharmacy 
car,  for  that  was  most  convenient  for  emergency  treatiuent. 
Gassed  cases  were  put  together,  fracture  cases  together  and 
so  on.  The  oflicers  directed,  the  corpsmen  carried  in  the 
stretchers  and  lielped  the  wounded  to  their  cots,  and  two 
nurses  assisted  in  making  them  comfortable,  while  the  other 
nurse  tagged  the  beds  with  diet  cards,  liquid,  light  or  regular, 
to  make  food  service  easier  for  the  corpsmen  and  to  make 
sure  that  a  lifpiid  patient  did  not  get  a  big  plate  of  beans. 
This  imrse's  routine  was  also  to  ])re])are  a  slip.  ])laiidy  show- 
ing the  exact  location  of  seriously  wounded  patients,  or  tlu)se 
on  special  treatment  am]  Tuedications  ;  copies  of  these  slips 
were  then  given  to  the  other  nurses  and  to  tlie  doctors. 

r)nce  on  our  wav.  llio  duties  were  so  divided  that  each  nurse 
had  her  own  rfspousihilities  and  sections  to  keep  her  eye  on. 
Afl'T  n   few  trij)s  we  found  it  tlie  better  plan  for  all  to  stay 


THE  EUROPEAN  WAR  639 

on  duty  during  the  entire  trip  if  tliere  were  many  serious  or 
uneomt'ortable  patients  on  Iward ;  on  the  trip  back  to  the 
front,  our  time  was  our  own  and  we  would  tiien  rest,  do  our 
laundry,  or  write  and  read. 

There  is  much  to  contrast  in  the  careful  movement  of  these 
wounded  and  the  mutilated  Serbian,  Italian  and  Austrian 
wounded  who  were  brought  down  to  Vienna  and  Budapest  in 
jolting  ox-carts  during  the  early  days  of  the  war. 

During  the  drives  which  centered  in  the  Chateau-Thierry 
sectors,  work  on  all  hospital  trains  of  the  American  Expedi- 
tionary Forces  was  heavy.     ]Miss  Burrey  wrote: 

During  the  drive  at  Chateau-Thierry  a  great  number  of 
the  hospital  trains  were  mobilized  at  Pantin,  a  suburb  of 
Paris,  for  duty  into  Chateau-Thierry.  From  Paris  to 
Chateau-Thierry  w^as  about  three  hours'  ride  and  Train  Xo. 
57  was  ordered  to  make  the  trip.  The  train  was  sent  to 
evacuate  patients  from  Hospital  Xo.  7,  a  mobile  unit.  These 
patients  had  received  First  Aid;  major  operations  were  cared 
for.  Some  had  hardly  reacted  from  their  anaesthetic  and 
most  of  them  were  in  a  pitial)le  state.  .  .  . 

In  the  station  and  surrounding  it  were  litters  covered  with 
boys;  mud-spattered  and  torn  were  the  ujiiforms  they  wore. 
They  were  ])atic'ntly  waiting  to  be  taken,  they  did  not  care 
where,  but  some  place  where  they  could  be  given  proper  care. 
After  we  received  our  train  load,  about  400  ])atients,  one  of 
the  things  that  bothered  l)()th  ])atients  and  nurses  most  were 
the  countk'ss  numbers  of  flies  that  infested  our  train.  The 
odors  from  tlic  wounds  that  had  no  care  cannot  l)e  described 
but  shall  li\e  in  the  memory  of  the  nurses  and  orderlies.  We 
made  three  trips  to  Ciiateau-Thierry.  Tlie  third  one  was  to 
a  small  town  outside  of  Chateau-Thierry.  It  was  after  dark 
when  we  got  there  and  we  immediately  started  to  load  our 
train  with  patients  that  had  Ijcen  gassed.  At  the  height  of 
our  work,  we  had  an  alarm  of  tlie  enemy  airplanes  wliich 
meant  all  liglits  out  and  we  had  to  work  iii  the  dark  getting 
as  many  ]iatients  under  shelter  as  ])ossib]e.  We  loaded  our 
train  without  kce])ing  count  of  tiie  jiatients  tliat  could  walk. 
After  the  train  ])ulle(l  out  and  we  got  to  a  ])lace  of  safety,  tlie 
lights  were  turned  on  and  we  found  we  had  patients  every- 
where, in  the  l)erths,  on  the  seats  and  crowded  in  the  aisle. 

^fiss  I-)urrey's  report  contaiiu'd  a  brief  ci^mparisou  between 
the  American.  Britisli  and   I^'rench  hospital  trains: 


640   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  also  had  opportunity  to  see  the  hospital  trains  belonging 
to  the  English  Government.  They  were  very  much  like  our 
own  as  ours  also  were  made  in  England.  The  English  trains 
had  nurses,  whom  they  addressed  as  Sisters.  .  .  . 

The  Fren('h  hospital  train  was  an  ordinary  box-car  fitted 
up  with  litters  for  patients.  To  pass  from  one  car  to  another 
you  had  to  wait  until  the  train  stopped  to  get  out  and  on  to 
the  other  car.  There  were  no  nurses  on  the  French  trains. 
The  French  soldiers  cared  for  their  wounded  while  on  these 
trains. 

Both  the  French  peasants  and  the  soldiers  of  the  Allied 
Armies  evinced  great  curiosity  regarding  the  hospital  trains. 
Mrs.  Hill  wrote : 

The  arrival  of  an  American  hospital  train  created  as  much 
interest  among  the  French  people  and  the  U.  S.  men  en- 
camped nearby  as  would  a  circus  parade  in  a  small  American 
village.  Our  train  was  usually  held  on  a  siding  with  a  plat- 
form on  one  side  of  it,  and  as  we  slept  later  than  did  the 
French  we  were  greatly  disturbed  and  embarrassed  the  first 
few  mornings  by  being  awakened  between  five  and  six  o'clock 
by  voices  exclaiming  over  the  grandeur  of  the  train  and  by 
heads  coming  even  inside  our  compartment  windows.  A 
guard  was  then  ordered  to  promenade  the  platform  until 
the  nurses  had  awakened,  removed  curl  papers  and  drawn  the 
shades. 

Hospital  train  service  formed  one  of  the  most  adventurous 
and  interesting  branches  of  war  nursing.     Miss  Burrey  wrote : 

To  get  to  a  certain  base  hospital,  which  was  in  a  moun- 
tainous dislrict,  tlie  train  had  to  be  divided;  the  engine  could 
not  pull  tbo  entire  train  up  the  mountain.  We  got  no  in- 
structions as  to  the  splitting  of  the  train,  so  it  was  just  luck 
that  all  the  nurses  were  not  in  one  part  of  the  train,  I  found 
myself  on  one  hall'  of  the  train,  garaged  in  a  railroad  yard 
with  about  two  hundred  pati(!nts;  the  other  half  with  two 
nurses  was  starting  up  the  hill.  While  they  were  gone,  an 
engine  was  attaclied  by  mistake  to  our  train  and  soon  we  were 
rapidly  moving  away.  We  traveled  about  eight  hours  before 
we  finally  found  the  rest  of  our  train.  We  were  surely  hapi)y 
to  see  them  again,  for  they  happened  to  have  the  supply  and 
the  kitchen  car. 

Mrs.  Hill  wrote: 


THE  EUROPEAN  WAR  641 

The  middle  of  August  found  us  traveling  through  the 
lovely  country  of  Dijon  and  (^haumont.  At  (.'haumont,  we 
got  unexpected  orders  to  garage  at  Vaucouleurs,  south  of  Toul, 
and  await  further  orders.  We  had  passed  through  Bazoilles, 
where  Base  Hosj)itals  Nos,  18  and  ll(i  were  stationed.  They 
were  picturesquely  spread  out  on  the  hillsides  in  barracks  and 
tents  on  either  side  of  the  tracks,  most  conveniently  arranged 
for  the  reception  of  the  wounded. 

We  arrived  at  night  at  Vaucouleurs  to  the  humming  of 
aeroplanes  and  learned  that  the  village  had  been  bombed  the 
night  before,  wounding  many  of  the  peasants.  Occasional 
signal  lights  went  up  into  the  black  sky  from  the  German 
air-dromes  over  the  hill  in  the  distance  and  occasional  bar- 
raging  made  us  thrill  with  the  nearness  to  the  activities  of 
war.  Our  train,  however,  stayed  in  this  little  village  for 
nearly  three  weeks  before  receiving  orders.  .  .  . 

Soon  came  orders  to  go  to  the  Argonne  and  from  then  on 
we  were  very  busy  making  trips  from  the  first  evacuation 
hospitals  to  the  bases.  On  these  trips  we  saw  a  great  deal  of 
the  paraphernalia  of  war,  big  guns,  tanks,  thousands  of  sol- 
diers going  to  the  front  in  camouflaged  cars.  These  cars 
were  chalked  in  every  available  space  with  all  sorts  of  jokes. 

Some  nights,  when  we  were  side-tracked  near  the  front  or 
when  we  were  taking  on  wounded,  were  full  of  the  sights  and 
sounds  of  war.  The  constant  roar  of  the  guns  and  the  inter- 
mittent whir  of  the  Boclie  ])lanes  as  distinginshed  from  the 
French  or  American  scouting-planes  over  us  filled  us  with 
excitable  exjieetancy.  When  we  had  time  during  the  day- 
stops  at  the  front  line  or  evacuation  hospitals,  we  were  some- 
times allowed  to  inspect  the  hospitals.  They  were  all  splen- 
didly equipped  and  systematized,  but  to  ste])  out  from  a  bar- 
rack of  men,  who  tliongli  badly  wounded  were  so  grateful  for 
the  care  they  were  receiving  and  who  were  trying  so  hard  to 
be  cheerful,  to  the  lu^arby  hillside  of  hastily  made  crosses  was 
tragic.  Even  now  when  the  subject  of  war  is  brought  up.  I 
do  not  picture  tbe  horrors  or  suffering  or  hear  the  sound  of 
the  guns,  but  see  those  hazy  ])atches  of  crosses  where  Ameri- 
cans were  buried  and  those  scattered  graves  on  the  o]ien  bill- 
sides,  marked  by  a  solitary  cross  showing  where  a  French 
soldier  had  fallen. 

Hospital   trains  wovo   often   side-tracked   to   make  way  for 
combat  troops  and  suppliers.    ^Irs.  Hill  wrote: 

During  our  first  few  trips,  we  were  very  impatient  be- 
cause it  took  tliree  or  four  times  lonii^er  to  ixet  our  wounded 


642    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  their  destination  than  through  service  would  take  in  ordi- 
nary times.  Some  were  so  badly  wounded  and  were  made  so 
extremely  uncomfortable  by  the  jogging  of  the  train  that  we 
wondered  how  they  lived  or  endured  it,  but  they  did,  and 
with  the  greatest  patience.  We  soon  discovered  that  this  slow 
service  was  a  part  of  war,  that  the  trains  coming  away  from 
the  front  had  to  be  side-tracked  to  permit  the  rushing  in  of 
troops  and  ammunition  and  supply  trains.  At  no  time  were 
there  sufficient  tracks  to  take  care  of  the  greatly  enlarged 
train  service. 

Miss  Stimson  stated  tersely  the  difficulties  which  the  nurses 
experienced  in  this  precarious  branch  of  the  service: 

The  most  obvious  were  the  constant  motion,  the  restricted 
space  which  made  it  necessary  for  the  nurses  to  walk  long 
distances  to  get  needed  articles,  the  great  irregularity  of  the 
hours  and  the  uncertainty  of  the  time  of  arrival  and  de- 
parture from  the  station.  These  trains  could  not  be  operated 
on  any  fixed  schedule  or  over  any  regular  route.  In  times  of 
heavy  fighting,  even  hospital  trains  with  wounded  must  give 
precedence  to  men  and  supplies  on  their  way  to  the  front.  It 
was,  therefore,  necessary  to  send  the  trains  by  roundabout 
ways  or  to  hold  them  on  sidings  until  arrival  at  their  desti- 
nation was  greatly  delayed.  Extra  meals  had  to  be  provided 
and  dressings  changed.  Though  the  average  duration  of  a 
trip  was  about  forty  hours,  it  was  often  necessary  to  serve 
Army  rations  to  as  many  as  six  hundred  patients  for  from 
two  to  four  days. 

Miss  Burrey  wrote: 

When  the  train  was  empty  and  we  were  moving,  the  scenery 
and  tlie  wonderful  views  of  France  thrilled  us.  but  when  the 
train  stopped,  we  were  garaged  in  some  railroad  yard  and  we 
might  stay  there  an  hour  or  maybe  two  days  before  our  train 
was  ordered  to  move.  You  can  picture  the  average  train- 
yard  in  America ;  picture  it  in  France  in  war  times ! 

When  we  nurses  would  get  ofi^  the  train  to  stretch  our  legs. 
we  were  greatly  amused  at  ourselves.  We  felt  like  tbree 
geese  walking  along,  for  we  noticed  we  trailed  one  another. 
Did  you  ever  see  geese  walking  oiie  in  the  lead  and  the  others 
following?  We  used  to  do  that  till  we  realized  wc  were  not  on 
the  train  any  longer  but  out  in  the  street,  and  then  we  would 
chuckle  to  oursolvos.  Our  reason  for  doing  this  was  that  the 
aisle  in  the  train  was  so  narrow  that  wo  had  to  walk  single- 
file. 


THE  EUROPEAN  WAR  643 

That  only  niirsos  of  liigli  mental  and  moral  caliber  were 
3uccessfiil  in  hospital  train  service  is  self-evident.  Miss  Stim- 
3on  stated  the  needed  qualifications: 

Great  professional  skill  and  an  ability  to  meet  every  kind 
of  emergency  were,  of  course,  primary  requisites.  Excep- 
tional physical  endurance  and  a  willingness  to  abandon,  if 
need  be,  the  usual  ideas  of  a  routined,  ordered  life  are  also 
necessary.  These  requirements  are  not  hard  to  fill  and  no 
difficulties  would  be  encountered  in  having  the  most  desirable 
type  of  nurses  on  tbe  trains  if  the  work  was  always  heavy. 
But  since  there  must  be  times  when  work  is  very  light  and  the 
waits  in  garage  must  be  long  and  tiresome,  other  qualities  in 
trained  nurses  cannot  be  overlooked.  The  restricted  area  of 
living  quarters  and  the  close  association  of  officers  and  nurses, 
the  isolation  from  other  groups  of  workers  and  from  the 
diversions  possible  in  hospitals  also  make  this  duty  a  severe 
test  of  the  tact,  adaptability  and  character  of  all  in  the 
service.  It  is  greatly  to  their  credit  that  there  have  been  so 
few  failures.  In  those  which  have  occurred,  the  principal 
reasons  appear  to  have  been  due  to  errors  in  selecting  the 
individuals  fur  tbe  work  and  to  a  lack  of  harmony  and  an 
unwillingness  to  cooperate  with  others. 

On  Xovember  11,  1918,  sixty-three  nurses  were  on  hospital 
train  duty. 

The  hospital  train  service  was  operated  to  transport  sick  and 
wounded  from  the  evacuation  hospitals  in  the  zone  of  the  ;ul- 
vance  to  the  base  units  in  the  zone  of  the  base.  Evacuati(ui 
hospitals  were  developed  entirely  by  the  United  States  Army 
Medical  Corps,  with  the  exception  of  the  American  Ived  Cross 
emergency  hospitals  already  outlined.  To  each  division  of  com- 
bat troops  was  attached  two  evacuation  columns.  Evacuation 
Hospital  Xo,  1  was  located  at  Sebastopol  on  the  Lorraine  Fnuit. 
At  Baccarat,  Xo.  2  occupied  a  hillside  above  the  village  of 
Xancy.  Priscilla  J.  IIuglu\s,  Army  Xurse  Corps,  described  the 
ever  changing-  pageantry  of  the  front: 

From  Le  Havre  we  went  to  Paris  and  from  Paris  to  Blois, 
the  mobilization  center  for  "casuals.''  From  P)iois  1  was 
sent  in  a  detachment  of  nurses  to  Fvacuation  Hospital  NO.  '^^ 
at  Baccarat  in  tlu^  Lorraine  sector.  The  hosjutal  was  partly 
in  a  l-'rcncb  liarracks  and  partlv  in  tents  and  huts.  The 
vilbi're  had  hccn  held  by  the  (u^rmans  for  eighteen  days  in 
liMl  and  was  now  partially  in  ruins. 


6U   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  were  about  six  kilometers  from  the  line.  The  Forty- 
second  Division  had  just  left  and  the  Seventy-seventh  Divi- 
sion was  coming  in  when  we  first  reached  there.  When  the 
Thirty-seventh  Division  relieved  them  later  in  July,  the 
Boche  certainly  kept  us  on  the  jump.  Sometimes  when  there 
was  a  quiet  interval,  we  would  steal  to  the  window  to  watch 
the  planes  flying  around,  their  lights  like  big  stars  and  the 
sky  ablaze  with  signals  sent  up  from  below  and  also  dropped 
from  the  planes.  The  sky  seemed  as  bright  as  if  the  sun  was 
shining  and  the  moon  was  the  biggest  and  clearest  I  have 
ever  seen. 

All  through  the  night  we  could  hear  the  men  marching  to 
and  from  the  trenches,  the  rumble  of  the  ammunition  and 
supply  wagons  and  ambulances  coming  and  going,  the  noise 
of  the  motorcycles  carrying  dispatches.  It  certainly  was 
wonderful  that  there  were  not  more  collisions.  We  used  to 
fall  asleep  listening  to  the  guns  and  awaken  to  their  voices. 
The  flashes  from  a  barrage  lighted  up  the  walls  of  our  dormi- 
tory. Our  windows  and  doors  were  camouflaged.  On  dark 
nights,  however,  all  out-doors  seemed  like  the  bottom  of  a  deep 
well. 

Miss  Hughes  described  the  general  type  of  service : 

As  we  are  in  a  comparatively  quiet  sector,  the  patients 
were  not  evacuated  as  they  otherwise  would  have  been  in 
twenty-four  hours.  We  had  some  excellent  surgeons  and  a 
well  equipped  operating-room  and  X-ray  apparatus,  so  the 
men  were  given  every  chance  possible.  During  July,  August 
and  September  the  Boche  grew  active  again.  As  our  patients 
were  faste]ied  up  in  slings  and  all  kinds  of  surgical  appli- 
aiices  and  therefore  quite  helpless,  the  night  raids  were  very 
hard  on  them  and  their  distress  worried  the  nurses  quite  as 
much  as  did  P^ifz. 

About  the  first  of  October  the  whole  "Wild  Cat"  Division 
(at  least  so  it  seemed)  came  landing  on  us.  One  day  we 
admitted  four  hundred  and  the  next  day  about  six  hundred, 
all  sick,  cold,  hungry  and  certainly  jn  iioed  of  nursing.  They 
had  mumps,  measles,  pneumonia  and  meningitis.  There 
were  only  thirty-two  nurses  all  told  on  the  staff,  so  ambu- 
lances were  sent  to  bring  back  the  twelve  that  had  been  sent 
away  on  temporary  duty.  I  have  had  seven  and  eight  boys 
delirious  at  the  same  time,  some  of  them  doing  "guard  duty" 
and  the  otber  poor  fellows  answering;  others  were  at  home 
talking  witb  "Motlier"  or  "Dad."'  They  were  nearly  all 
Southern  bovs.     W'bcn  one  of  them  would  start  sino-ing  old 


THE  EUROPE  A  x\  WAR  645 

darkie  chants,  you  may  imagine  the  effect  it  had  on  the  whole 
ward. 

Located  near  a  shell  torn  wood  at  lilcury,  Evacuation  Hos- 
pital No.  4  formed  a  center  for  surgical  teams  and  wounded 
during  the  German  offensive  of  July,  1918.  Helen  Pratt,  re- 
serve nurse  and  a  member  of  Base  Hospital  No.  20,  reported  a 
few  of  the  difficulties  encountered  here : 

The  night  of  -Uily  14  was  stifling;  with  l)lanket.s  and  pil- 
lows, the  nurses  went  into  the  open  wheat  fields.  All  the  next 
day,  the  wounded  boys  came  back  to  us.  That  night  heavy 
rain  churned  the  broken  soil  into  mud  and  a  tornadolike 
wind  blew  down  many  of  the  smaller  tents.  At  such  times 
the  veneer  of  one's  disposition  rubs  off  and  you  see  the  stark 
outlines  of  your  own  and  your  coworkers'  characters. 

The  day  shifts  and  the  wounded  were  tortured  by  flies. 
Each  morning  the  orderlies  broke  off  large  boughs  from  the 
neighboring  woods  and  tried  to  beat  them  from  the  tents. 

A  night  and  a  day  at  Evacuation  Hospital  No.  6  was  described 
by  Daisy  Pirie  Beyea,  a  reserve  nurse  and  a  member  of  Base 
Hospital  No.  24: 

In  an  open  wlieat  field,  wath  an  ammunition  dump  on  one 
side  and  the  artillery  on  the  other,  wliile  the  boys  were 
throwing  a  pontoon  bridge  across  the  ]\Iarne  in  front  of  us, 
we  began  to  get  things  in  order  for  the  drive  t)eginning  in 
forty-eiglit  hours.  Oh,  the  flies,  the  dead  liorscs  and  the  dead 
Germans !  At  three  a.  m.  the  barrage  started.  Then  the 
word  came  down  the  line :  "The  boys  go  over  the  top  at 
five!"  A  flash  of  light,  the  roar  of  the  guns  and  then  the 
very  earth  rocking  imder  our  feet  as  wo  fumbled  with  our 
helmets  and  gas  masks.  Crash  after  crasli  followed  all  day 
long  until  five,  when  the  ambulances  'uegan  jiouring  in.  The 
tents  were  overflowing,  hut  still  the  anihulaiices  lined  the 
roads.  Darkness  came,  lit  every  few  seconds  with  an  explod- 
ing shell.  Drivers  shouted  instructions:  trucks  nnnhled  ])ast 
to  the  front  and  above  the  incidental  noises  roared  the  lu'avy 
guns. 

Mrs.    Beyea   described   the   stretchers   and   tluur   blanketed   oc- 
cupants : 

Now  and  again  you  hear,  "Kasy  there,  Ruddv.  I  ;ruoss  that 
leg  is  about  oil'.'"     A  voice  from   under  niv   tVet   called   up: 


646  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"Got  a  match,  Sister?"  A  stretcher  passed,  the  lad  on  it 
still  under  ether,  screaming :  "At  'em,  boys  I"  And  always 
the  ambulances  coming  in,  until  we  had  three  thousand  before 
the  night  was  over. 

Lights  were  on  in  the  operating  tents,  nurses  and  doctors 
were  working  faster  and  faster.  The  strain  grew  intense. 
Suddenly  above  the  din,  a  peculiar  sound  struck  the  air,  the 
sound  of  a  motor,  once  heard,  never  forgotten.  Then  the  cry : 
"Lights  out  I  The  Boche !"'  Pitch  blackness,  then  the  ex- 
plosions outside.  A  muffled  shout  from  the  surgeon  across 
the  table :  "Someone  bring  a  candle,  I've  got  an  artery  here  !" 
and  then  to  me :  "Xurse,  can  you  hold  the  patient  under  ?" 
"Yes,  Major."  Then  a  yell,  "Everybody  flat  on  your  faces, 
they're  right  over  us !"  "Hell,"  growled  the  Major,  "we 
haven't  got  time !"  There  was  a  roar  above,  then  "After 
'em,  boys — it's  the  pursuit !"  Back  came  the  lights  and  the 
work  went  on. 

Maude  S.  Crawford,  a  reserve  nurse  and  a  member  of  Base 
Hospital  ^o.  7,  wrote  of  her  experiences  at  another  evacuation 
hospital : 

We  left  Paris  at  noon  for  a  destination  whose  name  will 
bring  a  shudder  to  the  nurses  who  were  there  in  the  awful 
days  of  July.  We  reached  Chateau-Thierry  about  five  o'clock 
and  waited  an  hour  at  the  station  until  our  officers  found  the 
evacuation  hospital  to  which  we  were  assigned.  Finally  we 
arrived  at  a  camp  of  yellow  tents,  pitched  on  a  recent  battle 
field  in  "Xo  ]\Ian's  Land"  near  what  was  left  of  a  railroad 
station.    Beliind  the  station  lay  a  town  in  ruins. 

Here  we  became  acquainted  with  "bully  beef,"  "goldfish," 
moldy  black  l)read  and  black  coffee.  ]\Iost  people  are  familiar 
with  the  discomforts  of  ordinary  camp  life,  but  try  and 
imagine  tents  pitched  on  ground  that  an  army  has  left,  the 
dead  not  all  Ijuried,  shell  holes  and  trenches,  mud  and  rain. 
Imagine  always  the  sound  of  artillery,  air  machines  and  no 
sounds  or  signs  of  normal  life.  Our  initiation  into  the 
advanced  zone  was  made  in  fly  time.  It  really  seemed  as  if 
we  could  stand  anything  if  the  flies  could  be  lessened. 

Oh,  the  moon  that  shone  above  Chateau-Thierry  those 
August  and  Septeml)er  nights  I  The  searchlights  that  swept 
across  the  skies  outvied  any  Aurora  Borealis  that  ever  flamed 
above  the  liorizon.  "Jerry'"  came  over  every  night.  Before 
we  could  distinguish  the  burr  of  his  machine,  we  heard: 
"All  lights  out  I"  We  sat  in  darkness  until  the  bombing 
ceased.     Night  in  these  tents  is  unlike  any  other  experience. 


THE  EUROPEAN  WAR  64T 

The  cots  were  so  low  that  the  blankets  drabhled  in  the  mud. 
Down  the  center  of  the  tent  were  loose  boards.  They  never 
seemed  so  narrow  as  when  the  stretcher-bearers  carried  in 
their  burdens  by  the  light  of  a  smoicy  lantern.  Poor  as  the 
accommodations  were,  the  men  were  always  glad  to  get  under 
shelter  and  in  bed.  The  devotion  of  these  doughboys  to  eacli 
other  was  the  only  beautiful  thing  that  we  saw.  If  they  had 
seen  their  comrades  fall,  they  wept  for  them ;  if  they  were 
uncertain  as  to  their  fate,  they  worried  and  fretted. 

How  cold  it  was  in  September !  There  were  no  fires  in  the 
damp  tents,  but  there  were  plenty  of  blankets  for  the  patients 
and  always  hot-water  bottles.  When  the  railroad  track  was 
put  into  commission  and  the  first  hospital  train  came  in, 
"Jerry"  kept  watch  for  that  train  and  we  were  always  anxious 
until  it  got  away.  Evacuation  usually  took  place  at  night, 
quietly,  with  very  little  light,  the  patients  lying  on  the 
ground  on  stretchers  waiting  to  be  put  on  board.  They  would 
have  cocoa  and  sandwiches  from  the  Ped  Cross  tent,  choco- 
late and  cigarettes.  The  nurses  who  were  able  to  do  so  would 
leave  their  posts  and  come  down  to  say  good-by  and  good 
luck.  Very  often  the  train  would  leave  about  three  in  the 
morning.  It  was  always  a  comfort  to  see  the  three  "red 
eyes"  at  the  end  of  the  train  wink  and  disappear  in  the  dark- 
ness. It  seemed  strange  to  us  that  the  boys  never  wanted  to 
go.  They  were  perfectly  satisfied  to  stay  wliere  they  were,  in 
their  first  bed,  with  American  women  to  care  for  them. 

As  the  troops  moved  forward,  the  evacuation  hospitals  moved 
forward  with  them,  keeping  several  miles  in  tlioir  rear.  The 
nurses  were  sent  to  a  ncarbv  base  and  when  their  outfit  had 
been  set  up  again,  rejoiiuxl  it.  Weird  moments  of  the  trips  for- 
ward during  the  night  have  etched  their  fantastic  outlines  upon 
the  memories  of  many  American  nurses  who  waited  through  the 
long  hours  in  the  rain  bv  a  railroad  track,  watching  weary 
platoons  stumble  from  belated  trains,  while  fresli  companies  as 
silently  climbed  aboard.  After  combat  troops  had  been  moved, 
the  sanitary  units  went  on  up  through  the  soddcni  grayness  of 
dawn  to  the  evacuation  hospital  with  its  shambles.  Aliss  Craw- 
ford's report  continued: 

We  bad  sometliing  to  eat  aiul  got  into  uniform.  How 
unreal  that  operating-room  scorned  !  The  tables  were  placetl 
as  close  togelJKM'  as  ]iossible  down  the  center.  They  were 
never  empty,  one  patient  waiting  until  the  surgeon  bad  fin- 
ished  with   the  other.     The  wounded   man   lies  silent   on   the 


648    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

table.  The  nurses  are  too  busy  to  do  more  than  give  him  a 
smile  or  an  encouraging  pat  as  they  pass  by.  The  anesthetist 
has  a  better  chance. 

I  remember  a  midnight  lunch  beyond  St.  Mihiel.  The 
kitchen  was  situated  in  the  woods,  well  out  of  sight.  It  had 
been  part  of  a  German  camp.  The  night  was  cold;  it  was 
raining  and  the  mud  was  the  best  of  its  kind.  There  were  no 
lights  to  show  us  the  up-hill  way.  When  we  had  pulled  our 
feet  through  the  stickiness  and  reached  the  cabin,  it  looked  as 
if  we  had  reached  the  lower  regions.  The  oil  lanterns  tied  to 
the  tent  stakes  cast  grotesque  shadows.  Dark  figures  flitted 
about  with  cups  and  plates  in  their  hands.  Officers  and 
nurses  were  laughing  away  the  discomfort  and  the  wretched 
food. 

Anna  J.  Johnson,  an  American  Red  Cross  nurse  who  was 
loaned  to  the  Army  by  Paris  headquarters,  wrote : 

On  October  6,  1918,  I  reported  to  Evacuation  Hospital 
No.  9  at  Vaubecourt,  near  Verdun.  The  chief  nurse,  Kuth 
Golden,  assigned  me  to  a  tent  full  of  desperately  sick  pneu- 
monia patients.  We  worked  hard  for  them,  but  they  died 
sometimes  as  many  as  four  in  less  than  an  hour.  .  .  . 

Vaubecourt  was  a  frightful  place.  It  rained  every  day  and 
was  very  cold.  We  lived  in  wooden  barracks;  fifty  of  us 
nurses  were  in  one  of  the  large  rooms  which  had  been  divided 
into  apartments  eight  feet  square.  Two  Army  cots  and  a 
rough  table  Avere  in  each  apartment.  There  was  noise  and 
mud  everywhere,  but  we  were  glad  to  get  into  the  barracks 
after  our  former  quarters  in  tents.  One  night  our  tent  had 
come  down  in  the  rain  and  the  whole  place  had  seemed  like 
tents  and  cots  in  a  sea  of  yellow  clay  mud. 

We  took  care  of  many  patients  with  very  little  to  do  with. 
We  got  towels  and  pajamas  from  the  Eed  Cross.  Dr.  Clark, 
the  l^ed  Cross  representative,  established  a  diet  kitclien  witli 
]\riss  Elizabetli  Witter  in  charge.  She  prepared  cereals,  cus- 
tards, toast,  jellies  r.nd  many  other  dishes  for  our  sickest 
patients.     She  did  splendid  work. 

Enough  cannot  be  said  in  praise  of  the  young  women  who 
did  the  Red  Cross  canteen  work  in  this  frightful  place.  They 
worked  early  and  late,  night  and  day,  many  times  in  the 
pouring  rain  in  nind  up  to  their  knees.  When  the  hospital 
trains  were  loaded,  they  were  always  there  with  hot  drinks 
and  blankets  for  tlie  boys.  We  all  worked  hard  and  there 
was  very  little  sloe])  at  night;  everyone  talked  or  coughed. 
The  wliole  thing  was  depressing.   .  .  . 


THE  EUROPEAN  WAR  649 

Pare  do  Prince,  near  Paris,  was  tlie  mobile  liospital  train- 
ing center  of  the  United  States  Army  Medical  Corps.  Here 
each  unit  was  stationed  for  several  weeks  before  their  assign- 
ment to  the  field.  Sophie  M.  Bums,  Army  Nurse  Corps,  of 
Mobile  Hospital  No.  9,  described  this  period  of  training: 

Here  we  had  opportunity  to  familiarize  ourselves  with  the 
features  of  an  efficient  tent  hospital.  The  corridors  connect- 
ing the  ten  wards,  the  complete  operating-room,  the  hot  and 
cold  running  water,  the  camion  sterilizer  and  the  well 
equipped  laundry  all  provoked  appreciative  admiration.  The 
beautiful  level  grounds  of  the  park  afforded  admirable  space 
in  which  three  mobile  hospitals  might  practice  setting  up 
tent  hospitals  at  one  time.  The  officers  found  need  for  all 
the  knowledge  of  arc-hitecture  they  possessed,  for  there  are 
many  different  ways  of  putting  up  a  hospital.  Each  way  is 
the  best  way  in  some  particular  emergency.  In  the  meantime 
we  nurses  were  completing  our  preparation,  making  operating- 
room  supplies  enough  to  last  at  least  three  days  and  going 
through  gas  mask  drill. 

Mobile  Hospital  No.  9  was  sent  forward  into  Belgium  to 
serve  American  divisions  participating  with  the  British  in  the 
last  stages  of  the  Ypres-Lys  offensive.  Miss  Burns  described 
the  trip  up  the  line: 

Our  train  consisted  of  thirty-one  cars,  coaches  for  nurses 
and  officers  and  box  cars  for  the  enlisted  men.  We  were  on 
our  way  to  the  front  at  last  and  every  one  of  us  Avas  thrilled 
at  the  prospect.  The  British,  through  whose  sector  we 
passed,  rather  dampened  our  enthusiasm;  they  were  so  thor- 
oughly accustomed  to  this  war  business  and  so  iieartily  sick  of 
it.     We  understood  their  attitude  better  later  on. 

After  passing  through  l^]taples  and  Calais,  we  reached 
Dunkirk,  where  we  received  new  orders  to  proceed  to  Staden. 
On  the  way  up  we  met  some  American  regiments  who  shouted 
at  us  cheerful,  comradely  questions:  "(ioing  to  the  front?"' 
"We've  just  finished  the  Argonne  !"'  "'^Anybody  from  Ohio?" 
"What  town?''  "^Fy  brother  lives  there."  The  next  nKU'ning 
we  passed  through  "No  Plan's  Land."  T  rememher  tliat  my 
first  impression  was  not  of  shell  holes  or  devastated  hinds, 
but  of  American  soldiers  sitting  hefore  deftly  projijied  trench 
mirrors,  sha\ing  with  great  enjoyment.  ^lany  of  the  l)oys 
bad  gay,  flowered  Ked  Cross  hags  which  made  bright  spots  of 
color  on  the  ^■eIleral  drah-hued  scene. 


650    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Burns'  report  contained  a  graphic  description  of  the  swift- 
ness with  which  these  mobile  units  could  be  set  up: 

We  pulled  in  close  to  a  site  where  the  French  labor  bat- 
talion was  busily  constructing  a  French  evacuation  hospital. 
Before  nightfall  eight  Bessonneau  tents  were  up  in  the  shell- 
riddled  fields  and  accommodations  for  two  hundred  patients 
were  in  readiness.  We  had  ample  time  to  prepare  for  the 
drive.  Two  Bessonneau  tents  together  formed  the  admission 
tent  and  pre-operative  wards.  In  the  admission  tent  a  nurse, 
acting  as  dietitian,  served  hot  coffee  to  all  the  incoming 
patients  and  prepared  special  diets.  Patients  were  first  car- 
ried here  on  stretchers  and  their  dressings  cut  down ;  then 
they  went  to  the  X-ray  room  and  thence  to  the  pre-operative 
ward  of  fifty  beds  where  they  were  bathed  and  at  last  to  the 
operating-table.  After  the  operations,  the  patients  were  again 
lifted,  still  on  the  same  stretchers,  and  carried  to  beds  in  any 
one  of  the  six  wards,  which  were  connected  by  corridors.  A 
short  time  later,  the  operating  teams  arrived  and  in  three 
days  we  were  in  working  order.  When  the  drive  came,  we 
evacuated  a  daily  average  of  a  hundred  patients. 

The  speed  with  which  a  mobile  hospital  could  strike  camp 
and  move  back  is  described  bv  Yioletta  C.  Mercer,  reserve 
nurse,  of  Base  Hospital  Xo.  2,  in  an  account  of  the  evacua- 
tion on  the  evening  of  July  25,  1918,  of  Mobile  Unit  No.  1, 
American  Expeditionary  Forces : 

The  barrage  seemed  about  as  usual  until  11 :30  p.  m.  We 
were  watching  the  fire-works  when  at  midnight  the  alarm  of 
a  gas  attack  sounded.  All  nurses  were  immediately  ordered 
to  the  dug-outs,  while  corpsmen  began  to  clear  the  wards  of 
patients.  Down  I  went  accompanied  by  the  other  night 
nurses.  With  a  sigh  of  relief  Major  Barclay  and  Colonel 
Brewer,  standing  at  the  doorway,  saw  us  safely  in.  They  had 
been  counting  nurses'  noses  and  ours  were  the  last. 

Let  me  say  a  word  about  this  place  of  safety.  It  Avas  a 
huge  affair,  lined  with  steel,  like  a  great  tunnel,  supposed  to 
hold  a  thousand  j^eople.  We  had  stayed  here  about  two  hours 
when  ambulance  after  aml)ulance  of  wounded  began  to  arrive. 
They  decided  to  begin  operating  at  once.  Those  who  were 
ordered  upstairs,  were  glad  to  go.  To  wear  a  tin  hat  and  a 
rf'spirator  durinp-  an  operation,  however,  is  not  the  pleasantest 
thino-  in  the  wnrld. 

The  attack  befran  again  about  six  o'clock  that  morning' 
and  we  all  went  to  the  dugout  again.     There  the  Hun  pelted 


THE  EUROPEAN  WAR  651 

us  for  two  hours.  I  shall  never  forget  that  scene  under- 
ground. Stretcher  after  stretcher  was  brought  in,  the  poor 
men  in  hideous  condition.  We  did  our  best,  which  was  very 
little,  but  two  died  down  there  in  the  close  darkness.  About 
eight  o'clock  an  order  came  for  general  evacuation.  We 
weren't  allowed  to  go  back  to  our  quarters.  The  corpsmen 
threw  everything  we  owned  in  sheets  and  tied  them  up  and  so 
they  traveled.  Absolutely  nothing  was  lost.  We  had  break- 
fast and  were  packed  into  lorries,  following  the  evacuation  of 
the  patients.  We  feel  now  we  know  the  meaning  of  "an 
orderly  retreat."  After  us  came  the  rest  of  the  personnel  as 
fast  as  they  could  be  loaded  in  the  motors. 

In  the  meantime,  the  equipment  of  the  mobile  unit  had  gone 
on  ahead.  Within  twenty-four  hours  they  were  again  ready 
for  their  nurses,     Miss  ^Mercer  continued: 

It  seemed  like  heaven  to  arrive  in  this  nice,  clean,  open 
field  and  see  our  own  tents  grouped  together  in  one  adorable 
little  hospital  and  our  officers  and  men  so  glad  to  see  us  and 
welcome  us  home.  We  certainly  camped  out, — the  officers' 
mess  by  day  was  their  sleeping  quarters  by  night  and  we  all 
mess  together.  That  very  afternoon  we  received  patients  and 
did  so  all  night  until  our  place  was  full,  but  everything  went 
like  a  breeze,  the  patients  got  immediate  operation  and  good 
care,  rest  and  food,  even  while  the  hospital  was  being  put 
together  I 

They  were,  however,  an  easy  target  for  bombing  planes.  Miss 
Mercer's  letter  gave  a  grimly  amusing  incident : 

I  forgot  to  tell  you  that  in  the  area  we  were  in  there  was 
much  aeroplane  activity.  The  night  before  our  convoy 
started,  the  colonel  of  the  division  was  on  his  way  to  see 
our  commanding  officer.  After  three  hours  he  finally  arrived 
with  the  astounding  story  that  he  had  been  chased  by  a  Hun 
plane  and  had  had  to  hide  in  a  ditch,  making  three  different 
attempts  to  get  away,  but  each  time  l)eing  ])ickcd  up  again  by 
this  TTun  highwayman,  who  immediately  turned  liis  machine 
gun  on  the  car.  At  the  end  of  three  hours,  the  Hun  grew 
weary  and  Colonel  F.  crawled  out  and  hurried  to  us. 

AYithin  five  days  they  moved  again.     ]Miss  Mercer  wrote: 

We  had  to  evacuate  every  patient,  ])ull  \ip  stakes  and  be 
readv  to  move  in  twelve  hours,  but  there  was  sdine  delav  in 


652   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  arrival  of  our  convoy  so  we  did  not  get  off  until  five 
o'clock  in  the  afternoon.  We  started  the  whole  circus  parade 
again.  We  stopped  on  the  road  at  seven  and  had  cheese  and 
crackers,  which  was  dinner.  It  was  a  heavenly  night,  full 
moon  and  not  a  light  to  be  used.  We  drove  until  one  a.  m., 
when  orders  came  to  stop,  so  we  slept  for  two  hours  on  the 
side  of  the  road  wrapped  in  bmucaup  blankets.  Sharp  at 
three  the  whistle  blew  and  we  were  soon  on  our  way;  we  con- 
tinued without  further  interruption  until  we  arrived  at  a 
French  chateau  with  a  nice  park  in  which  many  troops  were 
sheltered.  It  looked  like  heaven  to  us  after  the  awful  flat, 
dusty  country  we  had  come  from.  The  next  morning  bright 
and  early,  our  patients  began  arriving  and  are  still  coming ; 
our  stay  here  has  only  lasted  a  few  days ;  the  future  is  a  sealed 
order.    It  may  be  months  before  we  move  again. 

Miss  Stimson's  report  stated  that  at  the  signing  of  the 
Armistice  there  were  sixty-eight  camp  hospitals  functioning  in 
the  Medical  Corps  of  the  American  Expeditionary  Forces. 

Coveted  above  all  forms  of  assignment  within  the  Medical 
Corps  was  the  professional  service  at  the  front,  made  up  of 
"officers,  nurses  and  enlisted  men  especially  selected  for  their 
professional  attainments  and  formed  into  surgical,  'shock'  and 
gas  teams,  so  mobilized  as  to  permit  them  to  be  sent  fully 
equipped  on  short  notice  to  any  part  of  the  front  where  their 
services  were  needed."  ^^ 

Of  these  units  the  most  numerous  were  operating  teams  or- 
ganized from  base  hospitals.  Two  hundred  and  forty-four 
existed  on  December  31,  1918.  The  prevailing  shortage  of 
medical  personnel  in  the  zone  of  the  base  prevented,  how- 
ever, the  withdrawal  of  all  these  units,  so  that  less  than  two 
hundred  teams  actually  saw  service  at  the  front.  Ninety-five 
additional  operating  teams  were  organized  from  among 
"casuals"  of  the  American  Expeditionary  Forces. 

An  operating  team  usually  consisted  of  one  surgeon,  one 
assistant,  one  anesthetist,  two  nurses  and  two  orderlies.  Of  the 
nature  of  the  service,  Sigrid  H.  Jorgensen,  reserve  nurse,  of 
Base  Hospital  Xo.  15,  wrote: 

On  July  14  our  troops  were  making  the  first  big  offensive 
by  tlienisclvos.  We  were  dumped  off  in  the  middle  of  a 
wheat  field  outside  a  small  town  called  ficury.     The  hospital 

**  Report  of  tlie  Director  of  Nursing  Service,  A.  E.  F.,  p.  16,  Surgeon 
General's   Oflice. 


THE  EUROPEAN  WAR  653 

[Evacuation  No.  4  J  consisted  of  ten  Bessonneau  tents,  a  dozen 
large  khaki  tents  and  numerous  smaller  ones.  This  whole 
hospital  was  just  twenty-four  hours  old  when  we  arrived  and 
from  the  time  the  drive  began  the  day  before  they  had  ad- 
mitted over  a  thousand  wounded.  A  dozen  tired  but  cheerful 
nurses  greeted  us. 

Our  operating-room  was  the  usual  Bessonneau  tent  con- 
nected with  a  smaller  tent  whieli  served  as  sterilizing  and 
supply  room.  Four  tables  were  arranged  down  each  side. 
The  niglit  teams  relieved  the  day  teams.  There  was  no 
stopping  for  explanations.  The  faces  of  the  wounded  all 
around  us  on  the  ground,  on  the  tables,  everywiiere  we 
looked,  seemed  to  say:    "When  will  my  turn  come?" 

About  eleven  o'clock  that  night  the  shelling  of  Chiilons, 
about  four  kilometers  away,  began.  Now  and  then  tlie  ma- 
chine guns  would  be  peppering  about  us  trying  to  get  the 
Boche  planes.  The  next  night  the  Boche  came  about  ten- 
thirty  and  after  circling  about  the  camp  a  few  times,  dropped 
a  large  bomb  about  twenty  feet  from  tiie  nurses'  tent  and 
played  al)out  with  liis  machine  gun.  Many  of  the  boys  whose 
nerves  were  pretty  well  shattered,  wanted  to  get  away.  We 
newcomers  did  not  know  enough  to  be  scared. 

The  work  of  the  teams  was  the  usual  round  of  heavy  surgery. 
Miss  Jorgensen  continued : 

Sometimes  we  were  fortunate  enough  to  have  two  tables 
for  one  team,  wliich  meant  that  we  were  al)le  to  prepare  and 
anesthetize  one  patient  ahead  and  in  that  way  we  could  get 
on  witliout  stopping.  By  adding  one  extra  surgeon  and  one 
anesthetist  (hiring  rush  days,  a  team  like  this  could  handle 
from  sixty  to  eighty  minor  cases  or  thirty  mixed  cases  on  one 
eighteen-hour  shift. 

Sixteen  or  twenty  hours  in  the  operating-room  is  liard 
work.  If  we  went  off  duty,  though,  it  Tueant  that  for  every 
hour  we  rested  their  wounds  would  become  infected.  And 
such  bravery  as  those  boys  displayed  !  I  remember  one  young 
boy  witli  a  fractured  skull.  lie  was  too  badly  slidckeil  for 
ether  and  so  the  operation  was  performed  under  local  anaes- 
thesia. For  huge  skull  wounds,  drills  and  all  sorts  of  otlu>r 
instruments  were  used.  ()iu>  large  ])i(Me  of  shrapnel  was  ex- 
tracted by  a  vei'V  ])owerful  magnet  and  never  a  whiinjier 
from  the  boy  I  When  we  ])raised  his  pluck,  he  told  us  that 
anyone  who  could  stand  the  life  in  the  trenches  as  it  had 
been  for  the  past  week  could  stand  anything. 


654    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Another  youngster  about  eighteen  years  old  had  gone  to 
sleep  on  the  table,  waiting  for  his  turn  to  come.  Suddenly 
his  voice  rang  through  the  operating-room :  "Why,  hello,  it 
is  an  age  since  I've  seen  a  woman  like  you !"  The  surgeon 
wanted  to  know  if  he  was  a  friend  of  mine.  Poor  little  chap, 
he  was  brave  enough  for  anyone  to  be  proud  to  claim  him. 
I  went  up  to  examine  his  wound  and  found  one  hand  com- 
pletely blown  to  pieces  and  asked  him  what  he  would  do  if 
it  had  to  be  amputated.  "Do?"  he  joked.  "Do  without  it, 
I  guess."  I  told  him  not  to  look  at  it  lest  it  make  him  sick. 
He  raised  himself  up,  eyed  it  and  said,  "Why,  there  ain't 
none !"  I  asked  him  how  he  could  be  so  cheerful.  "Why, 
nurse,"  he  said,  "it  might  have  been  the  right  one.  This 
time  it  was  only  the  left!"  And  his  childish  laughter  rang 
through  the  tent. 

Ruth   Cushman,   reserve  nurse,  of  Base  Hospital   No.    18, 
described  the  bombing  of  Chalons: 

Up  until  the  night  of  July  14  everything  was  quiet  save  for 
the  barrage  which  rocked  our  barracks.  We  were  awakened  at 
midnight  by  a  shell  exploding  in  our  midst  and  the  immediate 
order  of  "gas  alerte." 

As  the  patients  were  pouring  in,  the  night  force  went  on 
duty  in  the  operating-room  and  wards.  The  rest  of  us  re- 
mained in  ahris  and  dugouts.  By  six  o'clock  that  morning, 
part  of  the  hospital  had  been  demolished,  two  patients  killed 
and  some  of  our  personnel  injured.  Orders  to  evacuate  came 
at  eight  o'clock  from  Headquarters. 

We  rode  for  several  hours  (and  the  memory  of  the  real 
refugees  journeying  along  the  roadside  still  remains).  Some 
of  the  nurses  slept  on  the  floor  of  the  trucks.  We  soon  found 
ourselves  attached  to  an  evacuation  tent  hospital  in  a  large 
open  field.  Our  own  team,  however,  was  ordered  back  to 
Chalons  to  operate  that  night  on  the  more  serious  cases  which 
had  been  left  behind. 

From  our  hospitals  we  watched  the  brilliant  display  made 
by  the  signals  and  shrapnel  from  the  anti-aircraft  guns.  In 
the  bright  moonlight,  we  could  see  the  Boche  planes  flyijig 
low,  then  the  terrific  explosions  of  the  ])ursting  shrapnel. 
Personnel  and  patients  alike  sought  the  wheat  fields  and  to 
my  dying  day  I  believe  a  field  of  grain  will  hold  a  certain 
fascination  for  me. 

Our  hospital  train  of  over  a  thousand  trucks  moved  by 
night,  so  our  way  along  the  main  roads  was  lighted  by  burn- 
ing ammunition  dumps  set  oil'  by  enemy  bombs.     We  led  a 


THE  EUROPEAN  WAR  655 

gypsy  life  constantly  in  evacuated  territory  of  the  once  beau- 
tiful ]\Iarne  Valley  about  Chateau-Thierry.  The  devastated 
country  lying  stark  in  the  brilliant  moonlight  grew  to  have  a 
natural  aspect,  town  after  town  in  ruins,  fields  plowed  with 
shell  holes,  roadsides  lined  with  ammunition  and  graves.®^ 

From  ficury  the  teams  moved  forward.     Miss  Jorgensen 
continued : 

Soon  Soissons  had  been  taken  and  the  Germans  were  driven 
back  about  thirty-five  miles.  On  August  C  we  were  on  our 
way,  only  this  time  it  was  quite  different  scenery  to  which  we 
were  introduced.  Everywhere  along  the  road  we  saw  ruins, 
torn  trees,  dead  horses,  shelled  roads,  trenches  and  wire  en- 
tanglements in  every  direction;  but  through  all  this  misery 
we  did  not  see  one  sad  face;  we  were  all  going  forward. 

Our  entrance  to  Chateau-Thierry  was  five  days  after  the 
Germans  had  left.  The  city  must  have  been  very  beautiful 
before  the  attack.  Such  wonderful  architecture  and  such 
scenery  over  the  hills  and  the  Marne !  Now  almost  every 
house  was  shelled  to  pieces ;  furniture  littered  the  torn  streets. 
No  civilian  inhabitants  remained.  One  beautiful  home  with 
damask  curtains  and  tapestries  attracted  our  attention.  We 
peeked  in  and  there  were  our  boys  peacefully  asleep  on  the 
most  comfortable  divan. 

Olive   I.    Thompson,   also   reserve  nurse   of  Base   Hospital 
No.  18,  described  the  historic  advance: 

Our  team  with  a  number  of  others  was  moved  after  five 
days  to  Viilers-sur-Marne,  where  we  were  stationed  with  Field 
Hospital  No.  148  in  Mme.  Huarde's  chateau.  The  thoracic 
team  on  night  duty  at  this  hospital  was  called  during  the  day 
only  for  emergency  cases.  As  all  of  the  boys  had  lain  out 
on  tlie  ground  for  twenty-four  hours  before  they  were  picked 
up,  tliey  were  in  very  bad  shape  when  they  were  brought  in. 
Delay  in  reaching  the  base  was  due  to  the  fact  that  the  one- 
way road  was  congested  by  the  trailic  of  the  advance. 

During  the  lull  in  the  offensive,  we  went  with  the  surgeon 
in  charge  of  our  team  to  Paris  to  obtain  supplies  and  instru- 
ments from  the  Ked  Cross.  Returning,  we  overtook  our  hos- 
pital on  July  'U  at  Chateau  de  la  Forret.  The  operating- 
room  hero  was  in  an  old  hunting  lodge.  All  around  the  room 
were  stuffed  animals,  whicli  we  were  not  allowed  to  touch,  as 

*"  T\oport    written    by    Ruth    Cnsliinan    for    tlie    Johns    Hopkins    Alitmncc 
.Vayaci/ic,  May,  1!M!<.  pp.  75-77. 


656   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

it  was  feared  that  they  had  been  wired  by  the  retreating  Ger- 
mans. The  flies  were  horrible  and  a  foul  stench  arose  from 
dead  men  and  horses  which  still  littered  the  ground. 

Anne  E.  Schneider,  reserve  nurse  of  Base  Hospital  No.  6, 
wrote  of  Field  Hospital  No.  27: 

Monday,  July  29,  found  us  again  on  the  move,  this  time  in 
the  direction  of  Chateau-Thierry,  where  we  made  our  home  in 
a  deserted  chateau  with  spacious  grounds.  Team  77  to  which 
I  belonged  was  placed  on  night  duty,  for  which  I  will  always 
be  grateful.  Our  stay  was  destined  to  be  a  lively  one.  Early 
in  the  game  I  discovered  that  it  was  much  easier  to  be  busily 
engaged  with  one's  mind  on  one's  patients  than  to  lie  quietly 
in  bed  trying  to  figure  out  just  where  the  next  bomb  was 
going  to  land. 

Here  during  our  leisure  hours  we  explored  the  surrounding 
country,  visiting  the  dugouts  so  recently  occupied  by  the 
enemy,  made  comfortable  by  the  looting  of  the  homes  of 
Chateau-Thierry;  crossing  the  river  on  the  pontoon  bridges 
thrown  across  by  our  brave  engineers  in  that  bitter  struggle 
across  the  IMarne;  climbing  Hill  Xo.  204  with  its  countless 
shell-holes;  stopping  by  the  way  to  examine  a  broken  plane 
resting  by  the  grave  of  its  fallen  hero;  viewing  from  its 
height  the  beautiful  valley  of  the  Marne,  at  its  base  the  utter 
destructioji  and  ruin  of  a  once-thriving  city ;  through  Belleau 
Wood  where  hardly  a  tree  remains  unscarred ;  through  many 
a  valley  where  no  stone  remained  unturned;  and  back  through 
the  poppy  fields  of  France  in  all  the  glory  of  their  brilliant 
hues. 

We  watched  the  return  of  the  refugees  in  groups  and  in 
single  file  by  every  train  or  wagon.  Into  Chateau-Thierry 
they  came,  some  on  foot  with  the  old  family  cow  and  the 
faithful  shepherd  dog  close  on  the  heels  of  the  bal)y  carriage, 
heaped  with  all  their  pitiful  worldly  possessions.  While  the 
sound  of  the  guns  was  still  to  be  heard,  these  people  returned 
to  reestal)lish  their  homes  and  to  rebuild  the  city  and  with 
their  coming  we  again  joined  the  mighty  caravan  of  the  road. 

Of  the  simnltanoons  arrival  of  various  types  of  forward  sani- 
tary formations  of  the  American  Expeditionary  Forces  at  a 
given  point  of  evacuation,  Kathervn  A.  Leverman,  reserve 
nurse  of  Base  Hospital  No.  40,  wrote: 

From  Field  Hospital  Xo.  27  we  were  taken  to  Eed  Cross 
Hospital   No.   114  then  at  Chateau-Thierry  to  remain  over 


THE  EUROPEAN  WAR  657 

night,  expecting  to  retuni  to  our  base.  After  scrubbing  all 
morning  in  our  new  quarters,  we  received  our  orders.  While 
waiting  for  the  ambulance  to  take  us  to  the  station  there  came 
a  call  for  more  nurses  up  the  line.  We  were  hastily  shoved 
into  ambulances  and  there  followed  a  wild  ride  to  Crezancy, 
where  Evacuation  Hospital  No.  3  was  stationed. 

Arriving  at  Toul  one  night,  we  were  taken  by  ambulance 
to  Evacuation  Hospital  No.  1  which  was  permanently  located 
at  Sebastopol,  a  good  distance  from  Toul.  After  resting  here 
for  a  day  we  moved  on  again,  this  time  occuj)ying  a  large 
French  military  barracks  barely  outside  of  the  city.  A  num- 
ber of  tents  were  also  set  up  and  one  of  the  large  Bessonneau 
type  was  fully  equipped  for  operating,  containing  eight  ta- 
bles for  that  purpose,  with  two  extending  the  entire  length  on 
one  side  to  be  used  for  sterile  supplies.  Other  hospitals  were 
arriving  daily  and  all  were  stationed  around  this  neighbor- 
hood and  were  designated  the  "Justice  Group."  1  cannot 
now  recall  all  the  different  numbers,  but  one  was  for  gassed 
cases  only,  another  for  medical,  one  for  the  slightly  injured 
and  we  were  to  take  only  the  seriously  wounded.  It  was 
here  that  Captain  Cutler,  our  surgical  director,  organized  the 
work  so  that  this  particular  hospital  handled  an  enormous 
number  of  cases  during  the  St.  Mihiel  Drive. 

Those" of  us  who  worked  in  the  tent  still  shiver  when  we 
think  of  those  cold  September  nights,  when  we  were  sterile 
nurses  for  several  o})erating  teams,  our  hands  in  wet  gloves 
constantly,  standing  within  a  small  space,  handing  out  sterile 
supplies  and  setting  up  instrument  tables.  Although  this 
organization  was  wonderfully  equipped,  there  was  no  over- 
supply  of  aprons,  or  other  articles,  so  we  had  to  be  especially 
careful.  Each  operating  team  had  a  "floating  nurse,"  who 
was  kept  so  busy  that  she  did  not  feel  the  cold  quite  so  much. 
There  were  just  two  of  us  to  handle  the  sterile  supplies  for 
those  eight  tables  and  we  did  not  dare  to  move  outside  of 
our  own  little  sphere.  About  four  A.^f.  we  felt  more  like 
wooden  idols  than  human  beings  and  oh  I  how  unmercifully 
cold  it  could  get ! 

After  the  St.  ]\Iihiel  Drive  we  went  on  to  Flcury,  where  we 
worked  with  IJed  Cross  No.  114  for  one  week  and  were  then 
ordered  to  the  Champagne  Front.  When  we  arrived  at 
Cuperly  in  the  Champagne  sector  early  that  Octol)er  morning, 
the  ground  was  white  with  frost.  Our  hospital  tents  were 
pitched  across  the  railroad  track  from  the  Mt.  Fronet  French 
hospital  barracks.  ...  It  was  in  this  sector  that  we  had  to 
wear  rubber  boots  so  much  and  we  ran  a  terrible  risk  of  losing 
them  comiiletelv.     1   reallv  don't  know  of  anvthiiiij  that  has 


658    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  stick-to-itiveness  that  French  mud  has.  The  most  popu- 
lar costume  those  days  were  raincoats  over  either  a  jersey  or 
gray  crepe  uniform,  rubber  boots  and  sou'wester  hat.  Our 
boys  told  us  we  looked  like  the  advertisement  of  codliver  oil. 
Xo  wonder  the  mademoiselles  asked  our  soldiers:  "Are  all 
American  women  so  homely?" 

Of  their  last  stand  at  Fromerville,  Sigrid  Jorgensen  wrote ; 

It  was  hardship,  sacrifice  and  toil  from  the  day  we  came 
there.  Something  seemed  to  tell  us  that  this  our  last  fight 
was  to  be  the  end.  The  tents  were  pitched  on  the  top  of  a 
hill  overlooking  the  ruins  of  the  villages.  The  mud,  alive 
with  the  filth  of  war,  grew  thicker  in  the  cold  rain.  Instead 
of  uniforms  with  such  trimmings  as  white  collars  and  caps, 
we  nurses  then  wore  high  rubber  boots,  trench  coats  and  rain 
hats  and  sweaters  in  several  layers. 

Verdun,  pounded  by  German  guns,  Avas  about  four  kilo- 
meters from  us,  but  we  never  dreamt  for  a  minute  that  they 
were  after  our  little  camp.  On  November  3  they  got  our 
range  and  threw  over  thirteen  shells.  Headquarters  was 
shelled  down  completely;  some  shells  struck  the  tents  and  the 
shrapnel  flew  in  every  direction.  Everyone  rushed  to  the 
help  of  the  wounded.  Some  carried  stretchers,  others  wejit 
about  with  bandages  and  dressings  and  still  others  did  their 
best  to  cover  the  boys  up. 

Thirty  "splint  teams"  w^ere  organized  by  the  Medical  Depart- 
ment for  service  in  the  zone  of  the  advance.  The  service  which 
the  personnel  of  this  type  of  unit  saw,  closely  resembled  that 
experienced  by  the  personnel  of  operating-teams.  These  ''splint 
teams"  are  of  especial  interest  to  members  of  the  American 
Red  Cross,  because  at  the  request  of  the  Army  and  without  any 
expense  to  the  ^lilitary  Establishment,  the  American  Red  Cross 
supplied  more  than  294,000  splints  to  soldiers  of  the  American 
Expeditionary  Forces. 

''Shock"  work  at  the  front  represented  the  most  forv/ard 
branch  of  American  military  nursing  service  during  the  Euro- 
pean War.  Seventy-eight  "shock  teams"  were  organized.  From 
a  professional  point  of  view,  their  work  demonstrated  un- 
equivocally the  value  of  expert  nursing  technique  in  the  imme- 
diate zone  of  the  advance.  ElizalK>th  Coombs  Strode,  res(^rvo 
nurse,  of  Base  Hospital  No.  20,  described  the  nature  of  their 
work : 


THE  EUROPEAN  WAR  659 

"Shock"  is  produced  by  loss  of  blood,  destruction  of  tissue, 
exposure  and  privations  of  every  kind.  Patients  had  often 
lain  undiscovered  in  the  cold  and  wet  for  days  in  shell  holes 
or  some  other  exposed  spot,  under  constant  fire,  where  it  was 
impossible  to  conduct  rescue  work.  Life  was  sustained  only 
by  water  from  mud  holes.  Many  others,  desperately  wounded, 
after  receivin<r  First  Aid,  were  moved  rapidly  back  of  the 
lines  for  further  treatment.  Owing  to  the  great  necessity  for 
haste,  the  ambulances  covered  the  distance  in  the  shortest 
time  possil)le  so  that  the  Jolting  over  rough  roads  had  further 
added  to  the  suffering  and  devitalization  of  the  men. 

If  the  patient's  condition  warranted  it  on  arrival  at  the 
hospital,  we  removed  soiled  clothing,  bathed  him  and  sup- 
plied clean  clothes  before  taking  him  to  the  wards  or  operat- 
ing-room. We  wore  on  constant  guard  to  keep  the  wards  as 
free  from  "cooties"  as  possible.  Those  suffering  from  ex- 
treme shock  were  admitted  to  the  "shock  wards"  with  none 
of  the  liorrors  of  war  removed.  In  most  cases  we  could  only 
wasli  the  hands  and  faces  of  these  men  for  many  days  before 
their  condition  enabled  us  to  remove  fully  the  blood,  mud 
and  filth  of  the  trenches  caked  on  them. 

Tlie  treatment  consisted  first  of  giving  heat.  Clothing 
was  cut  away,  the  patient  put  immediately  on  a  warm 
stretclier  [mounted  sometimes  on  trestles]  and  surrounded 
by  hot-water  bottles  or  canteens.  If  very  cold,  he  was  given 
a  warm  air  bath  by  placing  over  him  a  large  wire  cradle 
covered  with  blankets,  following  the  method  formerly  used 
in  civil  lios]iitals  for  giving  vapor  baths,  but  giving  dry  in- 
stead of  moist  heat.  Warm  air  was  supplied  by  means  of  a 
pipe  running  under  the  cradle  from  a  small  kerosene  stove  at 
the  foot  of  the  cot.  The  blood  pressure  was  then  taken  to 
determine  the  degree  of  shock.  The  "T.P.R."  usually 
sliowed  subnormal  temperature,  feeble  rapid  pulse  and  in- 
creased respiration. 

In  addition  to  extreme  shock,  many  patients  were  dying 
from  gas  bacilli  infection.  The  suffering  caused  by  this  in- 
fection was  so  acute  and  the  effects  so  deadlv  that  our  most 
vigorous  efforts  to  save  life  were  of  little  avail.  Indications 
for  active  treatment  were  first,  hemorrhage;  second,  blood 
pressure  below  nijiety;  third,  blood  pressure  that  falls 
continuously. 

Following  rest  and  the  application  of  heat  came  active  treat- 
ment. Pauline  1.  Stock,  reserve  nurse,  of  Base  Hospital 
Xo.  18j  continued  a  description  of  the  work: 


660   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

If  the  man  was  conscious  and  not  an  abdominal  case,  he 
was  given  hot  coffee  on  admission  with  a  teaspoonful  of 
bicarbonate  of  soda  to  counteract  acidosis.  The  soda  was 
repeated  in  all  their  hot  drinks  which  were  given  every  two 
hours.  A  quarter  of  a  grain  of  morphine  was  given  if  the 
patient  was  suffering  or  restless  and  large  doses  of  atropin  if 
he  had  lost  much  fluid  through  perspiration,  a  loss  of  which 
was  frequently  as  proportionately  great  as  the  excessive  thirst. 
The  stimulants  used  were  strychnia  and  caffein  sodium 
benzoate. 

In  cases  where  it  was  imperative  to  get  fluids  into  the 
system  at  once,  sterile  salt  solution  with  six  per  cent  gum 
acacia  was  given  intravenously.  The  theory  advanced  was 
that  the  salt  solution  with  gum  acacia  was  less  liable  to  be 
lost  by  osmosis  than  plain  salt  solution.  But  after  all,  blood 
transfusion,  when  the  blood  could  be  obtained,  proved  to  be 
the  most  satisfactory.  The  blood  was  usually  taken  from  the 
gassed  patients,  who  were  really  better  for  it.  When  the 
situation  was  explained  to  them,  the  boys  were  very  good 
about  offering  themselves  as  donors  and  were  always  greatly 
interested  in  the  recipient  and  whether  the  blood  had  hel])ed 
him.  It  was  remarkable  how  quickly  the  patient  would  pick 
up,  as  a  rule,  after  such  a  transfusion.  Of  course,  many 
times  it  was  only  temporary,  but  frequently  he  would  improve 
enough  to  warrant  operation.^^ 

Of  further  treatment,  Miss  Strode  wrote : 

Special  diets  of  milk,  eggs,  etc.,  were  issued  for  patients 
whose  condition  permitted  it.  The  Eed  Cross  gave  daily  con 
tributions  of  cocoa,  chocolate,  small  cakes,  canned  milk  and. 
at  times,  fruit.  Everything  possible  was  done  to  alleviate 
the  terrible  suffering  but  only  tliose  working  under  existing 
conditions  realized  liow  stupendous  was  the  task  of  supplying 
comforts  so  close  to  the  lines.  As  many  patients  were  in  a 
dying  condition  when  admitted,  the  mortality  was  exceed- 
ingly high.  The  daily  scenes  in  the  shock  ward  truly  illus- 
trate the  horrible  cruelty  of  war,  with  its  ghastly  waste  of  life, 
its  inexpressil)le  agony. 

Gertrude  Bowling,  vcficvxo  nurse,  who  with  IMiss  Stock  had 
been  sent  forward  frou\  Base  Hospital  ]^o.  18,  wrote  of  experi- 
ences in  Chateau-Thierry: 

■"Report  written  by  Pauline  Stcnk,  Johns  Hopkins  Aluynnw  Magazine, 
May,  iniD,  pp.  70-71.' 


THE  EUROPEAN  WAR  661 

For  a  coii})le  of  hours  we  jogged  along  a  road  pitted  on 
either  side  with  shell  holes,  the  tell-tale  wrappings  of  a  First 
Aid  packet,  or  a  bit  of  clothing  beside  them.  Through  the 
shell  wrecked,  half  demolished  villages  of  Vaux  and  Esson, 
naked,  forbidding  skeletons  in  the  summer  dusk,  we  were 
held  up  by  ammunition  trains  going  up  or  empty  camion 
convoys  returning  from  the  front. 

Less  than  a  week  after  its  evacuation  by  the  Huns,  we 
entered  Chateau-Thierry.  The  dead  were  still  unburied  on 
the  battlefields.  Kuiiis  of  the  great  bridges  blown  up  by  the 
Boche  were  still  in  evidence,  as  was  the  pontoon  bridge 
thrown  over  the  Marno  by  the  victorious  French  and  Ameri- 
can troops.  Hotel  Dieu,  where  we  joined  the  ll"^th  Field 
Hospital  of  the  28th  Division,  was  filled  with  shell  holes 
and  without  a  pane  of  glass. 

Wanton  destruction,  indescribable  devastation  and  filth 
were  everywhere  manifest.  Houses,  churches,  public  build- 
ings in  ruins,  here  and  there  whole  sides  stripped  off  of 
homes  showing  intimate  details  of  family  life  rudely  inter- 
rupted, a  piano  with  music  still  o{)en  upon  it,  a  victrola  with 
records  scattered  about,  a  table  partially  set,  a  baby  carriage 
or  cradle  just  as  the  inhabitants  had  left  it,— one  could  not  but 
wonder  what  had  become  of  them.  At  our  own  hospital,  fur- 
niture, tapestry,  bedding,  china,  broken  and  trampled,  were 
strewn  on  the  floors  and  in  the  court  yards.  Piles  of  every- 
thing from  candlesticks  and  fine  linens  to  hospital  supplies 
were  massed  in  heaps  in  the  cellars  and  about  the  grounds. 
From  these  we  gathered  equipment  for  our  new  ward. 
Through  our  paneless  windows  and  tlie  ragged  shell  holes  in 
our  wall,  the  flare  from  the  big  guns  and  their  boom  kept 
us  awake.*'' 

The  following  day,  shock  work  began  again.  In  Miss  Bow- 
ling's account,  as  in  the  notes  of  other  nurses  at  the  front, 
appeared  a  total  disregard  of  the  passing  of  tinu;.  Days  and 
nights  became  only  a  blur  of  exhausted  vet  unsurrenderin<r 
endurance. 

You  forgot  manv  tilings  you  had  been  taught.  You  only 
remenihered  to  roll  up  your  slccvcs'and  dig  in.  It  was  work. 
eat,  sleep,  work.  One  stretch  of  duty  was  the  same  as  the 
next,  ^'ou  fdi'gDt  the  days  of  tlie  week;  you  thought  oidy  of 
how  many  you  could  kee})  from  dying. 

""Report   writtfii   hy   (Icrt  riido    liowliii^'   for  ■Johns   Ilopkina  Aluftnur   Miuja- 
zinc.  May,  l!)lit,  pp.  (it-t;.'). 


662   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Never  will  I  forget  some  of  the  faces,  wonderful,  physical 
types  of  American  manhood,  and  the  spirit,  sometimes  in 
mere  slips  of  hoys,  well, — superhuman !  They  were  a  game 
lot.  Dust-caked,  hloody,  often  wet,  they  came  to  us  some- 
times too  fast  to  handle.  One  little  second  lieutenant,  hadly 
smashed,  grinned  from  ear  to  ear:  "Boys,"  he  said,  "I  got 
my  seven  Boches  before  they  got  me !" 

Another  dark-haired,  broad-shouldered  chap  of  twenty, 
with  both  legs  amputated  almost  to  the  hip,  his  face  and  body 
peppered  by  bits  of  shrapnel,  lay  helpless  in  our  ward. 
"Well,"  he  told  us,  "I  was  studying  to  be  a  dentist,  but  now 
that  is  impossible.  At  one  time  I  learned  to  make  artificial 
teeth.  When  I  go  back  1  think  I  can  be  able  to  make  a  living 
with  that  as  my  trade." 

The  dumb,  long-suffering  look  in  the  eyes  of  a  lad  who 
came  to  us  after  lying  for  three  days  in  "No  Man's  Land" 
before  being  found,  still  haunts  me.  His  back  bore  huge 
shrapnel  wounds  alive  with  maggots.  Words  cannot  do  jus- 
tice to  the  gruesomeness  of  those  crawling  things  in  human 
flesh. 

After  two  weeks  at  Chateau-Thierry,  the  American  field 
hospital  moved  up  to  Cohan,  five  miles  across  country  from 
Fismes.  ]\Iiss  Bowling  wrote  of  her  anxiety  lest  in  the  dark- 
ness she  could  not  get  her  unconscious  patients  into  their  gas- 
masks in  time.     She  described  the  nightly  bombing: 

At  such  times  a  piece  of  roof  is  a  certain  satisfaction. 
Even  the  best  canvas  seems  thin.  No  sooner  did  the  moon 
show  her  face  than  the  buzz-buzz,  with  its  peculiar  singing 
whine,  was  overhead.  ]\Iany  bombs  exploded  near  us.  Two 
that  proved  to  be  "duds"  fell  just  back  of  our  tents.  Had 
they  exploded  quite  a  few  of  us,  to  use  the  parlance  of  the 
boys,  would  have  been  saying  "Good  morning,  St.  Peter  I" 
Later  we  learned  that  a  woman  spy  had  signaled  the  planes 
with  a  flasldight  from  the  top  of  the  hillside  on  which  our 
tents  were  placed.  She  was  a  middle-aged  French  woman  and 
pretended  to  speak  no  Knglish.  until  her  condemnation  was 
pronounced. 

Of  the  shelling,  ]\liss  Bowling  wrote: 

Suddenly  one  morning  we  heard  over  our  heads  a  new 
sound, — the  long,  shrill  wliistle  of  the  Ilun's  P)ig  Bertha, 
followed  in  a  fvw  seconds  bv  tlie  crash  of  ex])l()sion  at  the 
])oint    of    contact.      Tlu'v    were   searching   for   the   big   naval 


THE  EUROPEAN  WxVR  663 

guns  just  back  of  us.  All  my  life  I  have  read  of  the  whistle 
and  whine  of  shells.  The  vacuum  left  over  our  heads  as  tiie 
shells  seemed  to  j)ass  lower  and  lower,  was  so  vivid  to  our 
minds,  we  felt  we  could  reach  up  and  touch  it  with  our  hands. 

One  of  their  stations  was  in  an  old  cow  stable.    ^liss  Bowling 
continued : 

Open  to  the  air  only  by  one  small  door  which  we  kept 
blanketed  at  night  to  hide  the  candle  by  which  we  worked, 
we  set  up  our  "shock-ward"  near  the  manger,  with  the  du.<ty 
cobwebs  clinging  to  the  rafters.  The  stable  itself  was  at  the 
mouth  of  a  wine  cellar  running  fifty  feet  underground,  under 
a  hill.  Here  we  carried  our  patients  for  shelter  in  necessity. 
When  not  on  duty,  we  slept  upstairs  over  the  little  X-ray  and 
operating-room.  When  "Jerry's"  shells  began  to  whistle 
with  the  regularity  of  clock  work  about  ten  P.M.  and  again 
at  four  A.M.,  we  repaired  in  pajamas,  raincoats,  tin  hats  and 
gas  masks  to  the  wine  cellar  until  it  was  over.  It  was  at  this 
place  they  brought  us  one  night  a  Pittsburgh  boy  an  hour 
after  he  had  been  wounded.  He  was  at  the  key-board  at  a 
general's  chateau  when  a  piece  of  shrapnel  caught  him,  sever- 
ing an  artery.  He  came  to  us  with  a  tourniquet  made  of  a 
blue  bandana  handkerchief  and  a  wooden  spoon. 

I  might  tell  you  many,  many  incidents  of  the  brave  boys 
who  passed  through  our  hands;  of  the  way  some  of  them 
died  ;  of  the  things  all  of  them  endured ;  of  the  rats,  huge  as 
guinea  pigs;  of  tlie  thirst  and  the  mud;  of  the  swarming 
flies,  the  fleas,  the  "cooties"  that  tormented  them;  of  the 
periods  of  intense  suspense  not  harder  to  l)ear  tlian  the  long 
days  of  monotony  and  great  physical  exhaustion  that  often 
followed.  But  1  could  never  really  picture  things  as  they 
were. 

Of  the  St.  ^rihicl  Drive,  Alice  A.  Kelly,  Armv  Xursc  Corps, 
of  Base  Hospital  ]S^o.  41),  wrote: 

Our  team  consisting  of  a  cai)tain  of  the  ^Nfedical  Corps, 
an  orderly  and  myself,  were  joined  on  September  !•  at  Toul 
by  another  "shock"  from  a  (Jeorgia  unit,  ^^'e  were  givi'n 
an  ambulance  and  told  to  find  the  triage  of  the  (S'.Hh  I)i\ision. 

In  the  early  morning  of  September  lo  we  were  riding  over 
territory  which  our  forces  had  left  the  day  before.  Our  driver 
lost  his  way.  At  one  time  we  were  riding  ahead  of  the  artil- 
lery of  one  of  the  divisions  on  its  wav  to  the  fast  advancing 
Jine.     We  saw  everything  from  dead  horses  up,  camouflaged 


664   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

guns  beside  the  road,  everything  bearing  the  look  of  hasty 
departure.  Several  times  we  were  obliged  to  stop  and  inquire 
the  location  of  this  triage.  Whenever  the  boys  saw  us,  they 
stared.    I  heard  one  man  say :   "My  God,  it's  a  woman  !" 

We  stopped  in  a  very  much  ruined  little  village  where  parts 
of  one  division  were  having  a  hasty  breakfast  before  they 
pushed  on.  p]xcitement  was  everywhere.  Of  course,  the 
boys  cheered  and  told  us  that  we  were  the  only  two  girls 
around  that  section  and  it  did  please  them  to  see  "some  really 
and  truly  American  women." 

A  triage  has  been  defined  as  the  sorting-station  immediately 
behind  the  First  Aid  dugout  in  the  field.  Of  this  one,  Miss 
Kelly  wrote: 

It  consisted  of  about  ten  canvas  tents ;  one  of  them  was  an 
extremely  large  one  which  was  used  as  a  receiving  ward. 
The  boys  were  evacuated  almost  as  soon  as  they  came  in, 
remaining  only  to  be  redressed.  Though  there  were  many 
cases  that  needed  transfusion,  we  did  not  have  the  supplies 
to  do  much  work  there.  To  apply  heat  we  improvised  a  hood 
to  be  placed  over  the  stretcher  and  used  lanterns. 

As  for  our  living  conditions,  our  one  and  only  trouble  was 
the  mice.  Often  I  woke  up  with  them  running  over  my  cot. 
At  first  we  could  not  sleep  on  account  of  the  barrage  each 
night,  but  finally  got  accustomed  to  it.  I  remember  late  one 
evening  hearing  a  steady  beat,  beat,  beat.  1  got  up  and 
peeked  out  of  the  tent  to  see  a  steady  line  of  soldiers  march- 
ing to  the  front  in  the  gorgeous  moonlight.  As  these  boys 
swung  ou,  not  a  sound  was  heard  except  the  tread  of  their 
feet.    I  watched  them  pass  for  ten  full  minutes.  .  .  . 

We  had  arrived  in  time  for  the  Argonne  Drive,  September 
2G.  We  were  immediately  put  in  charge  of  a  regular  "shock- 
ward,''  the  two  teams  relieving  each  other  on  tlie  day  and 
night  work.  And  there  the  real  work  began.  We  got  every- 
thing, but  had  more  shrapnel  wounds  than  fractures.  Those 
were  busy  times.  It  was  discouraging  to  bring  Imck  some  of 
those  frightful  cases  only  to  have  them  die  later  with  gas 
bacillus  infections. 

Of  the  cost  of  the  Argonno  victory,  ^liss  Bowling  wrote  :  "It 
is  no  new  story,  the  frightful  carnage  of  that  hard-fought  ground. 
The  dead  scmietiTiics  waited  tlircc;  and  four  on  the  wards  with 
the  living,  because  the  stretcher  bearers  were  too  busy  carrying 
the  wounded  and  the  dead  could  wait." 


THE  EUROPEAN  WAR  665 

Approximately  four  thousand  officers,  nurses  and  enlisted 
men  comprised  the  professional  team  service  of  the  American 
Expeditionary  Forces.  Of  this  number,  two  thousand,  six 
hundred  and  sixty-two  were  nurses.  Miss  Stimson  described 
how  these  more  fortunate  ones  were  regarded  by  nurses  serving 
in  the  zone  of  the  base : 

Tlie  work  in  the  liospitals  at  the  front,  with  all  its  trying 
conditions,  was  the  prize  and  goal  for  which  every  nurse  of 
the  American  Expeditionary  Forces  longed.  No  .special 
credit  should  be  given  tlie  nurses  who  achieved  it,  even  wlien 
recognition  of  their  skill,  their  courage  and  tlieir  uncomplain- 
ing willingness  to  adapt  themselves  to  all  the  hardships  en- 
tailed, is  made.  The  work  was  its  own  reward.  Each  nurse 
knew  that  she  was  fortunate  indeed  to  be  there  and  that 
waiting  to  take  her  place,  nay,  only  too  eager  for  the  chance, 
were  literally  hundreds  of  other  nurses. 


Attached  to  the  332nd  Regiment  from  Ohio,  brigaded  with 
the  Italian  Armies,  was  United  States  Base  Hospital  'No.  102, 
of  one  thousand  beds,  organized  by  Dr.  Joseph  A.  Danna  within 
the  !^^cdical  School  of  Loyola  University  of  New  Orleans, 
Louisiana.  Although  this  unit  was  not  ordered  into  the  field 
until  August  of  1918,  its  experiences  as  the  most  forward  base 
hospital  operating  on  the  Italian  Front,  comprised  a  most 
])ictures(|ue  section  of  war  nursing  history. 

Born  in  Bisacquinto,  in  the  provence  of  Palermo,  Italy,  Dr. 
Danna  at  the  age  of  seven  came  with  his  parents  to  the  United 
States,  and  subsc(]uently  made  his  home  in  New  Orleans.  When 
the  American  lied  (^ross  suggested  the  organization  of  a  base 
hospital  from  the  staff  of  Loyola  University  Medical  School,  he 
was  appointed  director.  Chrvsostom  Moynahan,  a  Daughter 
of  Charity  of  St.  Vincent  de  Paul,  was  chief  nurse.  Sister 
Isabella,  another  Daughter  of  Charity,  was  delegated  by  Sis- 
ter Chrvsostom  to  compile  the  repcu'ts  describing  the  activities 
of  Base  Hospital  No.  102  as  quoted  in  this  section.  She  wrote 
of  her  chief: 

Sister  C'lirysostom  was  born  in  Ireland  and  came  to  this 
country  at  an  early  age  with  her  parents  who  settled  in 
Massachusetts.  Entering  the  ("onnnunity  of  Daughters  of 
Charity  of  St.  \'in(ont  de  Paul  at  l*'inniittsburg,  Maryland, 
their  Mother  House  in  this  countrv.  she  was  sent  at  the  ex- 


666  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

piration  of  her  seminary  term,  January,  1889,  to  Carney  Hos- 
pital, Boston.  This  Community  opened  here  its  first  train- 
ing school  for  nurses  in  1892  with  Miss  Emily  Stoney  as 
superintendent.  Sister  Chrysostom  was  one  of  the  graduates 
of  this  first  class,  the  term  then  heing  two  years.  She  then 
transferred  to  St.  Mary's  Hospital,  Evansville,  Indiana,  where 
she  remained  until  1898.  At  the  outbreak  of  the  Spanish- 
American  War,  she  was  called  with  nine  others  of  this  Com- 
munity to  Washington  preparatory  to  being  sent  to  Santiago 
to  jiurse  fever  patients.  The  day  previous  to  their  departure. 
President  ^FcKinley  requested  that  no  Sister  be  sent  to  Cuba 
who  was  not  immune.  As  Sister  Chrysostom  was  the  only 
exception,  a  Sister  from  Providence  Hospital,  Washington, 
who  had  had  the  fever,  was  hurriedly  called  and  Sister 
Chrysostom  was  sent  to  Providence  Hospital  to  replace  this 
Sister.  Some  months  later,  however,  she  was  detailed  to 
Portsmouth,  Virginia,  to  help  nurse  the  Spanish  who  had 
been  injured  by  the  burning  of  the  Marie  TJieresa  and  on 
recovery  of  these  patients.  Sister  Chrysostom  was  transferred 
to  Fort  Thomas.  Kentucky,  where  she  helped  to  care  for 
fever  patients  until  February,  1899.  From  here  she  returned 
to  Evansville,  Indiana,  and  was  thence  sent  to  Birmingham, 
Alabama,  where  she  later  built  the  beautiful  St.  Vincent's 
Hospital. 

From  1899  until  1918,  Sister  Chrysostom  was  in  charge  of 
this  institution,  receiving  while  there,  in  January,  1918,  her 
appointment  as  chief  nurse  of  Lovola  Base  Hospital  Unit 
Xo.  10-2. 

Sister  Chrysostom  was  the  first  registered  nurse  in  the  State 
of  Alabama. 

Ten  Daughters  of  Cliarity  from  representative  hospitals  in 
the  South  held  executive  positions  under  Sister  Chrysostom 
upon  the  nursing  staff  of  Base  Hospital  No.  102,  These  women 
were  the  only  nuns  who  served  with  the  American  Army  in  the 
European  War.  They  were  Sisters  De  Sales  Loftus,  Lucia 
Dolan,  Agatha  ]\Iuldoon,  Catherine  Coleman,  Angela  Drendel, 
M.  David  Ingram.  Mariana  Flynn,  Vahu-ia  Dorn  and  Florence 
Cleans.  Their  order,  however,  had  long  before  blazed  the  way 
to  the  modern  woman's  part  in  the  alleviation  of  suffering 
among  the  wounded  of  armic^s.      Sister  Isabella  wrote: 

The  Daughters  of  Charity  of  St.  Vincent  de  Paul  were  the 
forerunners  of  the  Pcd  Cross,  operating  on  the  battlefield  in 
the  wars  of  Custavus  Adoljibus.     Tlieir  Comnninity  numbers 


THE  EUROPEAN  WAR  667 

thirty-five  thousand  subjects.  They  are  found  in  every  coun- 
try in  the  worhl,  their  works  being  well  known  in  China,  the 
Philippine  1  sands,  through  South  America,  in  the  Levant, 
Constantijiople  and  the  Turkish  possessions,  Jerusalem, 
Northern  Africa,  ^ladagascar  and  all  over  Europe. 

When  they  were  first  sent  out  in  1654  and  KIoo  by  Vin- 
cent de  Paul,  their  Founder,  to  the  battlefields  of  Sedan  and 
Arras,  it  was  a  world  wonder,  for  women  had  never  before 
engaged  in  this  work.  They  were  the  first  religious  women 
of  any  Community  to  brave  the  dangers  and  hardships  of  the 
battlefield. 

Florence  Nightingale  visited  the  Daughters  of  Charity  in 
their  Mother  House  in  Paris,  for  the  purpose  of  learning  their 
methods  and  she  acknowledged  that  her  own  work  would  have 
failed  without  their  cooperation.  Thus  from  the  day  when 
the  Turk  christened  the  Daughters  of  Charity  the  "White 
Swallows  of  Allah"  have  they  continued  their  errands  of 
mercy,  reaching,  perhaps,  the  climax  in  their  recent  faithful 
service  to  the  dead  and  wounded  in  Belgium.  It  is  recorded 
of  several  Daughters  of  Charity,  following  the  French  Army 
back  from  Belgium,  that  for  twelve  days  they  went  without 
changing  their  garments  and  upon  reaching  shelter,  such 
was  their  soiled  and  disheveled  condition,  that  they  were  not 
recognized  as  Sisters,  but  had  to  prove  their  identity. 

Since  the  beginning  of  the  war  five  thousand  members  of 
the  Mother  ITouse  of  this  Community  in  France  have  been 
doing  field  work. 

The  remaining  ninety  nurses  who  formed  the  nursing  per- 
sonnel of  Base  Hospital  No.  102  came  largely  from  training 
schools  in  all  parts  of  the  United  States  conducted  by  the 
Daughters  of  Charity.  Sister  Isabella  wrote  of  their  mobiliza- 
tion : 

Twenty-two  nurses  were  from  Xew  Orleans,  twelve  from 
Birmingham,  six  from  Montgomery,  five  from  Mobile,  five 
from  Chicago,  ten  from  VA  Paso,  ten  from  Los  Angeles,  eight 
from  San  Francisco  and  five  from  St.  Louis,  several  from 
Austin,  Texas,  and  several  others  from  various  Southern 
cities.  Acting  upon  official  orders,  for  several  months  pre- 
vious to  mobilization,  the  nurses  were  detailed  to  difi^erent 
cantonments. 

The  equipment  of  Ease  Hospital  Xo.  102,  costing  $100,000, 
was  purchased   by   funds  contributed   entirely   by   Mrs.   John. 


668   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Dibert,  a  New  Orleans  philanthropist.  Its  assignment  to  Italy 
was  in  part  determined  by  the  strong  sympathies  of  Dr.  Danna 
for  his  mother  country  and  by  the  need  for  a  sanitary  unit  to 
serve  with  the  332nd  Regiment  of  the  American  Expeditionary 
Forces,  brigaded  in  the  summer  of  1918  with  General  Diaz' 
troops. 

Early  in  July,  1918,  the  nursing  staff  of  Base  Hospital  No. 
102  mobilized  in  New  York.  Nurses  and  Daughters  alike  re- 
ceived complete  equipment  for  foreign  service  from  the  Ameri- 
can Red  Cross.  The  nuns,  however,  were  permitted  by  special 
ruling  to  wear  the  dark  blue  cloth  habit,  the  white  collar  and 
the  cornet  of  their  order.  The  embarkation  of  the  unit  was 
made  the  occasion  for  ceremonials  of  a  deeply  religious  char- 
acter. An  eloquent  flag  blessing  at  St.  Stephen's  Church, 
delivered  by  Chaplain  George  T.  McCarthy,  July  23,  was  the 
first  public  Catholic  demonstration  of  this  kind  given  in  New 
York  City.  A  last  High  Mass  was  held  at  three  o'clock  Sun- 
day morning,  August  4,  and  Major  Chaplain  Joseph  P.  Dineen 
sent  the  unit  forth  with  an  inspirational  blessing.  The  Rever- 
end Godfrey  P.  Hunt,  a  Franciscan  from  the  monastery  in 
Washington,  D.  C,  accompanied  Base  Hospital  No.  102  into 
the  field  as  chaplain.  Sister  Isabella  wrote  as  follows  of  their 
embarkation : 

Sunday,  August  4,  at  2  A.M.  under  cover  of  darkness,  the 
Sisters  and  nurses  marched  in  file,  four  abreast,  full  uniform 
and  headed  by  Lieutenant  McCarthy,  to  St.  Stephen's 
Church. 

The  nurses  tlion  returned  to  tlie  hotel,  got  suitcases  and 
crossed  in  the  ferry  to  Jersey  City.  Here  darkened  coaches 
awaited  tlieni.  The  train  was  composed  of  first-class  cars  and 
before  startintr.  the  Lieutenant  turned  them  over  to  a  secret 
service  man.  The  train  pulled  out  at  one  P.^F..  reached 
Baltimore  and  went  straight  to  the  wharf,  where  the  S.  S. 
JJmhrki  awaited  it. 

The  Finhna.  an  Italian  boat  built  in  1901  and  for  the  past 
three  years  used  as  a  freight  steamer,  had  had  a  thorough 
overhauling  in  preparation  for  this  trip.  It  was  small  for 
the  unit  and  in  many  respects  very  inconvenient,  hut  it  had  a 
good  captain  and  a  generous  crew,  which  more  than  compen- 
sated for  all  shortcominirs.  On  arrival  of  Chaplain-Reverend 
Hunt  from  Wasliington,  D.  C,  the  Umhria  started  on  her 
voyage. 


THE  EUROPEAN  WAR  669 


The  first  morninj«:  out,  tlio  8.  S.  Umbria  picked  up  a  black 
speck  on  her  left.  It  proved  to  be  the  lifeboat  of  the  American 
oil  tanker  Jennings,  containing  the  survivors  of  the  Jennings 
which  had  been  torpedoed  twenty-four  hours  before.  The  life- 
boat was  re-provisioned  and  with  its  passengers  carried  back 
until  it  was  within  sight  of  Cape  Hatteras.  This  caused  a 
delay  of  six  hours  to  the  Umbria. 

Of  their  approach  to  Gibraltar,  Sister  Isabella  wrote : 

Until  August  17,  the  Umbria  was  without  convoy,  but  on 
that  (lay,  a  great  English  man-o'-war  came  out  to  escort  her 
through  the  Strait  and  into  the  harbor.  It  had  been  in  search 
of  the  Umbria  all  night,  but  could  not  locate  her  until  the 
following  morning.  This  convoy  was  more  than  welcome, 
as  on  tlie  previous  afternoon  fourteen  messages  had  been  re- 
ceived by  the  officers  warning  them  to  be  on  the  lookout  for 
submarines. 

While  the  ship  was  coaling  at  Gibraltar,  the  nurses  were  given 
shore  leave.  American  jackies,  many  of  whom  had  not  seen 
an  American  girl  for  three  years,  came  alongside  and  took  the 
nurses  ashore.  The  United  States  Naval  Hospital  entertained 
them  for  tea.  The  Umbria  lay  under  the  Rock  for  three  days 
before  she  sailed  under  convoy  August  21  for  Genoa.  A  nurse's 
diary  described  their  convoy  as  follows : 

As  you  know,  the  Gulf  of  Gibraltar  and  the  Mediterranean 
were  a  nest  of  submarines.  We  sailed  Tuesday  afternoon  and 
such  a  sifjjht  1  shall  never  forget,  twenty-nine  beautiful  boats 
leaving  the  Old  Rock !  The  sea  was  calm  as  a  tub  and  we 
moved  out  singing  a  hymn  to  our  Blessed  ^Fother  and  also  a 
good-by  to  (libraltar,  the  latter  to  the  air  of  "Tipperary."' 

We  had  a  beautiful  P'rench  man-o'-war  in  front  of  us, 
whose  duty  it  was  to  look  out  for  mines  and  to  serve  as  our 
pilot  ship;  tlie  Admiral  of  the  fleet  was  on  this  man-o'-war. 
In  the  rear  was  a  large  Italian  man-o'-war.  which  we  calliMl 
our  "hull  do.U"."'  hecause  their  bow  reminded  us  of  a  l)ull 
dog's  nose.  This  is  the  largest  shi]i  in  the  fleet  and  could 
get  around  the  fastest, — she  was  constantly  around  tlie  fleet, 
sometimes  would  almost  go  out  of  sight,  on  the  lookout. 
Then  we  had  three  small  ijun-hoats,  one  each.  Enijlish,  Ameri- 
can and  Italian;  we  called  these  the  "fists."  as  tlioy  kept 
themselves  around  the  sides  and  ran  ahead  and   heliind  our 


670    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

fleet  looking  for  something  at  which  to  strike.  The  other 
boats  were  carrying  oil  and  provisions. 

We  spent  most  of  our  time  watching  the  ships  do  their 
silent  talking.  Our  Umbria  seemed  to  be  the  pet  of  the  fleet, 
she  was  put  in  the  center, — this  no  doubt  because  she  was  the 
only  one  carrying  women.  Every  Ally's  flag  was  taken  down 
shortly  after  we  left  the  Rock  and  only  the  signal  flags  were 
used.  Each  ship  had  her  own  peculiar  camouflage  paint. 
The  pilot  ship  received  all  wireless  messages  and  sent  them 
to  us.  They  had  boat  drills  twice  a  day,— a  sailor  gave  a 
signal,  our  boat  whistled  and  all  the  other  boats  answered, 
then  centered  around  us  at  rest,  or  changed  the  course  of 
position  of  their  ships. 

One  day  we  passed  a  large  school  of  porpoises  taking  a  sun 
bath.  We  saw  flying  fish  in  droves  and  it  was  almost  im- 
possible to  believe  they  were  not  black-birds.  Another  day 
one  flew  in  on  the  lower  deck;  it  was  very  pretty  and  after  a 
while  we  threw  it  back  into  the  water.  Several  times  our 
pilot  ship  swung  around  and  made  a  smoke  screen  through 
which  we  passed.  We  will  never  know  just  what  the  men  in 
the  crow's  nest  saw  to  make  them  so  cautious.  One  morning 
just  at  daylight,  two  innocent  looking  fishing  sailboats  were 
seen  at  our  left.  Our  "bull  dog"  put  out  her  signal  flag  and 
not  getting  the  satisfactory  response  signal,  she  made  for 
them.  We  do  not  know  what  happened  l)ut  eupposc  the  crew 
were  taken  prisoners  and  the  boats  sunk.  We  learned  later 
they  were  supply  boats  for  submarines.  The  night  of  August 
26,  a  neighbor  boat  came  up  near  enough  to  call  out:  "S.  S. 
Umbria,  put  out  your  light  on  aft  side."  An  officer  investi- 
gated and  found  that  one  of  the  ship's  crew  had  lighted  a 
cigarette  and  was  smoking. 

Of  their  safe  arrival  in  Genoa,  August  27,  a  member  of  the 
unit,  Blanche  Asber,  wrote : 

We  awakened  one  sunny  morning  in  the  harbor  of  this 
ancient  port  and  T  am  sure  our  heartfelt  thanks  at  ]Mass  tliat 
morning,  in  view  of  Columbus'  native  city,  were  no  less 
devout  than  were  bis  at  sight  of  our  own  native  land. 
Columbus  braved  unknown  hazards  (ignorance  is  bliss!)  but 
we  were  one  and  all  well  aware  of  the  danger,  which  thro\igli 
the  grace  of  (Jod.  we  passed  safely  and  every  member  of  our 
party  attributed  our  safe  voyage  to  our  invisible  convoys,  the 
many  prayers  which  were  offered  for  our  safe  and  happy 
journey. 


THE  EUROPEAN  WAR  671 

A  young  officer  remarked,  a  few  evenings  ago,  while  we 
were  discussing  the  wonderful  way  in  whicli  we  were  pro- 
tected :  "1  tell  you  1  wanted  to  pray  too,  sometimes,  but  I 
didn't  know  how,  so  when  the  rest  of  you  ])rayed,  I  just 
smoked  like  the  dickens  and  thanked  (lod  I  had  got  into  such 
good  company !" 

Miss  Asher  wrote  of  their  first  billet: 

The  United  t'^ates  military  band  met  us  at  the  docks 
and  T'nited  States  ambulances  conveyed  us  to  this  quaint  l)ut 
beautiful  old  building,  which  until  recently  was  a  convent. 
Sisters  are  in  charge  here  now,  assisted  by  returned  crijjpies 
from  the  front ;  poor  fellows,  they  look  thin  and  old,  but  are 
cheerful  and  courteous  aiul  do  not  invite  pity.  Jn  fact,  noth- 
ing about  the  town  or  its  inhabitants  suggests  war  much  more 
than  in  our  own  country.  We  were  awaiting  orders  to  proceed 
to  our  hospital  and  active  duty,  but  in  the  meantime,  the  offi- 
cers and  Father  arranged  us  in  sight-seeing  groups. 

Finally  on  September  5  Base  Hospital  Xo.  102  reached  its 
destination,  Vicenza,  Italy,  in  the  province  of  Venice,  about 
fifteen  miles  from  the  firing  line.  Italian  Sisters  turned  over 
to  the  American  unit  the  hospital  established  in  the  Rossi  In- 
dustrial School.  As  the  work  increased,  a  second  hospital  in- 
tended exclusively  for  Italian  medical  cases  was  opened  in  an 
orphan  asylum,  the  "Miscricordia."  At  the  outbreak  of  the 
infiuenza  epidemic  six  American  nurses  from  this  unit  were 
furnished  to  a  French  hospital  in  Vicenza.  Several  teams  con- 
sisting of  officers  and  enlisted  men,  but  no  nurses,  were  sent 
to  the  First  Aid  stations. 

Of  the  Eossi  Hospital,  Sara  M.  F.  Babb  wrote  Miss  Delano 
as  follows: 

The  Ttli  of  September  we  were  ordered  to  the  war  zone 
and  the  week  following  an  Italian  hospital  was  turned  over 
to  us.  At  ])rescnt  we  have  several  hundred  ])atients,  Italians, 
Americans  and  a  few  British.  We  have  also  had  the  ])rivilege 
of  caring  for  three  British  Ked  Cross  nurses,  who  were  doing 
work  in  our  little  city,  in  the  civilian  department  of  the 
British  Ked  Cross.  We  have  a  great  many  medical  cases, 
influenza,  jiueuiuonia  and  gassed  cases;  since  the  offensive 
started,  our  surgical  wards  are  filled  and  the  operating  rooms 
are  l)usy.  The  Frencli  hospital  here  asked  for  help  until 
their  nurses,   for   whom   tlu'V   luul    wired,   could   rcadi   them. 


672   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Six  of  our  nurses  were  lent.  In  the  immediate  future,  two 
other  hospitals  will  be  taken  over.  It  is  evident  we  are  going 
to  have  all  the  work  we  can  do  and  our  capacity  will  be 
taxed  to  the  utmost. 

But  I  think  you  are  most  interested  in  our  living  condi- 
tions. We  are  quartered  in  an  old  house  in  which  Sir  Walter 
Scott  would  have  loved  to  put  his  heroines.  The  entrance  is 
severe  and  forbidding,  great  heavy  oaken  doors,  with  iron 
gratings  in  front  of  which  is  stationed  the  patrol.  The  court- 
yard is  paved  with  cobble  stones  and  a  beautiful  rose  bush 
and  a  wisteria  vine  have  climbed  to  the  top  of  the  high  gray 
walls.  Under  broad  overhanging  eaves,  hundreds  of  doves 
make  their  home.  In  the  tower  there  is  a  winding  marble 
stairway  and  rooms  into  which  the  sunlight  never  falls.  To 
reach  my  room  I  have  to  go  up  four  stories,  through  a  nar- 
row hall,  up  another  flight  of  steps  into  another  hall,  out  on 
a  small  stone  terrace,  down  another  flight  of  steps  and  then 
into  my  room,  which  I  have  dubbed  the  "Crow's  Nest"  be- 
cause it  hangs  out  on  the  side  of  the  house  and  is  such  a 
splendid  post  for  observation.  I  have  one  tiny  casement 
window  into  which  the  Great  Bear  peers  at  night,  with  the 
smile  of  a  familiar  friend.  Aeroplanes  fly  low  over  the 
"Crow's  Xest"  and  from  the  stone  terrace  I  look  across  to 
snow-covered  mountains,  over  which  the  smoke  of  battle 
hangs  like  a  cloud.  The  roar  of  big  guns  is  like  thunder  in 
a  far-off  storm. 

Although  we  are  the  nearest  nurses  to  the  Italian  Front, 
we  have  many  of  the  comforts  of  moderns.  The  tomb  of 
Eomeo  and  Juliet  is  almost  near  enough  for  us  to  make  pious 
pilgrimages,  for  the  sake  of  all  the  old  loves  we  have  left 
behind.  We  have  moonlight  nights  such  as  Shakespeare 
conceived  and  Browning  loved  to  describe.  We  have  also  elec- 
tric lights,  three  bath  tubs  and  a  shower  and  an  abundance  of 
cold  running  water.  The  American  lied  Cross  in  liome  sent 
us  a  generous  shipment  of  silver,  china,  glassware,  table  linen, 
trays,  chairs  and  many  other  accustomed  home  appointments 
for  our  dining-room,  which  we  also  use  as  a  recreation  room. 
This  room  is  our  special  pride,  a  great  ball-room  splendidly 
lighted,  with  high  Venetian  windows  that  open  out  upon 
charming  balconies.  The  floor  is  inlaid  in  beautiful  design 
with  bits  of  marble  from  the  Mosque  of  Santa  Sofia  in 
Constantinople. 

We  have  no  lack  of  recreation,  our  Dibert  Club  has  put  on 
two  shows;  tlie  Y.  M.  C.  A.  gives  us  moving  pictures  aiid  the 
band  of  a  famous  British  regiment,  stationed  near  us,  comes 


THE  EUROPEAN  WAR  673 

over  to  play  for  us.  We  have  also  been  invited  to  the  British 
camp  for  four  o'clock  tea.  The  wife  of  the  American  consul 
in  Palermo  on  her  return  from  the  trenches,  where  she  had 
gone  to  sing  to  the  soldiers,  came  by  to  sing  for  us.  We  have 
had  a  great  cartoonist,  a  minstrel  show  by  the  enlisted  men 
and  an  inspiring  lecture  by  Professor  Clark  of  Cbicago  Uni- 
versity who  gave  us  "The  Latest  News  From  Home."  For 
thrills  we  have  had  a  few  air  raids.  It  is  very  unpleasant  to  be 
wakened  in  the  middle  of  the  night  and  made  to  run  for  your 
life  down  winding  stairs  in  the  dark.  On  the  way  I  wonder 
which  is  worse,  to  be  blown  up  or  to  die  of  a  broken  neck. 

On  October  24  the  Allied  offensive,  composed  of  fifty-one 
Italian,  three  British,  four  French  and  one  Czecho-Slovak 
division  and  one  American  regiment,  was  hurled  against  the 
Austrian  Armies.     Vicenza  felt  the  answer  of  Austria's  shells. 

Sara  Babb  wrote  IMiss  Daspit,  Director  of  Nursing  of  the 
Gulf  Division,  as  follows : 

I  shall  never  forget  the  opening  of  the  great  Italian  Drive. 
At  midnight  we  hoard  the  most  terrific  explosion,  our  old 
stone  house  that  has  stood  for  several  centuries  was  shaken 
to  the  foundation  and  the  guard  on  duty  at  our  door  was 
thrown  to  his  knees.  We  thought  we  were  in  another  air  raid 
and  the  nurses  began  to  run  down  stairs  for  the  refugie, 
sure  that  the  first  bomb  had  struck  us.  The  cannonading  was 
like  tiuinder  in  one  of  our  terrific  storms.  Next  day  the 
wounded  began  to  come  in,  bringing  news  of  the  battle. 
When  the  victory  was  won  the  people  were  wild  with  joy, 
held  great  demonstrations  and  the  children  went  through 
the  streets  singing,  "Viva  la  Pace !"  Several  of  our  doctors 
have  gone  to  the  dressing  stations  at  the  front.  Xone  of  tlie 
nurses  have  been  allowed,  as  yet,  to  go  in  spite  of  tlieir 
pleading. 

Tlie  victory  has  l)rought  to  us  a  feeling  of  security.  We 
are  gradually  em{)tying  our  air  raid  liags.  1  laughed  at 
breakfast  tin's  morning  when  one  of  the  nurses  began  to 
count  over  all  the  contents  of  her  air  raid  bag;  face  ])owil('r. 
perfume,  double  curling  tongs,  money  belt,  a  package  of  love 
letters  and  some  warm  clothing.  Isn't  that  the  psychology  of 
women  for  you  y  Nothing  so  strong  as  our  vanity. — neither 
fear  or  jnety  I  Kverybody,  though,  behaved  beautifully  in  the 
air  raids.  There  was  no  ]ianic.  only  a  little  grumbling  for 
being  awakeiu'd  in  the  middle  of  the  night  and  made  to  get 
up  out  of  a  warm  bed  and  run  for  life  down  a  dark,  winding 
stairway. 


674    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  nurse's  diary  reads  as  follows: 

October  30.  Many  more  thousand  prisoners  taken.  Ar- 
tillery fighting  heard.  An  eighteen-year-old  Ardite  stopped 
at  our  hospital  this  evening,  said  he  was  on  his  way  to  the 
front.  His  regiment  and  four  thousand  Americans  were 
going  over  the  top.  The  regiment  is  made  up  of  eighteen- 
year-old  boys  who  are  known  as  "Little  Devils."  They  carry 
a  bomb  under  each  arm,  a  knife  in  the  mouth  and  a  gun  at 
their  side.  The  lad  seemed  to  be  nervous, — said  he  did  not 
feel  well,  complained  of  a  sore  throat  and  cold,  but  said  that 
it  was  a  small  matter — when  he  got  to  running  that  would 
disappear. 

November  3.  At  11  P.M.  a  crowd  of  Italians  was  heard 
below  our  windows  shouting  and  cheering  the  Americans. 
The  official  bulletin  which  announced  that  all  firing  on  land, 
sea  and  air  was  to  cease  at  3  P.M.  tomorrow,  was  read  to  the 
patients.  The  poor  Italians  were  beside  themselves  with  joy. 
One  little  Ardite  hopped  out  of  bed  to  the  middle  of  the 
floor.  The  nurse  led  him  back  to  his  bed  and  told  him  to  stay 
there.  A  few  minutes  later  he  was  in  the  farthest  corner  of 
the  room  on  a  high  bench  waving  the  American  flag  and 
shouting  "Viva  I'America !"  Another  lad  with  a  drainage 
tube  in  a  badly  infected  arm,  pulled  out  the  tube  and  getting 
out  of  bed,  danced  around.  Only  these  poor  Italians  them- 
selves know  what  they  have  gone  through  within  the  last 
three  years. 

Xovember  18.  This  evening  at  6  o'clock,  fourteen  Aus- 
trian Red  Cross  nurses  were  brought  to  our  hospital  by  the 
United  States  Ambulance  Corps.  They  were  prisoners;  they 
asked  for  something  to  eat  and  a  night's  lodging.  They  were 
given  their  supper,  but  permission  to  keep  them  over  night 
was  refused  our  commanding  officer.  Orders  were  given  to 
watch  them  very  closely.  They  were  taken  to  the  Italian 
♦Sisters'  hospital,  about  ten  minutes'  ride  from  here,  two 
Italian  officers  guarding  them.  They  were  not  allowed  to 
open  their  bags  for  anything. 

December  17.  We  are  the  nearest  field  hospital  to  the 
Front  and  the  only  one  that  has  trained  nurses.  Xow  that 
the  war  is  over,  1  may  give  you  military  news.  Our  American 
Ambulance  Corps  (Ohio  boys)  brought  us  the  patients  from 
the  first  dressing  station.  After  the  drive  our  officers  took 
turns  of  three  or  four  in  going  to  the  relief  of  the  First  Aid 
station.  They  say  it  was  a  terrible  sight, — dead  men.  horses 
and  wounded  everywhere,  mostly  Austrians.  Among  the 
prisoners  was  an  Austrian  Red  Cross  nurse  and  we  had  her 


THE  EUROPEAN  WAR  675 

here  four  days  as  a  guest.     She  told  us  she  had  been  an 
.    Italian  prisoner  of  war,  but  was  treated  as  a  visitor.     She 
has  volunteered  to  remain  with  four  Austrian  soldiers  who 
were  dying  when  the  Austrians  retreated. 

Of  the  Italian  people,  Miss  Babb  wrote  Miss  Delano: 

The  spirit  of  the  people  of  Italy  is  inspiring.  In  the  faces 
of  the  old  men,  the  women  and  the  little  children  who  kneel 
witli  great  devotion  in  the  churches,  there  is  the  look  of  the 
early  Christian  martyrs, — patient,  uncomplaining  resigna- 
tion. Italy,  today,  is  worthy  of  her  glorious  past.  Since 
coming  here,  I  understand  why  great  souls  of  other  coun- 
tries have  loved  her  and  lived  and  died  for  her, — not  only 
because  of  her  beauty  and  her  old-world  charm,  but  because 
of  licr  heroic  soul  and  1  read  in  these  lines  of  Browning  a 
deeper  meaning: 

Open  my  heart  and  you  will  see 
Graved  inside  of  it,  "Italy." 
Such  lovers  old  are  I  and  she : 

Here,  as  everywliere,  the  hardest  task  of  the  T?ed  Cross  will 
come  with  peace.  The  need  for  work  along  public  health  lines 
is  a])palling. 


During  the  summer  of  1918,  the  Allies  landed  military  forces 
in  North  Russia  to  operate  against  the  Bolshevik  armies  which 
were  then  felt  to  be  strongly  pro-German.  The  situation  has 
been  described : 

The  rej)orts  concerning  the  activities  of  the  Czecho-Slovak 
troops  and  the  Allied  forces,  which  were  landed  at  ^lurmansk, 
Archangel  and  Vladivostok,  were  very  meager  and  conflict- 
ing throughout  the  war.  Eeports  given  out  by  the  Soviet 
government  of  Ihissia  and  the  various  governments  of  Sil)eria 
differed  widely  from  and  often  contradicted  those  given  out 
by  Allied  governments.  Therefore  the  material  contained  in 
this  section  cannot  be  strictly  vouched  for.  The  method  of 
obtaining  it  was  to  gather,  as  far  as  possible,  material  from 
Kur<)]K'an  and  American  sources  and  then  to  compare  it  and 
keep  that  matter  which  seemed  to  be  founded  on  fact.  .  .  . 

.\fter  the  l)olsheviki  had  made  peace  with  tlie  Central 
Powers,  their  attempts  to  pacify  that  j)art  of  Russia  which 
remained   in   their  hands  were  ratlier  unsuccessful.     A   con- 


676    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

siderable  army  of  Czecho-Slovaks  were  roaming  around  the 
central  part  of  Eussia,  attempting  to  reach  Vladivostok  and 
and  rejoin  the  Allies  in  order  to  down  their  hereditary  ene- 
mies, the  Germans  and  Austrians,  These  men  had  deserted 
from  the  forces  of  the  Central  Powers  and  had  fought  with 
the  Eussians  against  their  enemies.  When  the  Treaty  of 
Brest-Litovsk  was  signed  and  Eussia  retired  from  the  war, 
they  received  permission  from  the  Bolsheviki  to  cross  Siberia 
and  rejoin  the  xA-llies.  For  some  time,  their  relations  with  the 
new  rulers  of  Eussia  were  very  friendly.  Then,  presumably 
at  the  request  of  Germany,  the  Bolsheviki  ordered  them  to 
be  disarmed,  but  the  Czecho-Slovaks  resisted  and  conflicts 
occurred  between  them  and  the  Soviet  forces.  The  first  bat- 
tles began  in  the  latter  part  of  May  and  continued  through- 
out 1918  and  1919.  .  .  .8° 

The  reasons  for  the  assignment  of  Allied  forces  to  ]S[orth 
Russia  and  their  subsequent  activities  there  have  been  de- 
scribed : 

When  it  became  known  that  the  treaties  of  peace  between 
Germany  on  the  one  hand  and  Finland,  Eussia,  Eoumania 
and  the  Ukraine  on  the  other  were  to  be  used  by  Germany  as 
a  means  of  making  these  countries  subservient  to  Germany, 
the  Allies  determined  upon  a  certain  amount  of  military  in- 
tervention in  order  to  try  to  save  something  from  the  chaos 
that  existed  in  Eussia.  The  Allies  first  seized  the  region 
around  the  Murman  coast,  with  the  cities  of  Murmansk,  Kola 
and  Kem  (July,  1918).  The  purpose  of  this  was  to  prevent 
Germany  from  obtaining  submarine  bases  on  the  Arctic 
Ocean  and  from  seizing  control  of  the  Murman  railroad 
which  might  have  resulted  in  the  cutting  off  of  Petrograd 
from  the  rest  of  Eussia.  There  were  also  vast  quantities  of 
war  materials  there  which  had  been  ordered  by  the  old  Eus- 
sian  Government  and  which  had  never  been  paid  for.  From 
April  to  July,  1918,  the  Germans  and  their  Finnish  allies 
were  planning  an  attack  on  the  railroad  and  even  went  so 
far  as  to  build  a  railroad  across  Eussia  from  Finland  to  the 
neighborhood  of  Kem.  Consequently  in  July,  1918,  Allied 
forces,  including  Americans,  were  landed  at  Murmansk  and 
were  welcomed  by  the  anti-Bolshevik  inliabitants.  who  almost 
immediately  seceded  from  Eussia  and  established  an  inde- 
pendent government.  The  Allies  advanced  at  once  along  the 
railroad  and  seized  Kem. 

'""A  Reference  History  of  the  War,"  I.  S.  Guernsey,  p.  141,  Dodd,  Mead 
and  Company,  1920. 


THE  EUROPEAN  WAR  677 

...  On  August  4,  li)18,  it  was  announced  that  the  Allied 
troops  had  taken  posssession  of  Archangel,  after  ineffectual 
resistance  by  the  Bolsheviki.  The  Allies  (including  Ameri- 
cans) now  controlled  the  entire  coast  from  Archangel  to 
Murmansk.®^ 

Following  the  assignment  of  American  troops  to  North  Russia 
in  Julv,  li»18,  the  American  Red  C^ross  organized  a  commission 
to  take  a  shipload  of  foodstuffs  and  other  articles  to  Russia  on 
a  boat  which  would  be  under  the  protection  and  control  of  the 
United  States  Government.  The  personnel  of  this  commis- 
sion included  a  commissioner,  a  doctor,  a  sanitarian,  two 
nurses  and  two  executives  with  knowledge  of  storage  and  dis- 
tribution of  supplies. 

Alma  E.  Foerster  and  Beatrice  M.  Gosling  were  chosen  as 
the  two  nurses  of  the  American  Red  Cross  Commission  for 
North  Russia.  Miss  Foerster  was  the  daughter  of  a  Chicago 
clergyman.  Following  her  graduation  from  the  Presbyterian 
Hospital,  Chicago,  she  did  public  health  nursing  with  the 
Infant  Welfare  and  Jewish  Aid  Societies  there.  She  was  later  in 
charge  of  the  Out-Patient  Obstetrical  Department  of  Rush 
Medical  College.  She  was  enrolled  in  the  American  Red  Cross 
Nursing  Service  in  November,  1911.  Two  years  later,  she  did 
disaster  relief  work  in  the  Ohio  flood.  She  sailed  upon  the 
^lercy  Ship  in  1914  and  saw  sei'vice  in  Kief,  Russia,  and  later 
in  1917  and  1918,  with  the  Red  Cross  Commission  in  Roumania. 
Of  that  sturdy  temperament  which  regarded  hardships  and 
emergencies  only  as  a  challenge  to  greater  resourcefulness  and 
more  persistent  good  humor,  ^liss  Foerster  proved  herself  an 
indefatigable  worker  and  an  able  executive.  Her  heroic  work 
at  Archangel  rounded  out  Red  Cross  service  which  covered  four 
years  and  which  brought  her  in  1919  the  Florence  Nightingale 
Medal  of  the  International  Red  Cross. 

Beatrice  ]\[.  Gosling,  of  ^lilburn,  New  Jersey,  was  graduated 
from  the  Prospect  Heights  Training  School,  Brooklyn,  New 
York.  She  did  public  health  nursing  at  H(Mirv  Street  Settle- 
ment, New  York  City,  and  was  for  some  years  engaged  in  social 
service  work  with  the  New  York  Association  for  Improving  the 
Condition  of  the  Poor.  Her  first  Red  Cross  service  was  with 
the  Commission  for  Kouinania  in  1917. 

^lajor  (^harles  T.  Williams,  of  Baltimore,  ]\raryland,  form- 

"  "A  Rcforenco  History  of  tlio  War."  pp.   142-14.'?. 


678    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

erly  in  1917  American  Red  Cross  Commissioner  for  Roumania, 
was  appointed  Commissioner  for  Russia.  Major  William  D, 
Kirkpatrick,  Medical  Corps,  U.  S.  A.,  of  Bellingham,  Washing- 
ton, was  his  deputy ;  Major  Kirkpatrick  had  served  at  Dr. 
Ryan's  hospital  in  Belgrade  in  1914,  and  later  with  the  Ameri- 
can Red  Cross  Commission  for  Roumania.  Eight  other  men, 
including  a  motion  picture  camera  man,  Lieutenant  Harold  M. 
Wyckoff,  formed  Major  Williams'  staff.  Mrs.  Aurora  N.  Mer- 
riman,  of  Minneapolis,  Minnesota,  secretary  to  the  Commis- 
sioner, was  the  only  other  woman  besides  Miss  Foerster  and 
Miss  Gosling  to  accompany  the  party  of  eleven. 

The  unit  mobilized  during  the  last  week  of  August,  1918, 
in  ISTew  York  City.  Transportation  for  the  personnel  and  for 
their  four  thousand  and  two  hundred  tons  of  food  and  medicine, 
valued  at  one  million  and  a  half  dollars,  was  secured  on  a  mer- 
chant steamer,  the  Ascutney. 

Miss  Foerster  described  the  spirit  in  which  the  unit  cm- 
barked,  August  30,  1918,  and  their  subsequent  reversal  of  feel- 
ing upon  arrival  a  month  later  at  Archangel : 

You  remember  on  what  an  indefinite  mission  we  started, 
how  useless  it  seemed  to  send  two  nurses  when  there  would  be 
no  nursing  for  them?  What  we  found  was  more  work  than 
we  could  possibly  handle. 

Our  ship,  only  a  five  thousand  ton  vessel,  was  a  very  smooth 
sailer.  They  turned  the  wheel  house  into  two  cabins  for  us 
women.  The  crew  and  the  gun-crew  seemed  to  appreciate 
having  us  on  board.  After  five  weeks  on  the  Ascutney,  whose 
engines  were  constantly  giving  us  much  difficulty  and  worry, 
we  finally  reached  Archangel,  September  29.  Here  on  the 
quay  we  were  astonished  to  see  American  soldiers.  With 
tears  in  their  eyes,  those  lonesome,  homesick  boys  breathlessly 
told  us  how  glad  they  were  to  see  and  talk  with  American 
women,  how  tliey  had  been  there  only  a  month  but  it  seemed 
a  year  to  them,  how  disappointed  they  were  to  have  been  sent 
there  rather  tlian  to  France,  how  already  sixty-eight  of  their 
number  had  died  of  influenza. 

Major  Williams  summarized  the  military  situation  in  North 
Russia : 

The  whole  Archangel  district  is  more  or  less  under  mili- 
tary control.  There  are  a])proximately  twelve  thousand 
.M-iod  trn(i]!s   (five  thousand  Americans),  in  this  part  of  the 


THE  EUROPEAN  WAR  679 

country.  Tliey  were  landed  here  early  in  September  but  not 
until  the  Bolsheviki  had  been  able  to  remove  southward  or 
else  destroy  most  of  the  vast  quantity  of  ammunition  and 
stores,  which  were  here  last  year.  I  have  within  an  hour  re- 
turned from  Bakaritza,  which  twelve  months  ago  was  the 
great  Eussian  military  depot.  Today  it  looks  like  another 
place.  In  lieu  of  airplanes,  guns,  steel  rails  and  limitless 
piles  of  ammunition  and  supplies  either  for  the  Russian 
Army  or  Roumania,  there  are  now  only  those  of  the  British 
and  American  Armies.  .  .  . 

The  Bolshevik  forces  in  which  German  elements  are  found 
from  time  to  time,  are  facing  the  Allies,  Americans,  English 
and  French,  on  a  battle  front  approximately  one  hundred  and 
twenty-five  miles  south  of  Archangel.  Along  this  line,  there 
is  almost  continual  fighting  and  practically  every  day 
wounded  Americans  and  others  arrive  in  Archangel.  Up  to 
two  weeks  ago.  General  Poole,  of  the  British  Army,  was  Com- 
mander-in-Chief of  the  Allied  Forces.  He  has  since  gone  to 
London  and  there  are  intimations  that  General  Ironsides  will 
succeed  him. 

In  regard  to  the  civil  situation,  there  is  bound  to  be  suffer- 
ing in  the  remote  districts  as  soon  as  the  ice  closes  in.  We 
are  arranging  for  sled  service  and  expect  to  be  able  to  do 
what  we  can  for  emergencies.  While  we  are  now  able  to  get 
only  about  one  hundred  and  twenty-five  miles  to  the  south, 
there  is  a  vast  region  east  and  west,  occupied  by  people  whose 
needs,  according  to  reports,  must  be  great.  Since  our  arrival 
in  Archangel,  we  have  been  deluged  by  requests  for 
assistance.®^ 

^liss  Foerster  wrote  of  their  first  days  in  the  bleak  northern 
port :  "It  was  verv  muddy  indeed  and  it  rained  continually. 
There  were  no  hotel  accommodations  so  we  remained  on  ship- 
board. In  October,  however,  it  began  to  snow  and  the  ugliness 
of  the  little  town  was  blanketed  in  white." 

Major  Williams  wrote : 

Archangel  is  just  about  as  crowded  this  year  as  last.  Brit- 
ish and  American  soldiers  are  everywhere.  Our  doughboys 
patrol  tlie  streets.  .  .  . 

The  Troitsky  Prospect  on  which  the  American  Pod  Cross 
headquarters  is  located  is  Archangel's  Great  Wliite  Way, 
except  that  Broadway  has  no  cobblestones,  less  nnid  and  slusli 

"Report  written  Oct.  15,  1918,  by  Major  Williams  to  Georj^'e  1?.  Case, 
War  Council,  National  Headquarters,  Wasliintrton,  i).  C. 


680   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  no  drainage  system  which  inclines  from  the  sidewalk  to  a 
trough  of  mud  in  the  middle  of  the  street.  Here  and  there 
the  houses  have  been  torn  by  Bolshevik  bombs.  Dame  Rumor 
is  not  helpful :  "Wait  till  we  are  frozen  in  and  the  Bolsheviki 
are  coming  through  from  the  south  on  the  ice  and  drive  us 
into  the  White  Sea  !" 

There  were  only  nine  American  women  in  Archangel.    Miss 
Foerster  enumerated  them : 

There  were  five  Y.  W.  C.  A.  girls  who  had  been  working 
along  the  Volga  River  with  the  Russian  girls  but  left  Petro- 
grad  when  the  diplomats  did.  They  came  back  from  Stock- 
holm to  Archangel  with  additional  Y.  M.  C.  A.  men  and 
established  a  hostess  house,  visited  American  boys  in  the 
British  hospitals  and  worked  in  the  Y.  M.  C.  A.  canteens. 
Then  there  was  Mrs!  Davis,  the  wife  of  a  consul,  and  also  a 
young  woman  employed  in  the  Embassy.  Mrs.  Merriman 
left  us  in  December,  so  we  nurses  make  up  the  nine. 

Of  the  first  work  of  the  commission,  Miss  Foerster  wrote 
Miss  Delano,  October  5  : 

We  immediately  saw  that  our  social  service  work  was  out 
of  the  question.  This  proved  a  greater  disappointment  to 
Miss  Gosling  than  to  me  because  I  don't  mind  hospital  work 
especially  when  we  can  care  for  our  own  boys.  They  do  need 
us.  We  are  less  than  a  drop  in  the  bucket.  They  still  come 
to  us  in  relays  to  tell  us  with  tears  in  their  eyes  how  glad  they 
are  to  see  us.  .  .  . 

We  two  are  the  only  trained  nurses  in  all  Xorthern  Russia 
now  occupied  by  the  Allies.  There  is  an  English  girl  who 
visits  the  soldiers  but  no  British  nurses.  There  are  three 
hospitals,  one  of  them  a  small  Russian  hospital  which  we  have 
not  yet  been  a])le  to  locate,  the  Interallied  Base  Hospital  of 
three  hundred  beds;  and  a  little  American  Red  Cross  hospi- 
tal of  thirty  beds.  The  British  doctor  in  charge  of  the  Inter- 
allied Base  was  in  command  of  one  of  the  hospitals  in  Rou- 
mania  before  the  Red  Cross  took  it  over,  so  we  have  met  an 
old  friend.  There  are  about  fifteen  Russian  Sisters  of 
Charity  in  his  institution ;  almost  starving,  they  asked  the 
authorities  to  feed  them  in  return  for  their  care  of  the  troops. 
In  the  wards  American,  British  and  French  orderlies  assist 
several   American   Army  doctors. 

I  wish  vou  could  see  the  little  American  Red  Cross  hospital  I 


THE  EUROPEAN  WAR  681 

It  is  located  in  a  small  Russian  chapel  and  has  twenty  beds 
in  the  church  proper,  two  beds  at  the  altar  rail,  and  eight 
along  the  two  sides.  A  long  table  down  the  center  serves 
for  reading  and  dinner  table.  There  are  two  small  rooms  on 
one  side  with  about  six  patients  in  them  and  another  cubby 
hole  in  the  front  with  three  officers  in  it.  A  little  reception 
room  on  the  other  side  serves  as  an  operating  and  dressing 
room.  It  is  really  only  a  small  convalescent  home,  but  my ! 
how  our  boys  do  love  this  little  place!  Soldiers  off  duty  come 
here  and  you  should  hear  them  brag  about  this  tiny  spot  of 
the  U.  S.  A. ! 

This  hospital  later  became  the  "Annex." 

The  first  work  of  the  American  Red  Cross  Commission  for 
North  Russia  was  the  establishment  of  a  hospital  for  American 
sick  and  wounded  soldiers.  These  cases  had  previously  been 
cared  for  at  the  Interallied  Base,  which  was  maintained  largely 
by  the  British.  Miss  Foerster  wrote  of  Miss  Gosling's  and  her 
work  during  the  interval  while  Major  Williams  endeavored  to 
secure  a  suitable  building  for  the  future  Red  Cross  Military 
Hospital : 

Our  entire  plans  had  to  be  changed  immediately  to 
"Americans  first."  Miss  Gosling  did  such  civilian  relief 
work  as  was  absolutely  necessary.  With  Captain  [Daniel 
O'Connel]  Lively,  she  visited  the  scliools  and  taught  how 
cocoa  should  be  prepared.  From  our  supplies  they  furnished 
cocoa,  sugar,  condensed  milk  and  a  little  hard-tack  biscuit, 
for  the  emaciated  children.  By  April  1.  one  hundred  and 
seventy-eight  schools  had  been  visited  and  thirteen  thousand 
youngsters  supplied  with  eight  hundred  thousand  hot  school 
lunches. 

In  the  meantime,  I  helped  in  the  small  operating  room  in 
the  "Annex.*'  .  .  .  Some  hours  each  day  I  spent  at  the  con- 
valescent depot,  accommodating  about  one  hundred  and  fifty 
light  cases.  The  Hed  Cross  also  supplied  tiiis  place  with  extra 
food.  We  had  British  rations,  and  our  own  supf)lies,  so  we 
were  not  starving  as  in  Roumania.  How  good  our  white 
bread  and  beef  and  bacon  tasted ! 

Through  the  cooperation  of  Ambassador  Francis  and  of  Presi- 
dent Tchaykovskv,  ^lajor  Williams  secured,  October  15,  for 
hospital  purposes,  a  building  previously  nscd  as  a  school  by  the 
local  nu'tcorological  department.  ^lajor  William  II.  Henry, 
of  the  Medical  Corps,  was  assigned  by  the  Chief  Surgeon  of 


682   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  American  Expeditionary  Forces  to  duty  as  commanding 
officer  of  the  American  Red  Cross  hospital  established  in  this 
school.  Major  Williams  cabled  for  ten  nurses  to  staif  the 
hospital  but  the  British  Government  would  not  permit  National 
Headquarters  to  send  them.  Miss  Foerster's  report  contained 
the  following  comment: 

The  reason  we  had  no  relief  nurses  sent  us  is  very  plain 
now,  but  it  did  seem  cruel  then  when  we  needed  them  so 
badly.  The  British,  in  charge  of  the  situation  up  there,  would 
not  vise  any  passports  for  women  to  Archangel.  It  was  true 
that  the  slii])s  from  England  to  Murmansk  M-ere  very  bad 
but  we  nurses  during  this  war  have  put  up  witii  many  incon- 
veniences and  I  know  any  nurse  would  have  felt  doubly  repaid 
when  she  found  out  how  much  she  was  needed. 

Our  American  Red  Cross  Hospital  was  located  in  an  old 
but  fairly  clean,  white  building  on  the  quay  street,  overlook- 
ing the  Dviiia  Kiver.  With  my  little  Russian  vocabulary,  I 
was  able  to  direct  the  maids  in  cleaning.  We  also  had  four 
washerwomen.  We  almost  despaired  of  ever  getting  linen  dry 
before  it  froze. 

It  was  hard  work  for  me  at  first  alone.  Miss  Gosling  was 
naturally  more  interested  in  the  public  health  work  which 
she  had  come  over  to  do.  .  .  .  Later,  however,  she  supervised 
the  work  of  the  Army  orderlies.  Her  mechanical  turn  of 
mind  expressed  itself  cleverly  in  little  improvements,  such 
as  wooden  trays  for  the  bed  patients,  wood  boxes  in  the  halls, 
improvised  closets,  extra  tables  and  chairs. 

Major  Williams  placed  me  in  charge  of  the  operating  room 
as  well  as  of  the  hospital.  As  in  the  Annex  I  did  any  steril- 
izing in  the  basement  on  the  kitchen  stove  imtil  Major  Kirk- 
patrick  conceived  the  happy  idea  of  building  a  brick  stove 
under  our  big  linen  sterilizer. 

In  addition  to  their  own  stores,  the  American  Red  Cross 
Commission  for  Nortli  Russia  received  generous  hospital  sup- 
plies from  the  Red  Cross  Commission  for  Great  Britain.  Miss 
Foerstcr  described  some  of  these  articles: 

We  had  nice  iron  cots,  good  mattresses,  plenty  of  linen, 
pajamas,  socks  and  towels.  Fortunately  wc  had  brought  from 
New  York  a  number  of  extra  things  which  we  feared  might 
be  hard  to  secure  in  Russia.  Among  these  was  a  sewing  ma- 
chine. 1  secured  a  clever  Russian  woman  and  showed  her 
how  to  make  operating  gowns,  caps  and  masks. 


Looking  across  the  frozen  Dvina  River  to  the  American  Red  Cross  Hospital 
(left)    at  Arcliangel,  Russia. 


Two  types  of  ambulance  used   ])y   tlic  Aiiierieau  Expeditionary   Forces 
in  Xortli   Russia. 


THE  EUROPEAN  WAR  683 

We  never  had  to  look  about  for  help;  the  Russians  were 
only  too  eager  to  work  for  us  in  return  for  tlie  good  food  we 
gave  them.  Fortunately,  too,  for  us  was  the  assignment  to 
our  liospital  of  American  Army  cooks.  I  made  the  eggnogs 
and  did  the  necessary  invalid  cooking  myself.  Hggs  were  one 
dollar  each,  but  for  one  e^^i;^  we  traded  a  pound  of  Ked  Cross 
rice,  costing  us  about  six  cents.  .  .  . 

^liss  Foerster  wrote  of  their  living  conditions: 

Our  hospital  accommodated  seventy  patients,  but  about 
twenty  of  the  personnel  also  slept  there.  Our  wards  were 
very  light  and  had  an  average  of  ten  beds.  Major  Henry,  in 
charge  of  the  hospital,  had  a  room  upstairs,  as  also  did  Miss 
Gosling  and  I.  We  covered  what  had  formerly  been  tiie  coat 
rack  with  blankets  and  hung  our  clothes  on  it.  This  impro- 
vised closet  really  separated  our  room  into  two  parts  and  gave 
us  considerable  privacy.     Our  meals  were  served  here. 

Our  coldest  weather  was  thirty-seven  degrees  below.  We 
managed  nicely  to  keep  warm  with  our  twenty-two  stoves. 
Major  Williams  bought  us  black  coats  lined  with  sheep  skin, 
and  we  wore  brassards  on  the  sleeve.  Knitted  caps  protected 
our  ears.  We  got  out  into  the  fresh  air  almost  every  day. 
]\Iiss  Oosling  enjoyed  particularly  the  skating.  Our  engi- 
neers had  also  built  a  toboggan  slide  and  there  were  reindeer 
sled  rides,  and  we  took  a  trip  to  Murmansk  by  dog  train. 

The  patients  at  the  American  Red  Cross  Military  Hospital 
at  Archangel  were  medical  and  lightly  wounded  surgical  cases 
from  among  the  soldiers  of  the  American  N^orth  Russian  Expe- 
ditionary Force.  Allied  fighting  had  increased  in  the  Archangel 
district  in  the  fall  of  1!»1S.  The  military  situation  at  that 
time  has  been  summarized  as  follows: 

Many  towns  along  the  Dvina  Kiver  were  occupied  })v  the 
Allied  aiul  American  troops.  Kadish,  in  the  province  of 
Archangel,  was  occupied  on  October  IS.  IDIS.  During  the 
latter  half  of  October  and  in  early  November,  the  lighting 
seemed  to  favor  the  Bolshevik  forces.  The  Czeciis  were  driven 
from  Samara  and  reported  tliat  without  immediate  assist- 
ance they  would  not  be  alile  to  hold  out  much  longer.  The 
Allies  were  forced  to  abandon  some  of  their  newly  won  ground 
along  the  Dvina  (Kadish)  but  succeeded  in  driving  the  Hol- 
sheviki  across  the  Finnish  l)ord(>r  from  Karelia. 

The  signing  of  the  .Vrmistice  with  (Jermanv.  contrarv  to 


684   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  expectations  of  many  people,  did  not  bring  to  a  close  the 
hostilities  in  Russia.  No  official  declaration  of  war  had  ever 
been  made  against  the  Bolsheviki  and  consequently  a  legal 
state  of  war  did  not  exist,  although  fighting  continued.  .  .  . 
The  Allies  advanced  up  the  Onega  River  in  the  Archangel 
district,  for  a  distance  of  fifteen  miles  on  December  30  and 
recaptured  Kadish  and  made  their  rather  precarious  position 
more  secure. 

During  1918  and  1919  the  whole  situation  in  Russia  and 
Siberia  was  still  unsettled.  Arguments  were  rife  in  Allied 
countries  as  to  what  should  be  done.  Some  contended  that  a 
large  force  should  be  sent  into  Russia  and  Bolshevism 
crushed,  while  others  maintained  that  the  armies  should  be 
withdrawn  and  Russia  permitted  to  work  out  her  own  salva- 
tion.   The  question  was  for  the  Peace  Conference  to  decide.^^ 

The  American  ISTorth  Russian  Expeditionary  Force  was  re- 
called in  the  spring  of  1919.  The  American  Red  Cross  Hos- 
pital was  closed  in  April  and  Miss  Foerster  and  ]\Iiss  Gosling 
returned  to  the  United  States  as  soon  as  the  ice  broke  and  the 
Arctic  Ocean  was  open  again  to  navigation.  Moreover,  eighteen 
British  nurses  had  arrived  for  duty  at  the  Interallied  Base  and 
the  sick  and  wounded  among  the  American  troops  were  sent 
there  until  the  American  Force  was  withdrawn. 

The  American  Red  Cross  Hospital  at  Archangel  had  a  record 
of  six  hundred  and  twenty-two  patients.  Four  hundred  and 
thirty-eight  of  these  were  medical  and  one  hundred  and  eighty- 
four  were  surgical  cases.  Seventy-two  operations  were  per- 
formed. Only  three  American  soldiers  died  at  this  hospital 
just  below  the  Arctic  Circle. 

""A  Reference  History  of  the  War,"  p.  143. 


CHAPTER  VIII 


SERVICE    WITH    THE    NAVY 


Organization  of  Units — Uniforms  and  Insignia — Navy  Nurs- 
ing Service  in  the  United  States — Navy  Nursing  Service  in 
Foreign  Stations — Detached  Service  of  Navy  Nurses 

FOUR  outstanding  accomplishments  of  the  American 
Navy  during  the  participation  of  the  United  States  in 
the  European  War  were  the  successful  escort  duty 
furnished  to  American  troops  and  supply  ships  in  home  and 
foreign  waters;  American  mine  and  patrol  activities  in  the 
North  Sea ;  the  re-fitting  for  transport  duty  of  the  interned 
German  liners;  and  the  accomplishments  of  the  Marine  Corps 
in  France.  For  the  combatant  Navy,  the  most  formidable 
dangers  were  German  submarines  and  mines ;  in  addition  there 
were  the  risks  of  collision  and  the  natural  perils  of  winds  and 
sea.  As  for  the  Marine  Corps,  it  faced  and  checked  the  ad- 
vancing enemy  divisions  in  the  Bois  de  Belleau  during  the  third 
German  offensive  of  May  30,  1918,  on  Paris;  its  accomplish- 
ment on  that  occasion  and  in  the  subsequent  Inter-Allied  offen- 
sive of  July  18  to  November  11  needs  no  further  comment 
here. 

The  accident  and  casualty  list  of  the  American  Navy  during 
the  period  beginning  April  G,  1917,  and  ending  November  15, 
1918,  numbered  117  officers  and  893  enlisted  men;  that  of  the 
Marine  (\)rps  totalled  201  officers  and  5084  enlisted  men.-^ 
Responsibility  for  the  sick  and  wounded  of  the  ^Marine  Corps 
and  the  combatant  Navy  in  home  and  foreign  waters,  and  for 
medical  and  accident  cases  of  the  Navy  personnel  in  training 
in  the  United  States  was  vested  in  the  Bureau  of  Medicine  and 
Surgery,  Navy  Department. 

>  Report  of  the  SocTctary   of  the  Navy,    1918,  pp.   212-255;    310-322. 

()S5 


686    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

By  Act  of  Congress,^  during  the  year  1908,  the  Navy  Nurse 
Corps  came  into  being  as  part  of  the  Bureau  of  Medicine  and 
Surgery,  of  which  Rear  Admiral  William  C.  Braisted  was  then 
Surgeon  General.  Esther  Voorhecs  Hassan  was  its  first  super- 
intendent. Though  of  New  England  ancestry.  Miss  Hassan 
was  born  in  Maryland.  Following  her  graduation  from  the 
New"  Haven  Training  School  for  Nurses,  she  served  both  as 
staff  and  chief  nurse  in  the  Isthmian  Canal  Service,  Army 
Nurse  Corps.  Her  name  has  appeared  previously  in  this  his- 
tory in  connection  with  the  Spanish-American  War.  Katrina 
Hertzer,  who  represented  the  Navy  Nurse  Corps  at  National 
Red  Cross  Headquarters  during  the  European  War,  wrote  of 
Miss  Hasson : 

^Yhen  the  Xavy  Nurse  Corps  was  established,  Miss  Hasson 
was  given  the  appointment  as  Superintendent,  August  18, 
1908,  on  account  of  the  splendid  service  slie  rendered  under 
the  Army  during  the  Spanish- American  War  on  the  United 
States  Sl  S.  Relief. 

When  the  Corps  was  first  established  no  public  quarters  for 
nurses  nor  an  appropriation  to  finance  them  were  available. 
The  nurses  were  allowed  commutation  for  quarters  and  sub- 
sistence. Miss  Hasson  leased,  furnished  and  financed  quar- 
ters at  541  Twenty-first  Street,  N.  W.,  Washington,  D.  C. 
These  were  the  only  quarters  available  in  Washington  until 
the  present  quarters  on  the  Naval  Medical  School  Reservation 

'601.  Establishment  of  the  Nurse  Corps.  (Act  of  May  13,  1908). 
"The  Xiirse  Corps  (female)  of  the  United  States  Navy  is  hereby  established 
and  shall  consist  of  one  superintendent,  to  be  appointed  by  the  Secretary 
of  the  Navy,  who  shall  be  a  graduate  of  a  hospital  training  school  having 
a  course  of  instruction  of  not  less  than  two  years,  whose  term  of  office 
ma}'  be  terminated  at  his  discretion  and  of  as  many  chief  nurses,  nurses, 
and  reserve  nurses,  as  may  be  needed:  Provided,  That  all  nurses  in  the 
Nurse  Corps  shall  be  appointed  or  removed  by  the  Surgeon  General  with 
the  approval  of  the  Secretary  of  the  Navy,  and  that  they  shall  be  grad- 
uates of  hospital  training  scliools  having  a  course  of  instruction  of  not 
less  than  two  years.  Tlie  appointment  of  superintendent,  chief  nurses, 
nurses,  and  reserve  nurses  shall  be  subject  to  an  examination  as  to  their 
professional,  moral,  mental  and  physical  fitness,  and  they  shall  be  eligible 
for  duty  at  naval  liospitals  and  on  board  of  liospital  and  ambulance 
ships  and  for  such  special  duty  as  may  be  deemed  necessary  by  the  Surgeon 
General  of  the  Navy.  Reserve  nurses  may  be  assigned  to  active  duty  when 
the  necessities  of  the  .service  demand  and  when  on  such  duty  shall  receive 
the  pay  and  allowances  of  nurses:  Provided.  That  they  shall  receive  no 
compensation  except  when  on  active  duty.  The  superintendent,  chief  nurses, 
and  nurses  shall,  respectively,  receive  the  same  pay,  allowances,  emolu- 
ments and  privileges  as  are  now  or  may  hereafter  be  jirovided  by  or  in 
pursuance   of   law   for   the   Nurse   Corps    (female)    of   the   Army." 


SERVICE  WITH  THE  NAVY  687 

were  completed  in  1910.  She  managed  the  quarters  so  well 
that  when  they  were  disposed  of  after  the  completion  of  gov- 
ernment quarters,  the  nurses  realized  from  them  not  only  all 
they  had  i)ut  in  l)ut  a  considerahle  bonus. 

Miss  Hasson  designed  the  indoor  uniform  and  the  insignia 
of  the  Navy  Nurse  Corps.  During  her  incumbency  as  super- 
intendent nurses  were  assigned  to  the  Naval  Hospitals  in 
Washington,  New  York,  Norfolk,  Annapolis  and  Mare  Island, 
California. 

She  resigned  from  the  Navy  Nurse  Corps  in  January,  1911, 

Lenah  Sntclitfe  Iligbce  was  the  second  superintendent  of  the 
Navy  Nurse  Corps.  She  was  born  in  Chatham,  England,  but 
received  her  training  at  the  New  York  Post  Graduate  Hospital, 
New  York  City.  Later,  she  became  a  citizen  of  the  United 
States.  Before  joining  the  Navy  Nurse  Corps,  she  was  en- 
gaged in  institutional  nursing  in  Bellevue  and  Allied  Hospitals 
(Fordham).  Her  enrollment  in  the  American  Red  Cross  Nurs- 
ing Service  dated  from  ^fay,  1912.  She  was  a  w^oman  of 
strong,  quiet  personality  and  her  native  English  reserve  was 
impregnated  with  a  keen  sense  of  justice  and  of  proportion 
which  greatly  endeared  her  to  the  members  of  her  Corps. 

Requirements  for  enrollment  in  the  Navy  Nurse  Corps  were 
set  forth  in  the  Circular  of  Information  for  Persons  Desiring 
to  Enroll  in  the  United  States  Naval  Reserve  Forces  as  Nurses : 

A  candidate  for  enrollment  as  nurse  is  first  examined  for 
enrollment  in  tlie  provisional  grade  of  nurse.  United  States 
Reserve  Force.  After  her  enrollment  is  accomplished,  should 
she  so  desire,  she  may  make  request  for  active  duty  for  con- 
firmation in  grade  and  after  the  completion  of  a  minimum 
period  of  three  months,  active  service,  she  is  again  examined 
and  if  found  qualified  is  confirmed  in  grade. 

A  member  must  be  a  citizen  of  the  United  States. 

A  member  enrolls  or  re-enrolls  for  a  term  of  four  years. 

The  minimum  active  service  required  for  maintaining  tlie 
efficiency  of  a  member  (Naval  Coast  Defense  Reserve),  is 
three  months  during  each  term  of  enrollment.  This  active 
service  may  be  in  one  period  or  in  periods  of  not  less  than 
three  weeks  each  year. 

A  member  receives  retainer  pay  of  $1'^  per  annum  while 
enrolled  in  lier  provisional  grade.  ]irovided  she  makes  sucli 
reports  concerning  her  movements  and  occupation  as  may  be 
required  by  tlie  Secretary  of  the  Xavy.  After  confirniation 
in  grade,   ber  annual   retained  pay  is  two  months"  base  pay 


688    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  nurse  in  the  Xavy.  Retained  pay  is  in  addition  to  any 
pay  to  which  a  member  may  be  entitled  by  reason  of  active 
service.  As  noted  below,  numbers  of  the  Volunteer  Naval 
Reserve  do  not  receive  any  retained  fee. 

Enrollment  of  persons  shall  be  made  in  the  Naval  Coast 
Defense  Reserve,  Class  4,  or  Volunteer  Naval  Reserve  for 
duty  in  the  Naval  Coast  Defense  Reserve,  Class  4,  U.  S.  Naval 
Reserve  Force.  (Members  of  Volunteer  Naval  Reserve  re- 
ceive no  retainer  fees  or  uniform  gratuity  in  time  of  peace, 
but  when  on  active  duty  receive  the  service  pay  of  their  grade 
and  service.) 

A  candidate  for  enrollment  as  above,  must  be  between  23 
and  44  years  of  age,  and  a  citizen  of  the  United  States  and 
unmarried.  She  must  be  a  graduate  of  a  reputable  training 
school  connected  with  a  recognized  general  hospital  giving 
not  less  than  two  years  continuous  training.  Candidates  for 
enrollment  from  states  where  State  Board  laws  are  operative, 
are  required  to  be  registered. 

A  certificate  of  enrollment  in  the  American  Red  Cross  will 
be  accepted  in  lieu  of  the  above  (professional)  certificates.^ 

In  three  respects  the  Navy  ISTurse  Corps  set  up  requirements 
of  no  little  embarrassment  to  its  reserve,  the  American  Red 
Cross  Nursing  Service. 

First,  it  was  required  that  a  candidate  for  the  naval  services 
be  a  woman  of  the  highest  professional  training  and  of  mature 
judgment,  because  she  was  expected  to  have  entire  charge  of 
the  nursing  education  of  the  hospital  apprentices  of  the  Navy. 
When  in  the  exigency  of  war  the  Red  Cross  Nursing  Service 
let  down  its  enrollment  bars  to  admit  young  graduates  of 
smaller  institutions,  the  Navy  Nurse  Corps  refused  to  accept 
these  nurses,  on  the  ground  that  they  lacked  the  experience  and 
the  years  which  make  for  proficient  instructors. 

The  second  point  covered  physical  condition  and  was  de- 
scribed in  a  circ\ilar  letter  sent  in  June,  1917,  by  Miss  Noyes  to 
all  Committees  on  Red  Cross  Nursing  Service : 

Perfect  pliysical  condition  is  essential.  Overweight  or  im- 
perfect eyesight,  unless  corrected  by  glasses,  will  debar  a 
nurse  from  enrollment.  A  chest  expansion  of  not  less  than 
two  inches  and  freedom  from  organic  diseases  of  any  kind  is 
imperative. 

"■Nav.  375,  March  31,  1917,  Govornmenf  Printinfr  Office,  Washington,  D.  C. 


SERVICE  WITH  THE  NAVY  689 

The  requirement  covering  eyesight  proved  particularly  trouble- 
some. Miss  Noyes  once  remarked  to  Mrs.  Higbee :  "Does  the 
Navy  contemplate  making  sharp-shooters  out  of  your  nurses?" 
But  the  most  formidable  recjuirement  of  the  Corps  was  that 
its  members  be  of  American  citizenship.  However,  when  the 
pending  shortage  of  nurses  was  foreseen  in  1917,  the  Navy 
lowered  this  requirement.  A  statement  covering  this  change 
was  given  in  a  postscript  written  by  Miss  Delano  and  attached 
to  a  letter  written  by  Miss  Noyes  in  June,  1917,  to  chairmen 
of  State  and  Local  Committees  on  Red  Cross  Nursing  Service : 

Since  writing  the  enclosed  letter  we  have  been  advised  that 
a  law  has  recently  been  passed  making  it  possible  to  enroll 
nurses  who  have  tai<en  out  their  Declaration  of  Intention, 
providing  they  were  l)orn  in  the  countries  of  the  Allies.  This 
holds  good  only  for  nurses  who  are  expecting  to  sign  the  cer- 
tificate of  enrollnuMit  for  the  Voluntary  Naval  Reserve,  but 
does  not  apply  to  those  nurses  who  would  wish  to  come  into 
the  Reserve. 

Nurses  are  requested  to  submit  to  this  oflfice  an  affidavit  to 
the  effect  that  they  have  taken  out  their  Declaration  of  In- 
tention in  order  that  we  may  forward  it  to  the  Navy  Depart- 
ment for  their  files. 

The  Superintendent  of  the  Navy  Nurse  Corps  has  also 
advised  us  that  nurses  will  be  given  the  privilege  of  enrolling 
in  the  Naval  Reserve  Force  or  they  may  come  into  the  Navy 
through  the  Volunteer  Reserve.  This  latter  enrollment  does 
not  carry  with  it,  however,  the  definite  advantages  to  the 
nurses  as  does  enrollment  in  the  Naval  Reserve  Force. 
Nurses  are  expected  to  serve  as  long  as  the  emergency  exists. 

As  was  the  case  with  the  Army,  the  relations  of  the  Red  Cross 
Nursing  Service  and  the  Navy  Nurse  Corps  during  the  war 
were  at  all  times  intimate  and  cordial.  In  September,  ll»l(J, 
General  Braisted  assigned  Katrina  Hertzcr,  a  chief  nurse  of 
the  Navy  N^irse  Corps  and  one  of  the  members  of  the  Mercy 
Ship  Expedition  of  1914,  to  represent  the  Navy  Nurse  C(»rps 
at  National  IIead(iuarters.  ^liss  Hertzer  was  attached  to  Miss 
Delano's  staff;  she  aided  in  the  enrollment  of  nurses  and  was 
liaison  officer  Ix'tween  the  Nursing  Service  and  the  Navy  Nurse 
Corps. 

Some  months  before  ^fiss  Hertzer's  assignment  to  National 
neadcpiarters,    Admiral    Braisted   had   detailed    Dr.    Tlu^xlore 


690    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Rieliards,  Medical  Director,  U.  S.  Navy,  to  act  in  a  similar 
capacity  between  the  Bureau  of  Medicine  and  Surgery  and  the 
Department  of  Military  Relief,  National  Headquarters.  Dr. 
Richards  also  served  as  assistant  Director  General  of  the 
Department  of  Military  Relief,  of  v^^hich  Colonel  Kean  was 
Director  General.  On  August  30,  1917,  the  War  Council  cre- 
ated a  Bureau  of  Naval  Affairs  within  the  Department  of 
Military  Relief  and  Lieutenant  Commander  Richards  was 
appointed  as  director. 

As  international  events  during  the  year  1916  pointed  more 
and  more  to  participation  by  the  United  States  in  the  European 
War,  the  Red  Cross  was  authorized  to  undertake  the  organiza- 
tion of  sanitary  units  for  the  Navy  as  well  as  for  the  Army. 
Dr.  Richards  summarized  the  need  of  organizing  and  equip- 
ping Navy  base  hospitals  in  time  of  peace  for  service  in  v;ar: 

Although  navies  in  general,  our  own  included,  are  com- 
monly said  to  be  always  on  a  "war  footing,"  the  statement 
obviously  omits  from  consideration  the  well-known  fact  that 
enormous  expansion  of  the  personnel  will  occur  coincident 
with  or  immediately  subsequent  to  the  outbreak  of  hostilities. 
It  is  furthermore  apparent  that  such  expansion  must  take 
place  with  great  rapidity,  since  active  naval  operations,  so  far 
as  concerns  the  United  States,  might  be  appreciably  deferred 
pending  the  transportation  of  large  bodies  of  men  overseas. 
Step  by  step  Avith  enlistments  in  the  naval  service  come  de- 
mands for  hospital  facilities  and  unless  these  have  been  pre- 
pared in  excess  before  the  outbreak  of  war,  great  difficulty  will 
be  encountered  in  keeping  pace  with  the  growing  demands. 

Under  peace  conditions,  our  naval  hospital  facilities  have 
been  necessarily  limited  to  current  needs.  Public  opinion  in 
this  country,  as  reflected  in  Congress,  has  never  countenanced 
the  expenditures  which  would  be  involved  by  hospital  con- 
struction and  equipment  in  excess  of  such  requirements.  It 
was  foreseen,  of  course,  that  at  any  time  upon  the  outbreak 
of  war  Government  funds  would  he  available  in  ample  amount 
and  that  the  problem  which  would  then  confront  the  ^ledical 
Department  of  the  Army  and  Navy  w^ould  be,  not  the  lack  of 
money,  but  inability  to  expand  it  rapidly.  As  a  matter  of 
fact,  exactly  this  condition  })revailcd  last  spring  and  summer 
(1917)  when  it  was  found  that  the  available  markets  of  the 
world  would  not  immediately  suffice  to  procure  in  sufficient 
amount  medical  and  surgical  equipments  which  might  have 
been  urgently  needed.     Fortunately,  the  international  situa- 


SERVICE  WITH  THE  NAVY  691 

tion  was  such  that  opportunity  was  afTorded  to  meet  the  more 
pressing  demands  as  they  arose.* 

Of  the  initial  call  which  the  Navy  Department  made  upon 
the  American  Eed  Cross,  Dr.  Kichards  wrote: 

Under  the  nomination  of  the  Surgeon  General  of  the  Xavy, 
I  was  assigned  to  duty  in  charge  of  the  Bureau  of  Naval 
Affairs,  American  Ked  Cross,  for  the  special  purpose  of  or- 
ganizing five  Xavy  base  hospitals  which  the  Surgeon  (Jeneral 
considered  desirable.  My  connection,  therefore,  with  this 
undertaking  dates  back  to  July,  191(5,  at  which  time  no  equip- 
ment for  any  of  the  base  hospitals  had  been  procured.  As 
there  was  then  a  serious  shortage  of  personnel  at  l?ed  Cross 
Headquarters,  the  supervision  of  this  work  for  both  the  Army 
and  the  Navy  hospitals  was  temporarily  turned  over  to  me. 

Navy  base  hospitals  differed  from  those  of  the  Army  chiefly 
in  size.  Housing  at  a  naval  base  or  station  was  at  all  times  a 
serious  consideration.  In  view  of  this  problem,  hospitals  of 
250  bed  capacity  were  determined  upon.  Further,  it  was  be- 
lieved, in  consideration  of  the  small  size  of  the  Navy  in  com- 
parison with  the  Army,  250  bed  hospitals  would  fully  meet 
the  needs  of  the  Xaval  bases ;  certaiidy  they  could  be  more 
(piickly  set  up  than  500  bed  hospitals.  The  personnel  of  these 
first  Naval  base  hospitals  included  ten  doctors  (later  raised  to 
twenty-eight),  forty  nurses  (later  raised  to  fifty)  ;  fourteen 
nurses'  aides  (later  raised  to  twenty-six)  ;  twenty  reserve  nurses 
(later  changed  to  fifteen  reserve  nurses  and  twenty-five  reserve 
nurses'  aides)  ;  and  other  personnel,  approximately  ninety- 
eight,  necessary  to  care  for  a  two  hundred  and  fifty  bed  hos- 
pital (later  raised  to  five  hundred). 

As  a  guide  to  chi(>f  nurses  in  selecting  a  staff,  !Miss  Noyes 
S(uit  out  circulars  of  information  which  defined  the  dlff'erent 
divisions  of  executive  and  other  professional  details  of  the 
nursing  staff"  and  the  number  of  nurses  needed  for  each  division. 
She  recommended  that  at  least  three  of  the  forty  nurses  should 
have  had  practical  experience  in  the  care  of  contagious  diseases. 
Similar  outlines  relating  to  the  nurses'  aides  were  also  issued. 

Nurses  and  nurses'  aides  desiring  service  in  Navy  bas(^  hos- 
pital units  were  recpiired  to  enroll  in  the  American  lied  Cross. 
I>ocal  Chapters  undertook  the  raising  of  funds  by  means  of 
*l'.  .s'.  Xaval  Bullttin,  Aprib   1!)18,  p.    184. 


692    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

which  equipment  for  Navy  base  hospitals  was  purchased  and 
stored. 

After  the  declaration  of  war  by  the  United  States,  the  Navy 
called  upon  the  American  Red  Cross  to  organize  three  more 
base  hospitals  in  addition  to  the  five  original  ones  organized 
in  1916. 

Between  April  4,  1917,  and  November  11,  1918,  the  Ameri- 
can Red  Cross  Nursing  Service  assigned  339  nurses  to  the 
eight  Navy  base  hospitals  organized  by  the  Red  Cross.  A  list 
of  these  columns  will  be  found  in  the  Appendix. 

Up  and  down  the  long  coast  line  of  the  Atlantic  seaboard 
were  located  numerous  Naval  stations.  Upon  the  declaration 
of  war,  these  were  in  need  of  Naval  hospitals.  Admiral  Braisted 
in  June,  1917,  authorized  the  organization  of  ten  naval  station 
hospital  units.  A  circular  letter  issued  at  that  time  by  Dr. 
Richards  gave  more  complete  information : 

At  the  request  of  the  Surgeon  General  of  the  Navy,  the 
Bureau  of  Naval  Affairs,  American  Eed  Cross,  has  under- 
taken to  organize  a  new  group  of  units  to  be  known  as  "Navy 
station  hospital."  These  units  are  for  the  purpose  of  sup- 
plying in  part  the  personnel  for  a  number  of  new  hospitals 
now  being  erected  at  various  naval  stations  along  the  At- 
lantic Coast  and  at  one  or  two  points  elsewhere  within  the 
United  States,  for  care  of  the  rapidly  expanding  naval  per- 
sonnel. 

With  a  view  to  drawing  as  lightly  as  possible  upon  the 
civilian  profession,  only  five  medical  officers  will  be  required 
for  each  unit.  Additional  members  to  fill  the  complement 
will  be  furnished  by  the  Surgeon  General  from  young  officers 
already  enrolled  in  the  Naval  Reserve  Force.  No  equipment 
will  be  required,  but  if  funds  are  available  for  the  purchase  of 
X-ray  or  dental  outfits,  ambulances,  etc.,  such  donations  will 
be  gladly  accepted. 

Naval  station  units  called  for  an  initial  staff  of  from  ten  to 
twenty  nurses,  one  of  whom  was  authorized  to  act  as  head  nurse 
until  the  unit  was  called  into  service.  The  same  requirements 
of  enrollment,  physical  examination  and  immunization  existed 
for  this  service  as  for  other  military  units. 

In  size  and  purpose.  Naval  station  units  corresponded  in 
many  respects  to  hospital  units  for  the  Army.  As  did  their 
sister  formations  in  tlie  Army,  these  units  of  organization 
proved  exceedingly  popular  with  smaller  institutions,  the  staff's 


SERVICE  WITH  THE  NAVY  693 

of  which  could  not  provide  the  specialization  or  stand  the  drain 
of  personnel  necessary  for  such  elaborate  organizations  as  base 
hospitals. 

There  was  swift  expansion  of  the  Navy  immediately  after 
April  (),  1917,  and  the  Bureau  of  Medicine  and  Surgery  found 
it  expedient  to  authorize  the  organization  by  the  lied  Cross  of 
ten  additional  Naval  station  hospital  units.  Twenty-one  units 
in  all  were  thus  organized  by  National  IIead(iuarters  and  180 
Red  Cross  nurses  were  assigned  to  active  service  in  the  Navy 
Nurse  Corps  through  these  units.  A  list  of  them  appears  in 
the  Appendix. 

The  smallest  and  most  numerous  of  the  three  types  of  nurs- 
ing units  which  were  organized  by  the  American  Red  (Voss 
for  the  Navy  was  the  Navy  detachment.  As  early  as  October  6, 
1910,  Miss  Delano  wrote  to  all  superintendents  of  schools  of 
nursing  in  the  United  States : 

...  It  is  now  our  intention  to  develop  Xavy  units  from 
among  the  graduates  of  various  schools  which  have  not  al- 
ready been  called  upon  to  organize  base  hospital  units,  and 
have  selected  your  school  as  one  of  the  number  to  be  respon- 
sible for  maintaining  such  a  unit  for  service  with  the  Xavy 
in  the  event  of  war.  These  units  will  be  called  upon  only  in 
time  of  war  aiid  may  I  suggest  tbat  you  consult  with  your 
Board  of  Managers  and  secure  their  permission  to  maintain 
at  all  times  a  "Navy  detachment  of  nurses''  in  connection 
with  your  school. 

While  it  is  probable  that  Xavy  detachments  will  be  as- 
signed to  duty  in  their  own  locality  in  hospitals  established 
by  the  Xavy,  they  should  be  willing  to  acce])t  service  else- 
where. Preference  should  be  given  to  nurses  under  forty 
years  of  age  and  to  citizens  of  the  Thiited  States.  Whenever 
possible  these  units  should  consist  of  twenty  nurses  including 
the  head  nurse.  The  majority  of  the  nurses  should  he  ex- 
perienced surgical  nurses  with  one  or  two  anesthetists.  If 
absolutely  unable  to  maintain  a  unit  of  twenty  nurses  in  con- 
nection with  your  sctiool,  arrangements  can  doubtless  be  made 
to  authorize  a  smaller  number.  There  will  be  no  medical 
personnel  attached  to  tliese  units.  .  .  . 

Following  the  severance^  of  diplomatic  relations  with  Ger- 
many on  February  .">,  1917,  .Miss  Xoyes  wrote  to  the  superin- 
tendents of  lifty  training  schools  then  organizing  Navy  de- 
tachments : 


694   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Under  the  present  uncertain  conditions,  we  believe  that  we 
should  rush  the  completion  of  our  Xavy  detachments  as  rap- 
idly as  possible.  Should  our  country  be  so  unfortunate  as  to 
become  involved  in  war  the  Navy  would  probably  be  the  first 
engaged.  Under  such  circumstances  large  numbers  of  re- 
serve nurses  would  be  required.  In  anticipation  of  these 
needs  you  were  asked  to  enroll  a  group  of  selected  nurses 
around  your  school. 

Will  you  kindly  notify  me  preferably  by  telegram  what 
progress  you  have  made,  the  number  of  nurses  enrolled  and 
their  names?  The  enrolled  Red  Cross  nurse  has  always  an- 
swered the  call  for  service  willingly  and  promptly.  Let  us  not 
be  found  unprepared  should  our  country  need  us  now ! 


Five  hundred  and  forty  American  Red  Cross  nurses  were 
assigned  to  active  duty  in  the  Navy  Nurse  Corps  as  members 
of  Nav^y  detachments.  A  list  of  these  units  appears  in  the 
Appendix. 

Of  the  1500  American  nurses  serving  in  the  Navy  Nurse 
Corps  at  the  time  of  the  signing  of  the  Armistice,  1058  of  them 
had  been  mobilized  through  the  American  Red  Cross  Nursing 
Service.  This  number  was  sixty-six  per  cent  of  the  total 
strength  of  the  Navy  Nurse  Corps. 

When  the  United  States  entered  the  European  War,  the 
Navy  Nurse  Corps,  like  that  of  the  Army,  had  no  distinctive 
outdoor  uniform  for  its  nurses.  American  Red  Cross  nurses 
assigned  to  the  Navy  Nurse  Corps,  when  on  duty  in  the  wards 
of  Navy  hospitals,  wore  the  white  wash  uniform  of  their  school, 
with  the  Red  Cross  cap,  brassard  and  cape.  When  off  duty 
they  wore  civilian  clothes. 

The  first  Navy  nurses  to  serve  overseas  were  those  attached 
to  United  States  Navy  Base  Hospital  No.  1.  This  formation 
had  been  organized  by  the  American  Red  Cross.  When  its 
nurses  arrived  in  New  York  early  in  September,  1017,  for 
embarkation  overseas,  they  were  furnished  witli  the  blue  serge 
dress,  the  ulster,  the  velour  hat  and  other  articles  of  equipment 
which  the  American  Red  Cross  was  then  issuing  to  Army  base 
hospitals  assigned  to  foreign  service. 

The  following  instructions  were  issued  by  the  Surgeon  Gen- 
eral and  were  forwarded  November  IG,  1017,  by  ]\Irs.  Higbee 
to  ^liss  Delano : 


SERVICE  WITH  THE  NAVY  695 

Outdoor  Uniform  for  Members  of  the  Navy  Nurse  Corps 
Skirt  and  coat  of  heavy  dark  blue  serge.  .  .  . 
Wash    waists,   cotton   cheviot,   dark   blue   flannel,   dark  blue 

silk.  .  .  . 
Top  coat:  dark  blue  heavy  coating,  smooth  finish,  similar  to 

Navy  "cap  cloth."  .  .  . 
Cape:^  heavy  long  cape  of  cap  cloth.  .  .  .  Light  cape,  navy 

blue  serge  lined  with  flannel. 
Sweater    of  any  weight  desired ;  color,  dark  or  navy  blue  or 

.  gray. 
Baiji  coat:  Coat  of  tan  cravenette,  or  rubber,  and  rubber  hat. 
Hat:  Navy  blue  velour.  .  .  . 

Boots  or  shoes:  Black,  heels  not  higher  than  "Cuban;"  heavy 
soles;  under  certain  conditions  the  Surgeon  General  may 
authorize  tan  boots  for  heavy  walking. 
Hosiery:  black  with  black  boots  or  shoes;  tan  with  tan  boots 

or  shoos;  white  with  white  boots  or  shoes. 
Rubber  overshoes. 
High  rubber  boots. 

Corps  Insignia:  to  be  worn  on  duty  always  with  wash  uni- 
forms and  on  waists  of  outdoor  uniform,  when  such  uni- 
form is  ordered.     Collar  device  for  outdoor  uniform: — 
The  letters   T^   S.   for  members  of  the   Kegular   Nurse 
Corps,  and  U.  S.  R.  for  reserve  nurses  and  Nurses'  Re- 
serve Force:  to  be  worn  %  incli  from  collar  openings  on 
collar  of  coat  or  suit,  top  coat  or  heavy  cape;  Corps  de- 
vice to  be  worn  ^  iuf'h  from  letters  1"  S.  or  U.  S.  R. ; 
collar  devices  shall  not  be  worn  except  when  in  full  out- 
door uniform  or  when  top  coat  and  heavy  cape  are  worn 
over  wasli  uniform  in  hospital  reservation. 
Nurses  in  the  I'nited  States  are  not  obliged  to  obtain  the 
entire  outdoor  uniform  except  when  so  ordered  by  the  Sur- 
geon General.     No  part  of  this  uniform  shall  be  worn  on  duty 
in  hospital  or  hos])ital  reservation,  uidess  so  ordered  by  the 
Surgeon  General,  except  that  the  top  coat,  heavy  cape  or  light 
cape  or  rain  coat  or  authorized  sweater,  shall  be  worn  over 
wash  uniform  for  protection  and  warmth;  and  no  other  gar- 
ment shall  be  worn  with  uniform. 

(Signed)     \\.  C.  Brai.sted. 

The  collar  (hn'ico  referred  to  above  consisted  of  a  gold 
acorn  on  a  gold  oak-loaf,  which  was  superimposed  upon  the 
characteristic  gold  anchor  of  the  Xavy  Df^j^artmciit.  The 
letters  N.  N.  C.  in  gold  appear  upon  the  oak-leaf  and  acorn. 
Iveserve  nurses  who  had  entered  the  Xavy  Nurse  Corps  through 

■'Optional  fnr  duty  oNorseas. 


696   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  American  Red  Cross  Kursing  Service  were  allowed  to  wear 
the  Red  Cross  cap  and  the  Red  Cross  cape  from  which  the 
emblem  of  the  society  had  been  removed. 

Specifications  for  the  indoor  uniform  of  members  of  the 
Navy  iS^urse  Corps  were  transmitted  by  Mrs.  Higbee  to  Miss 
Delano  on  November  21,  191Y: 

White  uniform:  for  members  of  the  Navy  Corps,  Navy  Re- 
serve Force  and  Reserve  Nurses,  U,  S.  Navy,  who  are  not 
already  equipped  with  uniforms,  shall  consist  of  a  one-piece 
dress,^'  as  illustrated,  with  attached  soft  collar  and  attached 
belt.  .  .  . 

When  authorized  by  the  Surgeon  General,  the  wash  uni- 
form shall  consist  of  a  gray  chambray,  one-piece  dress,  as 
illustrated,  supplemented  with  white  collars  and  cuffs,  as 
illustrated,  and  with  an  apron  of  approved  style.  .  .  . 

While  the  Surgeons  General  of  the  Navy  and  the  Army  had 
been  working  out,  during  the  early  autumn  of  1917,  the  specifi- 
cations for  the  distinctive  outdoor  uniforms  for  their  respective 
Nurse  Corps,  the  American  Red  Cross  War  Council  had  had 
under  consideration  the  equipment  of  all  Red  Cross  personnel 
for  foreign  service.  As  has  already  been  stated  in  Chapter  VI, 
National  Headquarters  felt  that  it  was  the  responsibility  of 
the  Government  to  equip  Red  Cross  nurses  assigned  to  Federal 
service  but  the  recommendation  to  this  effect  of  the  Surgeon 
General  of  the  Army  to  Secretary  Baker  "was  returned  disap- 
proved, with  the  remark  that  it  was  not  the  policy  of  the  War 
Department  to  make  clothing  allowances  during  the  war."  ^ 

Upon  the  request  of  the  Surgeon  General  of  the  Army,  the 
Red  Cross  undertook  the  complete  equipment  of  both  regular 
and  reserve  members  of  the  Army  Nurse  Corps  at  an  individual 
cost  not  to  exceed  $200.00  per  nurse.  This  ruling  was  extended 
to  embrace  all  members  of  the  Navy  Nurse  Corps  who  were 
assigned  to  foreign  service.  Limited  articles  of  equipment  also 
were  given  to  nurses  assigned  for  duty  on  hospital  ships. 

Early  in  August,  1018,  a  change  in  the  insignia  to  be  worn 
by  members  of  the  Navy  Nurse  Corps  was  made.  General 
Braisted  on  August  9,  1918,  sent  ]\Iiss  Delano  a  print  of  the 

°"  The  gray  chambray  uniform  must  be  included  in  equipment  for  duty 
overseas. 

'See  letter  written  Sept.  26,  1917,  by  the  Acting  Surgeon  General, 
U.  S.  A.,  to  Col.  Kean,  Chap.  VI. 


SERVICE  WITH  THE  NAVY  697 

new  design.  "The  device  is  supplied  in  pairs  and  is  to  be  worn 
on  either  side  of  the  colhir  of  coat  or  suit,  top  coat  and  cape, 
the  anchor  to  be  horizontal  with  point  toward  and  one  inch 
from  opening  of  the  collar.  The  use  of  the  letters  'U.  S.'  and 
'U.  8.  !{.'  as  a  part  of  the  collar  device  of  the  Nurse  Corps  is 
herewith  countermanded."  In  a  letter  written  August  24, 
1918,  to  Miss  Delano,  General  Braisted  pointed  out  that  "the 
elimination  of  the  letters  'U.  S.'  and  'U.  S.  11.'  materially  re- 
duces the  amount  expended  on  the  Collar  Devices  of  the  Navy 
Nurse  Corps." 

In  Augiist,  1918,  after  Congress  had  raised  the  pay  for 
members  of  the  Army  and  Navy  Nurse  Corps  from  $50  to  $60 
a  month  for  service  in  the  United  States,  and  from  $60  to  $70 
for  service  overseas,  the  Surgeon  General  of  the  Navy  author- 
ized all  members  of  the  Navy  Nurse  Corps  on  duty  in  Naval 
hospitals  in  the  United  States  to  wear  the  outdoor  uniform 
which  had  hitherto  be(>n  worn  only  by  Navy  nurses  in  foreign 
service.  General  Braisted  on  August  30,  1918,  sent  a  copy 
of  this  ruling  to  Miss  Delano : 

1.  The  uniform  ap])roved  by  the  Secretary  of  the  Navy  fur 
members  of  the  Xavy  Nurse  Corps  will  be  worn  by  all  mem- 
bers of  the  Navy  Nurse  Corps  assigned  to  active  duty;  and 
instructions  liave  been  sent  to  the  Commandir^g  Officers  of 
Naval  hospitals.  Naval  stations,  hospital  and  ambulance 
ships  and  Xavul  transports,  that  there  shall  be  no  distin- 
guishing marks  in  the  uniforms  of  nurses  otber  than  those 
which  denote  their  othcnal  status. 

2.  It  is  a])])reciate(l  that  the  cajje,  which  is  issued  by  the 
Equijunent  Bureau  to  the  nursses  who  have  entered  the  Naval 
service  through  the  American  Ked  Cross,  is  a  satisfactory 
and  desirable  garment  to  be  worn  over  the  wash  uniforms.  In 
order  to  ])roni()te  contentment  and  etliciency.  however,  it  is 
inadvisable  that  tiiis  garment  should  be  issueil  to  some  nurses 
who  are  on  duty  and  not  to  others,  it  is  sugirestcd.  there- 
fore, that  the  American  Ked  Cross  consider  the  advisability 
of  giving  this  garnient  to  all  nurses  on  active  duty  who  sul)- 
mit  a  request   for  the  caj)e. 

This  ruling,  as  did  tlie  ruling  made  August  IT),  lOlS,  by  the 
Surgeon  GciHM'al  of  the  Army,  rcmovinl  entirely  the  licd  C^ross 
emblem  from  the  uniform  of  American  lied  Cross  nurses  as- 
signed to  Naval  service. 


698   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Three  hundred  and  thirty-four  (334)  members  of  the  Navy 
Is^urse  Corps  were  furnished  full  equipment  for  foreign  service 
by  the  American  Red  Cross  through  the  Bureau  of  Nurses' 
Equipment,  Atlantic  Division  Headquarters,  New  York  City, 
at  a  total  cost  of  $60,120.00.  Nurse  members  of  Navy  base 
hospitals  which  had  been  assigned  to  foreign  service  before  the 
full  list  of  equipment  had  been  authorized  on  October  30,  1917, 
by  the  War  Council,  were  furnished  the  supplementary  articles 
due  them  under  this  later  ruling,  through  the  office  of  the  Chief 
Nurse,  American  Red  Cross  in  France.  Navy  nurses  in  for- 
eign service  were  allowed  to  replace  worn  out  articles  of  wear- 
ing apparel  by  purchases  made  at  cost  from  the  Nurses'  Equip- 
ment Shop,  which  was  maintained  at  Paris  by  the  Red  Cross. 

On  April  6,  1017,  the  United  States  Navy  numbered  65,777 
enlisted  and  enrolled  personnel  and  had  a  complement  of  one 
hundred  and  ninety-seven  ships  in  commission.  Hospital  fa- 
cilities for  this  peace-time  Naval  force  had  been  provided  by 
the  erection  and  maintenance  of  permanent  base  hospitals  situ- 
ated at  the  principal  Naval  bases  along  the  Atlantic  and  Pacific 
seaboards  and  in  insular  and  foreign  waters. 

After  the  United  States  declared  war,  the  Navy  Department 
underwent  an  immediate  and  unparalleled  expansion  by  the 
utilization  of  personnel  of  the  Naval  Alilitia,  the  National 
Naval  Volunteers  and  the  United  States  Naval  Reserve,  and 
by  the  construction  of  new  ships  and  the  conversion  of  pleasure 
and  commercial  craft  to  war  uses.  On  November  11,  1918,  the 
Navy  Department  numbered  497,030  men  and  women,  with  a 
complement  of  2003  ships. 

The  training  of  this  enlarged  Navy  took  place  in  camps  in 
the  various  Naval  districts  in  the  United  States  and  at  schools 
for  specialists.  The  Naval  Academy  at  Annapolis  was  en- 
larged ;  ^'officer  material  schools"  were  hastily  improvised. 
Such  a  school  for  officers  of  the  Pay  Corps  was  established  at 
Princeton,  N.  J.  Deck  and  engineer  officers  for  the  merchant 
type  ships  were  trained  at  a  special  school  which  was  located  at 
the  Naval  Training  Camp,  Pelham  Bay  Park,  New  York  City, 
and  at  branches  of  the  school  in  Chicago,  Cleveland  and  at 
Stevens  Institute,  Hoboken,  New  Jersey.  Officers  for  the 
Flying  Corps  were  trained  at  the  Navy  Ground  Schools  at  the 
^Massachusetts  Institute  of  Technology,  the  I'niversity  of  Wash- 
ing-ton, Dinwoody  Industrial  Institute  at  ^linneapolis  and  the 


SERVICE  WITH  THE  NAVY  699 

Naval  Traiiiinji;  Station,  Great  Lakes,  Illinois.  Flio;lit  officers 
received  post-gradnate  instruction  at  Naval  air  stations  at  home 
and  abroad;  submarine  officers  at  the  Submarine  Base,  New 
London,  (.\)nnecticut ;  torpedo  officers  at  the  Naval  I'orpedo 
Station,  Newport,  Rhode  Island;  turbine-engine  officers  at  the 
Naval  Turbine  Engineering-  School,  Carnegie  Institute,  Pitts- 
burgh, Pa. 

Seamen,  firemen  and  certain  classes  of  petty  officers  and 
specialists  were  trained  at  the  four  Regular  Naval  training 
stations  which  had  existed  prior  to  the  war.  The  total  capacity 
of  these  stations  which  had  originally  housed  six  thousand  re- 
cruits, was  increased  to  well  over  one  hundred  thousand.  To 
supplement  these  four  principal  stations,  a  new  training  camp 
was  established  in  each  Naval  district,  either  at  Naval  stations 
or  on  land  loaned  on  nominal  lease  to  the  Navy  Department. 
Special  schools  for  trained  mechanics,  artisans  and  cooks  were 
also  established.  Naval  training  units,  which  offered  college 
students  '^opportunity  to  continue  their  education  along  the 
usual  channels,  at  the  same  time  electing  Naval  subjects  and 
receiving  military  drill  and  instruction,  were  established  in  over 
ninety  educational  institutions  of  collegiate  grade."  '^ 

To  care  for  the  sickness  which  inevitably  occurred  among 
these  large  groups  of  men  brought  together  under  new  and 
often  more  strenu(nis  habits  of  living  than  the  men  had  been 
used  to,  the  liureau  of  ^ledicine  and  Surgery  increased  the 
hospital  capacities  of  the  Navy  from  three  thousand  to  sevcn- 
te(>n  thousand  beds  in  the  United  States  alone.  Of  the  fifteen 
hundred  members  of  the  Navy  Nurse  Corps  who  saw  active 
service  during  th(>  European  War,  approximately  eleven  hun- 
dred of  tlunii  served  in  Naval  hospitals  in  the  Ignited  States. 
Three  hundred  nurses,  the  nursing  staffs  of  the  first  five  base 
hospitals  organiz(Hl  and  ecpiipped  by  the  AmcTican  Red  Cross 
for  the  Navy  I)t>pnrtment,  were  assigned  to  service  in  foreign 
waters  and  a  brief  account  of  their  experiences  will  be  given 
in  a  subse(iuent  section. 

Previous  to  April.  1017,  the  Bureau  of  ^Medicine  and  Sur- 
gery, Navy  Department,  had  established  and  maintained  Xaval 
hospitals  at  the  four  pc^rmanent  Naval  training  cam]>s.  at  Xaval 
bases  and  stations  along  the  Atlanti(^  and  Pacific  S(>ab();n'(ls  and 
iimong  insular  and  foreign  possessions  of  the  Dnited  States. 
Following  the  dechiration  of  war,  the  Navy  Department  greatly 

'  Aniuuil  lleport  of  tlif  Secretary  of  the  Navy:    Fiscal   Year.    I'.US,  p.  SO. 


700   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

enlarged  the  capacity  of  these  permanent  Navy  hospitals  and 
erected  additional  ones  in  the  various  newly  established  Naval 
training  camps  and  stations.  In  the  Annual  Report  of  the 
Secretary  of  the  Navy,  for  the  fiscal  year,  1917-1918,  Jose- 
phus  Daniels  wrote : 

As  an  illustration  of  the  hospital  expansion  in  the  naval 
service  may  be  cited  the  case  of  the  Naval  Hospital,  Norfolk, 
Va.,  wliich  during  one  quarter  of  the  year  preceding  the  war, 
had  an  average  of  two  hundred  patients  and  during  the  last 
quarter  of  1917  had  1,100  patients.  In  May,  1918,  this  hos- 
pital was  caring  for  thirteen  hundred  cases,  of  whom  five 
hundred  were  in  a  fully  equipped  camp  of  more  than  twenty 
buildings,  complete  in  all  matters  of  heating,  lighting,  water 
supply  and  sewerage.^ 

Elizabeth  H.  Dwycr  was  one  of  the  nurses  assigned  to  the 
Norfolk  Navy  Hospital.     She  wrote: 

Norfolk  Naval  Hospital,  curiously  enough,  is  situated  in 
the  town  of  Portsmouth  on  the  Elizabeth  River,  which  sepa- 
rates the  two  cities  and  the  hospital  is  styled  Norfolk  in 
order  to  save  confusing  it  with  the  Portsmouth,  N.  H.,  Naval 
Hospital.  It  was  the  first  U.  S.  Naval  hospital  to  be  built 
and  it  was  completed  in  1828.  Previous  to  the  period  of  the 
European  War,  the  hospital  could  take  care  of  two  hundred 
patients  but  during  that  time  its  capacity  was  increased  to 
accommodate  approximately  three  thousand  patients. 

The  Naval  Hospital  was  beautifully  situated  among  old 
trees.  In  the  rear  was  a  wide  court  and  on  either  side  of  it 
were  large  sleeping  porches.  A  circle  of  bungalows  stood  be- 
yond the  court  and  were  used  as  convalescent  wards. 

The  population  in  and  about  the  Norfolk  Naval  Base  in- 
creased during  the  war  to  one  hundred  thousand  people.  Little 
building  was  done,  so  the  housing  problem  was  an  acute  one. 
The  Elks  Club  leased  their  clubhouse  to  the  Government  and 
the  majority  of  the  inirses  w'crc  (piartc^rcd  there.  The  club 
was  located  at  a  twenty  minutes'  walk  frtmi  the  Naval  Hospital. 

One  of  the  most  interesting  events  in  the  routine  of  a  Navy 
nurse  at  Norfolk  was  the  arrival  of  the  hospital  ships.  Miss 
Dwycr  wrote : 

*  Annual  Report  of  the  Secretary  of  tlie  Navy,  p.  87, 


SERVICE  WITH  THE  NAVY  701 

Often  before  we  had  been  notified  of  lier  arrival,  we  would 
see  the  good  ship  Mercy  lying  in  the  harbor,  the  Red  Cross 
on  her  side  symbolic  of  her  mission.  The  Mercy  was  the 
hospital  ship  we  knew  best.  She  usually  brought  us  about 
seventy-five  cases  of  mumps,  the  disease  which  had  perhaps 
•always  the  largest  group  of  sufferers;  numerous  measles 
cases  and  smaller  groups  of  medical  and  surgical  patients. 

Whenever  the  Mercij  visited  our  shores,  some  few  nurses 
always  took  advantage  of  the  chance  to  visit  her  and  see  her 
in  operation. 

A  hospital  ship  is  truly  a  work  of  art.  Arrangement  is 
made  for  good  care  and  every  possible  space  is  used  to  such 
good  advantage.  One  would  almost  think  they  were  in  a 
shore  hospital,  save  that  the  beds  are  in  the  style  of  berths 
rather  than  beds.  The  operating-room  could  not  be  better 
equipped  or  look  more  real  in  a  shore  hospital ;  there  is  plenty 
of  room,  tlie  sterilizers  are  large  and  everything  immacu- 
lately white.  Afternoon  tea  was  usually  served  during  our 
visit. 

Early  in  May,  1917,  Dr.  Harriss  ofTered  the  Kavy  the  use 
of  his  yacht  Siirf.  It  was  accepted  by  the  Navy,  was  re- 
oqiiippcd  as  an  American  Red  Cross  ambulance  ship  and  was 
used  to  transfer  sick  sailors  from  battleships  in  Atlantic -waters 
to  Navy  hospitals.  Three  American  Red  Cross  nurses  were 
assigned  to  duty  on  the  Surf  in  July,  1917;  others  were  sup- 
plied to  fill  vacancies  which  occurred  from  time  to  time.  Nurses 
remained  on  duty  on  the  ambulance  ship  until  the  use  of  the 
Surf  was  discontinued  late  in  1917. 

Navy  nurses  were  assigned  late  in  1918  to  several  of  the 
large  transports  to  assist  in  the  care  of  sick  and  wounded 
American  soldiers  being  returned  to  this  country. 

Another  permanent  Naval  hospital  to  undergo  tremendous 
expansion  was  the  Naval  Station  Hospital  at  Gray's  Ferry 
Road,  Philadelphia.  One  of  the  first  Red  (^-oss  units  to  be 
mobilized  into  active  service  was  the  Philadelphia  General  Unit 
and  the  nurses  were  assigned  to  the  Gray's  Perry  Naval  Hos- 
pital.    Mary  C.  j\IcNelis,  one  of  these  nurses,  wrote: 

Tmmediatelv  after  our  country  declared  war  we  \V(>re  sent 
to  the  Naval  Hospital,  (iray's  Ferry  Hoad,  I'hiladelphia.  At 
this  hospital  we  had  trying  days  and  the  memory  of  them 
will  last  as  long  as  life.  The  work  in  itself  was  hard,  and 
the  ditficulties  seemed  harder  because  the  work  was  so 
strange.  .  .  . 


702   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  the  outbreak  of  the  war  this  hospital  was  the  only  Naval 
base  in  Philadelphia  and  we  saw  this  base  of  less  than  one 
hundred  patients  grow,  in  a  few  days,  to  one  with  more  than 
six  hundred  patients.  Many  of  these  men  were,  like  ourselves, 
new  in  the  service.  Add  to  this,  the  naval  discipline  which 
insisted  upon  sick  call  at  9  A.M.,  all  medications,  nourish- 
ments and  treatments  on  time  and  everything  in  readiness  for 
inspection  at  10  A.M.  This  was  usually  made  by  the  execu- 
tive officer  accompanied  by  the  chief  nurse.  Captain's  in- 
spection with  all  its  details  occurred  every  Saturday  morning. 

Miss  McNelis  wrote  of  the  instructive  phases  which  made 
nursing  service  in  the  American  Navy  different  from  Army  or 
civilian  nursing  service: 

We  were  employed  not  so  much  as  nurses  but  as  instruc- 
tors and  supervisors  of  the  hospital  corpsmen.  These  men 
were  to  serve  aboard  ship.  They  were  to  be  the  nurses  in 
time  of  distress,  and  we  had  to  work  with  this  thought  always 
in  mind.  Often  when  haste  was  imperative  it  would  have 
expedited  matters  to  have  done  the  work  ourselves;  for  exam- 
ple, to  give  a  hypodermic.  But  no,  we  had  to  supervise  the 
corpsman  while  he  gave  it ;  otherwise  present  expediency,  we 
knew,  might  interfere  with  a  terrible  future  contingency. 
This  reminds  me  that  as  yet  no  pen  has  been  so  facile  as  to 
describe  in  true  worth  the  hospital  corpsman. 

They  were  not  at  all  children  as  one  is  sometimes  led  to 
believe.  They  were  citizens,  young  men  who  immediately 
leaped  to  the  defense  of  country  and  to  them  the  Draft  was  all 
too  slow.  They  knew  no  fear.  The  sea,  perilous  by  nature 
and  made  more  perilous  by  the  machinations  of  man,  did  not 
trouble  them. 

They  came  from  e^'ery  walk  of  life.  At  one  time  I  had  two 
lawyers,  a  seminarian  and  a  registered  pharmacist  working 
with  me.  All  longed  to  be  off  to  war.  To  such  as  these  we 
had  to  explain  that  working  in  the  hospitals  "at  home"  was 
vital  participation  in  the  war.  To  their  credit,  be  it  said  they 
accepted  our  explanations  cheerfully,  worked  industriously 
but  longed  patiently  for  other  things. 

During  the  summer  of  1017,  an  epidemic  of  contagious  dis- 
eases broke  out  in  the  training  camps  and  stations  of  the  Navy. 
Miss  McNelis  wrote: 

in  the  summer  of  191T,  we  liad  epidemics  of  meningitis 
and  scarlet  fe\(T  which  kept  us  very  busy.     The  scarlet  fever 


(Ahovp)  The  Be- 
lief,  of  oOO  \m\  ca- 
pacity, witli  a  fully 
equipped  moliilc  lios- 
pital  of  -ilKt  licdsaiid 
ambulance,  ready  for 
immediate  detaciied 
duty. 

(Ceuier^  A  ward 
of   tlie    A'-  li'j. 

(r.eldw)  Nursing 
Stall'. 


rhoto.i.    hii    Siiri/    I)i  piirlmcnt 


Tiie  V.  S.  S.  ]!eU(f 


SERVICE  WITH  THE  NAVY  703 

cases  were  transferred  to  the  ^[unicipal  Hospital  for  Con- 
tagious Diseases  at  I'liiladclphia,  and  details  of  nurses  and 
corpsmen  were  sent  to  take  care  of  them.  Now,  if  you  wish 
my  idea  of  hard  work,  picture  a  nurse  surrounded  by  men  in 
quarantine  for  about  six  weeks.  The  country  is  at  war,  the 
])ationts  are  sailors,  eager  for  the  allurement  of  war.  ]t  was 
almost  more  than  she  could  do  to  maintain  military  disci- 
pline and  impress  upon  these  men  that  "They  also  serve  who 
only  stand  and  wait." 

A  respite  from  many  cases  was  obtained  in  the  summer  of 
1917  by  the  establishment  of  naval  bases  on  the  reservation 
at  League  Island  and  at  the  ]\Iedieo-Chirurgical  Hospital. 


An  early  opportunity  for  assistance  to  the  ^Navy  presented 
itself  to  the  American  Red  Cross  in  connection  with  the  hos- 
pital at  Philadelphia.  The  ^linutes  of  a  jMeeting  of  the  War 
Council  held  on  July  24,  1IJ17,  recorded  the  following  action: 

The  chairman  stated  that  in  Philadelphia  the  Medico- 
Chirurgical  Hospital  owned  by  the  city  had  been  condemned 
in  order  tliat  a  boulevard  might  be  cut  through ;  that  the 
hosj)ital  contained  about  two  hundred  and  fifty  beds  and  that 
its  use  had  been  offered  to  the  Ped  Cross  for  an  indefinite 
term  without  rental,  by  the  Mayor;  that  its  usefulness  was  not 
seriously  interfered  v,ith  by  cutting  through  the  boulevard,  as 
it  only  nec(>ssitated  tearing  down  some  of  the  outl)uildings 
that  house  the  laundry  and  refrigerating  plant  which  must 
therefore  l;e  mo\e(l  to  a  new  location. 

He  further  stat(Ml  that  it  was  ])ro[)osed  to  use  the  hospital 
for  the  Xavy  at  the  ])restMit  time  and  reconnnonded  appro])ria- 
tion  for  making  the  necessary  changes  in  tlu>  hos[)ital  aiul  for 
its  maintenance  which  had  formerly  cost  the  city  atjout 
$15, ()()()  a  month.  Whereupon  it  was  on  motion  voted  that 
from  the  K'ed  Cross  War  Fund  the  sum  of  $lt3.()()0  be  and  it 
is  hereby  appropriated  for  alterations  and  reconstruction  of 
the  Mcdico-Chirurgical  Hospital.  l*liiladel{)hia.  Pa.,  known 
as  IJed  Cross  Ceneral  Hospital   No.  1. 

Funds  for  the  niaintcuiance  of  this  hospital  were  also  voted  at 
this  and  suhsciiuent  meetings  of  the  War  Council.  National 
ll('ad([uar1cfs  continued  the  maintenance  of  this  institution  for 
the  Xavy  until  dune  1,  11)18;  it  was  then  surrendered  to  the 
city    of    Ph!hulelj)liia.    because    tlie    Xa\y    Department    had    by 


704   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

this  time  so  increased  its  hospital  accommodations  at  Cape 
May  and  at  Philadelphia  that  assistance  from  the  Red  Cross 
was  no  longer  needed. 

Nursing  service  in  permanent  Naval  hospitals  in  the  United 
States  during  the  period  of  the  European  War  was  full  of 
interest.  The  nurses  had  comfortable  quarters  and  interesting 
work.  Elizabeth  Hoag,  a  nurse  member  of  the  Springfield 
(Massachusetts)  Navy  Hospital  Unit,  wrote: 

Early  in  May,  1917,  sixteen  of  us  nurses  received  orders  to 
report  to  the  U.  S.  Naval  Hospital  at  Newport,  Rhode  Island. 
We  found  a  warm  welcome  awaiting  us.  The  hospital  was 
then  overcrowded  with  very  sick  boys  and  there  were  not 
enough  nurses  to  care  for  them.  I  was  assigned  to  Ward  D 
Medical  for  duty ;  I  found  seventy-six  patients,  most  of  whom 
were  very  ill  with  measles.  A  number  of  these  patients  had 
already  developed  pneumonia,  while  others  had  developed 
ear  complications.  One  nurse  had  the  supervision  of  this 
ward  and  the  nursing  care  of  these  patients.  She  had  as  her 
assistants  six  hospital  corpsmen.  These  hospital  corpsmen 
had  been  carefully  trained  in  the  care  of  the  sick  and  it  was 
really  wonderful  to  see  how  well  most  of  them  performed 
their  duties  and  bow  kind  they  were  to  their  "sick  buddies," 
as  they  called  them. 

I  remember  so  well  one  young  boy,  about  seventeen,  who 
was  very  ill  with  pneumonia.  He  said  to  me,  "Nurse,  won't 
you  put  some  lard  and  turpentine  on  my  cliest?  If  I  was 
home,  that  is  what  my  mother  would  do  and  I  know  it  would 
help  my  pain."  I  asked  permission  of  the  doctor  to  grant  his 
request.    Two  days  later  be  left  us, — forever. 

Another  case  tbat  conies  to  my  mind  was  a  boy  of  eighteen, 
whose  parents  were  missionaries.  This  boy  ran  away  from 
home  and  joined  the  Navy  under  an  assumed  name.  He  gave 
as  his  nearest  relative  tbe  name  of  an  aunt,  whom  he  said  he 
lived  with  and  wbo  later  proved  to  l)e  bis  own  mother.  When 
the  telegram  arrived  saying  her  son  was  seriously  ill,  tbis 
mother  hurried  to  his  bedside,  but  did  not  arrive  until  after 
be  bad  passed  away.  It  was  then  we  learned  the  sad  story  of 
this  heart-ljrokcn  mother  and  how  she  had  searched  months 
for  her  only  child  without  avail;  almost  the  first  thing  she 
asked  was,  "Did  be  leave  me  any  message?" 

Miss  Hoag  was  later  assigned  to  Ward  C,  the  ''pus  surgical" 
division.     She  wrote : 


SERVICE  WITH  THE  NAVY  705 

Here  we  had  fifty-six  bed  patients,  suffering  from  em- 
pyema, gangrenous  appendices,  infected  arms  and  legs  and 
crushed  hands  and  feet.  Some  of  these  patients  had  been  in 
the  hospital  for  months  and  had  grown  thin  and  pale,  but  still 
seemed  happy  and  cheerful. 

.  .  .  During  the  spinal  meningitis  epidemic,  we  had  one 
building  with  thirty-six  beds;  it  was  divided  into  two  sec- 
tions by  a  glass  partition.  In  one  half  we  had  our  bed 
patients  and  in  the  remaining  half  we  had  what  were  called 
carrier  patients.  These  carrier  patients  had  never  had  spinal 
meningitis,  but  they  were  carrying  the  germ  in  their  nose  and 
throat  and  transmitting  it  to  other  people  who  sometimes  had 
the  disease  in  its  severest  form.  When  the  epidemic  broke 
out  and  cultures  were  taken  of  every  man's  throat  at  the 
training  station,  these  men  were  sent  to  the  hospital  for 
isolation  and  treatment.  In  some  cases  the  germ  could  be 
killed  in  six  weeks,  while  in  others  it  took  three  months.  Dr. 
K,,  who  specialized  in  this  work,  had  the  care  of  these  pa- 
tients and  was  untiring  in  his  efforts.  He  was  just  as  cheer- 
ful when  called  at  three  A.M.  to  do  a  spinal  puncture,  as  he 
was  when  called  at  three  o'clock  in  the  afternoon.  His  labor 
was  well  rewarded  when  in  twenty-four  hours  after  starting 
treatment,  he  would  watch  them  come  out  of  their  delirium 
and  in  three  weeks'  time,  leave  the  hospital  to  finish  their 
convalescent  period  at  home.  Upon  their  return  at  the  end 
of  four  weeks,  they  were  well  and  strong  again. 

Newport  was  a  quaint  and  historic  town  and  the  view  from 
the  ocean  cliffs  one  of  great  beauty.  The  nurses  derived  much 
pleasure  from  walking  through  the  narrow  crooked  streets  and 
along  the  cliffs  overlooking  the  rolling  surf. 

Early  in  July,  15)17,  a  group  of  nurses  from  the  j^aval  Hos- 
pital at  Newport  were  sent  to  the  City  Hospital  at  Providence 
to  take  a  two  weeks'  course  in  the  technique  of  caring  for  con- 
tagious cases.  Minnette  Butler,  a  reserve  nurse  at  Newport, 
wrote : 

This  course  was  a  great  help  during  the  months  of  epi- 
demics which  followed.  In  July  a  hundred  cases  of  diph- 
theria developed  witb.in  one  week  among  the  civilian  popula- 
tion at  Newport.  Fearing  that  the  contagion  might  spread 
to  the  training  station,  our  commanding  otlicer  offered  to 
assist  the  city  health  department.  These  officials  furnished 
cars  and  a  past  assistant  surgeon,  a  nurse  and  a  corpsman 
were  detailed  to  visit  every  hotel,  bakery,  ice  cream  parlor^ 


706   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

restaurant  and  dairy  in  the  city  and  take  cultures  of  all  peo- 
ple handling  milk.  The  authorities  had  reason  to  suspect  that 
the  trouble  was  coming  from  the  milk  supply. 

After  the  city  had  been  "cultured"  in  this  way,  they  made 
the  rounds  of  farms  outside  the  city  and  visited  ninety  fami- 
lies. In  a  Portuguese  cottage,  a  seventeen-year-old  boy,  with 
a  heavy  membrane  in  his  throat,  was  found  ill  in  bed  with 
diphtheria.  His  mother  was  caring  for  him ;  she  also  milked 
the  cows  and  was  sending  a  supply  of  contaminated  milk  to 
many  city  houses.  A  constable  was  placed  on  the  grounds  to 
see  that  all  milk  was  buried.  No  new  cases  developed  but  had 
it  not  been  for  the  prompt  and  efficient  work  of  the  Naval 
culture  squad,  an  epidemic  might  have  developed  which 
would  have  proven  to  be  a  real  crisis. 

Fate,  however,  could  not  let  Newport  rest,  it  seemed,  be- 
cause a  terrific  explosion  occurred  soon  afterwards  at  the 
Torpedo  Station.  It  caused  many  deaths  and  maimed,  burned 
and  blinded  many  others.  .  .  . 

The  permanent  Naval  Hospital  at  Chelsea,  Massachusetts, 
was  located  in  broad-winged  buildings  which  crowned  the  crest 
of  a  hill  rising  from  the  water-front.  Nora  M.  McQuade  was 
one  of  the  nurses  assigned  to  duty  early  in  the  fall  of  1917 
there.     She  wrote : 

My  first  detail  was  to  a  busy  surgical  ward  with  a  staff  of 
one  regular  Navy  nurse  and  six  hospital  corpsmen.  It  was 
a  shock  to  me  to  see  those  young  men  doing  the  things  I  had 
been  brought  up  to  believe  were  the  sole  duty  of  a  trained 
nurse.  I  felt  sure  the  men  were  being  neglected ;  still,  they 
looked  happy  and  the  ward  was  beautifully  clean.  I  decided 
to  defer  judgment  for  a  little  while  and  it  took  but  a  short 
time  for  the  nurse  recruits  to  absorb  the  Navy  spirit  and  to 
realize  how  important  and  far-reaching  our  work  really  was. 
Upon  the  degree  of  skill  with  which  we  taught  the  hospital 
corpsmen  to  care  for  the  patients  in  our  wards  depended  the 
degree  of  skill  with  which  they  would  in  turn  nurse  the  sick 
men  on  the  ships  at  sea.  It  was  impossible  to  have  women 
nurses  except  on  the  largest  transports. 

The  expansion  of  the  Naval  Hospital  at  Chelsea  was  similar 
to  that  at  Philadelphia  and  Newport.     Miss  McQuade  wrote: 

Day  by  day  wo  watched  now  pavilions  going  up  0]i  tlio 
reservation.    Thoy  wore  l)adly  neodod.     Then  came  the  strike 


SERVICE  WITH  THE  NAVY  707 

and  building  was  held  up  for  weeks.  Finally  it  was  settled 
and  the  men  went  back  to  work.  None  were  gladder  than  the 
nurses.  The  first  weeks  of  our  ])articipation  in  the  war  found 
the  hospital  with  an  average  of  180  patients.  Within  a  year 
the  number  had  reached  !)'^0,  with  327  of  them  assigned 
hospitals  outside  the  reservation.  Extra  beds  were  put  in  and 
then  cots  on  which  tiie  men  were  cared  for  until  space  was 
available  in  the  outside  hospitals  and  they  could  be  trans- 
ferred there.  All  during  the  winter  of  1917,  patients  were 
transferred  in  this  way  as  soon  as  the  acute  stage  of  their 
illness  had  passed.  This  system  made  the  nursing  service 
difficult  all  the  time;  we  always  had  acutely  sick  men. 

During  that  first  winter  "Type  4"  pneumonia  with  the 
complicating  organism,  hemolytic  streptococcus,  which  proved 
so  fatal,  was  prevalent.  Many  of  these  })atients  who  survived 
this  infection,  later  develo])ed  empyema  and  were  in  the  hos- 
pital for  months  at  a  time.  These  men  required  infinite  care 
and  patience.  Their  appetites  needed  coaxing,  their  minds 
needed  diverting, — for  they  fretted  against  the  length  of 
inactivity, — and  their  ))odies,  especially  their  poor  backs, 
needed  and  received  (onstant  attention.  If  we  could  have  had 
the  same  corpsmen  with  us  all  of  the  time  it  would  have  been 
easier  for  us,  but  we  were  conducting  a  training  school.  As 
soon  as  we  trained  corpsmen  to  be  very  useful,  they  were  sent 
to  sea  with  the  next  draft. 


The  Xaval  Hospital  at  Chelsea  received  patients  from  the 
transports,  from  the  smaller  Xaval  craft  operating  about  the 
big  Boston  Harbor  Yard  and  from  the  various  training  stations 
near  Boston  such  as  the  Radio  School  at  Cambridge  and  the 
Aviation  School  at  the  ^lassachusetts  School  of  Technology. 
"One  of  my  first  troubh^s  was  with  Xavy  regulations  and  par- 
lance," wrote  Miss  ^IcC^nade.  ''The  Xavv  'paper  work'  was  a 
new  and  ditHcult  task  and  the  lang-uage  bewildered  us.  How 
were  we  to  know  that  's(iuil  gee  the  deck'  meant  to  polish  the 
ward  floor  f 

Outdoor  wards  wvyo  opened  at  Chelsea  on  June  1,  1018,  and 
the  transfer  system  was  largely  discontinued.  ^liss  ]\IcQuade 
wrote : 

The  summer  months  were  busy  ones.  The  Xavv  men  who 
had  Ijecomc  ill  en  the  other  side  were  being  returned  to  us. 
the  training  sclioels  were  growing  larger  and  sending  us  inore 
]iatit'nts.    and    the    military    situation    in    Iuir()[)e    was    daily 


708   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

becoming  more  critical.    It  was  an  anxious  as  well  as  a  busy 
time  for  all  of  us. 

Ona  day  toward  the  last  of  August  we  were  told  an  epi- 
demic had  broken  out  among  the  men  of  the  receiving  ship. 
It  was  influenza,  they  said.  The  word  did  not  mean  much 
to  us  that  lovely  August  afternoon  as  those  of  us  off  duty 
made  beds  in  an  empty  ward.  That  night,  during  which 
sixty-seven  sick  men  came  in,  was  the  beginning  of  the  influ- 
enza epidemic  that  has  become  history.  We  worked  as  we 
never  worked  before.  The  influx  of  patients,  the  calls  for 
extra  nurses,  the  illnesses  of  the  staff,  the  deaths,  all  were 
repeated  later  in  other  hospitals  but  to  those  of  us  who  ex- 
perienced the  initial  outbreak  when  the  disease  and  its  treat- 
ment were  unfamiliar  to  all,  this  tr^'ing  period  has  left  a 
memory  that  will  not  fade  for  many  years. 

N^avy  nurses  were  assigned  in  November,  1918,  to  the  Marine 
Station  at  Parris  Island,  South  Carolina,  to  nurse  influenza 
patients.  Myrtle  Gilmore  Chandler,  head  nurse  of  the  Naval 
Station  Unit  No.  11,  wrote: 

Parris  Island  is  the  most  interesting  one  of  a  large  group 
of  islands  in  Port  Royal  Sound,  South  Carolina.  It  is  a  long 
narrow  strip  of  sea-sand  which  is  held  in  the  wild  rice  and 
reeds.  Bleak  and  desolate  it  looked  Avhen  we  ten  nurses  ar- 
rived at  the  dilapidated  dock;  a  few  scattered  buildings, 
thousands  of  tents  and  rough  clay  roads,  with  a  covering  of 
oyster  shells,  greeted  the  eye. 

The  Xaval  Hospital,  which  was  a  rambling,  white,  two- 
storied  building  on  the  water's  edge,  had  had  only  corpsmen 
in  attendance  upon  the  patients  and  medical  officers  to  direct 
their  work.  Being  the  first  nurses  ordered  to  this  Post,  we 
naturally  felt  it  was  quite  an  adventure  and  tackled  the  work 
with  enthusiasm. 

Our  first  patients  were  suffering  from  influenza.  x\fter 
some  weeks  the  epidemic  abated  and  we  then  had  many  surgi- 
cal cases.  .  .  . 

During  the  spring  a  large  addition  to  the  hospital  was 
built ;  across  the  street  the  nurses'  new  quarters  was  com- 
pleted and  it  was  a  joyous  day  when  we  moved  in.  Instead 
of  sharing  a  dormitory,  each  nurse  had  a  delightful  room  to 
herself.  ...  Xumerous  large  barracks  were  opened,  many 
officers'  quarters  and  recreation  huts  were  built,  among  them 
a  very  fine  Red  (h'oss  building  nicely  arranged  for  reading, 
games,  music  and  dancing.  It  seemed  as  if  a  veritable  small 
city  had  sprung  up  almost  over  night. 


SERVICE  WITH  THE  NAVY  709 

Paving  of  the  roadways  was  one  of  the  most  appreciated 
improvements.  "The  Island  was  so  near 'the  sea-level,"  wrote 
IMiss  McQuade,  "that  previous  to  the  road-making,  small  creeks 
had  oozed  their  way  here  and  there  with  every  risin<^-  tide  and 
they  left  us  no  choice  but  to  wade  through  them.  Then  when 
the  tide  receded,  the  mud  was  alive  with  a  huge  army  of  small 
crabs." 

Of  the  permanent  ^larine  Barracks,  Miss  McQuadc  wrote: 

Tlie  Marine  I'ost  had  in  1!)19  a  largo  main  station,  a 
quarantine  camp,  a  training  camp,  an  aviation  field  and 
school  and  a  sea-going  depot,  with  thousands  of  Marines  in 
training  there.  There  also  was  maintained  a  large  Xaval 
disciplinary  barracks. 

Parris  Island  was  a  place  of  great  beauty  in  the  spring  and 
summer.     Miss  McQuade  wrote: 

The  winter  storms  subsided  and  spring  announced  itself  by 
covering  the  once  barren  and  bleak  island  with  a  carpet  of 
emerald  swamp  grass;  here  and  there  in  profusion  grew 
lovely  swamp  violets  and  lilies  and  later  the  wild  honey-suckle 
trailed  over  the  fences  in  masses  of  perfume.  We  explored 
the  farther  end  of  the  island  and  found  an  ideal  spot  where 
palms  and  palmettos  grew  under  the  huge  spreading  oaks  and 
the  light  gray  Spanish  moss  hung  and  swayed  in  graceful 
festoons  from  the  wide  branches.  We  often  had  picnics  here 
on  summer  days. 

Beaufort,  the  palatial  old  Southern  town  famous  before 
the  Civil  War  for  its  hospitable  people  and  beautiful  homes, 
still  retains  its  old  time  hos{)itality.  As  it  was  only  forty 
minutes  by  motor  boat  from  the  island,  we  spent  many  de- 
lightful hours  there.  We  had  many  diversions  of  our  own, — 
tea  at  General  Pendleton's  every  Friday;  dancing  and  mo- 
tion picture  shows ;  tennis,  for  the  ilariiies  had  hroiiglit  clay 
in  barges  and  built  a  court  behind  the  nurses'  quarters; 
swimming  and  horseback  rides  along  the  hard,  white  sand 
beaches.  At  one  side  of  the  island  the  Government  had  set 
aside  a  tract  of  land  for  the  negroes  wlio  had  previ(Misly  biM'ii 
scattered  about.  Here  tbey  lived  in  their  cabins  amidst  tlio 
cotton  fields.  As  we  cantered  liy  on  horseback  during  the 
Southern  twilight,  we  could  hear  the  tlinimming  on  tlic  ban- 
joes and  the  negro  melodies  floating  out  on  the  still  air. 

At  the  Naval  Training  (\imp,  Great  T.akes,  Illinois,  was 
located  one  of  the  largest  Xavy  base  hospitals   in   tlic   Cnited 


710   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

States.  Beatrice  Bowman,  supervising  nurse  of  Unit  D  of 
the  Red  Cross  Mercy  Ship  Expedition  of  1914,  was  chief  nurse 
of  this  Navy  base.     She  wrote : 

This  hospital  went  into  commission  in  May,  1917,  but  drew 
its  quota  of  patients  from  a  comparatively  small  number  of 
men  at  the  training  stations.  Since  last  summer,  however, 
it  would  seem  that  an  electric  button  had  been  touched  and  as 
a  result  many  units  sprang  into  existence,  over  farms  and  the 
great  plain.  Prior  to  August  26,  1917,  one  large  brick  build- 
ing and  a  group  of  tents  in  which  the  sick  were  cared  for, 
filled  the  park  in  front  of  the  hospital;  in  January,  a  village 
of  more  than  fifty  building  units  was  in  full  working  order. 
Twenty-nine  of  these  units  are  each  a  complete  hospital,  with 
quiet  rooms,  diet  kitchens,  offices  and  lavatories.  In  addition 
to  the  hospitals  proper,  modern  laundries,  nurses'  quarters, 
hospital  corps  barracks,  civilian  employees'  barracks,  garages 
for  ambulances,  trucks  and  jitneys,  a  complete  water  and  sew- 
age system  and  many  miles  of  cement  roads  have  been  built. 

Bernice  D.  Mansfield  was  assigned  in  July,  1917,  to  duty  at 
Great  Lakes.     She  wrote : 

Eleven  of  us  arrived  at  Great  Lakes  about  midnight  on 
July  7,  and  found  that  they  had  been  looking  for  us  for  some 
few  days,  but  had  only  that  day  succeeded  in  finding  a  place 
to  quarter  additional  nurses.  ...  At  that  time  there  was  the 
one  hospital  building,  just  as  there  had  been  before  April  6, 
1917.  As  the  training  station  was  rapidly  increasing,  the 
hospital  was  keeping  pace  and  new  buildings  going  up  all 
about  but  as  yet  were  in  a  state  of  mcompletion.  To  accom- 
modate the  number  of  patients,  all  available  space  in  work 
shops  had  been  utilized  and  tents  were  in  use  all  about.  It 
had  been  a  cold  rainy  spring  and  nnid  was  very  much  in 
evidence  around  the  tents,  as  roads  up  to  that  time  had  not 
been  completed. 

In  one  building  which  was  later  used  for  an  ice  plant,  the 
patients  had  cots  but  no  chairs  or  lockers  or  bedside  tables. 
The  first  thing  we  saw  on  entering  was  the  men's  clothes 
lying  among  the  sputum  boxes  and  pus  basins,  just  as  they 
had  been  drojiped  when  taken  off  by  the  wearers.  "Where 
shall  I  begin':'"  was  the  nurse's  first  thought.  The  patients 
called  to  us:  "Oli.  nurse.  1  am  so  glad  you  have  come,  we 
haven't  had  any  nurse  before.  Can  I  have  this?  Will  you 
get  me  that?''  Tbe  first  thing  we  did  was  to  have  the  clothes 
folded  and  tied  togetlier.  labeled  with  the  patient's  name  and 


SERVICE  WITH  THE  NAVY  711 

tied  to  the  head  of  liis  bed ;  when  the  clothes  were  all  off  the 
floor,  the  room  looked  as  large  again  and  we  felt  as  though  we 
could  reach  the  patients  to  do  something  for  them. 

An  epidemic  of  contagious  diseases  broke  out  at  Great  Lakes 
during  the  summer  of  1917.     Miss  Mansfield  wrote: 

Into  our  already  overcrowded  hospital,  we  took  in  two 
hundred  additional  patients  in  twenty-four  hours.  ...  A 
new  colony  of  tents  went  up  "on  the  front  lawn"  and  the  main 
hospital  was  emptied  and  made  ready  for  tlie  new  comers. 
As  long  as  they  were  in  bed,  we  had  no  trouble  but  as  soon 
as  they  were  convalescent,  eternal  vigilance  was  required  to 
see  that  they  did  not  get  out  and  into  other  camps  with  which 
the  main  building  was  surrounded.  ]\[any  of  the  hospital 
corpsmen  were  young  and  inexperienced  and  certainly  the 
patients  were  young  and  inexperienced  too ! 

In  the  meantime,  new  hospital  buildings  were  being  fin- 
ished and  equipped.  As  soon  as  one  ward  was  ready,  patients 
were  moved  from  tents  into  it. 

Evidently  the  infectious  diseases  of  childhood  had  never 
gone  through  that  body  of  recruits  before  they  entered  the 
training  station,  for  there  wore  continually  epidemics  of 
measles,  cbicken-jxjx  and  mumps.  The  tent  colonies  grew  to 
accommodate  the  increasing  number  of  patients.  One  group 
of  tents  was  put  u})  just  opposite  the  cemetery.  At 'first  tliere 
were  no  liglits  about  the  grounds  here  and  the  nurses  on  niglit 
duty  would  stumble  over  the  ropes  from  tent  to  tent,  keeping 
one  eye  on  the  cemetery.  Even  the  bravest  ones  found  it  a  bit 
lonely  in  a  dark  isolated  camp  with  a  spot  light  the  oidy 
source  of  illumination. 

The  sewerage  iii  the  camps  was  taken  care  of  as  rapidly  as 
possible,  ])ut  unless  a  nurse  has  gone  through  the  ex])erience 
of  caring  for  infectious  diseases  in  a  tem])orary  camp  where 
there  is  no  sewerage  and  flies  are  abundant,  then  siie  has 
something  to  look  forward  to!  In  the  mess  tents,  there  was 
an  electric  ]ilate  wliicli  was  used  to  lieat  water  and  nourisli- 
ments,  but  the  task  of  washing  dishes  for  forty  or  fiftv  men 
who  were  ill  with  an  infectious  disease  and  oiily  an  electric 
plate  to  heat  the  water,  seemed  at  first  to  be  beyond 
accomplishment. 

Groat  Lakes  Training  Station  increased  from  a  peace  ca- 
pacity of  two  thousand  incn  to  a  war  capacity  of  fifty  thousand 
men.  The  Xaval  Hospital  was  enlarged  from  one  hundred  to 
twelve  hundred  bed  c-apacity. 


712    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Bureau  of  Medicine  and  Surgery  maintained  four 
Naval  Hospital  Corps  Schools.  The  one  located  at  Great  Lakes 
was  the  largest  of  these ;  it  had  a  normal  capacity  of  three  hun- 
dred, with  an  emergency  capacity  of  three  times  that  size.  The 
greatest  number  of  students  registered  at  one  time  was  2200. 
The  three  other  schools  were  established  at  Newport,  R.  L, 
San  Francisco,  Calif.,  and  the  Naval  Operating  Base,  Norfolk, 
Va. 

The  Bureau  of  Medicine  and  Surgery  received  offers  of  as- 
sistance in  the  training  of  hospital  corpsmen  from  various  uni- 
versities and  three  of  these  were  accepted.  A  four  months' 
course  for  one  hundred  men  at  the  Medical  and  Dental  Schools, 
University  of  Minnesota ;  a  six-weeks  course  for  three  hundred 
men  at  the  College  of  Pharmacy,  University  of  New  York; 
and  a  three-months  course  for  one  hundred  and  fifty  men  at 
the  Philadelphia  College  of  Pharmacy  were  given.  Willard 
Connely,  a  nurse  of  the  United  States  Naval  Reserve  Force, 
who  was  on  duty  at  the  University  of  Minnesota,  Minneapolis, 
Minn.,  wrote: 

It  is  a  new  experiment  for  sailor  students  to  be  admitted 
to  a  medical  college,  as  it  is  a  new  and  essentially  valuable 
war  ^vo^k  for  nurses  to  assist  in  training  these  Navy 
men.  .  .  . 

For  the  first  month  of  the  four  months'  course,  the  teach- 
ing is  confined  to  the  medical  school,  including  the  institute 
of  pathology,  the  college  of  dentistry  and  the  institute  of 
anatomy.  There  are  lectures  and  recitations,  then  supple- 
mentary experience  in  the  laboratories  and  dispensaries.  It 
is  held  that  this  preliminary  knowledge  is  indispensable  if 
the  corj^smen  are  to  grasp  comprehensively  the  fundamentals 
of  practical  nursing  as  given  at  the  University  Hospital  dur- 
ing the  three  final  months.  During  this  time,  the  men  have  a 
course  of  lectures  and  experiment  action  in  pharmaceutical 
chemistry,  minor  surgery  and  first  aid,  anatomy  (with  weekly 
practice  in  dissecting),  physiology',  and  hygiene,  bacteriology, 
and  tlic  principles  of  dentistry  in  normal  conditions. 

When  tbe  Jiursiiig  instruction  begins  the  advanced  cor 
relative  training  in  the  foregoing  subjects  is  given  chiefly  iw 
the  mornings,  wliilc  one  or  more  divisions  of  the  sailors  (five 
divisions  of  twenty  minutes  each)  are  engaged  in  hospital 
work.  Througliout  the  afternoons  this  teacliing  is  directed 
by  Louise  M.  I'owcll,  superintendent  of  nurses,  by  Marion 
Vaimier,   assistant    supervisor,   and    Gertrude    Thomas,   die- 


SERVICE  WITH  THE  NAVY  713 

titian.  They  are  aided  by  a  staff  of  head  nurses  and  under- 
graduate nurses,  and  the  latter  also  help  at  the  medical  school 
clinics  where  the  sailors  obtain  practice  in  diagnosing  and 
treating  cases  in  dermatology  and  eye,  ear,  nose  and  throat. 
The  course  in  bandaging,  conducted  by  Miss  Powell,  is  in 
six  lessons,  each  lesson  covering  one  and  one-half  hours.  .  .  . 
In  a  room  at  the  University  Hospital,  Miss  Vannier  gives  ten 
demonstrations  in  practical  nursing.  After  observing  each 
Monday  the  methods  employed,  the  corpsmon  put  in  the  rest 
of  the  week  in  the  class  rooms  or  wards  where,  in  sections  of 
five  or  ten,  they  receive  individual  supervision,  at  the  hands 
of  the  assisting  head  nurses.  The  demonstrations  are  given 
before  fifty  men  at  a  time,  in  periods  of  one  and  one-half 
hours  duration,  and  after  some  ground  has  been  covered, 
demonstration  quizzes  too  are  held,  to  check  up  the  work 
which  has  been  carried  on  in  the  wards. 

The  ten  lessons  in  practical  nursing  included  instruction  in  the 
theory  and  technique  of  the  simpler  methods  of  nursing  proced- 
ure. The  lessons  were  thorough  and  together  with  the  practice 
gained  in  the  wards  of  the  University  Hospital,  gave  future 
corpsmen  an  excellent  working  knowledge  of  the  treatment  to 
be  given  for  all  the  common  ailments  and  for  emergencies  aris- 
ing on  shiplx)ard. 

Grace  Kline,  a  nurse  on  duty  at  the  N^aval  Training  Camp 
at  Charleston,  South  (\irolina,  wrote  that  one  of  her  pupils  had 
said,  on  completion  of  a  detail  given  him  to  clean  up  a  ward: 
"Gee,  I'm  glad  my  mother  can't  see  me  now,  or  she'd  fire  the 
hired  girl  when  I  get  home!" 

On  the  Pacific  Coast  a  larg(!  JS^avai  station  was  located  on 
Puget  Sound  and  another  at  Vallejo,  jMare  Island,  ('alifornia. 
Annie  ^filler  was  one  of  the  nurses  on  duty  at  Mare  Island 
Naval  Hospital.     She  wrote  : 

The  sun  was  shining  as  it  shines  in  few  places  outside  of 
California,  when  from  the  deck  of  tlie  Ferryboat,  on  a  June 
morning,  1917,  we  caught  our  first  glimpse  of  the  shores  of 
Mare  Island. 

At  A'allejo  wo  left  the  ferry.  A  Murine  guard  l()(»k(>(l  over 
our  orders  and  allowed  us  to  hoard  the  tug  for  the  islanil. 
Arriving  there,  we  were  again  accosted  hy  a  guard  and  a>ked 
to  show  our  passes.  Another  guard  was  instructed  to  take  us 
to  the  ollice  of  the  commandant.  1  rcnieniher  thinking  how 
nice  of  them  to  go  with  us  and  show  the  way  instead  of  simply 


714    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

pointing  it  out.  After  having  lived  on  the  island  awhile  and 
grown  more  accustomed  to  the  military  routine,  it  dawned 
upon  me  that  the  guards  had  no  thought  of  being  "nice"  to 
strangers,  but  we  were  simply  under  guard  until  passes  could 
be  secured  for  us. 

Arriving  at  the  nurses'  quarters  we  were  shown  to  our 
room.  Yes,  I  mean  it  in  the  singular.  We  had  four  other 
roommates  besides.  The  room  had  once  been  used  as  a 
gymnasium  for  the  nurses;  but  after  war  was  declared  the 
expansion  at  this  station  had  been  very  rapid  and  all  avail- 
able space  had  to  be  pressed  into  service  to  accommodate  the 
overflow. 

So  we  dubbed  our  room  "the  tenement"  and  while  nurses 
are  supposed  to  be  exacting,  I  have  always  been  rather  proud 
of  the  fact  that  we  proved  we  could  live  together  in  those  close 
quarters,  not  only  amicably,  but  very  pleasantly. 

During  the  European  War,  nurses  rendered  many  types  of 
service  which  differed  greatly  from  the  medical  and  surgical 
nursing  they  had  expected  to  do.  Miss  Miller's  assignment  was 
no  exception  to  this  rule ;  she  wrote : 

I  was  told  to  take  the  place  of  housekeeper  at  the  nurses' 
quarters.  The  rest  of  the  nurses  in  the  detachment  with  me 
seemed  to  find  this  quite  amusing  and  to  this  day  I  am  still 
addressed  as  "Housekeeper"  by  some  of  them. 

My  experience  with  servants  had  been  confined  only  to  the 
colored  ones  of  the  South,  so  that  I  approached  the  Chinese 
here  with  considerable  trepidity.  I  found  them  very  willing 
to  work,  but  also  found  they  had  to  be  handled  with  care. 
Old  Louie,  the  cook,  had  a  disconcerting  way  of  saying,  "No 
savvy,  no  savvy,"  when  it  was  to  his  advantage  not  to  under- 
stand the  point  under  discussion. 

One  Sunday  we  had  planned,  as  a  part  of  the  menu,  plain 
ice  cream  to  be  served  in  cantaloupes.  1  had  tried  to  instruct 
Louie  and  while  he  pretended  to  understand,  I  had  an  uneasy 
feeling  that  all  was  not  well,  so  came  back  later  to  investigate. 
Xot  finding  the  cantaloupes  in  the  refrigerator,  1  called  to 
Louie  to  know  where  they  were.  "In  the  lice  cream,''  he 
calmly  replied.  It  was  true.  He  had  in  some  way  contrived 
to  reduce  those  cantaloupes  to  a  pulp  and  combine  them  with 
the  cream  in  such  a  way  that  it  was  smooth  as  velvet  and 
delicious.  After  that,  cantaloupe  ice  cream  was  a  favorite 
with  us.  In  Louie's  own  vernacular,  it  was  "more  better" 
than  ordinary  ice  cream. 


SERVICE  WITH  THE  NAVY  715 

Though  housekeeping  on  Marc  Island  must  often  have 
seemed  only  a  monotonous  routine  of  uninteresting  details  com- 
pared to  fr(>nt  line  nursing  in  France,  life  on  JMare  Island  was 
not  without  the  thrill  of  danger.     Miss  Miller  wrote: 

The  day  of  the  explosion  of  the  black  powder  magazine 
stands  out  vividly  in  my  memory.  It  occurred  at  eight  in 
the  morning,  just  as  the  day  nurses  had  gone  on  duty  and  the 
night  nurses  were  being  relieved. 

The  chief  nurse  and  1  had  gone  into  the  kitchen  to  in- 
struct as  to  the  meni)  for  the  day.  I  think  I  was  more  puz- 
zled tlian  friglitened,  even  as  1  felt  the  floor  rock  under  my 
feet  and  saw  the  swayiiig  chandelier  and  falling  plaster;  for 
at  that  time,  even  if  1  knew  there  was  a  magazine  on  the 
island,  1  did  not  grasp  the  possibilities  of  what  might  occur. 

Louie  caught  hold  of  the  table  and  began  crying  and,  1 
presume,  praying,  in  his  own  language.  The  chief  nurse 
turned  to  me  with  an  expression  I  have  never  forgotten  and 
simply  said,  "The  magazine !" 

We  ran  to  the  door,  but  finding  it  completely  jammed, 
rushed  to  another  and  out  into  the  yard,  to  see  only  a  cloud 
of  dust  and  smoke  in  the  direction  of  the  magazine  that  told 
the  story.  Everyone,  including  afternoon  and  night  nurses, 
hurried  to  the  hospital  to  render  what  aid  they  could  in 
caring  for  the  injured.  Only  I  had  to  remain  behind  and 
try  to  keep  the  frightened  Chinamen  at  their  work.  All  that 
long  morning  I  helped  Huey,  the  house  man,  whose  work  that 
day  was  more  than  one  person  could  have  accomplished.  I 
swept  fallen  plaster  and  broken  glass,  while  he  shoveled  it 
up  and  carried  it  away.  And  together  we  picked  up  and  re- 
placed books,  pictures  and  other  fallen  articles  and  succeeded 
in  cleaning  the  house,  that  the  tired  nurses  wdio  had  done  the 
actual  work  with  the  injured,  could  rest  when  they  came  to 
lunch. 

California  is  a  long  way  from  France,  but  even  there  one 
could  have  the  satisfaction  of  knowing  that  their  small  bit 
was  helping  in  the  struggle.  Often  when  we  went  dowji  to  the 
docks  to  watch  a  detachment  of  marines  leaving,  nurses  would 
recognize  among  these  sailor-soldiers  who  were  afterwards  to 
make  liistory  on  the  fields  of  France,  boys  whom  they  iiad 
helped  back  to  health. 

Th(^  rigid  entrance  recpiircnuuits  of  the  Xavv  Xurso  Corps, 
the  limited  size  of  th(>  Xavy  and  tlie  responsible  nature  of  the 
nursing  service  demanded  of  members  of  the  Nurse  Corps, 
which   consisted   so   largely   in   the   training  oi   hospital   cor{)S- 


716   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

men,  tended  to  promote  an  excellent  morale  and  esprit  de  corps 
among  the  nurses  of  the  Navy.  However,  in  many  isolated 
naval  stations  life  for  the  nurses  was  undoubtedly  monotonous 
and  lonely  just  as  it  was  in  the  case  of  Army  nurses  at  canton- 
ment and  camp  hospitals  remote  from  recreational  facilities. 
A  ruling  that  members  of  the  Navy  and  Army  Nurse  Corps 
should  not  associate  with  enlisted  men — a  regulation  issued  in 
the  interest  of  discipline — was  the  cause  of  many  complaints. 
The  following  letter  was  written  by  an  American  Red  Cross 
nurse  in  Naval  service  on  the  Pacific  Coast : 

Everyone  liere  likes  the  work,  but  we  have  no  recreation 
except  the  movies  or  a  trip  to — (the  nearby  city).  Of  course 
that  costs  so  much  that  we  can't  go  very  often  on  a  $60.  a 
month  salary. 

When  you  work  only  eight  hours,  you  have  got  to  do  some- 
thing the  rest  of  the  time.  I  read  and  knit  and  sleep  but  that 
gets  rather  monotonous.  If  we  could  only  play  tennis  or 
swim  or  do  something !  We  had  a  court  but  they  built  new 
wards  on  it.  They  are  going  to  build  us  another  when  they 
get  around  to  it. 

We  are  so  entirely  out  of  everything  here.  Of  course,  we 
are  never  allowed  to  go  to  anything  where  there  are  enlisted 
men,  and  the  officers'  families  won't  have  us  at  their  parties. 
We  don't  mind  this,  but  we  certainly  would  like  to  talk  to 
some  one  who  wasn't  a  nurse.  Our  chief  nurse  is  very  good 
to  us  and  gets  up  little  parties  where  we  dance  and  sing  with 
the  same  girls  we  work  with  all  day.  I  have  thought  if  I  had 
happened  to  be  a  stenographer,  I  could  have  served  my  coun- 
try at  Washington  and  still  not  have  been  a  social  outcast. 

There  is  such  a  grind  of  petty  detail  on  the  ward  that  we 
lose  sight  of  the  fact  we're  at  war.  We  were  invited  to  a  big 
Christmas  dance  where  even  the  commandant  took  his 
family,  but  we  could  not  go  because  nurses  must  not  asso- 
ciate with  enlisted  men.  I  am  twenty-eight  years  old;  I 
wonder  how  the  younger  girls  just  out  of  training  school 
stand  it  I  We  haven't  even  thought  of  doing  something  ro- 
mantic to  keep  us  going.  There's  nothing  lieroie  in  caring 
for  measles  and  nuim]^s. 

Now  I'm  not  iroina'  to  resign.  I'll  stay  here  or  any  other 
place  wlicre  1  am  needed  just  u.s  long  as  I  am  wanted,  but 
never  in  my  life  have  I  been  so  blue  and  lonesome.  Everyone 
is  so  nice  to  tlie  "boys  in  the  service."  Why  do  they  never 
think  of  the  girls?  " 
•American  Red  Cross  Bureau  of  Archives. 


SERVICE  WITH  THE  NAVY  717 

Reasons  for  this  ruling  were  set  forth  by  !^^iss  Kline,  an 
American  Red  Cross  reserve  nurse  in  service  at  the  Charleston 
Navy  Yard: 

The  status  of  the  nurse,  officially,  is  that  of  a  head  nurse 
in  a  civil  hospital.  Professionally  and  socially  she  is  rated  as 
an  officer.  It  is  ditliciilt  for  the  nurse  to  understand  the  jus- 
tice of  this  ruling  at  first,  wlien  some  of  the  finest  timber  of 
our  young  manhood  is  of  the  enlisted  personnel.  Her  own 
brother,  friend  aiul  sweetheart  may  be  among  them,  and  why, 
when  she  has  no  rank,  should  she  be  subjected  to  officer's  regu- 
lations? When  she  considers  that  the  mere  restriction  is  a 
recognition  of  rank,  though  ever  so  meager,  she  usually  real- 
izes that  it  is  of  too  much  professional  value  to  treat  lightly. 
In  civil  life  an  intimate  friendship  is  not  desirable  with  one's 
patients;  so  in  military  circles,  reserve  is  a  safeguard.  Most 
of  the  patients  are  of  the  enlisted  personnel.  Cordial  rela- 
tions are  desirable  and  possible,  and  the  nurse  is  the  confi- 
dant and  advisor.  The  men  are  responsive  creatures,  sensi- 
tive to  their  environment,  though  stoical  when  "balled  out" 
and  appreciative  of  the  least  interest  evinced  in  their  welfare. 
The  opportunities  for  personal  influence  are  enormous  and 
the  nursing  care  is  often  a  minor  part  of  the  nurses's  duty.^" 

A  fine  devotion  to  duty,  evident  even  in  the  letter  of  com- 
plaint quoted  above,  prevailed  at  the  Naval  hospitals.  For 
almost  all  the  nurses  in  the  Navy  Corps,  war  service  meant  far 
more  than  the  mere  routine  of  daily  hospital  duty  and  the 
nurses  gave  willing,  skillful  and  patriotic  service.  Consciously 
and  unconsciously,  they  derived  inspiration  from  their  sur- 
roundings. The  infectious  eagerness  for  ocean  duty  which  was 
shown  by  the  young  boys  who  made  up  the  greater  part  of  the 
new  Navy,  the  sight  of  gray  battle  craft  anchored  in  the  harbor 
at  sunset  but  which  went  out  again  perhaps  in  the  turning  of  a 
tide,  the  play  of  searchlights  on  the  water,  the  hum  and  the 
crackle  of  the  wireless,  the  very  patients  who  came  back  sick 
from  exposure  to  the  rigors  of  the  open  sea,  gave  meaning  and 
purpose  to  the  life  of  Xaval  training  camps  or  station  hospitals. 
Josephine  Trippett,  Xaval  Reserve  nurse  in  service  at  Pelham 
Bay  Training  Station,  New  York,  wrote  in  the  Military  Num- 
ber of  the  Journal: 

.  .  .  And  then  tlierc  are  times  when  one  is  deeply  moved 
and  is  brought  to  a  realization  of  the  meaning  of  this  and 
^"American  Journal  of  Xursing.  Military  NmnlH'r,  p.  071. 


718   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

all  other  places  of  its  kind.  Watch  the  sailors  being  shipped. 
They  pass  out  of  the  gate,  their  sea-bags  on  their  backs.  Xo 
one  speaks ;  their  hearts  are  too  full.  We  listen  to  the  muffled 
sound  of  many  feet  marching  solemnly  along  the  road.  For 
a  mile  one  can  see  the  wide,  dark  line  and  hear  the  rhythm 
and  jangle  of  the  rifles. 


On  May  4,  1917,  a  destroyer  and  patrol  fleet  of  the  American 
Navy,  under  the  command  of  Rear-Admiral  William  S.  Sims, 
arrived  in  a  British  port.  Admiral  Sims  had  been  appointed 
as  the  commander  of  American  Naval  operations  overseas  and 
this  destroyer  and  patrol  fleet  was  the  first  unit  of  the  Ameri- 
can Navy  to  go  abroad.  Later,  five  thousand  officers  and  sev- 
enty thousand  enlisted  men  saw  active  service  in  foreign  waters. 

During  the  spring  and  summer  of  1917,  the  losses  of  mer- 
chant ships  by  reason  of  German  submarine  activities  became 
so  great  that,  at  the  suggestion  of  President  Wilson,  the  United 
States  adopted  the  convoy  system  of  transportation.  This 
meant  that  large  numbers  of  troops  and  supply  ships  were 
gathered  together  and  sailed  at  regular  intervals  along  estab- 
lished sea-lanes,  under  naval  protection.  Armed  cruisers, 
smaller  cruisers  and  later  old  battle  ships,  accompanied  the 
convoys  to  protect  them  from  raiders ;  destroyers  went  along  to 
protect  them  from  submarines.  Of  the  7,500,000  tons  of  cargo 
carried  to  Europe,  the  Army  lost  only  200,000  tons  and  no 
American  troop  transport  was  sunk  on  its  voyage  to  Europe. 

The  destroyer,  with  its  depth  bombs,  proved  to  be  an  effective 
craft  in  anti-submarine  warfare.  A  submarine  attack  which 
took  place  in  July,  1918,  was  described  by  Dr.  Howard  Ken- 
nedy Hill,  of  Philadelphia,  Pennsylvania,  a  surgeon  who  served 
under  the  American  Red  Cross  in  France : 

We  were  told  that  we  vrould  pick  up  destroyers  at  a  certain 
hour.  Exactly  on  the  minute,  although  it  was  foggy  and 
rough,  we  saw  a  little  xVmerican  flag  emerge  through  the  fog 
and  we  later  counted  seventeen  destroyers  in  all,  two  of  them 
the  fast  42 -knot  type. 

The  next  day  at  three  o'clock  in  the  afternoon,  when  the 
sea  was  as  sunny  and  quiet  as  a  millpond,  we  suddenly  saw 
a  tremeiulous  explosion  some  four  miles  to  the  south  and 
immediately  felt  the  concussion  of  a  bomb  against  the  side 
of  our  boat,  like  the  pushing  in  and  out  of  a  tin  pan.  The 
destroyers  then  began  a  systematic  dropping  of  d('j)th  bcunbs 


SERVICE  WITH  THE  NAVY  719 

which  are  supposed  to  at  least  injure  a  submarine  if  within  a 
radius  of  four  hundred  yards.  The  rumor  immediately 
spread  through  our  boat  that  the  destroyers  had  sunk  five 
submarines.  We  were  all  sure  that  we  saw  one  black  mass 
rise  in  the  air.  That  evening  the  British  Admiralty  officially 
confirmed  the  destruction  of  four. 

American  destroyers  and  submarine  chasers  had  their  bases  at 
Quecnstown,  Ireland.  Battleship  Division  Six  was  based  on 
Berchaven,  Ireland,  in  readiness  to  meet  and  escort  transports 
and  supply  ships.  A  snbmarine  patrol  off  the  west  and  south 
coasts  of  Ireland  was  also  maintained  from  Berehaven. 

A  second  major  enterprise  of  the  American  Navy  was  its 
participation  in  Allied  Naval  activities  in  the  North  Sea.  Bat- 
tleship Division  Nine  of  the  Atlantic  Fleet  under  the  command 
of  Admiral  Bodman,  constituted  for  nearly  a  year  the  Sixth 
Battle  Squadron  of  the  British  Grand  Fleet,  which  was  directed 
by  Admiral  Sir  David  Beatty.  A  mine  barrage  was  laid  by 
the  Allies  from  Scotland  to  Norway.  By  thus  closing  the  North 
Sea,  the  Allies  denied  enemy  submarines  free  access  to  the 
Atlantic  Ocean  from  German  bases.     Secretary  Daniels  wrote : 

]\rore  tlian  50,000  iVmerican  mines  have  been  laid  in  stra- 
tegical areas  in  European  waters.  The  Xavy  has  taken  part 
in  and  actively  laid  80  per  cent  of  the  great  mine  barrage 
230  miles  long,  from  Scotland  to  Norway ;  a  total  of  5(5,439 
mines  have  been  laid,  all  of  which  were  designed  and  manu- 
factured by  the  United  States  and  transported  and  laid  by 
the  United  States  Xavy. 

Rear  Admiral  Strauss  was  in  charge  of  the  American  mining 
activities  in  the  North  Sea.  Two  mine  bases  were  established 
overseas  and  a  personnel  of  over  G700  men  were  engaged  in 
mining  activities. 

Conveniently  near  the  Sixth  Battle  Squadron  and  the  ^line 
Bases  was  the  American  Naval  coaling  base  at  Cardiff,  Wales, 
from  which  coal  was  secured  for  the  Atlantic  Fleet  and  for  the 
American  Expeditionary  Forces  in  France. 

There  were  otluM*  Anu>rican  Naval  activities  in  foreign 
waters.  A  force  made  up  of  destroyers,  gunl)oats,  cruisers, 
yachts  and  Coast  Guard  cutters  which  were  based  on  Ciibraltar 
p(M'f(inned  twenty-five  per  cent  of  the  ocean  escort  duty  l)etween 
(libraltar,  Franci^  and  Italy,  and  seventy  per  cent  of  the  ocean 


720   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

escort  duty  between  Gibraltar  and  England.  A  temporary 
American  Naval  base  for  submarine  flotillas  was  established  at 
Ponta  Delgada  in  the  Azores. 

The  American  Navy  maintained  four  thousand  hospital  beds 
in  Europe  for  the  care  of  its  personnel  engaged  in  the  various 
activities  briefly  mentioned  above  and  also  for  the  care  of  the 
United  States  Marine  Corps  in  France.  The  major  portion  of 
these  beds  were  furnished  by  the  assignment  to  foreign  service 
of  the  five  base  hospitals  which  the  American  Red  Cross  had 
organized  and  equipped  for  the  American  Navy.  Two  of  these 
hospitals  were  assigned  to  duty  near  Edinburgh,  Scotland,  a 
third  at  Queenstown,  Ireland,  and  the  remaining  two  at  Brest, 
France.  Small  hospitals  and  dispensaries  were  established  in 
Great  Britain  and  in  France  by  the  American  Red  Cross  and 
were  later  taken  over  by  the  Navy.  Other  hospitals,  dispensa- 
ries and  sick-bays  were  staffed  by  Navy  surgeons  and  hospital 
corpsmen  at  Plymouth,  England ;  along  the  French  and  Irish 
coasts ;  at  Ponta  Delgada,  Azores ;  at  Gibraltar ;  at  Corfu  and 
at  Genoa,  Italy.  This  brief  mention  is  all  that  will  be  made  in 
this  history  of  these  dispensaries  and  sick-bays,  as  no  American 
Red  Cross  nurses  saw  active  service  in  them. 

Five  American  Naval  hospitals  were  maintained  in  Great 
Britain  during  the  European  War.  Three  of  these  were  United 
States  Navy  base  hospitals  and  the  other  two  were  institu- 
tions established  by  the  American  Red  Cross  and  later  turned 
over  to  the  Naval  authorities.  Similarly  as  with  the  Army,  the 
American  Red  Cross  in  Great  Britain  formed  an  emergency 
arm  of  the  American  Navy ;  its  nurses  rendered  service  to  the 
first  American  soldiers  to  be  torpedoed  by  German  submarines. 

On  the  evening  of  February  5,  1918,  His  Majesty's  troop- 
ship, Tuscania,  with  convoy  and  escorting  destroyers,  ap- 
proached the  entrance  of  the  North  Channel,  A  German  sub- 
marine pierced  the  ring  of  destroyers,  fired  on  the  Tuscania 
and  the  torpedo  struck  her  on  the  starboard  side.  She  immedi- 
ately listed  deeply.  The  2500  American  soldiers  who  were 
aboard  w^ere  ordered  to  the  boats  and  the  British  destroyers 
and  patrols  of  the  North  Channel  stood  by  and  many  hundreds 
of  her  company  were  rescued  by  them. 

The  life  boats  on  the  Tuscania  s  port  side  had  been  unin- 
jured, so  other  American  soldiers  rowed  away  in  them  as  she 
sank.  The  swift  out-flowing  tide  and  the  bitterly  cold  wind 
caught   the   boats   and   life-rafts   and   drove   them   toward  the 


SERVICE  WITH  THE  NAVY  721 

rocky  shores  of  the  Isle  of  Islay.  The  bodies  of  182  of  the 
Tuscania's  company  were  filing  ashore. 

Many  of  the  lifeboats,  however,  were  brought  safely  to  land 
but  the  survivors  were  in  a  desperate  plight  from  exposure. 
Along  with  other  Ked  Cross  personnel,  a  detachment  of  Ked 
Cross  nurses  from  American  Ked  Cross  Military  Hospital 
No.  4,  JMossley  Hill,  Liverpool,  were  immediately  hurried  to 
Islay  to  care  for  these  patients.  This  detachment  arrived  in 
record  time,  tended  the  soldiers  and  finally  accompanied  them 
to  the  Army  hospital  at  the  American  Army  Rest  Camp  in 
W^inchester,  England. 

Soon  after  the  sinking  of  the  Tuscania,  United  States  Naval 
Base  Hospital  Xo.  2  arrived  in  England;  on  ^larch  1,  1918,  it 
opened  a  Naval  base  hospital  of  six  hundred  beds  at  Strath- 
peffer,  Scotland,^ ^  This  Naval  unit  had  been  organized  by  the 
American  lied  Cross  from  personnel  of  the  Lane  Hospital,  San 
Francisco,  California.  Dr.  Stanley  Stillman  was  the  director, 
and  E.  Elizabeth  Hogue,  the  chief  nurse.  Miss  Hogue  was 
a  gTaduate  of  the  California  Training  School  for  Nurses,  Los 
Angeles,  California.  After  extensive  executive  experience  in 
several  California  institutions,  she  became  in  1!)14  superinten- 
dent of  the  School  of  Nursing  of  Lane  Hospital.  Two  years 
later  she  organized  the  nursing  staff  of  Naval  Base  Hospital 
No.  2,  and  in  the  autumn  of  1917  went  with  her  unit  into  naval 
service  in  the  United  States.     Foreign  assignment  followed. 

The  location  of  Navy  Base  Hospital  No.  2  was  in  a  pictur- 
esque spot,  for  the  little  Scotch  town  of  Strathpeffer  lay  in  the 
environs  of  Inverness  at  the  head  of  the  long  fingerlike  Cro- 
marty Firth.  Navy  Base  Hospital  No.  2  received  patients 
from  ^line  Bases  Nos.  17  and  18,  and  from  the  Sixth  Battle 
S(piadron. 

The  second  American  Naval  hospital  to  be  established  in 
Great  Britain  was  placed  in  London  by  the  American  Bed 
Cross  for  the  care  of  officers  and  men  of  the  American  Naval 
JTead(inart(>rs  at  London  and  of  naval  craft  from  the  inunediate 
vicinity.  Aldford  House,  th(>  residence  of  the  lloiiorabK'  Mrs. 
Frederick  Guest,  was  taken  over  by  the  (\)nnnissi{)n  to  Great 
Britain  and  was  opened  as  a  hospital  June  l-"),  19 IS.  The 
house,  which  covered  an  entire  city  block  in  Park  Lane,  had 
forin(>rly  been  used  as  a  hospital  for  British  wounded  and  had 

"  ••lu'ixiii  of  the  A.  R.  C.  C'onimissinii  for  (ircat  P>iitain,  I'art  I,  llosjii- 
tals:"   p.    12. 


722   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  capacity  of  fifty  beds.  A  ISTavy  surgeon  and  staff  were  as- 
signed to  duty  there  and  shortly  afterward  the  Navy  took  over 
its  entire  management,  raised  the  bed  capacity  to  seventy-five 
and  maintained  it  as  a  Naval  Hospital. 

Miss  Hall,  one  time  chief  nurse  of  the  American  Red  Cross 
in  Great  Britain,  wrote : 

Catherine  Taylor,  a  Canadian  woman,  an  American  Red 
Cross  nurse  and  a  graduate  of  St.  Lukes  Hospital,  New  York 
City,  was  chief  nurse  of  Aldford  House  and  remained  in  charge 
there  until  the  hospital  was  taken  over  by  the  Xavy  and 
staffed  with  a  unit  sent  out  from  America  by  the  Navy  Nurse 
Corps  on  September  10,  1918. 

The  third  American  Naval  hospital  to  be  established  in 
Great  Britain  was  U.  S.  Navy  Base  Hospital  No.  3,  which  was 
assigned  to  duty  at  Seafield  Leith,  near  Edinburgh,  on  the 
Firth  of  Forth.  Like  Navy  Base  Hospital  No.  2,  this  unit 
had  been  organized  by  the  American  Red  Cross  from  the  per- 
sonnel of  a  western  hospital,  the  California  Hospital,  Los 
Angeles,  California.  Dr.  Rea  Smith  was  the  director  and 
Sue  Sophia  Dauser  was  chief  nurse. 

Miss  Dauser  was  graduated  in  1914  from  the  California 
School  for  Nurses,  and  for  two  years  was  head  nurse  on  the 
surgical  department.  Anne  A.  Williamson,  superintendent 
of  nurses  of  the  California  Hospital,  had  organized  the  nurs- 
ing staif  of  Navy  Base  Hospital  No.  8,  but  ^Aliss  Dauser,  after 
instruction  at  the  Naval  Training  Camp  at  San  Diego,  led  the 
nursing  unit  into  foreign  duty.     She  wrote: 

Fnited  States  Navy  Base  Hospital  Xo.  3  nio])ilized  at 
Philadelphia  during  the  month  of  Decemljer,  1!)17.  Until 
August  1,  1918,  the  nurses  did  temporary  duty  in  and  near 
Philadelphia.  On  August  1,  1918,  we  embarked  from  New 
York  on  the  British  transport  H.  ^I.  S.  Mdndingo  for  Kali- 
fax,  where  we  joined  a  J-Jritish  convoy  of  twenty-one  ships. 
Seven  of  these  ships  were  transports  carrying  troops;  the 
rest  carried  freight. 

We  arived  at  Liverpool,  August  15,  1918,  and  by  train 
arrived  at  Ldinlnirirh,  Scotland,  early  the  next  morning. 
The  hospital  we  took  over  had  been  under  the  British  Ad- 
miralty for  four  years.  In  anticipation  of  the  change,  the 
British  Admiralty  transferred  all  the  enlisted  men  patients 
to  (rlasgow,  but  there  remained  about  fifty  officer-patients. 


SERVICE  WITH  THE  NAVY  723 

The  building  in  pro-war  days  was  a  poorliouse.  It  was 
well  built  and  so  arranged  as  to  adapt  itself  most  conven- 
iently for  a  hospital,  and  afforded  ani})le  room  for  seven  hun- 
dred and  fifty  ])atients.  The  British  hosi)ital  equipment  was 
established  in  the  building  and  all  of  our  own  equipment  had 
arrived  there  before  us.  We  installed  our  own  and  acce])te<l 
enough  of  the  old  to  enable  us  to  carry  about  seven  hundred 
and  fifty  patients.  Wc  found  our  own  equipment  more  con- 
venient. For  instance,  our  beds  were  the  high  white  hospital 
beds ;  tiie  old  ones  were  low  black  iron  cots.  We  also  had 
enough  white  paint  with  us  to  paint  the  walls,  which  had 
formerly  been  bright  and  striking  colors. 

The  nurses  of  Xavv  Base  Hospital  No.  3  were  assigned  to 
comfortable  and  attractive  quarters.     Miss  Dauser  wrote: 

The  nurses  lived  in  a  building  that  in  pre-war  days  had 
been  one  of  the  best  hotels  in  the  suburbs  of  Kdinl)urgh,  and 
was  about  three  miles  distant  from  the  hospital.  A  large  bus, 
similar  to  the  Fifth  Avenue  buses,  Xew  York,  made  regular 
trips  between  the  hospital  and  nurses'  quarters.  This  stretch 
of  three  miles  was  considered  one  of  the  most  beautiful 
drives  from  Edinburgh.  We  were,  as  we  always  put  it, 
"loaned  to  the  British  Admiralty"  and  in  spite  of  four  years' 
hardsliips  in  England  and  Scotland,  they  seemed  willing  and 
eager  to  give  us  the  best  of  the  country  in  appreciation  of 
our  services  to  their  wounded. 

Ignited  States  Xavy  Base  Hospital  Xo.  3  was  located  in 
F'.dinburgh  to  take  care  of  patients  sent  from  the  Grand  Fleet, 
which  was  tlum  op(^rating  in  the  Xorth  vSea.  ^[iss  Dauser 
wrote  of  the  sick  and  wounded  who  were  sent  to  this  big  Ameri- 
can base: 

The  hos]Mtal  was  open  to  the  four  military  organizations, 
the  ])ritish  Navy  aiul  Army  aiul  the  American  Xavy  and 
Army.  TIk^  majoritv  of  Naval  ])atients  were  influenza  cases, 
but  hlueja(k(>ts  wwr  only  a  small  \)vv  cent  of  the  nnndx^r  of 
])ati('nts  we  cnrtMl  I'ov.  Something  like  seventy-five  per  cent 
of  the  capacitv  of  th"  hospital  was  held  for  the  British  Army; 
e\('n  this  did  iidt  scciu  sutlicieiit  and  th(>  wounded  would  over- 
flow tliis  jxTcciitagc  most  of  the  time.  These  patients  caTue  to 
us  in  convoy  trains.  Tliey  had  been  taken  oil'  the  battlefields 
about  three  days  h,'fore,  ami  had  nothing  more  than  l-"irst 
Aid  at  the  field  stations.     Just  as  soon  as  we  reported  })a- 


724   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tients  on  the  convalescent  list^  they  were  transferred  to  some 
convalescent  home,  and  the  space  given  to  new  patients  arriv- 
ing from  the  Channel  ports. 

During  the  entire  stay  of  United  States  N^avy  Base  Hospi- 
tal No.  5  at  Edinburgh,  Scotland,  we  were  extremely  busy. 
Every  nurse  of  the  entire  nursing  staff  seemed  to  completely 
lose  herself  to  her  ward  and  ward-work.  The  spirit  of  the 
wounded  was  a  great  inspiration.  I  do  not  remember  of  ever 
having  heard  a  complaint,  no  matter  how  trivial,  from  a 
patient. 

The  N^aval  coaling  base  for  the  American  !Navy  in  foreign 
waters  and  for  the  American  Expeditionary  Forces  was  estab- 
lished at  Cardifi",  Wales,  as  has  been  stated  in  this  chapter. 
Seventeen  American  colliers  carried  Welsh  coal  taken  from  the 
mines  near  Cardiff  to  the  Atlantic  Fleet  in  the  North  Sea ; 
eighty-two  other  American  government  vessels  which  were 
known  in  the  Xavy  as  the  "Suicide  Patrol"  because  of  their 
constant  trips  through  the  mine-infested  Channel,  carried  coal 
from  Cardiff  to  Brest,  Bordeaux,  Xantes,  and  St.  Xazaire  for 
the  use  of  the  American  Expeditionary  Forces  in  France:  Over 
two  thousand  bluejackets  were  based  on  Cardiff.  To  care  for 
cases  of  influenza  and  pneumonia  among  these  sailors,  the 
American  Red  Cross  established  on  October  7,  1918,  a  hospital 
and  dispensary  in  Park  Place,  Cardiff.  Three  houses  adjoin- 
ing a  large  disused  aeroplane  factory  which  served  as  a  Red 
Cross  Club  and  dormitory  for  American  sailors,  were  fitted  up. 
Six  American  Red  Cross  nurses  were  detailed  to  service  there 
and  with  a  Xavy  surgeon  and  several  hospital  corpsmen,  cared 
for  a  daily  average  of  forty  bed  patients  and  one  hundred  dis- 
pensary cases.  The  following  summary  of  their  activities  has 
been  given : 

So  active  was  the  port  of  Cardiff  that  while  the  Eed  Cro^.s 
was  on  duty  there,  more  than  100,000  American  bluejackets 
and  Xaval  officers  entered,  passed  througli,  or  were  attached 
to  the  base.  Of  these,  the  American  l^ed  Cross  gave  service 
of  some  tyjje,  to  more  than  eighty  per  cent.  It  cared  for  374 
patients — 2^)0  of  them  "flu"  cases — in  its  own  hospital,  only 
nine  of  whom  died,  and  for  2(u  in  the  Xavy's  sick-l)ay  at  base 
headquarters.  At  the  Red  Cross  dispensary  3G00  sailors 
received  trcatnicnt.'- 

""The  Passinfr  Lt><:ioiis,''  G.  U.  Fife,  p.  2!)9.     The  :Macmillan  Co. 


SERVICE  WITH  THE  NAVY  725 

The  American  Ked  (/i-oss  Hospital  at  Cardiff,  Wales,  was 
taken  over  by  the  American  Navy  a  few  weeks  after  its  estab- 
lishment. Its  capacity  was  raised  to  two  hundred  beds  and  it 
was  maintained  as  a  naval  hospital  as  long  as  Cardiff  was  used 
as  a  coaling-  base. 

The  last  American  Naval  hospital  to  be  established  in  Great 
Britain  was  United  States  Navy  Base  Hospital  No.  4,  which  had 
been  organized  by  the  American  Ked  Cross  from  personnel  of 
the  Kliode  Island  Hospital,  Providence,  K.  I.  Dr.  George  A. 
Mattingly  was  director,  and  (irace  Mclntyre  was  chief  nurse 
of  this  unit.  ^liss  ^Iclntyre  was  graduated  from  the  Boston 
Lying-in  Hospital  and  for  twelve  years  did  private  duty  nurs- 
ing. She  was  a  student  of  the  Department  of  Nursing  and 
Health,  Teachers  College,  for  two  years,  and  then  returned  to 
her  alma  mater  as  superintendent  of  nurses.  She  later  be- 
came assistant  superintendent  of  nurses  of  the  Khode  Island 
Hospital  and  was  subse([uently  appointed  chief  nurse  of  Naval 
Base  Hospital  No.  4. 

After  service  in  various  naval  training  camps  and  stations  in 
the  United  States,  the  nurses  of  Navy  Ba,se  Hospital  No.  4 
were  mobilized  September  12,  1918,  in  New  York.  Miss 
]\laclntyre  wrote: 

We  sailed  8ppfenil)er  23  on  an  English  ship,  the  Briton. 
The  personnel  on  Ijoard  consisted  of  2200  troops  and  of  GO 
women,  including  our  nurses  and  a  group  of  Ked  Cross  work- 
ers. A  dirigible  balloon  and  a  group  of  airplanes  accom- 
panied us  out  of  the  harbor  until  we  met  our  convoy  wliich 
consisted  of  fourteen  troo])  ships,  one  cruiser  which  went 
ahead  of  us,  one  Ijattlesliij)  which  guarded  our  rear,  four 
destroyers  and  eight  or  ten  submarine  chasers  which  left  us 
the  second  day  out.  This  convoy  carried  about  30, 000  troops 
in  all. 

The  })()siti()u  of  the  ships  was  interesting.  During  the  day 
they  separated  so  that  they  were  barely  ])erceptibl('  to  each 
other,  but  at  retreat  they  came  together  like  a  hen  with  a 
brood  of  cliickens. 

On  October  2,  three  submarines  wer(>  sighted.  On  Octolier 
f),  a  wireless  was  rC'clNcd  aunouncin^iz  that  a  submarine  was 
after  the  Jlrilo/i.  While  at  dinner  that  evening,  we  received 
a  terribh>  shock.  One  of  our  own  sliips.  the  I'nuUiuj.  rannned 
us.  dc.-troying  one  of  our  life-boats  and  tcarinir  awav  a  portion 
of  the  rail  from  one  of  the  decks.  When  this  happened,  per- 
fect silence  j)re\ailed   in   the  dining  saloon.     A  gcn<'i-al   pale- 


726   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ness  was  on  everyone's  face,  as  we  all  felt  that  we  had  been 
torpedoed.  Our  ship  soon  righted  herself  and  happiness  per- 
meated the  room  again. 

Spanish  influenza  broke  out  among  the  troops  on  the  Briton 
and  the  nurses  of  Xavy  Base  Hospital  No.  4  volunteered  their 
services.     Miss  Maclntyre  wrote : 

.  .  .  The  medical  officer  in  charge  of  the  sick  men  invited 
me  to  inspect  the  patients,  men  from  the  319th  Regiment  of 
Engineers,  from  California.  On  the  promenade  aft  deck  were 
about  thirty  sick  men,  lying  on  the  deck  with  nothing  under 
them  but  a  canvas  hammock  or  a  blanket  serving  as  a  mat- 
tress. They  were  so  close  together  that  one  could  hardly  pass 
between  them. 

Within  forty-eight  hours,  one  hundred  and  sixty  cases  had 
developed.  Some  of  these  men  were  running  high  tempera- 
tures and  many  of  them  M'ere  in  great  pain.  At  first  the  very 
sick  patients  were  cared  for  in  the  sick-bay,  but  were  later 
taken  to  the  decks  of  the  ship  where  fresh  air  surrounded  them 
and  where  more  room  was  available.  As  the  voyage  length- 
ened, the  weather  grew  more  severe  and  the  sea  more  rough. 
The  decks  were  often  washed  by  the  waves  and  our  sick  men 
drenched  to  the  skin.  The  patients  were  then  moved  into  the 
officers'  smoking  saloon  and  into  the  main  saloon  of  the  ship, 
where  we  were  able  to  make  them  more  comfortable. 

Colonel  Otwell,  in  command  of  the  319th  Engineers,  wrote: 

The  sick  report  of  the  troops  on  board  .  .  .  jumped  from 
6  to  IGO  in  forty-eight  hours.  Seeing  the  danger.  Miss  Mac- 
lntyre and  her  co-workers  .  .  .  volunteered  their  services, 
with  the  result  that  what  was  chaos  (there  being  practically 
no  accommodations  or  facilities  on  board  to  care  for  such 
numbers)  was  liandled  in  what  I  consider  a  most  admirable 
manner  under  tlie  circumstances.  They  have  worked  niglit 
and  day  in  the  cold  and  damp,  on  decks  that  were  beiiig 
washed  by  seas,  without  any  lights  whatsoever,  exposed  to  the 
dangers  of  contagion  witli  a  deadly  malady  and  they  have 
rendered  these  services  most  cheerfully.   .  .  .^^ 

The  docking  at  Liverpool  was  impressive.  Miss  [Nfaclntyre 
wrote : 

"Report  written  October  7,  lOlS.  l)y  C.  W.  Otwell.  Commanding  Troops 
on  Board  H.  M.  'I'.  Briton,  to  the  Commanding  Oilicer,  U.  S.  Xavy  Base 
Hospital,  No.  4,  Queeiistown,  Ireland. 


SERVICE  WITH  THE  NAVY  727 

As  there  were  twenty-oiic  miles  of  docks,  it  took  us  several 
hours.  We  passed  ships  of  men  in  our  familiar  khaki  uniform 
who  exchan<]^ed  enthusiastic  greetings.  Many  pleasant  ac- 
quaintances had  heen  made  during  our  troublescjme  voyage, 
caused  by  the  illness  of  our  men  and  by  the  extremely  rough 
weather.  Colonel  Otwell  called  our  group  together  and  spoke 
most  feelingly  regarding  the  work  of  the  nurses,  and  when 
he  had  finished,  .  .  .  the  ship  rang  w^ith  applause  from  offi- 
cers and  men. 

At  Liverpool  seven  nurses  of  our  unit  were  detached  and 
sent  to  Leith,  Scotland,  and  four  others  to  Cardiff,  Wales. 
The  rest  of  us  soon  entrained  for  Queenstown,  Ireland.  .  .  . 

Our  hospital  was  opened  thirty  hours  after  our  arrival,  to 
meet  an  emergency  caused  by  the  Aquitania,  which  cut  the 
Shall',  a  destroyer,  in  half.  Several  men  had  been  killed  and 
about  twenty,  I  think,  injured.^*  Dr.  Carpenter,  our  com- 
manding officer,  was  much  pleased  with  the  manner  in  which 
the  nurses  threw  themselves  into  the  work  after  their  strenu- 
ous voyages,  both  across  the  Atlantic  and  the  Irish  Sea,  He 
said :    "They  all  rebounded  like  rubber  balls." 

TJ.  S.  ISTavy  Base  Hospital  Xo.  4  was  established  at  White- 
point,  one  of  the  most  b(>antifnl  and  picturesque  spots  along 
the  Irish  coast.  The  hospital  buildings  were  the  familiar  bar- 
rack hut  which  had  been  brought  from  the  United  States.  The 
capacity  of  the  seven  wards  was  two  hundred  and  fifty  beds. 

The  patients  which  came  to  i^avy  Base  Hospital  ]^o.  4  were 
largely  influenza  cases.     ]\liss  Maclntyre  wrote: 

Our  patients  came  from  the  torpedo  base  just  acroes  the 
harbor  from  us,  from  the  Air  Station  at  Aghada,  thirty  miles 
from  (Queenstown.  from  the  Passage  Barracks  two  miles 
north,  from  the  Air  Station  and  Pigeon  Carrier  Station  at 
Widdy  Island,  eighty  miles  away,  and  from  our  own  ships  in 
the  harbor.  There  Merc  two  large  ships,  the  Dixie  and  the 
Melville,  and  many  smaller  boats  stationed  in  the  harbor  near 
us  during  our  stay  in  (Queenstown. 

Through  the  worst  part  of  the  e])i(lemic.  we  loaned  a  few 
of  our  nurses  to  the  British  Xaval  lIos])ital  across  the  harbor 
at  Koulbowline.  They  had  a  hospital  of  eighty  bods  and  only 
two  graduat(>  nurses.  However,  tlicy  had  twelve  sjdendid 
Y.  .\.  D.'s.     This  li()S]utal  had  cared  for  our  sick  men  before 

"'T.  S.  S.  Shnir  I'ollision  witli  llio  Aquifania  OctolxM-  9,  lOlS:  (lead,  ton." 
Report  of  the  Secretary  of  the  Navy.  IHIS.  p.  249.  List  of  injured  not 
^iven. 


728   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

we  had  arrived  and  we  were  only  too  glad  to  be  able  to  be  of 
service  to  them.  We  also  sent  two  of  our  nurses  to  Widdy 
Island  eighty  miles  away,  to  care  for  a  few  patients  who  were 
too  ill  to  be  brought  to  us  at  Whitepoint.  .  .  . 

Three  American  Naval  hospitals,  in  which  Red  Cross  nurses, 
and  regular  and  reserve  members  of  the  Navy  Nurse  Corps 
served,  were  established  in  France  during  the  European  War. 
The  first  of  these  to  arrive  in  France  was  United  States  Navy 
Base  Hospital  No.  1,  which  was  attached  to  the  United  States 
Marine  Corps.  When  the  Marines  were  brigaded  with  Persh- 
ing's divisions  in  the  autumn  of  1017,  Navy  Base  Hospital 
No.  1  was  assigned  to  duty  with  the  American  Expeditionary 
Forces  at  Angers,  and  later  at  Brest,  France.  The  second  Navy 
hospital  in  France  was  United  States  Navy  Base  Hospital 
No.  5,  which  served  the  American  Navy  based  on  Brest.  The 
third  was  established  by  the  American  Red  Cross  Commission 
near  Bordeaux  for  the  care  of  patients  from  the  Naval  forces 
operating  in  the  waters  near  the  southern  port.  Sick-bays  and 
dispensaries,  staffed  entirely  by  Naval  Hospital  corpsmen,  were 
located  at  J^orient  and  Pauillac  and  at  various  Naval  air  sta- 
tions along  the  coast  of  France. 

Navy  Base  Hospitals  Nos.  1  and  5  were  mobilized  in  Sep- 
tember, 1917,  and  embarked  for  foreign  service  within  a  few 
weeks  of  each  other.  Although  Navy  Base  Hospital  No.  1  was 
the  first  to  arrive  in  France,  the  experiences  of  Navy  Base 
Hospital  No.  5  will  be  recounted  first  because  No.  5  was  more 
typically  a  Naval  hospital.  As  the  sanitary  unit  of  the  Marine; 
Corps,  Navy  Base  Hospital  No.  1  became  part  and  parcel  of 
the  American  Armies  when  the  Marines  were  assigned  to  land 
duty  in  France. 

United  States  Navy  Base  Hospital  No.  5  was  established  in 
October,  1917,  in  Brest.  The  professional  personnel  of  this 
unit  was  ccmiposed  largely  of  nurses  and  physicians  of  the 
^lethodist  Episcopal  Hospital,  Philadoly)hia,  Pa. ;  Dr.  Rob- 
ert LeConta  was  director,  and  Alice  M.  Garrett  was  chief 
nurse. 

Miss  Garrett  was  graduated  from  the  Pennsylvania  Hospital, 
Philadelphia,  and  held  various  executive  positions  in  the  surgi- 
cal wards  there,  as  head  nurse  of  the  operating  room  and  as 
assistant  to  the  snpc^rintendent  of  nurses,  Miss  Dunlop.  Miss 
Garrett    became    superintendent   of   nurses    of   the    Methodist 


SERVICE  WITH  THE  NAVY  729 

Episcopal  Hospital  in  Philadelphia  in  190G.  She  was  enrolled 
in  the  American  Ked  Cross  Nursing  Service  in  1911  and 
served  as  head  nurse  of  the  Red  Cross  field  hospital  at  the 
Fiftieth  Anniversary  of  the  Battle  of  Gettysburg,  1913.  Three 
years  later,  she  organized  the  nursing  staff  of  Navy  Base  Hos- 
pital No.  5. 

The  nursing  staff  of  this  unit  vi'ere  mobilized  in  Philadel- 
phia in  September,  1917.     Miss  Garrett  wrote: 

On  October  15,  1917,  we  were  ordered  to  New  York  by 
special  train.  We  went  directly  to  the  S.  S.  St.  Louis  and 
sailed  the  same  afternoon  at  5  P.M. 

We  reached  Liverpool,  October  24,  1917;  at  3  P.M.  we  left 
for  South  Hampton.  .  .  .  We  reached  Le  Havre  without 
accident  and  entrained  for  Brest,  our  destination.  We 
spent  two  nio^hts  and  one  and  a  half  days  making  this  trip 
which  usually  takes  a  few  hours. 

Navy  Base  Hospital  No.  5  was  set  up  early  in  November, 
1917,  in  an  old  Carmelite  convent,  at  Brest.  Miss  Garrett 
wrote : 

The  building,  which  was  not  adapted  to  hospital  use,  was 
divided  into  many  small  rooms.  The  plumbing  was  of  the 
most  primitive  kind;  water  was  often  a  missing  quantity. 
There  was  no  beauty  and  little  comfort  in  the  cold,  damp 
place,  yet  the  patients  were  happy,  appreciating  their  care 
and  treatment,  and  they  mostly  made  good  recoveries. 

With  tents  and  huts  in  the  grounds  surroimding  the  hos- 
pital, there  were  accommodations  for  six  himdred  patients, 
the  sick  and  injured  of  the  Navy.  We  cared  for  the  men 
composing  the  crews  of  the  transports,  destroyers,  mine 
sweej)ers  and  Naval  men  stationed  in  and  around  Brest.  It 
was  (he  Xaval  llos])ital  in  France.  .  .  . 

The  work  of  the  Navy  Xurse  Corps  was  perhaps  not  as 
spectacular  as  that  of  the  Army,  l)nt  it  was  nevertheless  just 
as  needful.  Our  pntieuts  were  survivors  from  torpedoed 
boats  or  lads  wlio  were  burned  from  explosions,  or  were 
almost  ])hysical  wrecks  from  the  hard  lives  they  spent  on  tlic 
smaller  craft  used  as  destroyers  and  convoys.  It  was  always 
a  pleasure  to  minister  to  them  ;  their  bravery  and  their  grati- 
tude were  boundless.  To  find  a  hospital  with  (as  the  boys 
exj)resscd  it)  real  .Vnicrican  nurs(>s  meant  more  to  them  than 
they  could  tell. 

Although   there  was  alwavs  enouiih   to   do.  the   work  was 


730  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

harder  at  times  than  at  others.  Wlienever  we  heard  of  a 
boat  being  torpedoed,  we  prepared  for  the  survivors;  our 
Xaval  Base  was  the  best  equipped  on  the  French  coast.  Every 
time  the  boys  went  out  they  never  expected  to  return,  so  the 
smaller  vessels  were  lightly  called  the  "Suicide  Fleet." 

Miss  Garrett's  report  contained  the  following  extract  from 
the  diary  of  one  of  the  nurses  of  Navy  Base  No.  5. 

April  18,  1918:  This  morning  we  had  emergency  call, 
sixteen  burned  cases.     The  Florence  IL,  a  small  freight  boat 

belonging  to  the  Steamship  Company,  was  reported 

to  have  been  torpedoed.  The  accident  (which  is  now  gen- 
erally believed  was  caused  by  a  time  bomb  placed  in  the 
engine  room)  happened  one  hundred  and  twenty  miles  out  to 
sea.  The  boat  had  anchored  on  account  of  the  fog.  The 
cargo  consisted  of  over  five  hundred  tons  of  ammunition 
purchased  by  our  Second  Liberty  Loan.  The  entire  crew 
was  lost  with  the  exception  of  thirty. ^^ 

These  survivors  were  frightfully  burned;  some  of  them 
had  the  ends  of  tlieir  fingers  drop  oif.  All  were  burned  on  the 
face,  chest  and  hands.  About  six  are  so  ill  that  tbe  doctors 
give  little  hope.  It  is  a  sad  sight  to  see  them  all  in  such 
horrible  pain.  The  explosion  happened  at  ten  o'clock  at 
nigbt,  and  tbe  crow  which  brought  the  survivors  in  said  the 
explosion  lit  up  the  sky  like  daylight. 

July  14,  liJLS:  To-night  twenty  survivors  were  brought  in 
from  the  Westover.  Four  were  wounded  and  the  rest  were 
shocked  and  in  a  bad  condition  generally.  The  boat,  carrying 
muniti(jns,  steel,  bospital  supplies,  locomotives,  ambulances, 
etc.,  was  making  lier  maiden  trip.  Sbe  was  with  a  convoy 
but  one  of  licr  engines  became  disabled  and  she  was  forced  to 
lag  behind,  an  easy  target  for  German  U-boats.  Twice  the 
\Vedover  was  torpedoed,  forty  minutes  apart.  She  went  down 
at  once  after  the  second  shot. 

The  crew  took  to  lifeljoats  and  were  afloat  from  Thursday 
morning,  July  11,  when  tliey  were  struck,  until  Sunday  night, 
July  14,  when  they  arrived  at  our  base.  They  were  four 
hundred  miles  out  from  the  French  coast  and  never  sighted  a 
boat  until  a  Frciicli  sailing  vessel  ])icked  them  up  ten  miles 
off  shore  and  hrouglit  them  in.  The  cajjtain  of  the  WcHlovcr 
was  an  old  salt:  he  had  hecn  in  the  Merchant  ^larine  service 
thirty-one  years  and  in  tlie  first  life  boat  be  had  guided  them 
by  tbe  stars. 

"Seventeen  men  of  tlie  crew  nf  the  S.  S.  Florence  II.  \vere  lost.     Report 
of  the  Secretiirv  of  llie  Nav\-,   l!tlS.  ],.  240. 


SERVICE  WITH  THE  NAVY  731 

They  had  a  little  hardtack  and  a  small  amount  of  water, 
but  as  they  did  not  know  how  long  they  might  be  at  sea,  they 
used  very  little  of  this  supply.  It  had  poured  rain  for  two 
nights  and  days,  and  they  had  no  protection  whatever.  They 
sang  all  the  way  "Pull  for  the  shore,  sailors,  pull  for  the 
shore."  They  arrived  at  Brest,  cold  and  wet  to  the  skin  and 
nearly  starved. 

We  fed  them  hot  coffee,  eggs  and  toast,  gave  them  each  a 
hot  shower  and  put  them  in  clean  beds.  Several  had  had 
scalp  wounds  which  needed  attention,  two  had  been  severely 
burned  on  the  face,  hands  and  feet,  and  one  with  a  fractured 
hip  had  suffered  intensely.  Two  were  given  antitoxin  serum 
as  they  ran  a  risk  of  getting  tetanus  under  the  circumstances. 
Many  were  given  sedatives  for  shock.  Poor  lads,  it  was  sur- 
prising how  cheerful  they  were.  There  are  still  three  life 
boats  missing;  the  destroyers  have  gone  out  for  them  at  once. 

July  15  :  This  afternoon  fourteen  more  of  the  Westover  sur- 
vivors came  in,  and  to-night  fifty  more,  now  making  eighty- 
four  in  all.  The  entire  crew,  with  the  exception  of  about 
twelve,^"  which  were  lost  in  the  explosion,  are  now  accounted 
for.  We  had  to  discharge  a  number  of  the  survivors  of  the 
transport  Covington  to  the  receiving  station  to  make  room  for 
them.  It  was  well  past  midnight  before  we  had  them  settled 
down. 

The  mascot  was  saved  and  he  was  brought  to  the  hospital 
and  cared  for.  They  would  not  leave  the  faithful  dog  behind. 
They  were  cheerful  in  spite  of  their  wounds  and  so  grateful 
for  all  we  did  for  them.  These  last  survivors  were  almost 
five  days  in  the  life  boats.  They  will  be  fitted  out  with  new 
clothing  by  the  Eed  Cross  and  when  ready  for  duty  will  go 
back  again  at  the  old  post. 

A  second  American  hospital  to  be  established  in  France  for 
the  care  of  sick  and  wounded  of  the  American  Xavy  was  Ameri- 
can Red  Cross  Hospital  Xo.  100,  which  was  established  in 
January,  1018,  in  the  picturesque  Chateau  Beaucaillon,  on  the 
Gironde  Kiver,  near  Bordeaux.  Lieutenant  Colonel  C.  C. 
Burlingame  wrote : 

Among  the  earliest  of  the  hospital  formations  of  the  Pcd 
Cross  was  American  Ped  Cross  Hospital  Xo.  100,  installed  in 
the  (^bateau  Beaucaillon,  near  St.  Julien  ((Jironde).  near 
enough  to  Bordeaux  to  be  easily  accessible  to  the  Xavy.    This 

"  Kiplit  men  of  the  crew  of  the  S.  S.  Westover  were  lost.  Report  of  the 
Secretary  of  the  Navy,  191S,  p.  242. 


732    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospital  was  operated  for  the  Navy,  which  supplied  the  actual 
medical  personnel,  exclusive  of  nurses.  ...  So  great  was  the 
need  and  so  effective  the  work  done  here  that  it  was  later 
expanded  to  one  hundred  and  fifty  beds  by  the  erection  of 
tents  on  the  grounds,  to  take  care  of  an  epidemic  which  oc- 
curred among  the  Navy  personnel.  .  .  . 

A  summarized  report  of  this  hospital  for  six  months  ending 
December  31,  1918,  is  as  follows:  Hospital  days,  22,864; 
Patients  admitted,  703;  Patients  evacuated,  197;  Patients 
returned  to  duty,  440;  Patients  died,  295.^^ 

Convalescent  patients  of  the  American  Navy  were  admitted 
to  the  American  Red  Cross  convalescent  homes  already  de- 
scribed in  Chapter  VI.  Bluejackets  were  entertained  largely 
at  Convalescent  Home  No.  1,  located  in  the  Chateau  de  Beyche- 
ville,  at  St.  Julien,  Gironde ;  at  Convalescent  Home  No.  2 
which  had  been  established  in  the  Hotel  Regina,  Biarritz ;  and 
at  Convalescent  Home  No.  3,  which  was  located  in  the  Hotel 
de  la  Source,  Morgat,  near  Brest. 

Navy  nurses  were  assigned  to  duty  in  Guam,  an  insular 
possession  of  the  United  States  which  was  located  on  the  direct 
water  path  between  the  Hawaiian  and  Philippine  Islands  and 
they  experienced  unusually  interesting  and  picturesque  service. 
Frederica  Braun  (Columbia  Hospital  for  Women  and  Chil- 
dren, Washington,  D.  C.)  wrote,  in  the  Military  Number  of 
the  Journal: 

The  Naval  Hospital  in  Guam  differs  from  any  other  hospi- 
tal in  the  Naval  service.  Officers  and  their  families,  civilians, 
enlisted  men,  and  the  natives  of  the  islands,  all  depend  on  the 
United  States  Medical  Corps  and  nurses  for  medical  care. 
There  is  a  small  private  hospital,  "Susanna,"  in  part  endowed 
and  also  supported  by  fees  from  the  patients;  a  ward  for 
enlisted  men  and  two  native  wards,  one  for  men  and  boys 
over  ten,  and  the  other  for  women  and  children. 

The  hospital  is  situated  in  a  beautiful  part  of  Agana,  the 
capital  of  the  Island,  with  a  population  of  five  thousand 
natives  and  about  one  hundred  Americans.  The  nurses'  duty 
is  varied  and  interesting  and  is  an  excellent  field  for  the 
nurse  who  has  or  desires  experience  in  public  health  and 
welfare  work ;  there  is  also  experience  in  nursing  tropical 
diseases.  From  thirty  to  forty  children  are  always  having  the 
treatment;  as  fast  as  one  set  is  ready  to  go  out  another  comes 

"  "Military  History  of  the  American  Red  Cross  in  France,"  p.  60. 


SERVICE  WITH  THE  NAVY  733 

in.  The  treatment  lasts  from  ten  days  to  three  weeks,  and 
while  the  children  are  there  they  are  examined  very  much  as 
we  would  school  children  in  the  States. 

When  the  Americans  first  took  over  the  Island  in  1898  the 
mortality  from  childbirth  and  among  infants  was  appalling. 
A  training  school  was  started  by  the  Medical  Corps  for  native 
nurses;  since  the  Navy  Nurse  Corps  was  established  part  of 
the  duty  of  Navy  Nurses  in  Guam  is  to  train  tiiese  young 
women  as  midwives.  They  do  remarkably  well  in  this  line, 
and  if  anything  abnormal  occurs  they  rush  their  patient  at 
once  to  the  hospital,  sometimes  by  automobile,  sometimes  on 
a  stretcher,  very  often  in  bull  carts,  occasionally  in  ilsh  nets. 

As  a  race,  the  Chamorros  are  superstitious  and  have  been 
taught  that  an  evil  spirit  will  get  them  if  they  leave  window 
or  door  open  at  night.  As  the  houses  are  most  primitive, 
having  usually  but  two  rooms,  with  the  entire  family  sleeping 
on  straw  mats  on  the  floor,  tuberculosis  claims  many  victims. 

There  are  queer  accident  cases;  such  as  injuries  from 
being  gored  by  caraboas  and  falls  from  cocoanut  trees  causing 
unusual  fracture  complications;  also  there  are  serious  infec- 
tions from  fish  bites. 

Navy  nurses  stationed  at  Guam  found  ample  opportunity  for 
recreation.     Miss  Brann  wrote : 

For  amusement  there  is  tennis,  swimming,  automobiling, 
walking,  dancing  and  moonlight  picnics.  Every  afternoon, 
machines  run  from  Agana  to  Piti  for  swimming;  the  water 
at  Piti  is  deep  and  still.  Dances  at  Dorn  Hall  are  held  every 
week,  with  music  by  the  ^larine  Band.  The  picnics  are  the 
best  kind  of  fun,  with  the  moonlight  shining  on  the  white 
beach  and  the  sea  sounding  on  the  reef.  .  .  .  The  darkness 
comes  quickly  in  the  tropics,  with  no  twilight,  like  a  curtain 
let  down.  In  the  natives"  houses  appear  candle  lights  or  tiny 
lanijis,  and  the  white  roads  and  beaches  gleam  against  the 
dark  ])alnis — a  fairy  land.  .  .  . 

On  night  duty,  one  hears  the  sea  all  the  time  and  every 
other  sound  is  stilled;  early  in  the  morning,  before  it  is  light, 
the  natives  so  slip-slip  to  churcii,  a  never-ending  procession. 
Then  quickly  comes  the  splendid  sunrise. 


As  was  previously  stated,  the  first  and  largest  Xaval  hospital 
to  arrive  in  France  was  United  States  Navy  Base  Hospital 
No.  1,  wliicli  was  attached  to  the  United  States  ^larine  Corps. 


734    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

This  unit  was  also  the  first  base  hospital  which  the  Red  Cross 
organized  for  the  Navy  Department.  Its  parent  institution 
was  the  Brooklyn  Hospital,  Brooklyn,  N.  Y.  Ur.  William  C. 
Brinsmade  was  director,  and  Frances  F.  Van  Ingen,  chief 
nurse. 

Following  her  graduation  from  the  Brooklyn  School  of 
Nursing,  Miss  Van  Ingen  did  private  duty  and  institutional 
nursing  in  Ohio  and  Minnesota.  She  was  a  member  of  the 
Yvetot  Unit  which  National  Headquarters  assigned  to  duty  in 
February,  1915,  at  the  Alliance  Hospital,  Yvetot,  France.  She 
returned  to  the  United  States  in  April,  191 G,  and  as  superin- 
tendent of  nurses  of  the  Brookl^'n  Hospital,  organized  the 
nursing  staff  of  Navy  Base  Hospital  No.  1. 

Navy  Base  Hospital  No.  1  was  ordered  to  mobilize  on  Sep- 
tember 11,  1917.     Miss  Van  Ingen  wrote: 

At  noon  on  September  11th,  while  T  was  stationed  at  the 
United  States  Navy  Hospital,  Brooklyn,  the  commanding 
officer  told  me  to  have  forty  nurses  ready  to  sail  for  France 
in  two  days.  It's  still  hazy  in  my  mind  just  what  did  happen 
during  those  two  days.  Kind  people  helped  me  'phone,  others 
loaned  their  automobiles  or  ran  errands  themselves,  the  Eed 
Cross  stretched  forth  its  mighty  arm  and  the  full  equipment, 
including  the  uniforms,  appeared. 

On  September  1-1,  191T,  the  unit  left  Grand  Central 
Station.  Jt  was  early  enough  in  the  war  for  our  uniforms  to 
be  new  to  the  public.  A  regular  officer  of  the  Navy,  Dr.  L.  S. 
Von  Wedikind,  with  Dr.  Vickery,  took  charge  of  the  unit. 
Our  destination  was  the  Navy  Yard  at  Philadelphia  and  we 
walked  from  the  train  to  the  U.  S.  S.  Henderson.  It  was  the 
first  time  ofHcers  and  crew  had  ever  had  women  traveling  with 
them  and  the  nurses  found  things  as  interesting  as  the  crew 
found  us. 

The  following  Sunday  evening,  the  Sixth  Division  of 
Marines  came  al)oard,  al)Out  1500  men  under  Major  Hughes. 
Comparatively  few  of  this  division  lived  to  come  back.  Two- 
thirds  of  the  officers  were  killed.  After  the  Armistice  Colonel 
Hughes  passed  througli  our  hospital  on  crutches  on  his  way 
back  to  tbe  I'nited  States,  a  mere  shadow  of  his  former  vig- 
orous self. 

Monday  morning'-  we  slii)])ed  from  our  moorings  out  be- 
tween the  nien-o"-war.  On  every  side  couhl  be  heard  the 
music  of  two  or  tbrce  bands,  tbo  shrill- whistles  of  Navy  and 
luuijor  crafty  tlie  cheering  of  the  Jackies.  .  .  . 


SERVICE  WITH  THE  NAVY  735 

Miss  Van  Ingen  wrote  of  the  trip  across: 

In  our  convoy  was  the  Cruiser  San  Diego, ^^  with  its  great 
observation  balloon  which  was  up  most  of  the  time;  two 
destroyers;  a  tanker;  and  two  transports,  the  Finland  and 
the  Antilles,  which  was  sunk  on  her  return  trip. 

1  was  told  one  morning  to  assemble  all  nurses  in  the  mess 
hall  for  ''inspection/'  Every  one  was  to  be  in  dress  uniform, 
which  included  hats  and  gloves.  At  the  appointed  hour  we 
gathered  together  very  solemnly  and  proceeded  to  wait. 
After  two  hours,  the  inspecting  party  approached.  All  the 
othcers  were  dressed  in  blue  and  white  and  gold,  with  swords 
buckled  at  their  sides,  and  white  gloves  on  their  hands.  They 
filed  tbrough  one  door,  took  a  searching  look  at  us,  and  each, 
according  to  his  rank,  filed  through  the  other  door  and  out  of 
sight.  It  was  awe  inspiring !  I  don't  know  what  became  of 
those  swords  and  white  gloves;  they  never  graced  another 
inspection.  We  surelv  took  ourselves  seriously  at  first.  We 
had  -Quarters"  at  9  :15  A.M.;  "Abandon  Ship"  at  9  :30;  deck 
drill  at  10;  with  "Sick  Call"  at  the  same  time  for  those  not 
feeling  well. 

The  Henderson  docked  at  St.  Nazaire,  France,  on  Octo- 
ber 4,  and  the  personnel  of  United  States  i^avy  Base  Hospital 
Xo.  1  proceeded  the  next  day  to  Angers  in  the  Department 
^larne-et-Loire,   France. 

The  ^I urines,  to  whom  ^NTavy  Base  Hospital  Xo.  1  was  at- 
taclied,  were  brigad(>d  in  the  fall  of  1917  with  the  American 
Kxpeditionarv  Forces  and  the  unit,  though  still  under  the  com- 
mand of  a  Xavv  officer,  was  taken  over  by  the  Army.  Hence 
this  Xaval  unit  was  temporarily  assigned,  until  the  end  of 
Xovember,  1917,  to  staff  the  Mongazon,  a  future  Army  base 
hospital  at  Angers.  Of  their  arrival  there,  ALiss  Van  Ingen 
wrote : 

It  was  extremely  weird  in  that  station  at  midnight.  We 
were  led  through  the  small  emergency  hospital  in  one  i)art  of 
the  building,  where  dim  lights  showed  us  soldiers  and  nurses 
in  the  French  uniforms;  everything  crude  and  rather  dirty. 
The  only  means  of  reaching  our  destination,  two  miles  outside 
the  city,  was  by  walking.  So  we  filed  throu>:h  the  d.irk. 
narrow  streets  of  Anders,  and  the  shuttered  houses  and  silent 
streets  left  a  dream-like  impression  with  me — so  unreal  from 
the  hustling  Anirers  by  day. 
"Later  tiuiik  bv  a  (.u'linaii  subiiuirine. 


736   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  were  given  a  great  building,  the  Mongazon,  formerly  an 
old  school  for  priests.  The  buildings  and  grounds  were 
ideally  situated  for  the  splendid  hospital  it  was  afterwards 
made  into. 

We  nurses  were  apportioned  to  the  top  floor  of  one  of  the 
wings  of  the  Mongazon.  Here  forty  nurses  found  forty 
French  beds,  forty  small  bedside  tables,  forty  chairs  in  one 
large  dormitory,  and  cest  tout.  A  small  room  was  given  me. 
Across  the  hall  from  it  was  a  wash-room  with  a  stone  floor,  a 
long  narrow  tin  trough  down  the  center  and  a  pipe  with  ten 
tiny  water  taps  suspended  above  it.  And  again  cest  tout. 
As  I  made  my  rounds,  my  heart  froze  within  me.  How  could 
forty  grown  women,  the  sprightly  and  the  silent,  the  tidy  and 
the  thoughtless,  the  tranquil  and  the  turbulent,  room  here 
together?  In  answer  to  most  of  my  requests,  it  was  either 
"Now  you  must  remember  that  this  is  war,"  or  "1  hardly 
think  that  the  nurses  rate  that." 

Xot  that  there  was  much  complainmg,  however ;  the  nurses 
were  really  very  game  and  sporty.  Baths  were  our  greatest 
difficulties.  On  the  ground  floor  at  the  extreme  end  of  the 
building  were  two  small  rooms  with  a  tin  bathtub  in  each 
and  a  hot  water  geyser  over  one;  this  geyser  was  expected  to 
supply  hot  water  to  both  tubs.  Everyone  was  warned  to  follow 
directions  of  operations  very  closely  and  all  went  well  for  two 
weeks.  Then  a  nurse  mismanaged,  there  was  a  loud  explosion 
and  the  geyser  was  a  wreck  !  After  that  we  walked  about  two 
miles  to  Angers  with  our  own  towels  and  soap,  waited  half  an 
hour  or  so  at  a  public  bath  and  had  a  clean  comfortable  bath 
and  walked  back  again. 

During  the  last  week  in  ISTovember,  191 Y,  the  personnel  of 
Navy  Base  Hospital  No.  1  was  ordered  to  permanent  quarters 
at  Brest.  The  Pittsburgh  Unit,  United  States  Army  Base  Hos- 
pital No.  27,  had  been  assigned  to  the  Mongazon  at  Angers 
and  desired  to  take  over  their  permanent  quarters.  ^Moreover, 
the  twenty  additional  nurses  of  Xavy  Base  Hospital  No.  1  who 
had  been  left  in  the  United  States  when  the  majority  of  the 
unit  sailed,  arrived  on  the  U.  S.  S.  Von  Steuhen  and  the  nurs- 
ing staff  of  Navy  Base  Hospital  No.  1,  thus  re-united,  pro- 
ceeded to  Brest.     Miss  Van  Ingen  wrote  of  their  arrival : 

I  will  never  forget  my  feelings  when  we  marclied  to  the 
hospital  whicli  was  to  be  ours  for  eleven  months;  it  so  closely 
resembled  the  Kaymond  Street  jail  in  Brooklyn.  .  .  .  The 
building  had  been  used  originally  as  a  school  for  boys,  the 


SERVICE  WITH  THE  NAVY  737 

Petit  Lycee.  Since  the  war  the  French  had  used  it  for  a 
hospital  and  their  evacuation  to  make  room  for  us  was  de- 
layed until  a  young  French  lad  made  complete  his  great  sacri- 
fice for  France. 

The  buildings  covered  about  two  hundred  square  feet  and 
had  been  erected  about  two  courts  in  which  we  afterwards  put 
up  tents  and  barracks  to  increase  the  number  of  our  beds. 
The  main  part  of  the  building  had  four  floors  above  tlie 
ground  floor.  Besides  isolation  tents,  sick  oflicers'  and  sick 
nurses'  quarters,  we  had  seven  wards  in  all,  which  accommo- 
dated from  ten  to  one  hundred  beds  each. 

The  nurses  of  Navy  Base  Hospital  No.  1  accepted  their  new 
quarters  with  the  same  good  humored  sportsmanship  which  they 
had  shown  at  Angers.     ^Miss  Van  Ingen  wrote : 

In  the  far  corner  of  the  larger  court,  with  its  windows  over- 
looking the  court  d'Anjou  and  the  Bay,  I  was  given  a  few 
rooms  for  nineteen  nurses.  Seven  were  in  three  unfinished 
attic  rooms,  with  dormer  windows.  The  other  rooms  held 
from  one  to  two  each. 

The  lower  part  of  a  Convent,  three  blocks  from  the  hospital, 
which  included  a  large  chapel,  five  fairly  large  bed-rooms  and 
two  or  three  small  ones  had  been  rented  for  the  remainder  of 
the  nurses.  Twenty-two  nurses  were  crowded  into  the  chapel, 
four  and  five  in  each  of  the  bed-rooms,  that  should  have  held 
only  two.  The  Ked  Cross  helped  us  out  wonderfully  in  adding 
a  few  comforts ;  they  provided  easy  chairs,  a  number  of 
screens,  to  furnish  a  little  privacy,  three  wash  basins  and  a 
bath  tub,  hot  water  heater,  gas  stove,  sash  curtains,  hand 
basins  and  pitchers,  a  few  mirrors,  china  dishes  to  replace  the 
tin  ones  we  were  using,  and  a  little  later  a  })iano.  The 
pleasant,  free  way  in  which  the  Ked  Cross  gave  to  us  came  as 
balm ;  never  once  was  it  said  that  we  did  not  "rate"'  these 
comforts.  l)ut  rather  "Is  there  anything  else  that  you  need?" 

The  nurses  were  wonderful  about  making  the  best  of  trying 
situations  and  tliere  were  many  of  them.  First  and  worst 
was  the  q\iestion  of  heating.  .  .  .  Another  distressing  circum- 
stance were  the  night  prowlers — cats,  mice  and  men.  Our 
rooms  were  on  the  ground  floor.  The  windows  opened  right 
on  the  street  and  our  entran(^e  door  on  the  garden,  ^luch  to 
the  horror  of  the  ]x^ople  of  Brest,  we  refused  to  slee])  behind 
those  window  shutters  made  of  solid  wood.  Lattic(^  shields 
were  put  half  way  up  the  windows,  but  they  failed  to  keep 
out  the  cats,  who  walked  ofi'  with  delectable  "eats,"'  or  to 
prevent  the  Frenchmen  from  climbing  to  the  window  ledges 


738   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  attempting  to  scramble  over.  The  garden  entrance  was 
rather  more  of  a  menace,  for  we  many  times  had  actually  to 
turn  out  of  our  hall  and  bed-rooms  intoxicated  soldiers  and 
sailors.  Nothing  even  approaching  a  serious  situation  ever 
happened ;  they  were  in  fact  often  more  ludicrous  than  alarm- 
ing, but  I  never  retired  at  bedtime  that  I  did  not  hope  the 
night  would  pass  without  someone  being  dreadfully  fright- 
ened. The  mice  and  rats  are,  of  course,  a  part  of  French 
housekeeping.  An  occasional  shriek  or  squeal  would  be  heard 
at  night  in  the  room  next  to  mine,  induced  by  the  travels  of 
some  mouse  across  the  pillow  of  a  nurse  or  a  too  venturesome 
one  getting  his  feet  tangled  in  her  hair. 

Our  garden  was  our  chief  joy.  It  was  a  really  French  one, 
with  all  that  implies,  hidden  behind  a  thick  wall  ten  feet 
high  with  fruit  trees  and  rose  vines  trained  against  it,  wind- 
ing paths  around  rather  neglected  flower  beds,  splendid  trees 
that  gave  shade  or  shelter  and  a  little  screen  door  that  opened 
on  to  an  unpaved  lane.  .  .  . 

Nurses  and  hospital  corpsmen  of  the  Brooklyn  Unit  imme- 
diately undertook  the  renovation  of  their  new  hospital.  How- 
ever, Paris  headquarters  on  December  20th  ordered  thirty 
nurses  on  detached  duty  to  Camp  Coetquidan,  then  the  largest 
American  artillery  training  center  in  France.  Anna  Burges 
was  chosen  head  nurse. 

Of  the  heavy  work  which  confronted  the  depleted  nursing 
staff  at  Navy  Base  No.  1  at  this  time,  Miss  Van  Ingen  wrote : 

The  demand  on  our  unit  to  send  these  thirty  nurses  to 
Camp  Coetquidan  came  just  when  our  hospital  was  filling 
rapidly  with  stevedores  and  men  from  the  transports,  all,  of 
course,  medical  cases.  The  States  were  sending  over  many  of 
their  colored  regiments,  and,  as  all  the  stevedores  were  of  that 
race,  two-thirds  of  our  beds  had  black  faces  on  the  white 
pillows.  The  wards  were  not  yet  fully  equipped,  many  very 
necessary  articles  were  still  unpacked  in  the  store  rooms; 
the  galley  was  in  need  of  stoves;  half  the  nurses  were  doing 
detached  duty  and  we  had  an  average  of  ten  sick  in  7inrses' 
sick  quarters.  Add  to  this  a  hospital  full  of  ])lack  men,  sick 
with  mumps,  measles,  meningitis.  .  .  . 

Our  most  serious  cases  were  the  measles  and  meningitis, 
especially  tlie  measles  cases  coming  from  the  transports. 
The  transporting  of  them  from  the  ships  to  the  hospital 
proved  fatal  to  many.  They  were  carried  from  the  ship  to 
the  lighter,  from  the  lighter  to  the  dock,  from  the  dock  to 


SERVICE  WITH  THE  NAVY  739 

ambulance,  from  ambulance  to  hospital.  It  sometimes  took 
from  six  to  eight  hours  to  accomplish  this.  At  this  time 
these  lighters  were  uncovered  boats,  more  l)arges,  so  that 
these  sick  boys  were  exposed  for  hours  to  the  cold  and  rain. 

The  work  of  the  nurses  and  corpsmen  was  made  exception- 
ally hard  through  the  lack  of  elevators,  dumb-waiters,  toilet 
facilities  and  running  water.  The  city  of  Brest  had  nearly 
three  times  its  normal  population  to  supply  with  water,  so 
there  was  constantly  a  fear  of  a  water  famine.  Sometimes, 
without  the  slightest  warning,  the  water  would  be  shut  off  for 
days.  We  would  have  to  send  out  relays  of  French  women 
and  corpsmen  with  great  varieties  of  pitchers  and  tubs  to 
bring  back  all  they  could  from  remote  public  fountains.  On 
each  floor  we  had  bath  tubs  placed  near  a  tap,  so  that  when 
the  water  was  turned  on  by  the  city  at  night  we  could  collect 
some  and  have  it  for  the  morning  toilets  and  cleaning.  It 
seemed  the  irony  of  fate  that  with  the  sky  constantly  pouring 
down  water  on  our  heads  that  the  city  pipes  should  be  so  'often 
dry — about  the  only  thing  dry  in  Brest. 

Our  second  greatest  difficulty  was  the  lack  of  good  plumb- 
ing. Brest  does  not  possess  sewage;  each  building  has  its 
own  cess  pool.  These  had  to  be  emptied  by  the  city  at  our 
own  expense;  generally  not  until  we  had  notified  the  authori- 
ties many  times  and  waited  until  the  cess  pools  were  over- 
flowing and  the  toilets  were  backing  up  and  out  of  use,  would 
they  pay  the  slightest  attention  to  our  demands. 

When  tliis  happened,  and  it  seemed  to  be  happening  all  the 
time,  it  made  necessary  the  carrying  down  from  the  upper 
floors  of  all  excreta.  I  am  sure  few  corpsmen  worked  any 
harder  than  ours.  All  the  stretcher  cases  had  to  be  carried 
up  and  down  the  one,  two  or  three  long  flights  of  stairs. 
Food,  water,  coal  and  refuse  had  to  be  taken  care  of  in  the 
same  way.  By  comparison  with  the  men  in  the  trenches, 
their  work  was  cliild's  play,  but  for  most  of  the  boys  with  us 
the  work  was  such  as  they  had  never  done  before  and  it  was 
hard  and  not  very  pleasant. 

During  tlio  spring  of  1018,  the  American  transports  began  to 
take  back  to  America  the  "Class  D"  men  and  Xavy  Base  Hos- 
pital Xo.  1,  which  was  then  the  only  American  hospital  in  l^rest 
serving  the  American  Army,  was  crowded  with  patients.  An 
Army  camp  on  the  outskirts  of  Brest  was  opened  in  April, 
1018,  and  lat(^r  another  was  established  at  Kehuron,  a  town 
near  I^rest,  and  later  several  of  the  largest  base  hospitals  of 
the  Army  wer(>  grouped  here  to  care  for  troops  of  tlie  American 


740   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Expeditionary  Forces  returning  to  America  after  the  signing 
of  the  Armistice. 

During  the  summer  of  1918,  Brest  and  its  environs  were 
crowded  with  American  troops.  Over  300,000  American  sol- 
diers, it  may  be  remembered,  were  carried  to  France  in  July, 
1918.  At  the  same  time  that  the  wards  of  Navy  Base  Hospital 
No.  1  were  filled  with  medical  and  accident  cases  among  these 
troops,  the  German  drives  on  Paris  were  greatly  overtaxing 
the  medical  and  nursing  facilities  of  the  Army  and  the  Red 
Cross.  Nurses  were  at  a  premium,  both  in  the  zone  of  the  base 
and  of  the  advance,  so  operating  teams  were  organized  from 
Navy  Base  Hospital  No.  1  and  sent  to  Orleans,  to  Paris  and  to 
the  front. 

Of  the  work  which  confronted  the  depleted  nursing  staff  at 
Navy  Base  Hospital  No.  1  at  Brest,  Miss  Van  Ingen  wrote : 

It  was  during  these  months,  when  we  were  so  short  of 
nurses  and  corpsmen,  that  our  work  was  heaviest.  American 
troops  were  pouring  mto  Brest  from  May  to  November.  Forty 
thousand  were  camped  in  and  around  Brest  in  the  early  part 
of  June,  1918.  Consequently  our  beds  were  filled  with 
sick.  If  it  had  not  been  that  nurses  were  being  sent  over  on 
these  transports  at  the  same  time,  we  would  not  have  been 
able  to  keep  up  the  high  standard  of  nursing  we  had  set  our- 
selves. These  transient  nurses  were  detailed  to  help  us  while 
they  waited  for  further  orders.  As  it  was,  the  hours  were 
long.  These  transient  nurses  would  just  about  have  learned 
the  routine  and  have  gotten  into  the  swing  of  the  work,  when 
their  call  would  come  and  they  would  go,  leaving  us  to  face 
twelve,  fourteen  or  sixteen  hours  without  time  off. 

In  September  we  began  to  get  the  "flu"  cases  from  the 
States.  ]\Ien  Ijrought  in  off  the  battlefields  shattered  and 
bleeding  were  not  as  tragic  to  nie  as  these  that  came  from  our 
own  ships.  ^len  with  the  pallor  of  death  on  their  faces, 
laborin<r  for  air.  yet  begging  for  food,  their  lips  and  tongues 
so  glued  to<:ether  they  could  hardly  articulate,  and  before  we 
could  care  for  them  they  would  be  out  of  their  agony,  beyond 
the  want  of  food  and  water.  Many  died  on  their  way  to 
hospital  or  as  they  were  put  on  their  beds.  ...  I  think  we 
all  aged  with  the  awfulness  of  it,  and  have  our  nights  haunted 
with  the  memories  ot  those  weeks. 

The  first  detachment  of  nurses  who  were  sent  from  Navy 
Base  Hospital  No.  1  left  Brest  April  G,  1918,  for  service  with 


SERVICE  WITH  THE  NAVY  741 

the  French  at  Orleans.     Anne  Burges  was  among  the  four 
nurses  who  saw  service  there  and  she  wrote  of  their  experiences : 

Upon  the  arrival  of  Dr.  Brinsmade,  his  assistant  and  a 
few  corpsmen  (at  Orleans),  a  pavilion  acconnnodating  KJS 
patients  was  assigned  to  him.  This  pavilion  had  been  entirely 
equipped  by  the  American  Red  Cross  with  the  one  exception 
of  beds.  .  .  . 

When  a  convoy  of  wounded  were  brought  in,  the  system 
adopted  was  excellent.  Everyone  expected  to  work  and  did 
so  until  all  the  men  were  cared  for.  .  .  . 

After  the  first  two  months  the  nurses  did  all  but  the  most 
serious  dressings. 

The  ward  nursing  was  done  by  volunteer  French  nurses, 
with  chambermaids  to  keep  the  wards  clean.  Nearly  ail  of 
the  volunteer  workers  had  been  nursing  since  the  outbreak  of 
the  war.  They  never  seemed  weary  of  doing  for  their  brave 
men.  They  were  on  duty  at  eight  a.  m.,  and  stayed  until 
eight  P.  M.,  none  coming  late  or  leaving  early.  The  greatest 
care  was  taken  by  them  to  see  that  any  American  wounded 
received  especial  attention,  as  so  few  of  our  boys  could  speak 
Frencli  and  make  tlieir  wants  known.  As  there  was  no  regu- 
lar night  nurse,  the  day  nurses  had  to  take  each  her  turn, 
about  once  a  week. 

Army  Base  Hospital  Xo.  202  was  opened  about  the  middle 
of  July.  On  August  14th  this  detachment  from  Xavy  Base 
Xo.  1  was  transferred  from  the  French  hospital  to  help  them, 
for  the  American  wounded  were  coming  back  in  great  num- 
bers. .  .  .  The  morning  after  they  had  reported  for  duty 
they  were  each  assigned  to  a  large  surgical  ward,  to  take 
charge  of  dressings.  .  .  .  They  were  returned  to  Brest  on 
October  21,  1918  '.  .  . 

In  addition  to  this  medical  and  nursing  detachment,  an 
operating  team  composed  of  two  surgeons,  two  nurses  and  se\^- 
eral  corpsmen,  all  from  Xavy  Base  Hospital  Xo.  1,  was  sent  on 
rlune  1,  1!)18,  to  the  front.  Dr.  .lohn  Long  was  in  command; 
Mary  Elderkins  and  Katherine  ]\IcCartliy  ^ycre  the  nurses.  Of 
their  experiences,  ^liss  Elderkins  wrote: 

About  February,  lOLS.  ^liss  ^IcCarthy  and  T  were  selected 
for  operating  team  service.  ...  At  last  definite  orders  ar- 
rived June  2.  ims:  Xavy  0]ierating  Team  No.  1  under  P.  A. 
Surgeon  John  H.  Long  was  to  jiroceed  immediately  to  Ameri- 
can  Ambidance  '"B"'  Jouilly    for  temporary  duty.  .  .  .  For 


742   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

equipment  we  took  only  such  articles  as  would  enable  us  to 
set  up  an  operating-room  wherever  we  might  be  sent.  It  was 
surprising  how  little  would  answer  the  purpose  when  neces- 
sary. A  few  instruments,  a  handful  of  sterile  goods,  an 
alcohol  lamp,  some  ether  and  iodine,  a  little  suture  material 
and  a  needle,  at  times  seemed  bountiful.  For  about  three 
weeks  we  were  operating  in  field  hospitals,  doing  some  of  the 
most  serious  work  of  our  whole  trip,  such  as  extensive 
laparotomies,  chest  wounds,  head  cases  and  the  like  when  our 
supply  of  needles  consisted  of  a  few  large  curved  cutting 
edges,  one  poor  dilapidated  "Mayo"  and  one  intestinal  needle. 
The  crown  jewels  were  never  guarded  more  carefully  than 
they.  .  .  . 

Brittany  was  at  her  loveliest  as  we  left,  the  early  June 
twilight  lingering  until  ten  p.  Ml  We  did  not  dream  of  the 
change  of  scene  twenty-four  hours  would  bring. 

The  destination  of  Navy  Operating  Team  No.  1  was  Ameri- 
can Red  Cross  Hospital  No.  7,  located  in  the  hospital  at  Jouilly, 
Seine-et-]Marne,  which  had  been  operated  since  1914  bv  ^Irs. 
Harry  P.  Whitney  for  the  French  wounded.  Miss  Elderkins 
wrote  of  their  journey  there : 

"While  on  the  platform  of  the  Gare  de  L'Est,  it  began  to 
dawn  on  us  that  there  was  something  unusual  in  the  air.  The 
place  was  filled  with  Americans  in  uziiform,  mostly  officers 
and  mostly  juniors,  and  all  going  in  the  same  direction  as 
ourselves.  Three  Marine  officers  shared  our  compartment 
when  we  boarded  the  train.  .  .  .We  soon  learned  the  reason 
for  that  tensity  of  feeling  which  seemed  all  about  us.  The 
Americans  were  at  last  in  action;  these  men  were  being 
rushed  back  to  their  outfits  from  the  Officers'  School  at 
Grandecourt,  from  furlough,  from  convalescent  camps,  from 
wherever  they  might  have  been  at  the  time.  They  did  not 
know  where  their  companies  were;  all  they  knew  was  that 
they  were  to  proceed  to  ^leaux,  that  there  had  been  heav}- 
fighting,  that  the  (Germans  had  been  making  definite  progress 
and  had  apparently  not  yet  been  stopped.  At  ^Meaux  we 
began  to  get  an  idea  of  tlie  seriousiiess  of  the  situation.  An 
American  officer  there  told  us  the  Germans  were  only  about 
nine  miles  away;  that  tlie  civil  population  of  ]\Ieaux  had  been, 
evacuating  all  the  previous  day;  that  refugees  from  towns 
nearer  the  fighting  were  pouring  into  the  city. 

We  had  some  time  to  Mait  in  making  train  connections  and 
thought  it  wise  to  have  lunch.     No  one  at  the  station  could 


SERVICE  WITH  THE  NAVY  743 

direct  us  to  any  place  where  they  thought  we  could  obtain 
anything  to  eat.  After  walking  a  few  blocks,  we  understood 
why ;  all  the  shops  and  cafes  were  closed.  It  would  seem  that 
everyone  had  turned  the  key  in  the  lock  and  fled.  The  few 
who  remained  eyed  us  suspiciously.  The  Naval  uniform  was 
not  a  familiar  one  inland  at  that  time,  nor  was  the  uniform 
of  the  American  nurse  recognized  as  quickly  as  it  was  in  the 
months  to  follow.  We  might  have  been  Germans  for  all  the 
information  we  could  gather  from  the  one  or  two  civilians  we 
met;  and  I  believe  they  half  suspected  we  were.  .  ,  . 

We  went  back  for  our  little  toy  train  to  take  us  to  Jouilly, 
and  after  leaving  the  city  could  see  the  French  preparations 
for  retreat  all  along  the  road  leading  back  from  the  front.  It 
was  not  exactly  reassuring! 

An  amusing  incident  occurred  at  one  of  the  stores.  Five 
German  prisoners  were  being  put  aboard  under  guard  of  a 
French  soldier.  He  had  them  safely  on  the  train  when  he 
remembered  a  large  basket  some  half  dozen  yards  away;  he 
gave  his  gun  to  one  of  the  prisoners  and  dashed  back  for  the 
basket.  We  expected  the  Boche  to  hold  up  the  train,  but  he 
simply  waited  patiently  for  the  return  of  the  guard. 

Warm,  travel-worn  and  hungry,  Navy  Operating  Team 
Xo.  1  arrived  at  their  destination,  Jouilly,  Seine-et-Marne,  at 
six  o'clock  in  the  evening  and  went  directly  to  work.  Miss 
Elderkins  wrote: 

Captain  Mixter  took  us  to  the  operating-room  after  supper. 
On  our  way  there  we  could  see  the  courtyard  filled  with 
ambulances  and  stretchers  containing  wounded  Americans. 
The  corridors  were  filled  with  stretchers;  a  long  line  of  them 
extended  down  the  center  of  the  ward  through  which  we 
passed,  and  when  we  reached  the  operating-room  the  floor  of 
the  ante-room  was  packed  and  the  four  operating-tables  in 
the  room  each  had  a  patient  on  it.  Poor  boys,  they  were 
sorry  looking  fellows,  as  they  lay  there,  waiting  for  their 
turn,  but  as  "game"  as  they  could  be.  The  nurses  and  doc- 
tors operating  luid  been  at  it  most  of  the  time  for  the  past 
three  days. 

Before  going  further  I  would  like  to  give  you  an  idea  of 
what  the  American  Ambulance  "B"  was  and  the  conditions 
when  we  arrived.  In  1914  Mrs.  Harry  Payne  Whitney  had 
estal)lished  this  hospital  in  the  wing  of  the  college  of  Jouilly 
for  the  French  hle.'i.^cs.  The  work  was  taken  care  of  by  Ped 
Cross  personnel  consisting  of  two  American  doctors,  a  chief 


744.   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nurse  with  twenty  nurses  under  her,  of  various  nationali- 
ties. .  .  . 

During  those  days  of  fighting  in  the  vicinity  of  Belleau 
Woods,  this  little  hospital  was  all  that  stood  between  the 
fighting  and  Paris,  thereby  cutting  in  two  the  long  ambulance 
journey  for  our  mutilated  boys.  It  was  only  equipped  with 
two  hundred  beds,  but  the  faithful  workers  kept  up  their 
supplies  for  the  possible  emergency  that  they  were  always 
watching  for  after  their  four  years'  experiences,  and  if  it  had 
not  been  for  their  well  stocked  sterile  lockers  and  the  instru- 
ment cabinets,  we  would  have  been  greatly  handicapped. 

About  the  time  we  were  receiving  our  orders  at  Brest  to 
proceed  June  2  to  Jouilly,  they  got  a  message  saying  there  had 
been  heavy  casualties  among  the  American  troops  and  asking 
if  they  could  care  for  some.  Before  they  had  time  to  answer, 
ambulances  began  to  arrive,  and  they  had  been  coming  in 
ever  since  and  continued  to  do  so  for  many  days.  The 
divisional  surgeon  had  been  giving  what  help  he  could,  but 
the  combined  efforts  of  all  seemed  like  but  a  drop  in  the 
bucket,  with  hundreds  of  wounded  men  pouring  in.  An 
additional  operating-room  had  been  improvised,  so  our  team 
took  over  the  original  and  the  other  surgeons  opened  up  the 
new  one.  Work  went  on  both  night  and  day  for  the  next  ten 
days. 

We  operated  all  through  that  first  night  and  I  don't  believe 
one  of  us  had  ever  imagined  men  could  be  so  absolutely  "shot 
to  pieces."  Many  of  them  were  the  Marines  who  had  crossed 
with  us  on  the  U.  S.  S.  II enderson  and  seemed  a  bit  closer  to 
us  for  that  reason.  Five  Marine  officers  whom  we  knew  were 
in  the  hospital  as  patients  that  night.  The  following  night 
one  of  the  young  officers  who  had  shared  our  compartment 
from  Paris  to  Meaux  came  in  severely  wounded,  giving  an 
idea  of  how  quickly  those  men  had  gotten  into  the  "thick 
of  it." 

About  11  p.  M.  some  one  from  the  office  announced  that 
there  were  twenty  enemy  planes  over  head.  We  were  barely 
conscious  of  the  bombing,  so  intent  was  every  one  on  the 
work  at  hand.  The  receiving  of  patients  and  care  of  them 
in  the  wards  was  all  done  in  the  dark  or  by  the  wee  flare  of  a 
candle ;  the  operating-room  was  the  only  place  where  lights 
were  allowed.  The  windows  were  heavily  blanketed  and  black 
curtains  hung  over  them. 

I  cannot  describe  those  nights, — the  long  hours  spent  at  the 
sterile  table,  or  in  giving  anesthetics  or  in  doing  the  many 
tasks  about  the  room;  the  intense  suffering  of  the  wounded; 
the  ghastly  sights  and  nauseating  smells  when  gas  gangrene 
was  present. 


SERVICE  WITH  THE  NAVY  745 


Some  days  after  the  arrival  of  Naval  Operating  Unit 
No.  1,  reenforcements  from  the  Paris  headquarters  of  the 
American  lied  Cross  in  France,  and  United  States  Army  Evac- 
uation Hospital  No.  8  were  brought  up  to  Jouilly,  Seine-et- 
Marne.  Other  operating  teams  arrived  also  and  the  little  cha- 
teau-hospital was  greatly  enlarged  and  became  the  principal 
evacuation  center  from  Belleau  Woods  to  Paris.  Miss  Elder- 
kins  wrote : 

Instead  of  two  hundred  patients,  there  were  at  times  close 
on  to  one  thousand,  these  being  evacuated  as  quickly  as  pos- 
sible to  make  room  for  the  fresh  cases  coming  in.  I  do  not 
remember  the  exact  figures,  but  over  three  thousand  patients 
passed  through  the  operating-rooms  during  the  Belleau  Woods 
and  Soissons  Drive. 

We  remained  at  Jouilly  during  June  and  July,  going  over 
to  Meaux  to  help  out  in  a  rush  for  la  few  days.  An  evacuation 
hospital  had  come  up  there  but  was  hardly  ready  for  work 
when  a  convoy  of  wounded  arrived. 

On  June  7  a  second  operating  team  had  been  sent  forward 
from  Navy  Base  Hospital  No.  1.  Dr.  James  Watt  was  in 
command.  Leola  Steward  and  Florence  Missimer  were  the 
nurses.  The  team  left  Brest  on  June  7,  1918,  and  after  various 
temporary  assignments  were  detailed  to  duty  with  Mobile 
Hospital  No.  1  at  Evacuation  Hospital  No.  7,  near  Coulom- 
miers.      Of  the  artillery  fire  there,  Miss  ]\Iissimcr  wrote: 

Big  Bertha  was  also  sportive  in  this  section ;  she  plowed  up 
great  holes  in  nearby  fields.  One  night  a  Bocbe  dropped  a 
huge  bomb  in  a  field  right  in  front  of  tbe  hospital  and  caused 
a  small  earthquake;  we  and  the  chateau  trembled  together. 
To  the  right  of  us,  the  French  had  an  anti-aircraft  station, 
with  their  big  To's  constantly  in  action. 

We  were  five  weeks  at  this  station,  doing  twelve-hour  duty 
either  day  or  niglit.  aiul  occasionally  it  would  be  twenty-four 
hours  at  a  strctcli  and  occasionally  a  like  time  off. 

On  the  twentiotb  of  July,  we  retired  at  night  very  tired, 
having  been  on  duty  all  tbe  niglut  before.  After  an  hour's 
sleep  orders  came  for  us  to  rejiort  to  tbe  "•^Sth  Division.  Stag- 
gering out  of  bed,  we  dressed,  slioved  our  few  belonginjr?  into 
our  sea-bags  and  by  eleven  o'clock  were  seated  on  tbeni  outside 
the  chateau,  waiting  for  transportation.    Here  we  nodded  and 


746  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

dozed  until  one-thirty,  when  a  French  ambulance  rattled  up 
and  all,  including  luggage,  was  bundled  in  and  the  journey 
begun. 

The  weather  was  extremely  hot  and  the  dust  so  thick  that 
our  lungs  seemed  choked  with  it.  We  were  supposed  to  reach 
headquarters  for  the  28th  Division  in  two  hours.  Every  mile 
seemed  to  take  us  nearer  real  activities.  Xot  a  civilian  was  to 
be  seen,  but  we  passed  continual  streams  of  soldiers  on  horse- 
back and  on  foot.  Large  ammunition  trucks  rumbled  by. 
The  soldiers  we  met  seemed  indifferently  puzzled,  as  if  they 
wondered  what  we  were  doing  there.  It  was  not  long  before 
we,  too,  wondered. 

Garde,  a  little  village,  at  that  time  only  three  miles  behind 
the  firing  line,  was  a  mass  of  ruins,  deserted  except  for  an 
occasional  sentry  on  duty,  the  roads  almost  impassable  with 
fallen  bricks  and  stones.  On  beyond  this  village  we  came 
upon  big  Naval  guns  swinging  back  and  forward  in  action. 
Still  further  on  was  the  artillery  carefully  camouflaged  in  the 
woods.  Time  and  again  we  met  whole  regiments  of  American 
and  French  soldiers  trudging  along  in  a  mechanical  way,  an 
unforgetable  expression  on  their  worn  faces,  desperate  through 
utter  exhaustion.  On  either  side  of  the  road,  men  had 
dropped  out,  throwing  themselves  on  the  ground,  unable  to 
go  any  farther.  We  found  out  later  that  these  were  men  who 
had  just  been  relieved  from  the  firing  line. 

With  high  explosives  whirring  past  us,  we  sped  on  past 
trench  after  trench,  actually  seeing  our  own  boys,  with  guns 
to  shoulder,  ready  for  the  words  that  would  send  them  over 
the  top,  and  came  finally  to  a  bridge  where  we  halted  for 
Dr.  Watt  to  ask  where  we  were  and  where  were  Division  28's 
headquarters.  An  officer  volunteered  to  take  him  to  a  dug- 
out where  he  could  telephone;  we  then  found  our  Freiich 
chauffeur  had  taken  us  miles  out  of  our  way.  While  we  were 
waiting  for  the  return  of  Dr.  Watt,  we  had  no  difficulty  in 
engaging  the  Ijoys,  doing  sentry  duty  at  the  bridge,  in  con- 
versation ;  they  had  not  seen  a  woman  in  weeks.  They  told 
us  that  under  the  bridge  was  enough  dynamite  to  blow  up  a 
whole  division  of  Germans.  We  delved  into  our  sea-bags  and 
found  several  ])Oxes  of  crackers,  which  we  passed  over  to 
them,  hating  ourselves  for  the  smallness  of  the  gift. 

When  Dr.  Watt  nppeared,  the  ^lajor  was  witli  him.  He 
pointed  out  the  (Jerman  lines,  which  were  just  over  tlie  hill- 
side, and  added  that  we  were  in  the  first  line  reserve  trenches, 
a  gas  section.  As  the  Germans  had  been  sending  over  gas 
shells  all  day,  he  begged  we  would  hurry  our  leave-taking. 
We  did,  tout  de  suite. 


SERVICE  WITH  THE  NAVY  747 

Dr.  Watt's  team  was  finally  ordered  to  Field  Hospital 
No.  109  and  reached  there  at  10  v.  m.  that  night.  However, 
the  end  of  their  journeying  had  not  yet  come.  Miss  Missimer 
wrote : 

Here  at  Field  Hospital  Xo.  109,  a  unit  under  Major 
Schalfer,  was  just  (retting  settled  in  a  lovely  chritcau,  with 
most  attractive  grounds.  The  Major  was  very  attentive  and 
kind.  So  far  we  were  the  only  women  in  the  personnel.  Be- 
fore dawn  of  the  second  night  there,  orders  came  for  us  to 
move  on,  first  to  Field  Hospital  Xo.  103  at  La  Ferte,  then  to 
Field  Hospital  No.  33,  and  at  midnight  four  days  later  we 
were  sent  by  motor  to  Field  Hospital  Xo.  112  at  Chateau- 
Thierry. 

Field  Hospital  Xo.  112  was  located  in  a  building,  one  end 
of  which  had  been  entirely  destroyed.  All  the  windows  were 
gone.  .  .  .  Pontoon  bridges  spanned  the  ^Farne  and  they  and 
the  ammunition  trucks  rumbling  over  them  were  a  constant 
target  for  enemy  bombs. 

Our  stay  at  Field  Hospital  Xo.  112  was  for  two  weeks  only. 
Dr.  Watt's  health  broke  down  and  we  were  returned,  August 
18th,  to  Brest. 

While  Dr.  Brinsmade's  detachment  was  at  Orleans  and  N^avy 
Operating  Teams  Xo.  1  and  Xo.  2  were  at  the  front,  twenty 
additional  Xavv  nurses  were  called  from  Xavy  Base  Hospital 
1^0.  1  at  Brest  for  service  at  Paris.  One  of  these  nurses,  Helen 
Hayward,  wrote : 

On  July  27,  1918,  we  left  Brest  for  Paris,  where  eight  of  us 
were  assigned  to  American  IJed  Cross  nosi)ital  Xo.  3,  in 
Paris,  and  twelve  to  American  IJed  Cross  Hospital  Xo.  5.  at 
Auteuil. 

American  Ped  Cross  Xo.  5  was  situated  on  the  race  tracks 
of  the  Bois  de  Boulogne  and  was  entirely  under  Ped  Cross 
tents.  It  accommodated  twenty-five  liuiidred  })aticnts.  Kadi 
ward  consisted  of  from  one  to  three  tents,  with  from  forty  to 
seventy-eight  beds.  We  went  on  duty  the  following  moniiiii:. 
and  were  extremely  busy.  Tlie  nurses  were  all  glad  to  wel- 
come even  twelve  nurses,  for  the  convoys  were  coming  in 
every  other  day.  There  was  one  convov  which  I  especially 
remember.  Tt  was  the  admission  of  eighteen  hundred  boys 
in  one  morning,  all  gas  cases.  Tlie  convalescent  ])atients  \(il- 
unteered  to  act  as  orderlies  and  saved  us  from  a  trving  pre- 
dicament :   we  were  at  the   time  sliort  uf  coriisnicii.     Tlirir 


748  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

fine  spirit  of  comradeship  for  the  men  worse  off  than  them- 
selves was  shown  in  such  a  splendid  way,  for  before  we  had 
time  to  ask  we  had  nv.merous  offers  of  help.  A  bad  gas  case 
is  absolutely  helpless.  It  is  surely  the  most  cruel  weapon  of 
warfare;  there  is  so  little  one  can  do  for  them  and  they  suffer 
so  dreadfully. 

The  ''Bertha"  was  shooting  over  the  hospital  and  of  course 
we  had  the  usual  air  raids  at  night  when  the  moon  was 
bright. 

The  spirit  around  the  hospital  was  wonderful.  Everj-- 
one  helped  the  other.  There  never  was  any  unpleasantness. 
Of  course  we  did  a  lot  of  pioneer  work,  for  we  did  not  have 
the  conveniences  or  the  things  to  work  with  that  we  had  at 
our  home  base,  but  the  boys  seemed  happy  and  certainly 
recovered  rapidly. 

Of  the  experiences  of  the  eight  Navy  nurses  assigned  to 
American  Red  Cross  Military  Hospital  No.  3,  Mary  Caldwell 
wrote : 

At  seven  a.  m.  the  next  morning  we  were  each  detailed  to 
different  wards  and  encountered  a  very  decided  change  of 
work.  Here  we  had  patients  from  generals  down  to  lieu- 
tenants, the  cases  nearly  all  surgical,  the  officers  mostly 
suffering  from  explosive  wounds  and  compound  fractures. 
No  more  great  black  stevedores,  with  mumps  and  measles ! 
The  majority  of  our  patients  belonged  to  tlie  181st,  2nd  and 
77th  divisions.  ]\Iany  of  them  were  prominent  xVmericans. 
Some  of  our  beloved  ]\rarines  from  the  S.  S.  Henderson,  whom 
a  year  before  we  had  last  seen  marching  away  from  the  ship 
well  and  hap])y.  came  back  to  us  shattered  and  miserable,  to 
be  nursed  back  to  a  poor  resemblance  of  their  former  sturdy 
selves.  .  .  . 

The  other  Navy  Base  hospital  in  France  which  furnished 
nurses  for  detached  duty  at  the  front  was  No.  5.  Elizabeth 
Dewey  was  one  of  these  nurses  and  she  wrote : 

As  we  were  going  off  duty  the  evening  of  July  19,  1918,  we 
four  nurses.  Miss  Faye  Fulton  and  Miss  Dewey,  anestheti- 
zers.  and  Miss  Alice  llurst  and  -Miss  Caroline  Thompson, 
were  told  to  1)0  readv  to  leave  for  the  front  at  5  a.  m. 

We  met  the  others  of  the  two  operating  teams  at  the  station 
the  next  morning.  Drs.  George  Eoss  and  John  Jones  were  in 
command  ;  assistants,  Drs.  Tanner  and  Dyon,  and  Chief  P.  ^I. 
Shank  and  P.  M.  Steel,  Diable  and  Hornsburger  were  the 
other  members  of  the  teams. 


SERVICE  WITH  THE  NAVY  749 

We  reached  Paris  about  8  r.  m.,  and  reported  at  Dr.  Blake's 
hospital.  .  .  .  About  3  p.  M.,  July  20,  we  started  oil  in  12 
new  Ford  anii)ulan(es,  with  a  sergeant,  on  a  motorcycle,  to 
act  as  convoy.  We  ])assed  the  fortifications  and  wire  entan- 
glements, huge  airdrcjmes  and  encampments  and  later  several 
hundred  (ierman  prisoners  huddled  in  a  farm  yard.  We 
heard  the  guns  and  saw  tlie  line  of  observation  balloons  above 
the  trenches.  The  road  was  a  solid  mass  of  trucks  and  artil- 
lery and  everything  was  veiled  in  the  dust.  Our  Fords  had 
to  get  off  into  a  field  every  little  while  to  cool,  and  we  tried  to 
remember  where  Crepy  was,  for  all  signs  pointed  to  Crepy. 
When  we  reached  there  some  soldiers  gave  us  hot  coffee  and 
hard  tack. 

About  dusk  we  sighted  a  castle  on  a  hill,  a  fairy-tale  castle, 
almost  too  beautiful  to  be  real.  We  made  a  turn  and  were  in 
the  square  of  a  small  town.  We  stopped  before  a  white  gate, 
and  in  front  of  us.  behind  us  and  on  both  sides  of  the  road 
were  stretchers,  each  with  its  l)urden  of  wounded.  Some  were 
very  still,  some  groaning,  some  muttering  in  delirium.  One 
man  caught  my  coat  as  I  passed  and  begged  for  water.  So 
we  entered  I/Ilulcl  des  Raines  at  Pierrefonds,  where  Field 
Hospital  Xo.  12  was  located. 

In  about  a  half  hour  both  teams  were  working  in  the  hotel 
parlor,  a  medium-sized  room  reached  by  a  hallway  three 
stretchers  long,  and  wide  enough  for  the  stretcher-bearers  to 
walk  beside  each  oilier.  The  long  French  windows  of  this 
room  were  closed ;  blankets  were  nailed  up  outside  the  shutters 
to  hide  the  light.  The  furniture  was  gone.  In  its  place  were 
two  o{)erating-tabk's  and  a  plank  on  clothes-horses  made  a 
third.  Pictures  and  mirrors  decorated  the  walls,  strong  elec- 
tric drop  lights  hung  over  the  tables,  fancy  stands  held 
instruments,  ailhcsive  strips  were  stuck  on  mirrors  and  win- 
dows. A  ]iilc  of  l)l()()(l-soaked,  filthy  clothing  grew  in  one 
corner  of  the  room  and  millions  of  flies  rose  and  buzzed  when 
an  addition  was  made  to  the  pile.  As  a  patient  was  carried 
out,  the  stretclier  nearest  the  door  was  brought  in  and  another 
shoved  in  at  tlu^  far  end  from  the  ground  outside.  The  work 
in  that  room  never  stnpjjod  day  or  nighr.  e-\ce])t  long  enough 
in  the  morning  to  scrape  out  tlie  filth  of  the  night  work,  and 
in  the  evening  to  clost'  everything  h(>fore  liglits  went  on;  the 
ground  outside  was  not  cleared  of  stretchers  until  the  fourth 
day. 

About  n  V.  ^\.  ihat  (irst  niglit.  a  dying  man  was  ]iut  on  my 
table.  lie  askeil  nie  to  write  home  for  him.  ami  one  of  the 
boys  found  a  jiad  for  me.  \)v.  h'oss  asked  if  I  thought  I  could 
kee])  a  record  of  ea(  h  case  for  him.     I   still  ha\e  that  pad,  the 


750   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

first  entry  being  the  address  of  the  only  man  who  died  on  our 
table,  though  the  record  covers  over  two  hundred  cases. 

The  next  morning  other  teams  arrived  and  the  tired  Navy 
nurses  were  told  to  find  a  place  where  they  could  get  a  few 
hours'  sleep.  They  stumbled  to  the  nearest  house.  Miss  Dewey 
wrote : 

On  the  second  floor  were  two  adjoining  rooms  with  double 
beds,  the  bedding  thrown  back  as  if  people  had  just  gotten 
out  of  them.  We  four  nurses  got  into  those  beds  and  pulled 
up  the  covers. 

Miss  Dewey's  team  went  on  duty  again  that  night.  She 
wrote : 

The  night  of  July  21  a  bomb  exploded  in  a  garden  about 
20  yards  from  us  and  blew  open  the  windows.  Chief  Shank 
stepped  away  from  one,  remarking,  "That's  too  close,  but 
thank  God  they  let  in  a  little  air."  Only  the  most  urgent 
cases  were  operated  at  Xo.  12.  The  others  were  sent  on  to 
where  facilities  were  better.  Some  of  the  wounds  contained 
maggots  and  nearly  all  were  gas  gangrene  cases,  and  the  stench 
of  that  room  was  beyond  words. 

The  pluck  of  the  men  kept  us  at  it.  Most  of  them  were 
conscious  and  told  us  they  had  the  Germans  on  the  run.  One 
boy  whose  leg  had  to  come  off,  said,  "All  the  fun  I  had  lying 
there  in  the  mud  was  seeing  the  Germans  beat  it.  Our  boys 
couldn't  get  to  me  any  sooner  than  they  did."  Some  asked  if 
we  thought  they  could  get  back,  because  "I  got  to  get  a  Boehe 
for  this." 

The  night  of  the  24th  we  operated  on  some  Scotchmen,  who 
had  come  up  to  relieve  our  1st  and  2nd  divisions.  By  morn- 
ing their  medical  corps  had  come  up  and  we  were  sent  back, 
reaching  Paris  at  9  p.  m.  that  night.  Over  3500  wounded 
went  through  Xo.  12,  between  July  18  and  July  24.  About 
300  non-transportable  cases  were  operated  upon  there  and  the 
Xavy  teams  performed  about  100  of  those  operations. 

On  July  29  Dr.  Ross's  team,  with  ]\Iiss  Dewey  and  Miss 
Hurst,  was  ordered  to  join  Field  Hospital  No.  0  at  Chateau- 
Thierry.  When  they  arrived  they  found  that  the  hospital  had 
not  yet  come  up,  but  were  told  to  report  temporarily  for  duty 
at  the  College  Jean  ^lace  where  some  operating  was  under 
way.  They  were  promptly  set  to  work  there.  ^liss  Dewey 
wrote : 


SERVICE  WITH  THE  NAVY  751 

;Miss  Hurst  was  asked  to  hand  instruments  for  three  tables 
and  during  the  night  had  three  abdominal  cases  going  on  at 
the  same  time  and,  as  Dr.  Koss  said,  "got  away  with  it  with- 
out a  hitch."  It  was  a  wonderful  piece  of  work.  How  she 
managed  to  get  all  those  needles  threaded  and  with  the  proper 
sutures  is  more  than  I  know,  but  she  did. 

The  following  day  we  joined  Field  Hospital  No.  6  and 
^lobile  1,  which  was  being  put  up  in  a  field  near  Chateau- 
Thierry.  We  were  taken  there  in  a  truck,  crossing  the  Marne 
by  a  pontoon  bridge.  This  was  a  large  tent  hospital  wonder- 
fully equipped  and  the  operating  there,  after  Pierrefonds, 
seemed  almost  ideal  in  spite  of  the  fact  that  we  were  boml)ed 
and  fired  over.  We  operated  every  day,  and  part  of  some  of 
the  nights,  ending  wth  a  stretch  of  twenty-four  hours.  .  .  . 

The  other  operating  team  from  ISTavy  Base  Hospital  No.  5, 
under  the  command  of  Dr.  Jones,  with  Miss  Fulton  and  Miss 
Thompson  as  nurses,  had  been  detailed  to  Field  Hospital  No.  7 
at  Coulommiers.  Miss  Dewey  wrote  of  the  type  of  service 
which  this  team  had  seen : 

Field  Hospital  Xo.  7  was  located  near  a  small  chateau, 
about  a  mile  from  the  town.  Tents  filled  the  woods  back  of 
the  chateau  and  eight  beds  were  in  a  tent.  The  first  few  days 
after  their  arrival  the  work  was  very  strenuous,  and  they 
had  long  hours  and  little  sleep,  then  more  teams  arrived  and 
the  work  was  better  regulated. 

One  night  while  they  were  working  all  the  lights  in  the 
operating  tent  wont  out,  and  they  had  to  finish  their  case  by 
flash  liglit.  That  was  during  one  of  the  severe  air  raids,  of 
which  they  had  several. 

Both  teams  returned  to  Brest  on  August  15.  ^Hss  Dewey 
was  commended^"  as  follows  by  the  Commander  of  the  U.  8. 
Naval  Forces  in  France : 

She  is  a  splendid  nurse  and  a  woman  of  fine  character  and 
exceptional  executive  ability.  Her  services  while  on  duty 
with  the  operating  teams  at  the  front  were  extremely  valu- 
able. She  acted  as  anesthetist  during  most  of  her  service 
there,  in  addition  to  which,  when  relieved  from  that  duty, 

"It  is  not  the  policy  of  tliis  history  to  publisli  individual  citations; 
space  does  not  permit  it.  A  list  of  nurses  wlio  have  been  decorated  for 
frallant  and  devoted  conduct  may  bo  found  in  the  Appendix.  This  citation 
is.  however,  i^iven  in  the  text  as  an  index  to  the  general  type  of  citation 
received  by  numerous  nurses  during  the  European  War. 


752   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

she  did  extra  duty  in  assisting  the  nurses  in  the  care  of  the 
wounded  with  their  dressings.  On  one  occasion,  under  ex- 
tremely unsatisfactory  surroundings,  she  gave  anesthetics 
steadily  for  fourteen  hours  without  leaving  the  table,  and 
after  this  strenuous  labor  she  visited  the  cases  which  had  been 
operated  upon. 

Following  the  return  of  Dr.  Watt  and  his  team  members  to 
Brest  in  August,  1018,  l^avy  Operating  Team  ISTo.  1  of  Base 
Hospital  No.  1  with  Dr.  Long  commanding,  was  sent  up  to 
replace  Navy  Operating  Team  No.  2,  at  Field  Hospital 
No.  112,  Chateau-Thierry.  Miss  McCarthy,  the  second  nurse 
on  Navy  Operating  Team  No.  1,  had  been  ill  and  Jeannette 
McClellan,  one  of  the  Navy  nurses  of  Navy  Base  Hospital 
No.  1,  who  had  been  on  detailed  duty  at  Paris,  was  sent  for- 
ward to  take  Miss  McCarthy's  place. 

Navy  Operating  Team  No.  1  set  out  on  August  11  to  find 
Field  Ilospital  No.  112,  which  had  been  moved  that  morning 
from  Chateau-Thierry  twenty  miles  closer  to  the  fast  advancing 
American  Front.     Miss  Elderkins  wrote: 

Twelve  nurses  attached  to  Field  Hospital  No.  112  were  also 
waiting  for  ambulances  to  be  sent  to  take  them  up  to  the 
next  sit«.  An  officer  coming  down  from  there  said  he  feared 
it  would  not  be  possible  for  any  of  us  to  go  on  that  night,  as 
the  Boches  were  shelling  the  roads  and  also  sending  over  a 
great  many  gas  shells  in  the  vicinity  of  the  hospital.  Never- 
theless, the  ambulance  came  and  ^liss  ]\lcCleIlan,  the  other 
nurses,  Sexton  and  Brady  and  1  started  up.  We  were  pro- 
vided with  helmets  and  gas  masks. 

That  was  a  wild  ride.  We  passed  through  village  after 
village  where  ]iot  a  house  had  been  spared,  and  the  only  signs 
of  life  were  the  military  guards.  Ammunition  trucks  were 
racing  in  both  directions,  and  as  no  lights  were  allowed,  the 
traffic  was  rather  perilous.  About  a  half  hour  before  we 
reached  camp,  we  were  stopped  and  told  that  all  masks  were 
to  be  worn  in  the  "alert"  position.  We  had  no  more  than 
adjusted  th^m  so,  when  the  rfal  gas  alarm  came.  .  .  . 

Upon  arrival  at  camp  we  found  everything  in  pitch  dark- 
ness. .  .  .  We  groped  our  way  to  the  last  tent,  where  four 
occupants  Avore  sleeping.  Cots  were  brought  for  us  .  .  .  but 
we  didn't  slcfp. 

Gas  alarms  sounded  continuously.  You  would  hear  the 
hoarse  cries  of  "gas  I  gas  I''  (oming  down  from  the  distance  as 
the  sentinels  passe*]  the  warning.     Tiicn  our  own  guard  would 


SERVICE  WITH  THE  NAVY  753 

take  it  up,  five  pistol  shots  would  be  fired  and  some  one  would 
start  beating  a  huge  shell  strung  up  on  a  tripod.  To  hear  the 
horses  whinnying  across  the  road,  where  some  cavalry  troops 
were  spending  the  night,  was  pitiful.  They  also  had  to  have 
the  masks  on  and  could  not  seem  to  understand  it. 

In  the  morning,  we  found  ourselves  in  a  little  town  called 
Cohan.  The  hospital  was  at  the  foot  of  a  hill ;  from  the  top 
you  could  get  a  good  idea  of  where  the  fighting  was  taking 
place.  Fismes  was  only  four  miles  away,  and  the  Germans 
occupied  the  town  on  the  opposite  side  of  the  river.  At  night 
it  seemed  like  the  battle  was  being  fought  just  outside  our 
tents. 

Army  nurses  have  described  the  severe  service  at  Cohan,  and 
Miss  Elderkins'  report  repeated  some  of  the  things  which  made 
that  post  of  duty  so  arduous.     She  wrote: 

Our  location  was  poor;  we  were  right  in  the  midst  of 
things  most  desired  by  our  enemy.  The  work  here  was  not 
especially  heavy,  but  conditions  were  such  that  every  bit  ol 
reserve  force  was  needed.  The  days  were  intensely  hot  and 
the  nights  bitterly  coid.  The  flies  were  unbearable.  We  had 
air  raids  niglit  after  night,  with  no  opposition,  for  there  were 
no  anti-air  craft  nearby  and  seemingly  very  few  French  or 
American  planes. 

When  we  were  not  operating  at  night,  we  spent  the  tini(^ 
from  darkness  to  dawn  in  a  cellar  twenty  feet  under  ground. 
It  just  held  seven  cots  and  thirteen  nurses  were  supposed  to 
sleep  there.  If  we  sat  erect  on  the  cot  our  head  struck  the 
rough  stone  above.  Water  dripped  on  us  all  night  long. 
Huge  black  bugs  crawled  about  and  after  we  quieted  down  we 
could  hear  the  rats.  We,  ourselves,  felt  like  rats  in  some 
trap,  for  in  case  of  a  direct  hit  our  chances  of  getting  out 
were  slim.  I  woidd  have  preferred  the  dugouts,  or  "graves" 
as  we  called  thcni,  that  Dr.  Long  and  the  corpsmen  had  dug 
under  our  cots  in  the  tent. 

The  morning  of  the  tenth  day,  the  Germans  had  found  our 
range.  Tliev  opened  fire  on  us.  or  rather  on  their  objectives 
about  us.  A\'itli  shells  falling  all  about  us,  we  went  back  that 
night  three  miles. 

Then  followed  a  series  of  moves,  first  to  Evacuation  Hos- 
pital Xo.  ").  outside  of  Chateau-Thierry,  then  across  the 
^larnc  to  lied  Cross  Hospital  Xo.  Ill,  aiul  a  few  days  later 
to  Vic-sur-Aisue.  wliere  we  were  attached  to  I'ield  Ibisjiital 
X'o.  l"iT  of  the  -I'^ut]  Division,  who  were  serving  with  the 
French  luuler  (ieneral  ^lanarin. 


754    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  casualties  were  heavy.  We  worked  a  twenty-hour 
shift,  which  really  became  a  twenty-four  hour  shift,  and  under 
the  most  trying  conditions.  The  furnishings  of  the  operating- 
room  were  of  the  crudest  kind.  Packing  boxes  were  used  for 
instrument  tables  and  seats  for  the  anesthetist,  a  stretcher 
on  two  carpenter  horses  was  the  operating-table,  while  we  had 
to  put  our  solutions,  etc,  in  tin  cans,  cooking  utensils  or 
stray  bits  of  china  ware.  A  pie  plate  made  a  splendid  con- 
tainer for  our  alcohol  sponges  for  "scrubbing  up."  I  think  it 
is  pretty  generally  known  that  only  non-transportable  cases 
were  cared  for  in  the  field  hospitals,  which  meant  all  major 
cases,  abdominals,  amputations,  severe  hemorrhages  and  head 
cases. 

When  the  32nd  Division  withdrew,  we  went  back  with 
them,  and  by  another  series  of  moves  and  short  stops  at 
various  field  and  evacuation  hospitals  eventually  reached 
Base  Hospital  No.  15  situated  at  Chaumont. 

At  Chaumont,  Dr.  Long's  assistant,  Dr.  Pierson,  was  given 
a  team  of  his  own,  composed  of  Miss  McClellan  and  Hospital 
Corpsmen  Brady.  Dr.  Long's  team,  with  Miss  Elderkins  as 
the  only  nurse,  was  ordered,  on  September  24,  1918,  to  report 
to  Evacuation  Hospital  jSTo.  8,  then  near  Souiily,  seven  miles 
from  Verdun.     Miss  Elderkins  wrote: 

It  was  noon  of  September  26  when  we  arrived  after  a  forty- 
hour  trip  with  no  sleep  and  little  to  eat.  .  .  . 

When  I  went  to  the  operating-room  to  inquire  about  the 
baggage,  I  found  Dr.  Long  already  "scrubbing  up"  and  he 
asked  me  to  start  the  anesthetic  of  the  patient  upon  whom  he 
was  preparing  to  operate.  It  was  necessary  to  continue 
giving  them  until  9  p.  m.,  so  I  did  not  have  an  opportunity  to 
get  into  my  gray  uniform. 

I  do  not  believe  there  was  a  better  organized  operating 
room  in  the  American  Expeditionary  Forces  than  that  at 
Evacuation  Hospital  Xo.  8.  It  kept  the  sterile  nurse  on  the 
alert  every  moment,  for  at  times  an  operation  would  be  in 
progress  on  all  the  tables.  I  remember  one  night  there  was  a 
bad  chest  wound  and  a  laparotomy  on  the  first  two  of  my 
tables.  At  the  next  Dr.  Hanson  was  removing  a  piece  of 
shrapnel  which  had  entered  through  the  skull  and  was  lodged 
somewhere  near  the  ethmoid,  while  the  other  three  tables  con- 
tained minor  cases. 

Again,  I  have  seen  six  surgeons  all  working  on  the  same 
case,  where  a  long  anesthetic  was  counter-indicated.  Each 
surgeon  would  take  a  section  of  the  body  and  the  multiple 


SERVICE  WITH  THE  NAVY  755 

wounds  would  be  cared  for  very  quickly.  Practically  all  tiie 
work  was  done  by  speciali!^ts  in  their  own  particular  lines. 
Colonel  Lilienthal  of  ]\lt.  Sinai  Hospital  did  most  of  the 
chest  work;  a  Dr.  Hanson  of  Minnesota  was  a  wizard  at 
brains;  Dr.  Long  did  all  of  the  abdominal  work  and  took 
over  the  chest  cases  when  Colonel  Lilienthal  left,  and  later  the 
head  cases. 

We  worked  twelve-hour  shifts,  changing  from  night  to  day 
and  vice  versa,  about  every  two  weeks.  .  .  . 

At  the  signing  of  the  Armistice,  two  hundred  and  ninety 
members  of  the  United  States  Navy  Nurse  Corps  were  in 
service  in  Great  Britain  and  France. 


CHAPTER  IX. 

KUESIXG  SERVICE   TO   THE   CIVILIAN   POPULATIOX   OF   THE  ALLIES 

The  Children's  Bureau  in  France — The  Refugee  Bureau  in 
France — The  Tuberculosis  Bureau  in  France — The  Com- 
mission for  Italy — The  First  Commission  for  Boumania— 
The  Commission  for  Palestine — The  C ommission  for  Siberia 

WHEN  Major  Murpliy  and  his  staff  of  seyenteen  men, 
who  formed  the  first  American  Red  Cross  Commission 
for  Europe,  sailed  for  France  in  June,  1917,  they  went 
with  the  purpose,  as  supplemental  to  the  military  responsibilities 
of  the  commission,  of  expressing*  in  relief  work  the  sympathy  of 
the  American  people  for  the  civilian  population  of  the  Allies. 
Upon  its  arrival  in  Paris,  the  commission  thus  immediately 
created  two  departments :  the  Department  of  Civil  Affairs  and 
the  Department  of  ^lilitary  Affairs,  the  organization  of  which 
has  already  been  given  in  Chapter  YI.  This  chapter  will  give  an 
account  of  American  Red  Cross  nursing  service  in  connection 
with  the  civilian  population  in  France  and  Belgium,  Italy, 
Roumania,  Palestine  and  Siberia,  as  it  was  administered 
through  National  Headquarters  and  through  the  American  Red 
Cross  Commission  for  Europe. 

France,  the  battle  ground  of  the  war,  was  the  theater  of  the 
most  extensive  relief  work  of  the  American  Red  Cross  abroad. 
Of  the  eighty-six  departments  into  which  the  French  Republic 
was  divided,  in  the  Xorth  one  was  wholly  in  tlie  enemy's  pos- 
session and  nine  others  were  partially  so.  The  ^larne,  the 
Aisne,  the  Sommo  and  the  Oise  regions  liad  been  sytematically 
devastated  by  the  (rcrmans  in  their  retreat  to  the  Hindenburg 
Line.  A  million  and  a  half  refugees  fi'om  th(>se  provinces  in 
1017  were  scattered  in  the  central  and  southern  parts  of 
France,  wandering,  di>;eased,  spirit-broken,  seeking  shelter, 
food  and  livelihood  as  best  tliey  could.  There  were  in  addition 
three  millions  in  the  occupied  territory,  the  women  and  children 

756 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     757 

who  had  stayed  in  their  homes  and  tliose  who  had  been  deported 
to  Gorman  J  but  who  from  December,  lOlO,  on  were  flung 
back  to  France  at  the  rate  of  from  one  hundred  to  twelve  .hun- 
dred a  day. 

The  work  which  confronted  the  Department  of  Civil  Affairs 
of  the  American  Red  Cross  in  France  fell  into  five  principal 
classes:  child  welfare  work;  the  establishment  and  maintenance 
of  homes  for  refugees,  rapalries  and  other  exiles  of  war ;  par- 
ticipation in  a  well  rounded  and  comprehensive  plan  for  the 
prevention  of  tuberculosis  throughout  France;  assistance  to 
civilians  returning  to  the  devastated  areas  and  training  of 
miitiles  to  enable  them  to  earn  their  own  and  their  family's 
livelihood.  The  Commission  for  France  created  within  the 
Department  of  Civil  Affairs  five  bureaus  to  deal  separately 
with  these  five  problems — the  Children's  Bureau,  the  Bureau 
of  Refug(>es  and  Relief,  the  Bureau  of  Tuberculosis,  the  Bureau 
of  the  War  Zone  and  the  Bureau  for  the  Reeducation  of 
M  utiles. 

Homer  Folks,  of  jSTew  York  City,  joined  the  Paris  head- 
quarters in  July,  1917,  as  director  of  the  Department  of  V\\'\\ 
Affairs.  He  had  previously  been  engaged  in  social  service  and 
child  welfare  work  in  the  United  States  and  was  the  author  of 
a  history  and  various  pamphlets  dealing  with  these  subjects. 
^Ir.  Folks  upon  his  arrival  in  France  appointed  experts  as 
directors  of  the  various  bureaus  of  his  department  and  relief 
work  was  immediately  started. 

Perhaps  the  outstanding  misfortune  which  confronted 
France,  a  misfortune  which,  if  not  remedied,  would  penetrate 
into  lier  future  and  en(lang(>r  her  existence  as  a  capital  nation, 
was  the  condition  of  her  orphaned,  homeless,  sick  children,  her 
babies  whose  devitalized  mothers  were  engaged  in  war  indus- 
tries, her  lowered  birth  rate.  Assistance  to  the  children  and 
women  of  France  ()ff(>red  opportunity  for  far-reaching  service 
of  a  type  which  a])j)eale(l  immediately  and  instinctively  to  the 
sympathy  of  the  American  peopk'.  whose  avatar  tlu^  American 
Red  Cross  strove  to  l)e.  To  the  (liildren's  Bureau  of  tlie  Paris 
otHce  was  entrusted  this  responsibility. 

Pediatricians  and  child  w(>lt"are  and  public  health  nurses 
were  the  first  need  of  the  Children's  Ihireau.  On  Auinist  12, 
I'.'IT,  a  ])i<)neer  American  lied  ( 'ross  pediatric  unit,  which 
consiste(l  (if  seven  physicians,  diie  child  welfare  nurse  aud 
three  lavwoinen,  ari'ived   in   I'"rance  and  foi-nied  the  micleus  of 


Y58   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

personnel  of  the  Cliildren's  Bureau.  Dr.  William  Palmer 
Lucas,  professor  of  Pediatrics  of  the  University  of  California, 
was, director;  Elizabeth  Haywood  Ashe  was  chief  nurse.  The 
other  members  of  the  unit  were  Mrs.  Lucas,  Dr.  and  Mrs.  J. 
Morris  Slemons,  Dr.  J.  P.  Sedg\vick,  Dr.  J.  I.  Durand,  Dr.  N. 
O.  Pearce,  Dr.  John  C.  Baldwin,  Dr.  Clair  F.  Gelston  and 
Rosamond  Gilder,  executive  secretary  of  the  Bureau.  Miss 
Gilder,  the  daughter  of  the  American  poet  and  editor,  Richard 
Watson  Gilder,  afterwards  wrote  the  most  comprehensive  re- 
port of  the  activities  of  the  Children's  Bureau  to  be  found  in 
Red  Cross  archives,  a  report  which  this  history  will  from  time 
to  time  quote. 

Before  sailing  for  France^  Dr.  Lucas  had  asked  that  the 
personnel  of  his  unit  should  include  twelve  public  health  nurses, 
but  the  Xursing  Service  at  National  Headquarters  advised 
Dr.  Lucas  to  wait  until  his  arrival  in  France,  as  it  was  felt 
that  among  the  many  American  nurses  already  in  France  an 
ample  number  would  be  available  for  this  type  of  work.  A 
memorandum  which  was  prepared  by  the  Nursing  Service  for 
Dr.  Lucas  before  he  sailed,  gave  the  names  and  addresses  of 
Alice  E.  Henderson,  formerly  supervising  nurse  of  the  French 
units  of  the  Mercy  Ship  Expedition,  then  in  Pau ;  IMary  K. 
Nelson,  Helen  Kerrigen,  Marion  McCune  Rice,  Josephine 
Clay  and  Emma  J.  Jones,  then  at  Evrcux ;  Margaret  Dunlop, 
then  thought  to  be  in  England ;  Grace  Barclay  Moore,  at  Dr. 
Blake's  hospital  in  Paris,  and  Caroline  Hatch,  at  Ris  Orangis. 

Immediately  following  the  arrival  of  the  unit  in  France, 
Dr.  Lucas  undertook  a  complete  survey  of  the  child  welfare 
situation.  He  found  that  cities,  towns  and  villages  had  been 
drained  of  medical  personnel  by  the  exodus  of  physicians  and 
surgeons  from  civilian  practice  to  military  service.  Twenty- 
five  to  fifty  per  cent  fewer  physicians  were  available  in  the 
larger  cities  in  1917  than  in  1914.  St.  Etienne,  with  a  popu- 
lation of  180,000  in  1914,  had  had  the  services  of  120  physi- 
cians; in  1917,  with  an  increase  of  population  to  250,000,  it 
had  the  services  of  only  14  physicians.  France  possessed  no 
group  of  professional  nurses  comparable  to  that  which  existed 
in  the  British  Empire  and  in  the  L^nited  States. 

Before  the  outbreak  of  the  European  "War,  the  birth  rate  of 
France  had  exceeded  the  death  rate  by  a  margin  just  enough  to 
keep  her  total  population  at  a  slight  increase.  Two  factors 
developed   during  the   war   and   caused  the   birth   rate   to   fall 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    759 

materially — the  presence  of  the  men  in  the  trenches  and  the 
entrance  of  women  into  indnstry.  Previons  to  1914,  only  five 
thousand  women  had  been  employed  in  factories;  in  1917 
eight  hundred  thousand  were  so  employed.  In  the  meantime, 
war  casualties  had  increased  the  death  rate  to  unprecedented 
proportions.  ''With  this  increased  death  rate  and  with  the 
inevitable  diminution  in  birth  rate,"  wrote  Dr.  Lucas,  "the 
result  to-day  is  that  the  birth  rate  is  forty  per  cent  lower  than 
the  death  rate,  a  figure  which  no  country  has  ever  reached 
before  except  as  it  began  to  pass  out  from  among  the  group  of 
first-class  nations  .   .   ."  ^ 

France,  herself,  was  making  heroic  efi^orts  on  behalf  of  her 
children.  Dr.  Lucas  summarized  the  maternity  and  child  wel- 
fare legislation; 

.  .  .  Certain  definite  steps  had  been  taken  to  ameliorate 
the  condition  of  women  in  the  factories,  most  noteworthy 
among  them  being  Paul  Strauss's  law  of  August,  1914,  which 
allowed  an  allocation  of  one  franc  a  day  for  a  mother  one 
month  before  tlie  birth  of  her  child  and  1.5  francs  per  day  for 
four  weeks  after  the  birth  of  the  child.  This  had  a  powerful 
influence  in  increasing  the  birth  rate  and  it  was  one  of  the 
objects  of  our  cani])aign  to  see  that  this  law  was  put  into  force 
throughout  the  country.  The  conditions  of  the  Koussell  law 
making  it  mandatory  for  factories  to  have  chamhres  d'aUaite- 
rncnt  and  creches  for  nursing  mothers  and  babies,  and  the 
creation  of  factory  inspectresses  to  see  that  these  laws  were 
carried  out,  showed  the  earnest  intent  of  the  government  to 
right  as  far  as  possible  tlie  deplorable  conditions  created  by 
the  war. 

In  the  Academy  of  ^Fedicine  throughout  the  whole  period 
of  the  war,  the  discussion  relating  to  infant  mortality  and  the 
lowered  birth  rate  ebbed  and  flowed.  Every  one  is  familiar 
with  Pinard's  firm  stand  against  the  employment  of  women 
in  factories.  .  .  .  To  save  France,  the  women  had  to  work 
and  the  French  mother  preferred  to  work,  although  it  jeopar- 
dized the  future  to  save  the  present.  ...  In  conjunction  with 
the  Ligue  conJre  la  MorhtlUe  InfuntUe  and  the  federal  gov- 
ernment of  tlie  l)e])artment  of  tlie  Interior,  the  Service  de 
Sante.  tlie  ('hildren's  Bureau  of  tlie  American  l\ed  Cross 
worked  out  a  definite  ])rogram.  In  ih(>  Ligue  are  the  fore- 
most   representatives    of    the    niedical    ]U'ofession    in     I-'rance 

'  "Uctl  Cross  liifniit  Mnriality  CaiiijiaiLrii  in  Fniriet'";  Dr.  Win.  1^.  T.iicas, 
la'pnrt  (if  tlu'  C'liildrcirs  liiiri-au.  I'osaiinuKl  (iildor,  \'()1.  III.  p.  14!t; 
J.iliiarv  National   lifa(l(|uarters,  W'asliiiiLrtoii.   D.   V. 


760   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

interested  in  women  and  childhood,  as  well  as  the  most  intel- 
ligent social  workers,  philanthropists  and  educators.  Senator 
Paul  Strauss,  author  of  ftie  beneficent  law  referred  to  above, 
is  its  president.  Dr.  Marfar,  of  international  reputation  as  a 
pediatrician,  is  its  first  vice-president;  Dr.  Le  Sage,  another 
well-known  pediatrician,  is  the  secretary  of  the  Ligue. 

With  the  advice  of  these  experts,  Dr.  Lucas  adopted  simple 
but  fundamental  policies  to  govern  the  development  of  the 
Children's  Bureau.  He  believed  that  preventive  measures 
were  far  more  forceful  in  lowering  infant  mortality  than  cura- 
tive measures  and  that  "these  preventive  measures  must  start 
in  the  prenatal  period  and  must  reach  every  mother  a  long 
enough  time  before  the  birth  of  her  child  to  insure  as  nearly  as 
possible  a  normal  pregnancy  and  a  healthy  child."  He  felt 
that  "every  baby  should  be  followed  up  so  as  to  prevent 
illness."^ 

Preventive  measures  for  the  infant  had  originated  in  France 
in  1891,  when  Budin  had  first  established  Nourrissons  Clinics. 
In  1917  many  of  these  clinics  existed  throughout  France,  and 
one  of  the  first  duties  of  the  Red  Cross  Children's  Bureau  w'as 
to  offer  assistance  to  those  in  operation,  to  help  reopen  those 
which  had  been  closed  during  the  war  and  to  assist  in  starting 
new  ones  where  they  never  had  existed.  To  secure  a  personnel 
to  carry  on  the  "follow-up  work"  which  Dr.  Lucas  felt  to  be 
imperative,  the  Children's  Bureau  undertook  to  recruit  and 
train  groups  of  health  visitors  by  giving  short  intensive  courses 
of  instruction  to  French  women  who  had  been  working  in 
French  military  hospitals  and  who  had  had  Red  Cross  training 
of  various  types.  With  these  policies  to  govern  constructive 
child  welfare  work  and  with  unlimited  funds  and  supplies  with 
which  to  render  emergency  relief,  the  Children's  Bureau  set- 
tled down  in  September,  1917,  to  its  gigantic  yet  elusive  task. 

]\liss  Ashe,  the  chief  nurse  of  the  Children's  Bureau,  was 
born  in  California.  Immediately  following  her  graduation 
from  the  Presbyterian  School  in  New  York  City,  she  returned 
to  her  native  state  and  became  director  of  the  Telegraph  Hill 
Neighborhood  Association  in  San  Francisco. 

]\Iiss  Ashe  was  a  woman  of  strong  personality  and  resolute 
will  and  had  had  many  advantages  of  birth  and  education.  In 
her  manner  six;  was  direct,  blunt,  fearless  and  often  impatient 

'Gilder  Roport,  \o\.  HI,  p.  110. 


NURSING  SERVICE  TO  CIVILIAN  TOPULATION    761 

— always  so  of  what  she  called  red  tape.  She  held  the  interests 
of  the  needy  children  of  France  and  Belginm  close  to  her  big 
heart  and  she  went  abont  her  work  of  alleviation  with  a  swift, 
fearless  and  brilliant  power  which  entitled  her  to  a  goodly 
share  of  the  credit  which  the  American  Ked  Cross  nursing 
service  in  the  Children's   linreau  deservedly  earned. 

During  the  pioneer  months  of  11)17,  the  organization  of  the 
Nursing  Service  in  France,  as  had  been  said  before,  was  im- 
perfect. Miss  Russell,  chief  nurse  of  the  American  Ked 
Cross  in  France,  was  in  the  Department  of  Military  x\ifair3 
and  ^liss  Ashe,  chief  nurse  of  the  Children's  Bureau,  was  in 
the  Department  of  Civil  Affairs.  The  two  departments  had 
different  chiefs  and  different  policies.  The  division  in  organi- 
zation tended  to  separate  the  military  nursing  service  from  the 
public  health  nursing  service,  yet  ]\Iiss  Delano  and  ^liss  Xoyes 
regarded  ^liss  Ashe's  bureau  as  a  subdivision  of  Miss  Kussell's 
bureau.  All  American  Ked  Cross  nurses  sent  overseas  for 
military  and  civilian  work  were  instructed  to  report  to  !Miss 
Kusscll ;  she  in  turn  assigned  them  to  ^liss  Aslie.  ^liss  Ashe 
felt  that  this  organization  w'as  unreasonable  and  inefficient  and 
made  vigorous  protest  regarding  it  to  the  ^N^ursing  Service.^ 
^liss  Xoyes  explained  to  ^liss  Ashe  that  "it  seems  only  good 
and  logical  administration  for  us  to  send  our  nurses  and  nurses' 
aides  to  the  Paris  llead([uarters  to  report,  as  !Miss  Kussell  is 
the  representative  of  tlie  Xursing  Service  in  France  and  as 
cablegrams  for  nurses  come  through  Paris  Headquarters.  By 
assigning  the  nurses  to  the  Paris  office,"  she  added,  "there  is 
on(>  place  in  which  a  complete  record  is  maintained  of  the 
arrival  and  assigniiient  of  all  luirses  to  Europe." 

As  has  been  suggested,  ^liss  Ashe  was  hampered  in  the  de- 
velopnuMit  of  lier  service  by  a  shortage  of  public  health  nurses, 
but  throughout  the  autunni  and  winter  of  l!»17,  and  the  spring 
and  summer  of  1!)18^  Xational  llead(iuarters  sent  units  of 
public  licaltli  nurses  as  rapidly  as  they  could  be  withdrawn  with 
safety  from  ])ositii»ns  in  the  United  States  and  could  be  trans- 
ported to  Fi'anee.  to  Paris  to  supply  civilian  nursing  needs. 

Harriet  L.  Leete,  whose  brilliant  professional  attainments 
have  been  outlined  in  the  section  which  relates  to  her  service 
as  chief  nurse  of  American  Ked  ('ross  Military  lliisi)ital 
Xo.   ft,  was  the  llrst  nui'se  to  join   Miss  Aslu'\s  statf.     As  _Miss 

^  Sfi'  IcttiT  written  Di'ccinhcr  1!>.  I!tl7,  by  l-].  11.  Aslic  to  ('.  D.  Xoyes, 
with   aiisuiT   of   C.    U.    N'o\rs   attaclu'cl. 


762   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Ashe  spent  much  of  her  time  in  the  field,  Miss  Leete  was  as- 
signed to  the  Paris  office  and  upon  her  devolved  the  routine 
work  of  directing  the  public  health  nursing  activities  of  the 
commission  during  the  fall  of  1917.  The  most  authoritative 
nursing  report  of  the  Children's  Bureau  which  Miss  Delano 
and  Miss  Noyes  saw  until  after  the  Armistice,  was  sent  by 
Miss  Leete  to  Miss  Russell,  under  date  of  December  3,  1917, 
and  was  in  due  time  forwarded  by  Miss  Russell  to  National 
Headquarters.  Early  in  1918,  Miss  Leete  was  placed  in  charge 
of  the  instruction  of  visiteuses  d'enfants  at  Paris.  In  May 
she  became  chief  nurse  of  the  Tent  Hospital. 

Marie  T.  Phelan  and  fifteen  public  health  nurses  of  promi- 
nence in  the  United  States  sailed  for  France  on  September  16, 
1917.  Miss  Phelan  was  head  nurse  of  this  unit.  She  was  a 
graduate  of  the  Rochester  City  Hospital,  Rochester,  New 
York.  She  did  public  health  and  tuberculosis  nursing  in 
Rochester  and  was  later  assistant  superintendent  of  the  Child 
Welfare  Society  in  Chicago.  She  was  a  woman  of  mature 
judgment  and  excellent  executive  ability  and  was  recognized 
as  one  of  the  pioneers  of  the  public  health  nursing  movement  in 
the  United  States.  Her  affiliation  with  the  Red  Cross  had  come 
through  the  Rochester  Chapter  in  1907. 

National  Headquarters  sent  a  second  unit  of  child  welfare 
and  public  health  nurses  to  the  Paris  headquarters  in  Novem- 
ber, 1917.  Dr.  J.  H.  Mason  Knox,  of  Johns  Hopkins  Uni- 
versity, Baltimore,  who  later  became  associate  director  of  the 
Children's  Bureau,  was  in  charge  of  this  group.  A  third  unit 
arrived  in  Paris  in  December.  From  time  to  time  during  the 
following  ten  months,  National  Headquarters  sent  over  addi- 
tional groups  of  public  health  nurses. 

Manifold  difficulties  attended  the  selection  and  assignment  of 
nurses  for  service  with  the  Red  Cross  Commission  for  Europe. 
Miss  Delano  and  Miss  Noyes  were  combing  the  country  for 
nurses  for  the  Army,  the  Navy  and  the  U.  S.  Public  Health 
Service.  The  exodus  of  nurses  from  hospitals,  training  schools 
and  public  health  nursing  organizations  into  military  service, 
placed  in  jeopardy  the  health  of  the  civilian  population  of  the 
United  States.  The  Nursing  Son'iee  was  loath  to  ask  public 
health  nurses  to  volnntcer  for  civilian  relief  work  in  France  or 
Italy  or  the  Balkans  when  the  need  for  their  services  was  so 
great  at  home. 

The  executives  and  physicians  of  the  Commission  for  Europe 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    763 

controlled  the  policies  of  the  American  Red  Cross  in  Europe 
and  they  were  zealous  of  doing  everything  in  their  power  to 
aid  the  Allies.  Civilian  relief  was  an  immediate  and  natural 
expression  of  this  desire  and  public  health  nursing  was  acknowl- 
edged to  be  an  efficient  instrument  in  civilian  relief.  The  War 
Council  at  National  Headquarters  was  resolute  in  its  determi- 
nation to  support  the  Commission  and  to  carry  out,  as  far  as 
possible,  all  its  requests;  they  thus  brought  pressure  to  bear 
on  the  Nursing  Service. 

Miss  Delano's  opinion  carried  great  weight  with  the  members 
of  the  War  Coimcil.  She  strongly  questioned  the  wisdom  of 
withdrawing  large  numbers  of  nurses  from  American  institu- 
tions to  assign  them  to  extensive  civilian  nursing  service  in 
France.  After  the  nurses  arrived  overseas,  local  conditions 
often  did  not  permit  their. immediate  assignment  to  the  highly 
specialized  phases  of  nursing  service  for  which  they  had  been 
sent  to  France.  Miss  Uelano  appreciated,  however,  that  since 
she  was  not  in  the  field,  she  must  accept  the  recommendations 
regarding  the  development  of  public  health  nursing  of  those 
who  were  in  the  field,  even  though  her  knowledge  of  the  public 
health  situation  in  the  United  States  led  her  to  question  the 
soundness  of  these  recommendations.  She  felt  that  she  could 
not  go  overseas  and  see  for  herself,  because  the  chief  duty  of 
the  Nursing  Service  was  to  secure  nurses  for  the  Army  and  she 
felt  her  presence  was  needed  in  this  country  to  r.cccniplish  that 
end.  Uncertainty  was  present  in  her  :.i:::J  reg.;rJ".:;g  the  wis- 
dom of  developing  this  extensive  servic?  fur  tli:  civr.Lin  popula- 
tion and  the  resulting  anxiety  formed  cue  oT  thv  great  burdens 
which  weighed  upon  the  shoulders  of  I'Ass  Delano  and  Miss 
Noyes. 

The  War  Department  established  passport  rulings  which 
materially  increased  the  difficulties  under  which  the  lied  Cross 
was  already  laboring  to  secure  nurses.'*     Notable  among  these 

*  Under  date  of  February  2.3,  1918,  the  Secretary  of  State  wrote  to 
National  Headquarters:  "I  deem  it  important  to  call  your  attention  to 
the  fact  that  this  Department,  upon  request  of  the  War  and  Navy  Depart- 
ments, lias  for  some  time  been  declininf;  to  issue  passports  for  Europe  to 
near  femali'  relatives  (tliis  is.  wives,  dau^diters.  motliers  and  sisters)  of 
Army  and  Navy  ofhcers.  Tlie  Department  considers  it  advisable  to  follow 
the  same  policy  witli  re^-'ard  to  the  issuance  of  passj)orts  to  near  female 
relatives  of   persons   who   are   sent   to   luirope   for   the    Red   Cross." 

I'nder  date  of  June  7.  1!)18,  l?rif:adier  (ieneral  William  S.  Graves, 
assistant  to  tlie  Cliicf  of  StafT.  National  Aiiny.  wrote  to  the  associate 
Director  of  tlu'  Amci-ican  Red  Cross  l?ureau  of  Personnel,  in  part,  as 
follows:     "The     Secretary     of     War   .   .  .   has  .  .   .  ado])te(l     the     followinf;^ 


764   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  the  so-called  "brother  ruling,"  which  forbade  the  issuance 
of  a  passport  to  any  nurse  who  had  a  brother  in  military  service. 
In  one  group  of  thirty  nurses  ready  to  sail  eleven  were  held 
because  they  fell  under  this  regulation.  During  the  summer 
of  1918  the  "brother"  restriction  was  removed  and  the  Nursing 
Service  was  able  to  send  many  more  nurses  to  France. 

National  Headquarters  also  sent  over  nurses'  aides  for  serv- 
ice with  the  Children's  Bureau.  Thirty  aides  were  called  for 
by  Dr.  Lucas  in  November,  1917,  for  work  in  connection  with 
children's  hospitals  and  orphanages  and  the  first  group  of  them 
arrived  in  Paris  on  December  15.  Other  units  were  subse- 
quently sent.  Nurses'  aides  were  required  to  be  able  to  speak 
French  fluently  and  to  have  volunteered  their  services.  Many 
also  paid  their  own  expenses.  National  Headquarters  also  re- 
quired that  they  undergo  the  training  and  pass  successfully  the 
examination  for  nurses'  aides  which  has  been  outlined  in  a 
preceding  chapter.  They  were  instructed  to  report  upon  ar- 
rival in  France  to  ^liss  Eussell  and  to  work  under  professional 
direction.  They  were  usually  housed  with  American  Ked  Cross 
nurses  in  the  various  children's  hospitals,  dispensaries  and 
other  establishments  maintained  by  the  American  lied  Cross 
in  France.  On  the  whole,  they  rendered  excellent  service. 
"Up  to  August  1,  1918,"  stated  the  Gilder  Report  of  the  Chil- 
dren's Bureau,  "not  one  moral  question  had  arisen  in  relation 
to  any  aide  in  this  service  nor  had  any  complaint  been  received 
from  any  nurse  or  doctor  as  to  the  poor  work  or  lack  of  discip- 
line of  any  aide.  The  Nursing  Service  at  Washington  should 
receive  the  credit  for  the  high  state  of  efficiency  of  this  branch 

rules:  1.  Under  no  circumstances  will  tlie  War  De])artmcnt  approve  the 
issuance  of  passports  to  go  to  Europe  for  the  wives,  mothers,  sisters  or 
daughters  of  the  following  classes  of  persons:  Officers  or  enlisted  men  of 
the  United  States  Military  Forces:  male  civilians  employed  witli  the  Red 
Cross,  Young  Men's  Christian  Association  or  otlier  organizations  of  a 
similar  nature,  that  may  Ije  in  Europe;  civilians  employed  or  attached 
to  tlie  American   Expeditionary   Forces. 

"'2.  Any  of  the  female  relatives  enumerated  in  paragraph  1.  who  liave 
recently  been  to  Europe  })ut  at  present  are  in  tlie  United  States  for  any 
reason  whatsoever,  are  now  included  in  the  restriction  imposed  by  para- 
graph 1  abo\e. 

'■  '3.  It  is  quite  useless  foi-  any  one  Ixdoiiging  t(j  tlie  restricted  classes, 
cited  above,  to  request  an  e.\ce])tion  in  her  case  as  no  exceptions  will  be 
made.' 

"It  is  realized  that  this  ]Hilicy  may  (kqirive  the  American  organizations 
now  cooperating  with  tlu'  Army  in  France  of  desirable  material  from  t'wf 
to  time,  iiut  it  is  bclicvcil  fnircr  and  wiser  t(j  adopt  and  announce  a  policy 
which   will   undoubtcdU    be   Uir  the  best   interests  of  all    concerntx'."' 


NURSING  SERVICE  TO  CIVILIAN  TOPULATION     765 

of  the  service,  as  it  was  the  result  of  their  careful  selection.  .  .  . 
Untrained  women  as  they  were,  the  majority  of  them  coming 
from  luxurious  homes,  they  never  murmured  at  any  task  .  .  . 
and  the  nurses  were  unstinted  in  praise  of  them." 

The  activities  of  the  Children's  Bureau  looped  France,  from 
Toul  southward  down  the  valley  of  the  Rhone,  from  Marseilles 
on  the  ]\iediterranean  to  Bordeaux  on  the  Bay  of  Biscay,  and 
northwards  through  Blois,  Corbiel,  Paris  and  liouen  back  to 
the  devastated  regions  of  the  Manic  and  Aisne  valleys.  To 
recount  all  the  activities  of  the  Children's  Bureau  in  the  many 
diverse  forms  of  child  welfare  work  would  lie  outside  the 
province  of  a  history  of  the  Nursing  Service ;  only  the  projects 
in  which  nurses  participated  have  a  definite  place  therein. 
However,  this  was  no  small  part,  as  will  be  shown  in  the  fol- 
lowing pages. 

The  first  call  which  came  to  the  Commission  to  Europe  was 
a  children's  call,  from  the  Departement  M eurthe-et-M oseJIe.  The 
rich  grain  fields  surrounding  Nancy  and  the  city  itself,  where 
mills  were  humming  with  essential  war  industries,  were  under 
fire  from  German  asphyxiating  bombs  and  shells.  The  peasants 
wore  gas-masks  and  reaped  the  harvests  but  the  children  were 
too  young  to  wear  the  masks  and  had  to  be  cared  for  elsewhere. 
They  were  gathered  together  and  taken  to  Toul,  which  lay 
immediately  to  the  southwest  of  the  Nancy  district. 

On  July  20,  lUlT,  ^1.  ]\lirman,  then  prefet  of  the  Meurthe- 
et-MoscUe,  telegraphed  to  the  Committee  of  the  American  Fund 
for  French  Woundcnl  that  three  hundred  and  fifty  children  had 
suddenly  been  put  in  his  charge  and  that  he  had  nothing  but  a 
temporary  shelter  for  them  in  some  old  barracks  at  Toul.  He 
asked  for  assistance  at  once.  Mrs.  Isabel  Latlirop,  president 
of  the  Committee  for  the  American  Fund  for  French  Wounded, 
to  whom  the  telegram  was  addressed,  brought  it  to  the  newly- 
established  headciuai'ters  of  the  American  Red  Cross  in  France. 
jMajor  ^lurphy  asked  Dr.  liobert  Davis  to  answer  the  call. 

Within  a  few  hours  .Mrs.  Lathrop,  Dr.  Davis,  another  physi- 
cian, a  nurse,  two  aides,  a  bacteriologist,  an  administrative 
director  and  two  women  to  look  after  supplies  were  on  their 
way  to  Toul  in  cars  loaned  by  the  American  Fund  for  Krencli 
Wounded.  Another  caniionette  which  carried  milk  and  cloth- 
ing fdllowed  tlieni.  They  ai'rived  late  that  night  and  fmind  the 
three  hundred  and  tifty  children,  twenty-one  of  whom  were 
babies  under  tweh'e  inimths  of  age  and  the  others  young  chil- 


766    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

dren  less  than  eight  years  old,  huddled  together  in  an  old  bar- 
racks, which  was  dirty  and  practically  unfurnished,  with  no 
sanitary  arrangements  whatsoever.  "The  sick  children  were 
crowded  in  with  the  well  ones,"  wrote  Mrs.  Lucas,  wife  of  Dr. 
Lucas.     "Skin  diseases  were  prevalent  and  vermin  abounded." 

On  the  following  day  Prefet  Mirman  and  the  representatives 
of  the  American  Red  Cross  set  up  a  temporary  organization. 
M.  Mirman  stated  that  the  French  Government  would  furnish 
new  and  sanitary  barracks  constructed  of  brick  and  cement,  of 
a  capacity  for  housing  800  persons;  would  provide  lighting, 
coal,  water  and  food  in  the  government  rations  furnished  to  all 
refugees ;  would  assign  soldiers  to  do  the  heavy  work  and  em- 
ploy the  necessary  unskilled  w^omen's  labor,  and  would  supply 
beds,  bedding  and  clothing  and  all  transportation  of  supplies 
from  Nancy  or  Toul.  The  American  Red  Cross  agreed  to  take 
over  the  complete  direction  of  the  center,  to  furnish  doctors, 
nurses,  drugs  and  all  hygienic  equipment,  all  extra  diets  and 
all  supplies  and  equipment  necessary  for  the  recreation  of  the 
children. 

From  this  beginning  the  "Toul  project"  of  the  Children's 
Bureau  developed,  with  the  cooperation  of  Prefet  Mirman,  the 
Committee  of  the  American  Fund  for  French  Wounded  and 
the  American  Friends'  Unit,  into  a  children's  home  known  as 
the  Asile  Caserne  de  Luxembourg^  with  a  capacity  of  500 ;  a 
Children's  Hospital ;  a  Maternity  Hospital ;  a  dental  depart- 
ment ;  a  system  of  dispensaries,  and  a  second  refugee  asile  at 
Fellering,  in  the  Vosges.  At  the  children's  home,  the  As'ile 
Caserne  de  Luxemhourg,  the  Red  Cross  set  up  and  maintained 
a  diet  kitchen  and  the  French  Government  established  school 
and  church  services. 

Dr.  John  P.  Sedg^vick  was  first  in  command  of  the  Asile 
Caserne  de  Luxemhourg ;  on  December  1,  1917,  Dr.  !^laynard 
Ladd,  of  the  Harvard  ]\[edical  School,  was  placed  in  charge  of 
the  work  of  the  Children's  Bureau  in  the  Meurthe-et-MoseJle. 
"Miss  Phclan,"  wrote  Miss  Lecte  to  Miss  Russell  on  Decem- 
ber 3,  1917,  "is  in  charge  of  the  group  of  nurses  at  Toul  and 
has  been  doing  remarkable  work  under  most  trying  conditions." 
Six  Army  nurses  on  detached  duty  and  three  American  Red 
Cross  nurses,  Eugenia  L.  Acevedo,  Helen  Z.  Gill  and  Laura  E. 
Krcamer,  scrubbed  and  painted  the  long,  dirty  barracks,  set  up 
and  made  the  small  white  beds  and  got  the  hospital  ready  for 
tlicir  young  patients.     It  was  opened  late  in  October,   1917, 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    767 

and  in  the  next  two  months  admitted  over  150  cases  of  measles 
alone.  At  first  the  hospital  had  only  one  operator,  one  assist- 
ant, two  etherizers,  one  set  of  instruments,  one  stove  ("very 
French,"  a  nurse  described  it)  and  no  running  water.  Later 
the  lied  Cross  supplied  excellent  equipment.  "In  nine 
months,"  wrote  Gladys  H.  Porter,  one  of  the  nurses  later  as- 
signed to  duty  there,  "we  operated  on  about  eight  hundred  cases, 
a  record  of  which  the  most  modern  hospital  might  be  proud, 
much  more  one  in  the  war  zone.  Our  first  big  rush  was  a 
drive  on  tonsils." 

In  a  letter  addressed  to  the  American  Journal  of  Nursing, 
Miss  Plielan  wrote  of  Toul : 

This  is  an  old  walled  city  and  is  wonderfully  interesting 
with  its  crooked  streets  and  narrow  passages  leading  back  to 
interesting  looking  courtyards.  There  is  an  old  cathedral 
here,  some  parts  of  which  date  back  to  the  twelfth  century. 
The  Caserne  is  located  on  a  hill  outside  the  city  and  was 
formerly  used  for  barracks.  I  came  up  here  to  take  charge 
of  the  nurses  and  my  first  commission  was  to  prepare  one  of 
the  long,  ugly  buildings  for  a  hospital.  It  looked  discour- 
aging five  weeks  ago,  but  to-day  it  is  really  attractive. 

We  never  could  have  done  what  we  have  if  the  Friends  had 
not  sent  us  five  young  men.  The  Friends  are  doing  some  of 
the  best  work  that  is  being  done  in  France.  These  boys  are 
all  college  men,  but  they  can  do  anything  and  everything  and 
do  not  hesitate  to  undertake  the  most  menial  labors.  We  are 
having  an  epidemic  of  measles  just  now;  we  have  fifty  pa- 
tients to-day.  Tliere  is  very  little  acute  illness.  Most  of  tbe 
children  have  scabies,  impetigo  and  heads,  just  the  conditions 
we  find  in  some  branches  of  public  health  work  at  home.-'' 

After  the  period  of  pioneering  was  over,  Miss  Phclan  re- 
turned to  Paris  and  the  direction  of  the  luirsing  activities  of 
tlu!  Asile  CdscDie  was  assigned  to  Josephine  Ellet.  Miss  Ellet 
was  graduated  from  the  Johns  Hopkins  School  in  May,  1917, 
and  had  been  in  charge  of  a  ward  of  the  pediatric  department 
there  until  she  sailed  in  Xovember  for  France.  She  was  a 
Viig'inian  by  birth  and  was  a  young  luirse  of  intelligence  and 
ability. 

In  January  the  Children's  Hospital  opened  a  surgical  ward 
for     peasant     women     from     t\w     surrounding     neighborhood. 
'  A))i(  ri(  an  JdUDt'il  of  Xuraing.  \(A.  X\'III,  p.  487. 


768   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Exhausted  from  manual  toil  in  the  fields,  privation  and  the 
sufferings  of  the  past  four  years,  these  women  were  in  great 
need  of  medical  attention  and  the  surgical  division  of  the  Chil- 
dren's Hospital  averaged  six  major  operations  daily  four  days 
each  week.  Helen  Z.  Gill  was  head  nurse.  The  hospital  at 
the  Asile  Caserne  received  1042  patients,  of  whom  12  died. 
Six  hundred  and  forty-eight  operations  were  performed. 

A  Maternity  Hospital  was  opened  on  March  1,  1018,  at  the 
Asile  Caserne.  The  Germans  had  bombed  a  maternity  hospital 
at  Nancy  the  day  before  and  Prefet  Mirman  telephoned  to 
Major  Ladd  to  ask  if  the  Eed  Cross  would  take  care  of  the  ex- 
pectant mothers  and  other  patients.  Major  Ladd  consented 
and  several  of  the  nurses,  two  French  women  and  the  Quaker 
orderlies  converted  one  of  the  barracks  of  the  Asile  Caserne 
into  a  hospital  in  six  hours.  ''At  four  o'clock  that  afternoon," 
wrote  Miss  Ellet,  "the  patients  arrived  and  our  first  baby 
was  born  two  hours  later." 

The  Red  Cross  furnished  clothing,  if  it  was  needed,  to  the 
mother,  and  supplied  layettes  for  the  babies.  If  a  pregnant 
woman  had  children  at  home  and  if  her  husband  was  at  the 
front,  she  was  allowed  to  bring  her  children  during  her  con- 
finement to  the  Asile  Caserne,  where  they  too  were  cared  for 
until  slic  was  well  enough  to  go  home.  Before  leaving  the 
hospital,  each  mother  was  taught  to  bathe  and  care  for  her 
child  and  was  shown  proper  methods  of  feeding  it.  If  the 
mother  was  unable  to  nurse  it,  a  supplementary  feeding  was 
provided  and  given  under  sterile  conditions.  When  the  mother 
was  well  enough  to  go  home,  she  was  given  written  instructions 
regarding  the  care  of  the  child  and  was  urged  to  rt^port  at  regu- 
lar intervals  to  the  American  lied  Cross  dispensary  nearest  her 
home  to  have  the  baby  examined. 

This  dispensary  service  which  radiated  out  from  Toul 
through  the  M curilie-el-Moselle  and  the  Vosges  was  an  im- 
portant pliase  of  child  welfare  work  in  France.  In  December, 
1917,  the  American  Fund  for  French  Wounded  and  the  Ameri- 
can Ked  Cross  entered  into  agreement  to  establish  joint  dis- 
pensaries in  centers  where  none  had  previously  existed  or  where 
there  was  a  dearth  of  loeal  medical  care  for  the  civilian  popula- 
tion. The  system  consisted  of  seven  base  dispensaries  wliieli 
operated  twenty-six  sul)-dispensarv  units  and  two  creches.  The 
personnel  of  a  base  dispensary  unit  usually  consisted  of  a  doc- 
tor, two  public  licaltli  nurses,  an  aide  and  a  chauffeur  to  drive 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     769 

a  camionctte.  The  doctor  and  the  nurses  established  head- 
quarters at  the  base  dispensary  and  then  made  the  rounds  of 
the  sub-dispensaries  in  the  camionette.  Dr.  Karlton  G.  Percy 
was  the  medical  director  of  the  system. 

Base  dispensaries  were  located  at  Toul,  Nancy,  Luneville, 
Neuve  Maison,  Gerbeviller,  fipinal  and  Foug.  The  Nancy 
group,  which  included  seven  sub-dispensaries,  was  entirely 
financed  by  the  town  of  Winetka,  Illinois.  The  Luneville 
group  of  six  sub-dispensaries  was  financed  in  part  by  the  Des- 
titute Babies'  Aid  Society ;  the  Gerbeviller  group  was  supported 
by  the  American  Fund  for  French  Wounded ;  fipinal  by  citizens 
of  Baltimore,  IMaryland,  and  Minneapolis,  Minnesota;  Neuve 
Maison  by  citizens  of  St.  Paul,  Minnesota. 

The  dispensary  service  worked  in  close  cooperation  with  the 
Asile  Caserne  de  Luxeinhmirg.  When  children  or  women  in 
need  of  operation  or  prolonged  medical  care  were  found  in  the 
radius  of  the  sub-dispensaries,  they  were  sent  to  the  Children's 
Hospital  or  to  the  surgical  or  maternity  wards. 

Early  in  March,  1018,  a  colony  of  nine  hundred  refugee 
children  from  the  Nancy  district  were  sent  under  the  patronage 
of  Prefct  ^lirman  to  Dinard,  where  the  warm  sun  on  the 
beaches  and  the  fresh  salt  air  helped  to  drive  tuberculosis  from 
their  emaciated  bodies.  They  went  under  the  chaperonage  of 
French  teachers  and  principals  from  the  Nancy  schools.  Dr. 
3\arlton  G.  Percy,  chief  of  the  Red  Cross  dispensary  system  in 
tlie  M eurthe-et-M os"lJe ,  and  several  Red  Cross  nurses  accompa- 
nied the  convoy  from  Toul  to  Dinard  and  remained  there  until 
a  permanent  statl'  was  sent  up  from  Paris.  Mary  (1  Nelson,  a 
nurse  who  had  gone  to  Franco  in  November,  1017,  with  the 
Rockefeller  ^J'liberculosis  Commission,  was  one  of  tlie  nurses 
and  she  remained  at  Dinard  as  supervisor.  Dr.  !May  Allen  was 
the  medical  director. 

Dinard  was  practically  deserted  during  the  war.  The  HnfcJ 
BoijnJ  was  taken  over  for  the  girls  and  the  boys  were  housed  in 
another  hotel  at  St.  Lnnaire,  on  the  seashore  five  miles  west. 
Both  of  these  hotels  had  been  used  by  FrcMich  troops  and  the 
military  autli()i-iti(\'^  had  left  some  Ix'ddiiig,  l)eds.  dishes  and 
other  (Mjuipnient.  'Flie  walls  were  damp  and  in  many  places 
the  pajx'r  hung  in  tattered  strips,  but  the  floors  were  compara- 
tively cl(^in.  Or.  Allen  secnred  French  women  to  clean  the 
hotel's.  Not  the  least  of  Dr.  Allen's  and  Miss  Nelson's  dith- 
cnlties  was  the  problem  of  lanndering  some  large,  heavy  and 


770   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

exceedingly  handsome  sheets  which  wealthy  residents  of  Dinard 
presented  to  the  colony. 

The  Children's  Bureau  established  a  dispensary  with  a  small 
infirmary  at  Dinard  and  treated  from  forty  to  fifty  children 
every  day,  furnished  all  sick  and  anaemic  children  with  nour- 
ishing food  and  provided  clothing,  linen  and  drugs  as  needed. 
The  children  suffered  from  tuberculosis  and  diseases  due  to 
malnutrition.  Their  hands  were  covered  with  sores,  "which  in 
many  cases  went  as  deep  as  the  bone."  ^  Some  had  scabies  and 
at  first  vermin  were  a  veritable  plague  to  them  all.  During 
the  month  of  May,  1918,  the  total  attendance  at  the  clinics  was 
2540.  Eighty-one  children  were  cared  for  in  the  infirmary. 
At  this  time  three  American  Red  Cross  nurses  and  six  aides 
were  on  duty  at  Dinard. 

A  second  colony  which  consisted  of  110  girls  was  installed  in 
a  chateau  at  Damarie-les-Lys  near  Melun  and  the  Children's 
Bureau  supplied  medical  and  dental  treatment. 

Throughout  the  spring  and  summer  of  1918  the  Toul  project 
expanded  and  flourished  under  the  happy  cooperation  of  Prefet 
Mirman,  representing  the  French  Government,  Mrs.  Lathrop, 
representing  the  Committee  for  the  American  Fund  for  French 
Wounded,  and  Dr.  Ladd  of  the  American  Red  Cross  Children's 
Bureau.  In  September,  however,  the  military  needs  engulfed 
the  work  for  the  civil*  population ;  American  troops  went  into 
action  at  St.  Mihiel  and  the  Asile  Caserne  de  Luxemhourg  was 
converted  into  an  evacuation  center  for  American  wounded.  In 
August  the  children  were  sent  to  I^eufcluitcau,  ]Nancy  and 
Lyon.  The  Asile  Caserne  with  its  hospitals  was  transferred 
from  the  Department  of  Civil  Affairs  to  the  Department  of 
IMilitary  Affairs  and  was  expanded  in  a  week  to  a  one  thousand 
bed  military  hospital.  The  nurses  already  at  the  Asile  Caserne 
were  taken  into  the  military  service  and  "casuals"  were  ruslied 
up  from  Paris  Headquarters.  An  American  Red  Cross  mobile 
unit  with  j\Iajor  i\IcCoy  as  commanding  officer  and  ]\liss 
Meirs  as  chief  nurse,  took  possession  of  tlie  Asile  Caserne  on 
September  11  and  established  American  Red  Cross  Hospital 
No.  114  and  at  dawn  two  days  later  one  thousand  American 
wounded  had  cora(>  back  from  St.  ]\rihiel.  The  Af<ile  Caserne 
with  its  hospitals  and  clinics  thus  disappeared  from  the  reports 
of  the  (children's  Bureau. 

"Soo  Report  of  Dr.  Allen.  Weekly  Report  of  the  Cliildren's  Bureau  end- 
ing June  8,  1918,  p.  (1. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    771 

The  American  Rod  Cross  closed  its  dispensary  service  in  the 
Meurthe-et-Moselle  and  the  Vosges  on  January  1,  1910.  Some 
of  the  dispensaries  were  taken  over  by  the  Women's  Overseas 
Hospital  Unit,  others  by  the  American  Fund  for  French 
Wounded,  still  others  by  private  organizations  which  were 
given  financial  assistance  by  the  French  government.  Dr. 
Ladd,  chief  of  the  Toul  project,  wrote  that  ''we  have  had 
33,232  dispensary  consultations  since  the  American  Red  Cross 
came  to  the  M eurthe-et-M oselle ;  29,307  of  these  consultations 
have  occurred  since  January  1,  1918;  9797  of  these  represent 
new  cases."'^ 

During  the  fourteen  months  in  which  the  Toul  project  was 
maintained,  the  following  division  of  responsibility  existed 
between  the  Committee  for  the  American  Fund  for  French 
Wounded  and  the  American  Red  Cross :  One-half  the  number 
of  motor  cars  which  were  used  were  supplied  by  the  American 
Fund  for  French  Wounded,  one-half  by  the  American  Red 
Cross ;  one-third  of  the  graduate  nurses  and  aides  were  fur- 
nished and  their  salaries  paid  by  the  American  Fund  for 
French  Wounded  and  two-thirds  by  the  American  Red  Cross; 
over  five-sixths  of  the  total  expense  was  borne  by  the  American 
Red  Cross,  the  remainder  by  the  American  Fund  for  French 
Wounded;  all  medical  service  and  all  supervision  and  admin- 
istration was  providc^d  by  the  American  Red  Cross.^ 

A  second  northern  province  to  know  the  work  of  the  Ameri- 
can lied  (^ross  was  the  Department  of  the  Somme.  On  Au- 
gust 15,  1917,  the  Children's  Bureau  received  an  appeal  from 
Nesles  and  seven  villages  in  the  immediate  vicinity.  The 
plight  of  these  villages,  Matigny,  Croix,  JMoligneaux,  Mesnil, 
St.  Xicaise,  Rouy-le-(Jrand  and  others,  was  pitiable.  They  had 
been  captured  and  occupied  by  the  Germans  in  the  early  years 
of  the  war  and  had  been  recaptured  by  the  French  in  March, 
1917.  The  retiring  Germans  had  sent  the  strong,  able-bodied 
women  and  children  to  Germany  and  had  systematically 
looted  the  c(Hnitrv  which  they  were  evacuating.  From  the  litth; 
farms  the  (Miemy  took  furniture,  bedding,  cooking  utensils  and 
all  farm  implements.  Orchards  were  leveled  and  isolatcnl 
houses  bombed  or  burned.  In  some  of  the  villages  no  house 
r(Mnain<Hl  intact.  Yet  among  these  bleak  ruins  still  existed 
many  old  women  and  uhmi  and  approximately  twelve  hundred 

'(Jildcr  l!ci)()rt.  Vol.  FIT,  p.  8. 
'Ibid..  ]).   14. 


772    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

yonng  children,  many  of  them  suffering  from  ringworm,  im- 
petigo, scabies  and  blepharitis.  "They  looked  stunned  and 
sullen,"  wrote  Mrs.  Lucas,  "and  no  smile  could  be  teased  from 
them."^ 

The  village  of  Voyennes  had  formerly  had  a  population  of 
nine  hundred  souls,  but  in  1917  only  four  hundred  and  fifty  re- 
mained. The  mayor  and  the  school  teacher  begged  above  all 
else  for  bathing  facilities.  During  the  German  occupancy  each 
civilian  had  been  required  to  take  a  shower-bath  once  a  week, 
but  upon  the  enemy's  retirement  all  bathing  facilities  had  been 
destroyed  and  since  March  the  civilian  population  had  suffered 
greatly.  One  hundred  and  seventy  children  had  been  collected 
in  this  village  and  were  going  to  school.  "One  wonders  at  the 
poise  of  the  little  French  child,"  wrote  Mrs.  Lucas,  "or  is  it 
just  the  eternal  child,  eager  to  learn,  that  sends  these  sick  chil- 
dren to  school  in  the  midst  of  devastation  and  within  hearing 
of  the  gams  ?  And  in  all  the  villages  are  the  old,  old  people," 
she  added.  "They  are  so  terrorized,  so  heart-broken  there  is 
nothing  more  that  life  can  do  to  them.  They  do  not  seem  to  be 
asking  for  a  place  to  live  in  but  a  place  in  which  to  die  un- 
disturbed." 

The  Children's  Bureau  sent  Dr.  John  C.  Baldwin,  of  Balti- 
more, to  establish  child  welfare  work  in  Xesle.  The  French 
offered  the  American  Hed  Cross  a  small  tuberculosis  pavilion 
in  the  gTounds  of  the  Hotel  Dieu  and  with  the  assistance  of  two 
American  Red  Cross  nurses,  ]\rarv  A.  Brogan  and  Susan  D. 
Potts,  and  two  aides,  Dr.  Baldwin  established  a  clinic  at  Xesle 
and  a  weekly  dispensary  service  through  nine  outlying  villages. 
Dr.  Baldwin  wrote  of  the  pioneer  work : 

Weekly  IJcport.  October  25- 
Xoveniber  3,  1917. 

The  situation  which  confronted  us  upon  arrival  at  Xesle 
was  a  dilliciilt  our.  .  .  .  The  thornionicter  r(\<ristere(l  zero. 
Some  one  liad  rcnioved  llir  little  iron  sto\e  from  tlio  pavilion 
and  our  only  ineans  of  heating  was  a  I)ut(h  oven  with  a 
broken  stov(']ti]K'.  The  water  works  had  not  been  repaired, 
so  there  was  no  runnini;-  water.  Supplies  which  had  been 
requisitioned  For  the  Hold  Dieu  and  for  ourselves  were 
heaped   to.irether   in   the  Hotel  Dieu,  still   packed.       As   they 

^  Sec  Icltcr   written    ScptcitilHT   22.   litlT.  liy   Ju'ic    RiclKirdson   Lucas,   to 
the    Dircitor.    Dcpt.    (if   Civil    Atr:iirs,    American    Ke<l    Cross    in    Franct'. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    773 

wore  identically  marked,  wo  had  to  unpack  all  of  them  to 
discover  the  thinfj^s  we  needed  for  the  night.  Darkness  came 
soon  and  we  used  the  lamps  from  the  auto.  .  .  . 

Sunday  passed  rapidly  in  an  attempt  to  shovel  and  sweep 
the  mud  and  dirt  out  of  the  pavilion.  Walls  and  ceilings  in 
some  of  the  rooms  were  scruhbed,  Monday  and  Tuesday 
cleaning  was  continued  and  a  semblance  of  order  creat<^'d  in 
the  drug  room,  supply  room  and  staff  quarters.  Signs  are 
being  painted  by  a  local  artist  for  our  building,  which  has 
been  christened  "Pavilion  Joffre." 

The  spirit  of  the  nurses  in  meeting  the  real  hardships  of 
the  period  of  invasion  has  been  splendid.  No  one  has  grum- 
bled at  wet  feet  and  lame  shoulders.  Xoses  have  been  red  at 
breakfast,  but  we've  eaten  it  standing  and  juggled  our  coifee 
glasses  (we  have  no  cups  yet)  from  hand  to  hand  as  we  hopped 
about  to  keep  warm. 

The  little  American  dispensary  nestled  down  behind  the 
high  and  forbidding  wall  of  the  Hotel  JJieu.  Every  morning 
an  average  of  twenty  children  came  through  the  ancient  portal 
or  the  grille  gate  behind  the  garden  in  the  rear  and  were  treated 
for  skin  direases  and  other  ailments  resulting  from  malnutri- 
tion, ^liss  Brogan  and  ]\Iiss  Potts  ran  a  small  hospital  of 
twelve  beds.  "The  work  was  very  gratifying,"  wrote  ]\Iiss 
Potts,  "not  only  because  all  but  two  of  onr  patients  recovered, 
but  because  the  hospital  was  so  small  that  we  came  to  regard 
the  children  as  our  own  little  family  and  they  in  turn  grew 
responsive  and  atiectionate." 

Xesle  was  close  to  the  British  front  lines  and  the  Red  Cross 
relief  work  for  the  civilian  population  there  was  greatly  limited 
by  war  restrictions.  Passes  could  be  secured  only  with  great 
difficulty  and  it  was  impossible  to  circulate  in  the  Xesle  dis- 
trict without  passes.  Gasoline  could  not  be  procured  and  so 
much  of  the  dispensary  work  which  had  been  well  organized  in 
many  neighboring  towns  had  to  be  given  up.  Yet  records  of 
t!'e  snuill  child  welfare  station  at  Xesle  showed  that  777  chil- 
dren were  examined  by  the  American  Bed  Cross  during  the 
month  of  Fel)rna7y,  1!*1S. 

On  February  1.")  \]\c  Ih'itish  I'^ifth  Antiy  tivik  up  its  head- 
(piartcrs  at  Xesle  and  ti\'e  weeks  latci'  Ikh'c  the  brunt  of  the 
fury  of  the  Cei'man  otl'ensive  of  March  lM,  HMs.  I'poii  tIic 
evacnatiiui  of  tlu>  city,  tlu^  American  lied  Cross  welfare  station 
was  abandoned.     ^Miss  Potts  wrote: 


774    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

On  March  23,  the  Germans  for  the  second  time  advanced 
with  lightning  speed  and  a  few  days  later  left  little  Xesle  a 
heap  of  ruins.  On  that  twenty-third  day  of  March  we  evacu- 
ated very  hastily  in  a  large  camion  with  a  hand-bag  each  and 
with  what  supplies  we  could  gather  together.  We  took  with 
us  an  eight  weeks'  old  baby,  a  girl  of  fourteen  who  had 
tuberculosis,  several  burned  and  several  convalescent  cases 
and  hurried  to  Koye,  southwest  of  Xesle. 

The  noise  of  battle  was  quite  as  terrific  there  as  it  had 
been  at  Xesle  and  we  soon  evacuated  again,  with  refugees 
from  Ham,  Xesle  and  villages  all  along  the  line.  We  started 
by  camion  for  Montdidier,  but  progress  was  slow  through  the 
congested  traffic  of  terrified  refugees,  carts,  cattle,  dogs,  geese 
and  pigs. 

Miss  Brogan  and  I  went  to  Amiens,  to  find  the  mother  of 
our  eight  weeks'  old  baby  Daniel.  He  had  been  fed  at  7  a.  m. 
but  we  could  not  find  food  for  him  until  three  that  afternoon ; 
an  infirniiere  at  a  hospital  at  Amiens  then  gave  him  a  little 
milk.  .  .  .  Dirty  with  camion  and  train  dust,  jostled  and 
jolted,  hungry,  tired  and  sleepy,  he  had  never  whimpered 
through  the  journey. 

Complete  records  of  the  Red  Cross  child  welfare  station  at 
X^esle  were  lost  in  the  evacuation  of  the  city. 

At  Amiens,  as  at  iSTesle,  the  work  of  the  Children's  Bureau 
was  destroyed  almost  before  its  complete  initiation.  In  August, 
1917,  a  public  health  nurse,  Annie  A.  Rathbone,  had  begun  to 
do  visiting  nursing  under  the  auspices  of  the  Secours  Ameri- 
caines  j)our  les  Refugees.  Her  expenses  were  at  first  paid  by 
Major  Richard  A.  Cabot,  but  soon  afterwards  the  work  was 
supported  by  the  American  Red  Cross  and  ^liss  Rathbone  was 
attached  to  ]\Iiss  Ashe'«  service.  jMiss  Rathbone's  duties  at 
Amiens  consisted  in  visiting  from  house  to  house  among  the 
11,000  refugees.  Until  such  time  as  the  Red  Cross  could 
arrange  to  assign  a  pediatrician  to  permanent  duty  at  Amiens, 
she  distributed  food  and  assisted  at  a  clinic  which  was  con- 
ducted by  a  French  physician.  The  long  anticipated  arrange- 
ments were  finally  completed  early  in  1018  and  Dr.  Baldwin, 
of  Xesle,  held  his  first  clinic  about  the  middle  of  Marcli.  A 
second  nurse.  Miss  Flanagan,  was  sent  up  to  assist  Miss  Rath- 
bone. 

However,  at  dawn  on  ^March  21,  the  enemy  launched  his 
offensive  at  the  junction  of  the  French  and  British  lines  near 
Cumbrai   and   the  possession   of   Amiens  hung  in   the  balance 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    775 

while  Gough's  Fifth  Army,  cut  off  from  the  British  at  Arras 
and  the  French  at  Le  Fore,  struggled  in  chaotic  disorganiza- 
tion until  French  and  British  reenforcements  came  up  on 
March  26,  filled  the  gap  at  IMoreiul  and  slowed  up  the  German 
drive.  Amiens  did  not  fall,  but  the  civilian  population  fled 
from  the  city  on  the  sixth  day  of  the  offensive.  Miss  Rathbone, 
Dr.  Baldwin  and  the  nurses  from  Nesle,  the  members  of  vari- 
ous American  colleges  and  the  Friends'  units  fell  back  in  the 
general  evacuation  to  jMontdidier  and  Beauvais  and  thence  to 
Paris.  Records  of  the  American  Bed  Cross  child  welfare 
station  in  Amiens  were  lost  in  the  evacuation  of  the  city,  an 
account  of  which  appears  later. 

£vian-les-Bains,  the  gateway  through  w'hich  the  Germans 
flung  back  to  France  inhabitants  of  the  occupied  northern 
provinces,  who  were  too  old  or  too  young  or  physically  unfit 
for  military  purposes,  was  a  town  with  a  normal  population 
of  about  2000,  situated  in  France  a  few  miles  from  the  Swiss 
border  on  the  slopes  of  the  hills  which  rise  above  the  southern 
shores  of  exquisite  Lake  Geneva.  Nearby  were  the  French 
villages  Annemasse  and  Thonon ;  the  snow-capped  ranges  of 
the  Bernese  Oberland  rose  in  the  east.  In  peace  times  Evian 
had  been  one  of  the  smartest  and  most  expensive  of  the  French 
watering-places.  However,  in  1917  and  1918,  its  two  Ritz 
hotels,  its  casino  with  theater,  gambling  rooms,  restaurant  and 
music  hall,  its  alkaline  springs  and  bathing  establishments,  its 
parks  and  boarding  houses  were  daily  the  scene  of  a  woeful 
influx  of  rapatries. 

Tlie  reception  which  the  French  Government  extended  to  its 
rapatrie  citizens  was  a  cordial  and  efiieient  one.  Representa- 
tives of  the  Minister  of  the  Interior  established  in  the  Kvian 
Casino  a  smoothly  running  system  of  reception,  entertainment 
and  distribution  to  other  parts  of  France  of  all  rapatries  who 
entered  Evian.  Two  convoys,  carrying  about  six  hundred  and 
fifty  people  eaelij  arrived  daily,  the  first  at  six  o'clock  in  the 
morning,  the  second  at  four  o'clock  in  the  afternoon.  Two 
French  nurses  and  a  French  physician  attached  to  the  goveu'n- 
ment  service  boarded  the  trains  at  Boub(>ret  Station  and  r(^- 
ceivcd  from  the  hands  of  the  Swiss  nurses  who  had  aceonipanied 
the  rapatries  to  the  French  frontier,  a  list  of  all  the  sick,  in- 
firm and  old  on  the  convoy  who  nocdc^d  attention. 

Fn  route  from  Boubcrct  to  I-lvian,  a  numbered  liai:"  was  uiven 
to  each  family  and  the  rapatries  were  instructed  to  put  their 


776    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

belongings  in  tliem.  They  were  then  given  checks  and  the 
bags  were  stored  at  the  station  at  £vian  until  the  owners 
claimed  them  upon  leaving  the  city.  A  list  of  all  the  people 
in  the  convoy  was  also  made  out,  to  be  given  to  the  Commissaire 
Special  upon  arrival  at  Evian. 

With  flags  flying  and  a  band  playing,  all  Evian  met  the  con- 
voy trains.  Sometimes  a  train  was  made  up  of  third-class 
carriages ;  again  it  might  be  composed  of  cattle  cars,  but  as  it 
came  winding  slowly  around  to  the  station  the  windows  or  the 
apertures  were  black  with  outthrust  heads  and  waving  arms. 
On  the  platform  nurses,  ambulance  drivers,  rapatries,  govern- 
ment officials  and  local  committee  members  cheered  and  waved 
their  flags  in  response  and  as  the  train  drew  in,  stretched  out 
eager  hands  to  help  the  weary  rapatrie  dismount. 

Some  cheering  and  singing,  others  with  the  easy  tears  of  age 
running  down  their  cheeks,  still  others  dazed  and  silent,  the 
old  women  and  men,  the  sick  mothers,  the  thin,  curious-eyed 
children  set  foot  again  on  French  soil  and  marched  down  the 
narrow  street  to  the  Casino,  with  the  band  playing  bravely  at 
the  head  of  the  straggling  line.  In  a  big  cheerful  room  of  the 
Casino  hot  food  was  served  to  them  and  the  prefet  of  the  Dis- 
trict welcomed  them  home.  The  band  struck  up  the  Marseillaise 
and  they  sang,  haltingly  at  first,  then  with  a  great  cry  "Mar- 
chons,  MarchonsV^  that  rang  to  the  flag-draped  ceiling.^" 

The  next  step  was  that  of  identification.  A  card  was  given 
each  rapjatrie  which  enabled  him  to  draw  allocation  and  an 
efi'ort  was  made  to  act  in  touch  with  his  relations.  If  clothing 
was  needed,  it  was  issued.  Medical  examination  followed ; 
carriers  of  parasites  were  segTegated  and  treated ;  those  too  ill 
to  go  on  were  detained  at  Evian  for  hospitalization.  Those 
who  were  in  good  health,  who  had  means  of  subsistence  and 
who  did  not  desire  government  assistance  in  traveling,  were 
allowed  to  go,  at  their  own  expense,  to  whatever  locality  de- 
sired, exceptions  being  Paris  and  tlie  war  zone.  Those  who 
had  been  claimed  by  relatives  and  desired  to  travel  at  govern- 
ment expense  were  hospitalized  at  Evian  for  the  moment  but 
were  allowed  to  leave  either  by  the  first  convoy  out  or  to  go 
individually  as  soon  as  arrangements  could  be  made.  Those 
who  were  waiting  to  be  claimed  by  relatives  were  cared  for  by 

"For  an  excellent  ileseription  of  tlie  ari-ival  of  rapntrir  trains  in  Evian. 
see  "Tlie  Children  of  France  and  the  Red  Cross,"  Ijy  June  Richardson 
Lucas,  pp.    111.      Frederick   A.   Stokes  Company,    1918. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    777 

the  government  at  flvian  or  at  Thonon  or  Annemassc.  Those 
who  were  not  claimed  after  a  due  period  of  waiting  \yerc  sent 
to  rapatrie  centers  which  were  maintained  by  the  govern- 
ment. 

Early  in  September,  1917,  T)r.  Lucas  went  to  l^^vian  to  ascer- 
tain if  assistance  from  the  C/hildren's  Bureau  would  be  needed, 
and  if  so,  acceptable.  He  found  that  only  thirty-five  beds  were 
available  in  the  entire  region  for  the  hospitalization  of  children. 
Moreover,  no  systematic  m(>dical  examination  was  given  to  the 
children  as  they  passed  through  ]^]vian,  to  find  out  if  they  were 
in  fit  condition  to  continue  on  their  way,  and  already  complaints 
had  begim  to  come  from  various  parts  of  France  that  rapatrie 
children  were  bringing  in  virulent  contagious  diseases. 

On  September  27  Dr.  Lucas  took  Dr.  C.  F.  Gclston,  of  San 
Francisco,  a  member  of  the  original  pediatric  unit,  and  ^Ir. 
W.  C  Stevenson,  an  administrator,  to  fivian.  A  conference 
was  held  the  following  day  between  officials  of  the  French 
Department  of  the  Interior,  the  Service  dcs  Rapatries  of  Evian, 
the  Comite  au.v  Rapairies  de  Lyon  and  the  three  Americans. 
It  was  decided  that  the  American  Eed  Cross  should  establish 
a  medical  service  at  the  Casino  for  the  examination  of  every 
rapatrie  child  immediately  after  its  arrival  in  Evian  and  a 
hospital  nearby  to  take  care  of  the  children  who  were  not  in 
condition  to  continue  on  their  way.^^ 

In  an  alcove  of  the  main  hall  of  the  Casino  Dr.  Gelston  set 
up  his  examining  booth.  The  equipment  was  simple,  three 
chairs,  an  electric  light,  a  table  with  toninie  depressors,  a  stetho- 
scope. All  the  rapairies  filed  through  this  hall  of  the  Casino 
and  as  the  line  moved  forward  an  American  Red  Cross  aide 
stopped  all  children  under  sixteen  and  led  them  over  to  the 
booth.  Here  another  aide  assisted  the  iVmerican  doctor  while 
he  examined  the  child's  throat.  A  nurse  stood  by  to  take  sta- 
tistics and  remarks  on  each  child  as  they  were  called  oil*  by  the 
physician.  After  examination  another  aide  tagged  the  child 
for  treatment  at  the  American  dispensary,  at  the  dentist's  or 
at  the  Children's  Hospital.  Healthy  children  were  allowed  to 
go  on  immediately  with  their  parents  or  guardians  to  other 
parts  of  France. 

The  nearby  Ainerlcan  Ivcd  Cross  Children's  Hospital  was 
established  in  the  Hotel  da   Chatclcl,  which  had  l)e(^ii  built  in 

"Report  of  the  Pa>d  Cross  Children's  I^ireaii.  rvusaiiiond  OiLler.  Vol.  TIT. 
p.    IS. 


778   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  handsome  park  on  a  sloping  hillside  above  Lake  Geneva. 
Several  private  villas  nestled  among  the  rose  gardens  and 
flowering  shrubbery  and  these  were  utilized  for  various  pur- 
poses, one  as  a  dispensary  where  both  dental  and  medical  work 
was  done,  another  as  a  temporary  orphanage,  a  third  as  nurses' 
quarters.  The  Hotel  du  Chdtelet  itself  had  many  open  bal- 
conies and  long  windows,  so  the  large,  high-ceilinged  rooms 
were  flooded  with  sunshine  and  fresh  air. 

On  October  19,  1917,  nine  child  welfare  nurses,  with  Miss 
Ashe  in  charge,  went  up  to  Evian  and  opened  the  Children's 
Hospital.  Fifty  children  were  admitted  and  twenty-one  dis- 
charged during  the  first  week  of  its  maintenance.  The  mala- 
dies from  which  these  patients  suffered  included  measles, 
chicken-pox,  scarlet  fever,  diphtheria  and  tuberculosis.  Some 
of  the  skin  diseases  resulting  from  undernourishment  were  in 
advanced  stages  and  very  repulsive. 

Following  Miss  Ashe's  return  to  Paris  after  the  first  days 
at  Evian,  Miss  Helen  King,  a  laywoman,  was  placed  in  charge 
at  Evian,  She  became  ill  and  a  Red  Cross  nurse,  Susanne 
Hoskins,  was  put  temporarily  in  charge.  In  December,  1917, 
Helen  Almy  Bigelow,  a  Massachusetts  nurse,  arrived  at  Paris 
Headquarters  and  was  immediately  assigned  to  Evian  as  chief 
nurse.  ^liss  Bigelow  was  a  graduate  of  the  Children's  Hos- 
pital, Boston.  She  had  done  public  duty  nursing  in  that  city 
and  had  had  institutional  experience  in  the  Cleveland  City 
Hospital.  She  later  was  supervisor  of  the  pediatric  service 
of  the  JSTew  York  Xursery  and  Child's  Hospital  and  resigned 
from  this  position  to  undertake  work  with  the  Children's 
Bureau. 

The  number  of  nurses  at  Evian  varied.  On  December  3, 
1917,  there  were  twelve.  For  the  major  part  of  the  time  the 
number  was  maintained  at  a  strength  of  fifteen  graduate  nurses, 
four  American  aides  and  ten  French  aides.  The  employment 
of  American  aides  on  a  comprehensive  scale  was  soon  found 
to  be  impracticable.  Their  lack  of  training  in  the  care  of  con- 
tagious diseases  made  them  of  little  use  and,  moreover,  they 
were  constantly  contracting  the  diseases  because  they  did  not 
know  how  to  take  care  of  themselves. 

Dr.  E.  J.  Lappo,  of  Portland,  Oregon,  was  medical  director 
of  the  Chatelct  Hospital  until  January  15,  1918;  he  was  then 
transferred  to  Xeslc  and  Dr.  Crelston  took  over  the  direction 
of  the  Children's  Hospital  in  addition  to  his  work  in  exaniiiia- 


NURSING  SERVICE  TO  CIVnJAX  POPULATION     779 

tion  of  children  at  the  Casino.  Dr.  Florence  Child  was  the 
resident  physician  at  the  Chatelet  Hospital ;  Dr.  Dorothy  Child 
was  the  dispensary  and  laboratory  doctor;  Dr.  Raymond  Mix- 
sell,  of  Pasadena  and  Dr.  E.  K.  Armstrong,  of  Chicago,  later 
were  in  turn  medicin-chef  of  the  Chatelet  Hospital.  Mr.  W. 
C.  Stevenson  was  in  charge  of  administration. 

The  rapatrie  children  who  filled  the  sunny  rooms  had  known 
to  the  full  the  hardships  of  existence  in  a  country  occupied  by 
the  enemy.  Many  of  them  came  to  the  hospital  with  their 
stunted  little  bodies  clothed  in  rags.  Their  eyes,  which  pecj-ed 
out  big  and  black  from  pinched  cheeks,  were  full  of  a  wisdom 
and  a  hunger  that  greatly  endeared  them  to  the  American 
nurses. 

The  Germans  closed  their  frontiers  on  February  26,  1918, 
and  the  convoys  stopped,  but  on  ^lay  21  they  began  again  and 
continued  uninterruptedly  until  August  3,  1918.  Between  Oc- 
tober, 1917,  and  August,  1918,  65,801  children  were  examined 
at  the  Casino;  1809  of  them  were  cared  for  in  the  American 
hospital,  1824  were  treated  in  the  Red  Cross  dispensary  and 
2597  were  treated  in  the  dental  dispensary.^-  The  convoys 
were  resumed  again  on  September  16  and  continued  until 
November,  1918. 

The  Germans  in  November  ceased  to  return  the  rapairies 
through  fivian.  The  convoys  were  then  scMit  tlirongh  Hoi  hind 
and  Dr.  Gelston  was  instructed  to  organize  at  Dieppe  a  service 
similar  to  that  at  Evian.  Eighty  thousand  rapatries  were  re- 
turned to  France  in  November  and  December,  1918,  tlnvMigh 
Holland  and  1750  children  were  examined  at  Dieppe.  Fifty- 
one  of  them  received  hospital  care  at  a  small  pavilion  which  the 
Ilopiial  Mixte  loaned  to  the  American  Red  Cross,^^ 

The  work  of  medical  examination  and  hospital  care,  both  at 
Evian-les-Bains  and  at  Dieppe,  was  perlia])s  the  most  far-i-carh- 
ing  in  its  professional  phases  and  the  most  appealing  in  its 
human  aspects  of  any  of  the  projects  undertaken  l)v  the  Chil- 
dren's Bureau.  "The  Red  Cross  at  I-]viaii.""  wrote  Leila 
Halverson,  a  nurse,  ''saved  many  sick  cliihlren's  lives  and  pro- 
tected the  lives  of  many  otlun's  who  wer(>  well,  by  segregating 
the  sick  from  the  healthy  before  they  had  had  opportunity  to 
spread  the  contagion." 

"r.ildcT  Report.  Vol.  TTT,  p.  22. 
"y/HV/..  pp.  41-42. 


780    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Southwest  of  I^]vian  lay  the  large  industrial  city  of  Lyons, 
which  during  1917  and  1918  became  a  stronghold  of  Red  Cross 
child  welfare  work  in  France.  Evian  was  primarily  a  center 
of  evacuation.  The  French  authorities  insisted  that  the 
rapatries  be  sent  on  to  other  localities  as  rapidly  as  possible  so 
that  this  small  border  town  would  not  become  congested.  The 
Children's  l>ureau  was  forced  to  look  elsewhere  for  a  site  on 
which  to  establish  a  convalescent  home  for  children  coming 
from  the  Chatelet  Hospital  at  Evian.  Dr.  Lucas  took  over  for 
the  purpose  the  Chateau  des  Holies,  at  Ste.  Foy  I'Argentiere, 
thirty  miles  from  Lyons.  Later,  the  Children's  Bureau  de- 
veloped and  maintained  two  large  convalescent  homes,  two  con- 
tagious hospitals  and  an  extensive  dispensary  service  in  the 
Lyons  district,  all  an  outgrowth  of  this  iirst  orphanage  at  Ste. 
Foy  I'Argentiere. 

Chateau  des  IlaUes  had  been  the  country  estate  of  Monsieur 
Mangini,  a  French  engineer  who  built  the  Riviera  railroad. 
Upon  the  death  of  Madame  jMangini  he  had  presented  the 
estate  to  V  Hospices  Civ  Us  de  Lyon  upon  condition  that  it  be 
used  as  a  convalescent  hospital  for  children.  L'Hospices  Civils 
de  Lyon  was  one  of  the  oldest  charitable  organizations  in 
Europe.  It  had  been  founded  about  900  A.  D.  by  Queen 
Hiltrud  and  had  been  in  continuous  existence  ever  since.  "It 
is  heavily  endowed  and  is  very  well  managed,"  wrote  Dr.  How- 
ard Kennedy  Hill,  a  pediatrician  of  the  Children's  Bureau, 
"and  all  the  hospitals  of  Lyons  are  under  its  control." 

IJHospices  Civils  de  Lyon-  offered  the  use  of  the  Chateau 
des  HaUes  to  the  Children's  Bureau  free  of  charge,  provided 
that  the  American  Red  Cross  would  leave  it  equipped  as  a 
hospital  after  the  war  was  over.  It  was  then  being  operated  by 
Dr.  Ellen  Cover  of  San  Antonio,  Texas,  Mrs.  ilcKinnon  of 
Oklahoma  City  and  ]\riss  Louise  Bybee.  It  stood  high  upon  a 
hill,  heavily  wooded  with  old  cedars,  pines  and  redwoods.  It 
was  surrounded  by  a  farm  which  furnished  milk,  butter,  eggs 
and  fresh  vegetables  in  abundance.  The  Chateau  had  been 
built  in  188;")  with  modern  conveniences,  but  the  Red  Cross  had 
to  enlarge^  the  heating  and  lighting  facilities  to  hospital  dimen- 
sions. !^Iuch  of  the  beautiful  carved  furniture  was  left  in  the 
C^hatean,  but  the  handsomely  carved  woodwork  of  the  walls 
was  covered  for  protection.  However,  the  nuirals,  the  white 
marble  stairway  with  its  crimson  carpet  and  the  line  mantels 
still  aavc  to  the  interior  of  the  Chateau  diu'iiitv  and  ciiarm. 


o 


c 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     781 

During  the  first  days  of  November,  1917,  a  detachment  con- 
sisting of  a  director  and  four  Red  Cross  child  welfare  mirses 
were  sent  up  from  Paris  headciuarters  to  prepare  the  Chateau 
des  Ilalles  for  occupancy.  Dr.  Frances  O'Neill,  one  of  the 
physicians  of  the  second  pediatric  unit  under  Dr.  J.  ^lason 
Knox,  was  in  charge;  Sophie  C.  Nelson  was  chief  nurse.  ]Miss 
Nelson  was  born  in  Copenhagen,  Denmark,  but  was  a  natu- 
ralized citizen  of  the  United  States.  She  was  graduated  from 
the  Waltham  (Massachusetts)  Training  School  for  Nurses.  In 
April,  1910,  she  undertook  infant-welfare  work  for  the  board 
of  health  of  Cambridge,  Mass.,  and  later  became  superinten- 
dent of  the  Public  Health  Nursing  Association,  Louisville, 
Kentucky.  With  this  experience  as  a  background  and  with  a 
fluent  knowledge  of  French,  Miss  Nelson  proved  herself  an 
able  organizer  and  executive.  Moreover,  she  was  possessed  of 
an  unusually  winning  personality. 

Frances  B.  Archer,  Elmira  W.  Bears  and  Mary  P.  McCand- 
lish  were  the  other  nurses.  [Nlrs.  Florence  Lee  Holtzman,  of 
Washington,  D.  C,  a  laywoman  of  initiative  and  business  acu- 
men, first  had  charge  of  the  financial  details  at  the  Chateau. 

By  November  22  the  nurses  had  cleaned  the  wards  and  set 
up  rows  of  small  white  cribs  in  readiness  for  the  arrival  of  ten 
children  from  Evian.  Other  detachments  were  soon  sent  in 
rapidly  until  there  were  seventy  patients  in  the  Chateau  in 
February.  The  nursing  staff,  though  recnforced  by  several 
aides,  was  limited  and  the  heating  facilities  were  very  poor, 
so  Dr.  O'Neill  did  not  dare  for  the  time  being  to  take  a  larger 
number  of  patients.  Llie  Chateau  had  some  sixty  rooms  which 
were  at  first  heated  only  by  wood  fires.  The  fall  of  snow 
around  Lyons  was  heavier  in  the  winter  of  1917  and  1918  than 
it  had  been  for  forty  years.  ''The  enormously  thick  stone  walls 
made  the  Chateau  a  veritable  ice-box,"  wrote  Dr.  O'Neill, 
''and  I  have  often  wondered  how  those  American  nurses  and 
aides  stood  the  cold.     Surely  they  nuist  have  sutl'ered.'' 

The  professional  work  at  the  Cltafeau  des  Ilnllcs  difi'ercd 
very  little  from  that  at  other  hospitals  of  the  Children's  Bu- 
reau. IIer(>  were  the  same  sick  babies,  the  same  thin,  wistful 
young  children  to  nurse  and  feed  and  bathe.  ''A  (Icpi'cssing 
thing,"  wrote  Dr.  O'Neill,  "was  the  inability  or  ])ossiliIy  fear 
of  one  child  to  play  with  another.  Lhe  IJoeln'  rule  liad  hekl 
them  down  so  long  that  they  wotild  simply  sit  wliei'e  they  had 
been  put  until  they  were  told  to  move."     To  be  always  hungry, 


782   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  be  sick  and  frightened,  to  have  seen  their  parents,  their 
brothers  and  sisters  killed,  to  have  watched  their  homes  burn 
down  with  "mes  affaires/'  which  means  everything  to  the 
French  child,  seemed  to  have  choked  the  play  instinct  within 
them  and  they  sat  motionless  and  dumb. 

''To  me  perhaps  the  saddest  sight,"  continued  Dr.  O'Neill, 
"was  the  little  Boche  babies  abandoned  by  their  mothers  as 
soon  as  they  reached  French  soil  again.  I  have  seen  several 
families  where  part  of  the  children  had  French  fathers  and 
part  had  had  Boche  fathers." 

As  soon  as  the  children  were  fully  recovered  they  were  sent 
to  the  Societe  de  Secours  aux  Bapatries  at  Lyons,  a  well  estab- 
lished French  organization  under  the  leadership  of  Madame 
Gillet-Motte ;  she  maintained  two  establishments  in  Lyons,  one 
for  boys  and  the  other  for  girls,  and  a  barracks  where  children 
suspected  of  exposure  to  contagious  diseases  were  placed  for 
observation.  The  Societe  de  Secours  made  efforts  to  return  the 
rapatrie  children  to  their  parents  or  relatives. 

The  Chateau  des  Halles  had  originally  been  intended  for  use 
as  a  convalescent  home  for  children,  but  on  account  of  the  great 
number  of  children  examined  at  Evian  and  the  lack  of  space 
there  in  which  to  house  children  for  the  proper  period  of  ob- 
servation, contagious  cases  slipped  Vy  to  Lyons  and  were  then 
taken  to  the  Chateau,  which  caused  it  to  be  quarantined  fre- 
quently. Another  disadvantage  was  the  location  of  the  Chateau 
thirty  miles  from  Lyons ;  the  railroad  service  from  Lyons  to  Ste. 
Foy  I'Argentiere  was  poor  and  the  transportation  of  patients 
and  supplies  became  a  difficult  problem.  For  these  reasons  the 
Chateau  did  not  entirely  meet  the  n(H^d  for  convalescent  beds, 
so  about  ^fay  1,  1018,  the  policy  which  governed  its  mainte- 
nance was  changed.  Dr.  O'^'eill  was  transferred  to  Paris,  the 
nurses  were  reassigned  to  other  more  vital  service  and  Chateau 
des  TJalles  was  used  as  an  orphanage  where  children  were  sent 
for  summer  outings.     It  was  then  filled  to  capacity. 

As  lias  been  suggested,  the  primary  need  at  Lyons  was  for  a 
general  hospital  for  children  which  would  care  for  cases  from 
Lyons  and  rapatrics  who  slipped  through  lOvian.  On  Febru- 
ary G,  1918,  Dr.  CliiTord  Grulee,  of  Chicago,  had  arrived  at 
l^aris  headcjuarters  for  work  in  the  Children's  i^ureau.  Dr. 
(irule(>  had  been  assistant  professor  of  Pediatrics  at  Rush 
^ledical  College  and  attendant  pediatrician  at  the  Presby- 
t(;rian  Hospital  and  the  llonu!  for  Destitute  Crippled  Children 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     783 

and  his  book  on  Infant  Feeding  was  regarded  as  an  authority 
throughout  the  United  States.  Upon  his  return  in  1918  from 
France  he  became  professor  of  Pediatrics  of  the  University  of 
Chicago. 

Early  in  February,  1918,  Dr.  Grulee  was  appointed  medical 
delegate  of  the  Children's  Bureau  for  Lyons  and  ho  immedi- 
ately went  there  to  develop  the  work.  Sophie  Nelson,  hitherto 
chief  nurse  of  the  Chateau  des  Ilalles,  was  appointed  as  chief 
nurse  of  the  Lyons  district  and  she  and  Dr.  Grulee  undertook 
the  establishment  of  a  contagious  children's  hospital  in  Lyons, 
Hospital  Violet ;  a  convalescent  home.  La  Chaux ;  a  dispensary 
service,  and  some  months  later  a  special  general  hospital,  Hos- 
pital Holtzman. 

Before  outlining  the  development  of  these  institutions  at 
Lyons  a  short  statement  of  the  educational  work  of  the  Chil- 
dren's Bureau  is  necessary,  for  to  this  phase  of  Red  Cross 
endeavor  was  undoubtedly  due  in  large  part  the  success  which 
attended  the  establishment  of  these  hospitals  and  homes.  The 
need  in  France  for  a  strong  public  interest  in  child  welfare  work 
was  vital ;  in  a  country  where  two  adults  were  dying  for  every 
child  born,  the  life  of  that  child  became  doubly  precious.  In 
conjunction  with  the  Educational  Service  of  the  Rockefeller 
Commission  for  the  Prevention  of  Tuberculosis  in  France,  the 
Children's  Bureau  undertook  an  educational  campaign  early 
in  1918  to  awaken  public  interest  in  saving  the  lives  of  babies 
and  children.  Philip  S.  Piatt  was  the  first  director  of  the 
Educational  Service  of  the  Children's  Bureau.  Ellen  C.  Bab- 
bitt, an  American  social  worker,  expert  in  preparing  child  wel- 
fare exhibits,  joined  the  Children's  Bureau  on  ^March  26,  1918, 
and  assisted  in  the  preparation  of  the  exhibits.  Health  litera- 
ture was  published  and  distributed  in  large  quantities.  Two 
traveling  exhibits  were  set  up  and  sent  through  seven  depart- 
ments of  France.  Large  cliild  welfare  expositions  were  organ- 
ized liy  the  American  Red  Cross  in  cooperation  with  the  French 
^Ministry  of  the  Interior  and  the  Infant  ]\rortality  League  and 
were  held  in  Lyons,  ^Lirseilles  and  Saint  l^ticnne.  The  exposi- 
tion at  Lyons  was,  however,  the  first  and  largest  of  these. 

A  detailed  account^'*  of  this  exposition  lies  outside  the  pro- 
vince of  a  history  of  the  American  Red  Cross  Nursing  Service. 

"For  siU'li  sec  Report  of  the  Childroirs  l')Ur('au.  Vol.  Ill,  Infant  Welfare 
Canqiaii^n,  Hosanioiul  (JiUler.  Library,  National  IleacUiuarters,  \\'a.<liing- 
tcn,  D.  C. 


784   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  exposition  was  opened  in  a  large  pavilion  on  the  Place 
Bellecour,  on  April  1>,  191 G,  by  Senator  Herriot,  then  mayor 
of  Lyons.  Health  plays  enacted  by  pnppets,  lectures,  motion 
picture  shows  and  charts  illustrating  all  types  of  child  welfare 
work  formed  the  principal  material  of  the  exhibit.  Among 
these  were  a  series  of  some  eighteen  posters  drawn  in  color  by 
Anna  Miles  Upjohn,  an  American  portrait  painter.  Demon- 
strations of  dental  hygiene  and  of  the  hygiene  of  the  nose,  ear 
and  throat  were  held  in  separate  booths.  In  the  center  of  the 
pavilion  on  a  platform  surrounded  by  glass  to  keep  it  warm 
Susanne  B.  Hoskins  demonstrated  the  proper  care  of  a  baby. 
''While  the  French  people  whom  I  met  personally  were  very 
pleasant  to  me,"  wrote  Miss  Hoskins,  "and  used  to  crowd 
around  to  see  the  jolly,  kicking  baby  plunged  into  the  tub  of 
warm  water  .  .  .  they  said  we  were  foolish  in  coming  over 
and  trying  to  teach  them  how  to  care  for  their  children.  My 
answer  was :  'We  are  only  trying  to  show  you  our  way.'  " 

The  exposition  at  Lyons  lasted  from  April  9  to  April  30  and 
during  these  twenty-two  days  173,155  people  attended  it,  one- 
fourth  of  the  population  of  the  Lyons  district.^''* 

On  April  1  the  doors  of  the  Children's  Hospital  at  Lyons 
were  opened.  During  the  early  summer  of  1914  Dr.  Violet,  a 
French  physician,  had  started  a  private  hospital  at  142  Cours 
Gambctta,  Lyons,  but  upon  the  declaration  of  war  he  had  been 
mobilized  into  the  military  service.  His  hospital.  Hospital 
Violet,  had  been  closed.  The  modern  hospital  building  in 
wliich  it  had  been  located  was  imoccupied  until  jMarch,  1918, 
when  the  American  Ked  Cross  rented  it  for  use  as  a  general 
hospital  for  children. 

Ida  F.  Lutler  was  chief  nurs(^  of  the  Hospital  Violet.  With 
]\liss  Butler's  assignment  to  war  nursing  service  in  France 
came  an  interesting  link  with  Civil  War  days.  Her  father,  of 
jSi^ew  England  stock  and  northern  sympathies,  was  severely 
wounded  in  Viruinia  and  was  brought  to  the  old  Armory  Square 
Hospital  in  Washington,  1).  (\  Whil(>  on  duty  as  a  volunteer 
nurse  in  this  hospital,  Ida  do  M.  Fazio,  a  Washington  girl  of 
Castilian  descent  and  southern  sympathies,  met  him  and  they 
wei'c  married  at  the  end  of  hostilities.  A  direct  link  between 
^liss  Hiitler's  family  and  the  American  Red  Cross  during  the 
European  Wai-  was  through  her  brother,  who  as  president  of 
a  large;  American    insurance  company,  made  possible  the  gen- 

"<;il.l(T    Itcport,  \()1.   Ill,   p.    158. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     785 

erous  arrangements  by  which  the  American  Red  Cross  was  able 
to  insure  the  health  and  lives  of  its  overseas  workers. 

Miss  Butler  was  a  graduate  of  the  Hartford  Training  School 
and  was  for  twelve  years  head  of  tlie  maternity  and  gyneco- 
logical department  of  the  Hartford  Hospital.  She  then  became 
supervisor  of  probationers.  By  temperament,  she  was  direct 
and  fearless,  with  a  vivid  and  droll  gift  of  expression  and  an 
intense  loyalty  for  her  friends.  Above  all  else,  she  was  con- 
scientious, a  good  nurse  who  never  forgot  the  old-fashioned 
ethics  of  the  relation  of  nurse  to  patient. 

Hospital  Violet  was  opened  on  April  1  and  drew  patients 
from  three  principal  sources.  "Refugees  from  the  north  who 
had  been  sent  to  the  two  Red  Cross  orphanages,  Chateau  des 
Halles  and  La  Cliaux,"  wrote  Miss  Butler,  "and  rapatrie  chil- 
dren coming  from  Evian  were  our  emergency  cases.  Our  con- 
structive work  was  done  in  connection  with  children  sent  into 
the  hospital  from  two  Red  Cross  dispensaries  established  in 
Lyons." 

The  first  of  these  dispensaries  had  been  opened  at  42  Avenue 
Berthelot  in  March,  1!)18,  by  Dr.  Virginia  Murray,  of  San 
Francisco.  The  dispensary  treated  rapatrie  children  then  liv- 
ing in  Lyons,  and  also  children  who  had  lived  there  since  in- 
fancy but  who  because  of  the  dearth  of  French  physicians  were 
in  need  of  medical  care.  By  July  1,  1918,  this  dispensary  had 
treated  over  19 GO  new  cases.  A  second  dispensary,  located 
at  2  Avenue  de  la  Bibliothe(iue,  was  opened  on  July  22. 

As  ^liss  Butler  stated,  these  dispensaries  were  one  of  the 
principal  sources  through  which  patients  were  sent  to  the  Hos- 
pital Violet  and  a  great  number  of  them  were  nose,  throat  and 
dental  cases.  Dr.  William  E.  Wiggin  of  Lowell,  Mass.,  was 
chief  of  the  nose  and  throat  department;  his  wife  Laura  Wig- 
gin,  a  nurse,  was  his  assistant  and  anesthetist.  Dr.  Raymond 
M.  Watson  of  Waltliam,  ]\Iass.,  was  chief  of  the  dental  de- 
partment and  treated  from  thirty  to  fifty  children  daily  four 
times  a  week. 

Following  the  establishment  of  the  Hospital  Violet  in  April, 
1918,  a  convalescent  home.  La  CJLaiw,  was  opened  early  in  ^fay. 
La  Cliau.v  was  located  on  the  RhuiH'  River  eiiiht  miles  from 
Lyons,  and  to  this  ])l('asaiit  estate  were  sent  three  lniiHli'e(l  chil- 
dren from  Toul  and  two  liundri>d  and  twenty  children  from  Paris 
who  had  been  hurried  cnit  of  the  city  under  the  chapei'onage  of 
Paris  school  teachers  during  the  spring  bombardments.      Two 


786   HISTORY  OF  AMERICAN  RED  CROSS  NURSIKG 

nurses,  Susanne  B.  Hoskins  and  Kathrjn  Flanagan,  opened  the 
old  chateau  late  in  April  and  set  np  the  several  hundred  beds  for 
the  reception  of  the  children.  ''The  little  brown  cots  neatly- 
spread  with  the  charming,  vari-colored  afghans  made  by  Ameri- 
can Red  Cross  Juniors,"  wrote  Miss  Flanagan,  "surely  were 
a  joy  to  see.  The  entire  chateau  was  surrounded  by  a  terrace 
banked  with  wistaria,  then  in  full  bloom,  and  when  those  tired 
youngsters  arrived  from  Paris,  the  first  thing  they  saw  were 
these  vivid  afghans  and  beyond  the  open  windows,  the  fragrant 
flower-hung  terraces."  The  children  at  La  Chaux  lived  largely 
in  the  open  air.  Classes,  drills  and  games  were  held  and  even 
meals  were  served  on  the  terraces  and  in  the  gardens. 

Xeither  the  two  orphanages.  Chateau  des  Halles  and  La 
Chaux,  nor  the  Hospital  Violet,  nor  the  dispensaries  afforded 
exactly  the  specialization  which  the  Lyons  situation  demanded, 
so  on  June  11,  1918,  Dr.  Grulee  converted  the  Hospital  Violet 
into  a  purely  contagious  hospital  and  sent  Miss  Butler  to  organ- 
ize a  hospital  for  acute  diseases  of  children  in  the  former 
German  Consulate,  37  Boulevard  des  Beiges.  This  was  called 
Hospital  Holtzman,  in  deference  to  Madame  Holtzman's  tire- 
less efforts  at  des  Halles.  The  nose  and  throat  department 
was  transferred  from  the  Hospital  Violet  to  the  new  hospital, 
but  the  dental  department  was  attached  to  the  main  dispensary 
in  the  Avenue  Berthelot. 

The  German  Consulate,  a  "magnificent  example  of  German 
ornate  extravagance,"  had  been  built  with  the  idea  that  the 
Kaiser  would  reside  there  whenever  he  chose  to  visit  Lyons. 
It  had  seven  bath-rooms,  "each  one  finished  in  marble  and 
onyx,"  wrote  Miss  Butler  to  Miss  Xoyes.  "It  makes  the  finest 
kind  of  service  room.  The  old  rose  halls  and  the  grand  salons, 
now  covered  with  l)ro\vn  paper  to  protect  them,"  she  continued, 
"are  wards  for  children  aged  from  two  to  four  and  the  brilliant 
light  from  the  magnificent  glass  chandelier  dazzles  their  little 
eyes.  The  library  is  still  f\ill  of  valuable  books;  the  shelves 
have  been  boarded  up  and  sealed  and  the  room  is  used  as  an 
infants'  ward."  Dorothy  Cox,  of  Terre  Haute.  Indiana,  was 
business  manager;  she  had  assisted  Miss  Babbitt  in  the  de- 
velopment of  the  Lyons  Child  Welfare  Exposition  and  remained 
at  Lyons  after  the  exposition  was  closed. 

The  Holtzman  Hospital  had  a  total  capacity  of  one  hundred 
and  fifteen  beds,  but  owing  to  the  scarcity  of  nurses  and  aides 
due  to  the  military  needs,  it  admitted  an  average  of  only  sixty 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     787 

cases.  Lentil  July,  ^fiss  Butler's  staff  had  consisted  of  four 
American  Red  Cross  nurses,  three  American  aides  and  numerous 
French  aides,  hut  hv  the  middle  of  'fuly,  only  one  o<:her  nurse 
was  left.  One  of  the  four  had  heen  taken  ill  and  Miss  Ashe 
had  recalled  two  others  and  the  American  aides  for  assi^imcnt 
to  the  Department  of  Military  Affairs,  so  ]\Iiss  Butler  and  the 
fourth  American  craduate  nurse,  a  French  nurse  from  the 
Nightingale  School  at  Bordeaux  and  ten  French  aides  did  all 
the  nursing  at  the  Iloltzman  Hospital.  "At  present  we  have 
nine  bone  cases,"  wrote  ^liss  Butler  to  Miss  Noyes  on  July  30, 
"and  fifteen  daily  dressings, — little  fingers  and  toes  just  slough- 
ing away.  We  also  have  several  cases  of  pulmonary  tuberculosis 
and  feeding  cases  with  complications  of  all  kinds."  In  August, 
50  per  cent  of  the  young  patients  at  Hospital  Iloltzman  were 
tubercular. 

The  policies  of  the  Children's  Bureau  included,  it  will  be 
remembered,  the  training  of  French  women  to  do  "follow-up" 
work  in  the  homes.  Tlu^se  women  were  called  visifcuses  d'en- 
fants  and  the  value  of  their  service  depended  almost  entirely 
upon  the  type  of  woman  selected  and  the  intensive  instruction 
given  them  by  the  Red  Cross.  A  committee  was  formed  which 
consisted  of  five  influential  women  of  Lyons  and  of  ^liss  Nelson, 
chief  nurse  of  tli(>  Children's  Bureau  in  the  Lyons  district. 
Lectures  were  delivered  to  the  visiteuses  d'enfants  by  prominent 
French  physicians  of  the  city.  American  Red  Cross  nurses 
at  the'  Hospital  Violet  gave  them  clinical  instruction  in  the 
wards.  Twenty-five  women  were  chosen.  The  general  ar- 
rangements were  made  by  Elizabeth  ^litchell,  a  nurse  from 
Newport,  Rhode  Island.  The  course  began  in  the  middle  of 
April  and  lasted  until  the  first  of  June.  It  consisted  of  forty 
lectures,  one  of  which  was  given  each  day.  The  practical  in- 
struction in  the  wards  of  the  Hospital  Violet  and  at  the  Red 
Cross  dispensaries  was  given  by  \\\v  American  nurses.  Twenty- 
one  women  passed  the  examiiuition  successfully  and  were  able 
to  give  material  licl})  in  the  Red  Cross  campaign  against  infant 
mortality. 

In  addition  to  the  maintenance  of  the  two  orphanages,  the 
contagious  hospital,  the  h()S])ital  for  acute  diseases  and  the  two 
dispensaries,  the  ('liildi'eirs  Bureau  at  Lyons  did  nnich  to  co- 
ordinate local  eliiltl  welfare  activities  in  Lyons.  It  also  aave 
subsidies  to  I'^i^eneh  charity  oi'gani^^ations.  ^foreover,  a  lied 
(*ross  (lisj)ensary   was  established   in    Koanne  and   a   rest  home 


788   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  pregnant  women  and  a  pouponniere  at  Vienne,  both  out- 
lying villages  near  Lyons. 

When  the  American  Army  planned  its  drive  on  St.  Miliiel 
in  August,  1918,  the  military  authorities  asked  that  the  Asile 
Caserne  de  Luxembourg  at  Toul  be  converted  into  a  military 
hospital.  The  five  hundred  children  who  were  being  cared 
for  there  were  sent  on  September  2  to  Lyons  ;  three  hundred  and 
forty  of  them  were  taken  to  La  Chau^  and  the  others  were  dis- 
tributed in  various  hospitals  in  the  city.  Even  Lyons,  how- 
ever, was  to  share  in  the  great  need  for  hospital  beds  for  the 
American  troops  during  the  influenza  epidemic.  A  large  reserve 
officers'  training  camp  of  the  American  Expeditionary  Forces 
was  located  at  La  Valbonne,  fifteen  miles  north  of  J^yons.  Late 
in  October,  when  the  influenza  epidemic  became  virulent.  Colonel 
Alorrow,  L^.  S.  A.  Medical  Corps,  asked  the  lied  Cross  to  find 
10,000  hospital  beds  for  American  soldiers  in  and  near  Lyons. 
La  Cliaux  was  converted  into  a  military  hospital,  as  has  already 
been  stated,  and  military  wards  were  opened  both  at  the  Hos- 
pitals Holtzman  and  Violet  to  care  for  influenza  cases. 

Twenty  miles  below  Lyons  on  the  Ilhone  lliver  was  situated 
the  industrial  city  of  St.  Etienne, — "the  Pittsburg  of  France," 
Dr.  Kichard  Cabot  called  it.  Both  within  the  city  districts  and 
in  the  outlying  villages,  the  normal  population  was  doubled  by 
the  influx  of  refugees  from  the  Xorth,  many  of  them  the 
rapatries  who  had  passed  through  Evian.  Only  fourteen  physi- 
cians were  available  in  1917  to  care  for  the  medical  and  surgical 
needs  of  these  250,000  people. 

Early  in  Xovember,  1917,  citizens  of  St.  Ktienne  asked  the 
Children's  Bureau  to  send  them  a  pediatrician  to  undertake 
child  welfare  work.  Dr.  H.  S,  J].  Smith  and  Eva  Louise 
Smythe  were  sent  from  Paris  Headquarters  and  opened  a  Red 
Cross  dispensary  at  St.  Etienne  on  December  .'51,   1918. 

Eva  Louise  Smythe  had  had  wide  experience  as  a  public 
health  nurse.  She  was  born  on  the  Island  of  St.  Helena.  She 
was  graduated  from  the  Massachusetts  Training  School,  ]\ral- 
deii,  and  for  sixj^een  years  was  office  nurse  and  surgical  assistant 
to  a  Maiden  pliysician.  She  then  took  up  school  nursing  in 
J'asadena,  C'alifornia.  In  1910  slie  joined  the  Bed  (^ross  Town 
and  CV)untrv  Xursiiig  Service  and  for  nine  months  did  rural 
nursing  in  Doylestown,  Pa.  She  went  overseas  with  the  first 
Harvard  T'nit  to  do  special  work  for  Dr.  Cabot  and  served 
with  the  Britisli   l^xpeditif)narv  Forces.     She  joined  the  Chil- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    789 

drcn's  Bureau  in  October,  1917,  and  was  sent  immediately  to 
St.  fitiennc.  She  was  a  woman  of  strong  personality,  an 
executive  who  did  not  shirk  responsibility;  she  was  honest, 
direct,  sometimes  to  the  point  of  bluntness,  and  possessed  of 
good  judgment. 

The  mayor  of  St.  fitienne  donated  a  room  e(|uipped  with 
electricity,  gas,  water  and  modern  dispensary  equipment ;  the 
American  lied  Cross  furnished  personnel,  medicines,  clothing 
and  other  necessary  supplies.  During  the  first  months  of  her 
work  at  St.  fitienne  Miss  Smythe  assisted  at  the  clinics  held 
every  afternoon  at  the  dispensary  and  did  visiting  nursing  in 
the  mornings.  Gradually  Dr.  Smith  extended  his  work  to  the 
neighboring  villages  and  established  Red  Cross  dispensaries  at 
La  Talaudiere,  St.  diamond  and  at  Roanne. 

As  the  dispensary  service  developed,  the  need  for  a  children's 
hospital  at  St.  fitienne  became  more  and  more  evident.  Ar- 
rangements were  effected  whereby  the  American  Red  Cross 
appropriated  175,000  francs  for  the  purpose  of  establishing  such 
an  institution,  and  the  citizens  of  St.  Etienne  raised  a  similar 
amount. 

This  hospital,  which  was  called  Chautalonette  and  which  was 
of  100  bed  capacity,  was  formally  opened  on  January  21,  1919, 
The  American  Red  Cross  turned  it  over  entirely  to  the  city 
of  St.  Etienne  on  ^larch  20,  but  during  the  two  months  of  Rod 
Cross  administration  267  cases  were  treated  there  and  231 
operations  were  performed.  Refugee  children  comprised  3.")  per 
cent  of  this  number;  the  others  were  children  from  St.  fitienne 
and  the  surrounding  villages. ^^ 

The  nursing  personnel  for  these  dispensaries  and  for  the 
Chautalonette  Hospital  was  recruited  and  trained  entirely  by 
Miss  Smythe.  ]\Iiss  Ashe  summarized  ^liss  Smythe's  work  in 
the  Weekly  Report  of  the  Children's  Bureau  ending  July  G, 
1918: 

^riss  Smythe  went  to  St.  fitienne  eight  months  ago,  alone. 
She  has  never  asked  us  for  hclj>  and  she  has  organized  theiT  a 
group  of  24  French  girls.  I  asked  lier  where  she  got  them, 
and  she  told  nie  slie  went  to  the  Xormal  School  and  asked  for 
volunteers  who  could  speak  Englisli  to  help  her.  Twenty- 
four  women,  all  volunteers,  responded  and  she  has  taught 
them,  and  right  straight  along  these  girls  have  gone  witli  her 
and  have  had  s]dendid  training.  She  asked  for  an  American 
^"CiMtT  lU-port.  \'i)l.  Ill,  p.  43. 


790    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nurse  to  do  the  work  at  the  child  welfare  exhibit,  and  I 
have  sent  her  one  nurse.  I  think  that  for  a  woman  coming 
over  alone,  without  a  word  of  Frencli,  to  have  developed  a 
situation  like  this  is  really  quite  remarkable. 

Miss  Smythe  expects  to  get  from  her  class  enough  nurses  to 
put  into  the  children's  hospital  about  to  open  at  St.  fitienne, 
without  asking  us  for  American  nurses.  There  were  some 
school  teachers  of  St.  fitienne  who  came  to  Miss  Smythe  out- 
side of  school  hours  for  the  training. 

One  of  Miss  Smythe's  first  steps  was  to  organize  a  little 
boys'  club.  St.  fitienne  is  a  manufacturing  city,  and  is  very 
dirty  and  crowded  at  the  present  time.  The  refugees  have 
gone  into  abandoned  hovises,  which  in  many  cases  are  simply 
filthy  holes.  By  putting  up  a  prize  of  a  pair  of  rubber  boots. 
Miss  Smythe  aroused  competition  among  the  boys,  and  got 
these  dirty  streets  and  alleys  cleaned  up.  She  also  started 
sewing  classes  for  the  girls,  and  they  made  necessary  articles 
for  the  dispensaries. 

St.  fitienne  was  one  of  the  three  large  industrial  cities  to  be 
visited  by  the  child  welfare  exposition  of  the  Children's  Bureau. 
The  exposition  was  held  in  the  Bourse  de  Travail  between  July 
11  and  July  28,  and  80,000  people  attended  it.  Margaret 
Frances  McLeod,  the  single  American  nurse  Miss  Ashe  wrote 
of  who  was  sent  by  the  Children's  Bureau  to  assist  Miss  Smythe, 
described  the  attendance: 

The  hall  was  filled;  over  5000  people  attended  the  opening. 
The  next  day  1  think  the  entire  city,  or  at  least  it  seemed  that 
many,  visited  the  exposition  and  displayed  intense  interest. 
School  teachers  came  not  once  but  several  times  and  brought 
their  classes.  The  French  girls  from  the  best  families  in  the 
city  donned  the  Ked  Cross  gown  and  cap  and  acted  as  inter- 
preters and  assistants  for  the  doctors  at  the  different  clinics. 
Literature  was  distributed  and  educational  posters  displayed 
everywhere.  I  have  never  seen  such  real  enjoyment  and 
appreciation  anywhere  else  and  it  was  genuine. 

]\Iy  small  part  in  the  exhibition  was  to  bathe  the  baby  and 
dress  it  in  the  American  way.  I  don't  think  I  ever  enjoyed 
anything  nwre  than  that  in  all  my  nursing  experience.  You 
really  felt  the  people  were  taking  an  interest. 

The  doctor  and  nurse  at  St.  fitienne  have  accomplished 
more  good  in  public  health  than  any  place  in  France.  Their 
cooperation  with  the  ])rominent  city  officials  and  the  j)eople 
of  St.  TCticnne  was  truly  remarkable.  .  .  . 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     791 

Directly  below  Lyons  and  St.  liltienne  lay  the  city  of  Mar- 
seilles, the  southeastern  gateway  to  France.  Like  its  sister  in- 
dustrial cities  in  the  north,  its  population  had  doubled.  The 
housing  facilities  which  had  accommodated  G00,000  in  1914 
were  wholly  inadequate  for  the  1,000,000  and  more  who  thronged 
the  city  in  1917.  The  war  had  practically  inhibited  new  con- 
struction. 

The  population  of  Marseilles  was  a  transient,  cosmopolitan 
one.  Soldiers,  refugees  and  merchants  of  every  race  elbowed 
each  other  in  the  dirty,  picturesque  streets.  A  colony  of  Greeks 
and  a  colony  of  120,000  Italians  had  settled  there.  Although 
unique  among  French  cities,  this  population  resembled  that  of 
many  American  cities  and  in  this  respect  did  not  offer  a  social 
service  and  public  health  nursing  problem  unusual  to  an  ex- 
perienced American  personnel. 

Both  the  native  and  the  refugee  child  suffered  at  Mar- 
seilles and  would  have  suffered  more  had  it  not  been  for  the 
efforts  of  some  sixty  local  philanthropic  institutions,  of  all 
types,  which  existed  in  the  city  and  which  expended  in  1917  over 
8,000,000  frs.  for  child  welfare.  The  Children's  Bureau  as 
well  undertook  extensive  work  at  Marseilles. 

In  January,  1918,  Dr.  and  Mrs.  Lucas,  Dr.  Oscar  H.  Sellen- 
ings,  of  Columbus,  Ohio,  and  Miss  Elizabeth  Wallace  visited 
the  city  and  made  a  swift  survey  of  conditions.  Two  facts 
brought  out  by  this  survey  were:  first,  the  need  for  relief  work 
for  the  children ;  secondly,  the  need  for  infinite  care  and  tact  in 
developing  this  work,  because  of  the  large  number  of  already 
organized  oeuvres. 

On  February  6,  Dr.  Sellenings  was  assigned  to  Marseilles 
to  develop  child  welfare  work  there. 

On  March  1  a  meeting  was  held,  at  which  representatives  of 
between  40  and  50  institutions  asiTced  to  form  an  office  central 
which  would  act  as  a  "clearing  house''  for  child  welfare  work 
at  ^larseillcs.  This  office  was  established  at  the  headquarters  of 
the  Children's  Bureau,  33  Boulevard  de  la  Liberte,  and  the 
American  lied  Cross  contributed  the  services  of  a  secretary  to 
this  organization. 

Emily  Hammond  Smith  arrived  in  ^[arseillcs  on  March  4 
to  assist  Dr.  Sellenings  in  the  development  of  the  dispensary 
and  milk  station,  and  to  develop  public  health  nursing,  ^[iss 
Smith  was  a  graduate  of  the  Children's  Hospital,  Boston,  ^Liss. 
She  was   for  two   seasons  superintendent  of  the   ^^'ortli   Shore 


792   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Babies'  Summer  Hospital,  Salem,  Mass.  She  later  became 
assistant  superintendent  of  the  Children's  Hospital,  Boston, 
and  resigned  to  enter  lied  Cross  service  early  in  1918. 

The  Bed  Cross  children's  dispensary  at  Marseilles,  which  was 
called  the  Maison  d'Enfance,  was  located  in  the  Rue  Tregance 
within  the  walls  of  old  Roman  ruins.  On  a  rainy  Saturday 
afternoon,  March  10,  Dr.  Sellenings  and  Miss  Smith  opened  the 
doors  of  the  clinic  and  found  the  ante-room  packed  with  mothers 
and  babies. 

Clinics  were  afterwards  held  on  Tuesdays  and  Saturdays 
from  2  to  7  P.M.,  and  the  average  attendance  was  40  cases. 
Dr.  A.  M.  Gove  was  in  charge  of  the  dispensary.  Only  children 
under  2  years  of  age  were  admitted  at  the  Maison  d'Enfance. 
A  canteen  for  nursing  mothers  was  conducted  in  connection 
with  the  dispensary.  Milk  formulas  for  bottle-fed  babies  were 
prepared  there,  and  follow-up  work  in  the  homes  was  done  by 
the  nurses. 

One  of  the  principal  aims  of  the  Children's  Bureau  at  Mar- 
seilles was  to  furnish  assistance  to  Nourrisons  Clinics.  Dr. 
Gove,  the  American  nurses  and  the  French  nursing  aides  gave 
medical  and  nursing  care  to  babies  at  three  such  clinics ;  this 
particular  service  was  only  for  well  babies.  The  Children's 
Bureau  also  furnished  a  doctor  for  the  Dispensaire  des  Enfants 
Malades,  Rue  St.  Sebastian  and  for  another  local  dispensary  at 
]^o.  22  Roucas  Blanc.  Other  miscellaneous  activities  included 
the  establishment  and  maintenance  at  Aubenas,  for  three  months 
of  a  dispensary  for  influenza  cases,  which  was  finally  turned 
over  to  French  physicians  on  their  return  from  the  front. 

During  its  14  months  at  Marseilles,  the  Children's  Bureau 

made  formal  donations  amounting  to  106,500  francs  to  eight 

local  charities:  Entre-Aide  Feminine;  Art  et  Charite;  Asile 

^t.  Louis;  Asile  St.  Joseph;  Ahri  Maternal;  Dispensaire  des 

infants  Malades;  Aide  aux  Veuves;  and  five  creches.^'^ 

Following  the  establishment  of  the  dispensary  service,  the 
Children's  Bureau  held  a  child  welfare  exposition  at  ]\rarsoilles 
from  ^lay  27  to  June  9  at  the  Maison  de  la  Muiualite.  In  this 
building  were  tli(>  ottiees  of  some  .'jT)  local  oeuvres,  so  the  exposi- 
tion was  held  in  the  very  center  of  organized  charity  work  of 
the  city.  It  was  arranged  for  by  ^liss  Babbitt  and  her  assistant, 
Dorothea  Baldwin,  and  .'>2,2;}1  people  attended.  One;  Inindred 
and  sixty-one  motion   picture  shows  were  given  and  290,250 

"Gilder  Report,  Vol.  Ill,  pp.  48-49. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     793 

pieces  of  child  welfare  and  anti-tuberculosis  literature  were 
distributed. 

Marseilles  supported  only  one  local  institution  which  hos- 
pitalized children  under  eighteen  months  of  age.  Children  were 
boarded  out  and  ''in  one  institution  not  manifestly  inferior  to 
many  others  in  management,  locale  or  equipment,"  wrote  Miss 
Gilder,^**  ''the  death  rate  was  49  per  cent."  The  local  oeuvres 
were  net  at  that  time  prepared  to  provide  one,  so  the  Children's 
Bureau  established  a  temporary  hospital  and  preventorium  in 
some  barracks  on  the  seashore  outside  the  city.  The  Barrack 
Hospital,  as  it  was  called,  was  opened  on  September  G,  1918, 
with  a  capacity  of  Hfty  beds.  At  the  same  time,  a  convalescent 
home  for  boys,  at  St.  Louis,  to  which  the  Children's  Bureau 
had  contributed  both  personnel  and  funds,  was  opened.  During 
the  summer,  the  staif  of  the  Children's  Bureau  at  ^farseilles 
also  rendered  assistance  in  relieving  an  epidemic  at  St.  Maxi- 
mun,  and  to  two  nour{s,-ions  clinics. 

Early  in  Ocj^uber,  1918,  Dr.  Scllenings  returned  to  the 
United  States  and  Dr.  May  Agnes  Hopkins  took  over  the  di- 
rection of  the  work  at  ^Marseilles.  A  general  reorganization  of 
the  child  welfare  activities  was  brought  into  line  after  the 
Armistice  and,  under  the  leadership  of  the  local  organization,  the 
Art  ct  Cliarife,  the  citizens  of  ^Marseilles  formed  a  special  com- 
mittee on  child  welfare,  which  was  called  the  Franco-American 
Committ(>e  and  which  agreed  to  act  as  a  central  clearing  house 
for  child  welfare  after  the  withdrawal  of  the  American  Bed 
C^ross.  Tills  committee  took  over  the  dispensaries,  the  visiting 
nursing  and  the  )iuurisso7is  clinics;  in  addition,  they  had  a  nine- 
years'  lease  on  a  convalescent  home  for  children,  San  Joseph, 
which  was  located  just  outside  the  city. 

In  Xovember,  1918,  the  American  Bed  Cross  appropriated 
150,000  frs.  to  be  given  to  the  Franco- American  Connnitte(>, 
with  the  understanding  that  it  was  to  be  divided  into  three 
s(>])arat(>  sums,  of  ."iO.OOO  frs.  each,  to  be  spent  for  three  separate 
projects.  The  first  of  these  sums  was  to  be  used  to  maintain 
a  permanent  convalesccnit  home  for  infants  and  children  up  to 
four  years  of  age,  at  San  Jose])li  and  was  given  on  the  conditicui 
that  "an  ('(jual  sum  be  guaranteed  to  make  a  permanent  fund 
of  100,000  frs.  for  the  running  and  management  of  the  San 
Jose])h   Convalescent   Home   for   Children,   for  a   period  of  at 

'M;ildrr   Wvinn-t,  \"ul.   Ill,  p.  4.1. 


794   HISTORY  OF  AMERICAN  IlED  CROSS  NURSING 

least  three  years,"  ^^  A  second  provision  of  this  bequest  was 
that  the  Home  should  be  directed  by  a  graduate  nurse  experi- 
enced in  the  care  of  children ;  that  she  should  have  a  staff  of 
trained  assistants ;  and  that  the  Home  would  be  used  as  a  teach- 
ing center  for  the  training  of  visiteuses  d'enfants. 

The  second  sum  of  50,000  francs  was  to  be  used  for  the  dis- 
pensary for  infants  and  children  at  Xo.  1,  Vieille  Tour,  and 
it  was  also  given  on  condition  that  the  citizens  of  Marseilles 
raise  an  equal  amount,  thus  guaranteeing  a  principal  foundation 
of  100,000  francs.  One  of  the  special  purposes  for  which  this 
bequest  was  made  was  for  the  development  of  health  visiting 
and  visitors  in  the  dispensaries  and  in  the  homes  of  the  children 
who  attended  the  clinics.  Like  the  Convalescent  Home  at  San 
Joseph,  this  nursing  service  was  to  be  under  the  direction  of  a 
graduate  nurse  experienced  in  child  care  and  the  dispensary 
was  to  be  used  as  a  teaching  center  for  visiteuses  d'enfants. 

The  third  sum  of  50,000  francs  w^as  also  given  under  condi- 
tion that  a  similar  sum  be  raised  by  the  French,  with  the  un- 
derstanding that  the  total  sum  of  100,000  francs  should  be 
used  for  a  school  of  visiteuses  d'enfants.  The  course  of  train- 
ing was  outlined  by  Dr.  Lucas : 

The  course  of  health  visitors  to  cover  a  period  of  at  least 
six  months;  three  months  are  to  be  given  in  practical  work 
at  some  cliildren's  institution  such  as  San  Joseph,  or  some 
other  institution  controlled  by  this  committee  and  by  the 
medical  and  nursing  staff  appointed  by  this  committee  to 
carry  on  the  theoretical  and  practical  training  of  these  health 
visitors.  The  other  three  months  are  to  be  given  to  teaching 
home  visiting,  using  Dispensary  Xo.  1,  Vieille  Tour,  as  a 
base,  and  the  special  district  as  the  training  place  for  prac- 
tical home  care  of  mother  and  child. 

It  is  not  intended,  of  course,  to  limit  the  places  of  training 
to  these  two  institutions,  San  Joseph  and  the  dispensary  at 
Xo.  1,  but  simply  that  these  two  be  used  as  the  basis  for 
practical  and  theoretical  training,  and,  further,  that  a  course 
of  3G  lectures  at  least  be  arranged,  covering  the  suljjects  of 
pre-natal  care,  nursing  and  general  hygiene,  and  feeding 
of  the  child,  to  be  given  by  members  of  the  medical  profession 
cliosen  by  tiiis  Committee,  engaged  especially  with  qualifica- 
tions and  training  for  sucli  teaching.^** 

'»C;ild(T    Report.    Vol.    ITT,    pp.   52-53.      See   letter   of   Dr.   W.    V.    Lucas, 
a^ldicpscd    Noveniher    2!).    liHS,    to    the    Franco-American    Committee    for 
Cliild  Welfare  in  Marseilles. 
'"'  Ihid. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     795 

On  Febnmry  1,  1919,  the  Children's  Bureau  turned  over 
its  activities  to  the  OtHce  Central  and  withdrew  from  ^larseilles. 
The  local  organization,  Art  et  Charlie,  took  over  the  dispensary 
in  the  Rue  Tregance.  The  Red  Cross  pledge  of  a  gift  of  150,000 
francs  for  the  subvention  of  the  School  for  Health  Visitors  and 
the  endowment  of  the  St.  Joseph  Convalescent  Home  for  Boys 
and  Girls,  was  fulfilled. 

Toulouse  lay  midway  between  Marseilles  and  Bordeaux  and 
here  the  American  lied  Cross  held  the  last  of  its  large  child 
welfare  expositions.  The  exposition  was  opened  in  the  Halle 
aux  Grains  on  October  20,  1918,  and  lasted  until  November  10. 
Eighty  thousand  people  attended  it.  At  the  health  clinics,  G08 
children  received  medical  examination,  1362  were  given  dental 
treatment  and  79  attended  consultations  on  corrective  gym- 
nastics, making  a  total  of  2147  children  treated.  Mary  C.  Nel- 
son, the  American  Red  Cross  nurse  who  had  been  charge  nurse 
of  the  Children's  Colony  at  Dinard,  was  assigned  to  Toulouse 
and  spent  a  month  there  doing  pre-natal  and  child  welfare  work 
in  connection  with  the  exposition. 

A  group  of  interested  people  in  Toulouse  formed  a  Children's 
Committee  for  the  purpose  of  training  French  girls  to  serve  as 
child  health  visitors.  The  American  Red  Cross  offered  to  assist 
the  Committee  in  the  development  of  the  course,  but  the  offer 
was  not  accepted. 

Bordeaux  was  the  principal  southwestern  seaport  of  France. 
Here  the  conditions  of  child  health  were  as  critical  as  at  Mar- 
seilles. The  birth  rate  at  Bordeaux  in  1913  was  ten  thousand 
and  the  infant  mortality  one  thousand;  two  years  later  the 
birth  rate  had  fallen  to  five  thousand  and  the  mortality  remained 
at  one  thousand.  Where  the  civilian  population  had  had  in  1914 
the  sei'\dces  of  twenty-two  physicians,  in  1919  there  were  only 
six. 

Although  the  American  Red  Cross  developed  an  extensive 
program  of  emergency  relief  and  left  a  foundation  for  con- 
structive welfare  work  at  Bordeaux,  no  nurses  were  assigned 
to  duty  there  until  October,  1918.  The  military  situation  was 
too  pressing  in  the  summer  of  1918  for  th(Mn  to  be  spared  for 
work  with  the  children.  The  medical  work  there  had  first 
been  initiated  l)y  Dr.  Philip  Van  linren  Johnson,  whom  the 
ChildrcMrs  liurcau  sent  to  Bordeaux  in  ^lay,  1918. 

The  Nigiitingalc  School  for  Nurses  of  the  ^['us()n  iJc  Sanfc 
rrofcsl'iiilc,  which  was  the  one  professional  school  of  nursing 


796    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  France,  was  located  at  Bordeaux  and  Dr.  Hamilton  had  de- 
veloped there  a  course  in  public  health  nursing.  In  August, 
1918,  Dr.  Johnson  recommended  that  the  Red  Cross  present 
two  scholarships  to  the  Nightingale  School  in  order  that  the 
services  of  two  of  Dr.  Hamilton's  pupils  might  be  available  for 
carrying  on  the  activities  of  the  Children's  Bureau.  These 
scholarships  and  eight  additional  ones  were  subsequently 
granted  ^^  and  Dr.  Johnson  thus  had  the  service  of  ten  French 
nurses  in  the  development  of  the  relief  activities  of  the  Chil- 
dren's Bureau. 

The  emergency  relief  at  Bordeaux  was  considerable.  Late 
in  June,  Dr.  Johnson  established  a  twenty-five-bed  hospital  in 
the  Bastide  quarter  near  the  Maison  du  Behe.  At  Bagatelle, 
an  estate  belonging  to  the  Maison  de  Sante  Protestanie,  which 
afterwards  became  the  site  of  the  American  Nurses  Memorial 
building  of  the  Xightingalc  School,  a  barrack  hospital  for  chil- 
dren was  established  by  Dr.  Johnson  and  405  cases  were  treated 
there  in  July,  1918.  In  August,  a  preventorium  was  developed 
at  Soulac.  A  new  dispensary  at  the  Maison  du  Behe  was  opened 
in  September  and  twelve  beds  at  iheMaison  de  Sante  Protestanie 
were  secured  by  the  American  Red  Cross  for  permanent  use  by 
Bordeaux  children  suffering  from  acute  diseases. 

When  the  time  came  for  the  Red  Cross  to  withdraw  in  1919 
from  Bordeaux,  the  Children's  Bureau  established  a  foundation 
of  10,000  francs  to  be  used  for  constructive  child  welfare  work 
at  Bordeaux.  A  permanent  nursing  organization  entitled 
L' Association Fran-co-Ameri^ne  pour  les  Infirmieres  Yisitciises 
was  organized.  Its  aim  was  to  "establish  in  the  city  of  Bor- 
deaux an  organization  to  cooperate  with  the  training  schools  for 
nurses  at  the  Maison  de  Sante  Protestante  and  the  Hopital 
TondiL  (and  other  similar  training  schools  as  may  be  subse- 
quently decided  upon)  with  the  object  of  providing  a  special 
course  of  six  months  practical  training  in  public  health  work 
particularly  as  applied  to  children."  "  The  Board  of  ^Ninnagers 
of  the  Association  included  Dr.  Hamilton,  Evelyn  Walker, 
]\radame  Gounouilhou,  ^l.  Charles  de  Luze,  Lt.  (^olonel  Cliarh^s 
Cazalet,  treasurer,  and  Doctcur  ]\Iousseau.  The  plan  of  organ- 
ization  specified    tliat    the    superintendent    of   the    Association 

*^Sco  ]\rinutos  of  the  Finance  Committee  of  the  Commission  to  France, 
September  17.   1018,  p.  ^^4S. 

^Contract  of  Afjreemcnt  lie! ween  Association  Franco-Americaine  jioiir 
les  Infirmieres  Visiteiiscs  and  ll'e  American  Ixed  Cross  signed  January  1, 
191!».     See  Gilder   Report,  Vol.   Ill,  p.  58. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     797 

should  1)0  an  American  graduate  nurse ;  Evelyn  T.  Walker  was 
appointed  in  October,  11)18,  to  this  position.  Miss  Walker  was 
a  medical  social  service  nurse  of  experience  and  ability.  Born 
at  Cork,  Ireland,  of  Irish  parentage,  Miss  Walker  was  educated 
at  private  schools  in  Cork  and  London.  Her  professional  train- 
ing was  obtained  at  the  East  London  Hospital  for  Children  and 
Dispensary  for  Women;  she  took  a  post-graduate  course  in 
medical  and  obstetrical  work  at  Bellevuc  Hospital,  I^ew  York 
City,  and  in  1914  attended  lectures  at  the  New  York  School 
of  Social  Work.  Erom  1 !)()()  to  11)11  she  was  in  charge  con- 
secutively of  the  tnb(>rcul()sis,  the  male  medical  and  the  chil- 
dren's division  at  Ecllevue  Hospital  and  later  organized  and 
directed  the  maternity  social  service  work.  Subsequently,  she 
became  supervisor  of  the  Department  of  Educational  Nursing 
and  Eresh  Air  of  the  Association  for  Improving  the  Condition 
of  the  Poor.  She  went  overseas  for  work  with  the  Children's 
liureau  in  July,  11)18,  did  military  nursing  at  American  Red 
Cross  ^Military  Hospital  No.  1,  and  on  October  9,  1918,  went 
to  Bordeaux,  where  h(>r  knowledge  of  French,  her  pleasing  per- 
sonality and  her  professional  attainments  led  to  her  appointment 
as  superintendent  of  nurses  of  the  district  nursing  association. 

On  a  direct  line  between  Bordeaux  and  Paris  lay  the  ancient 
city  of  Blois,  in  the  valley  of  the  Loire.  Blois  was  another 
of  the  French  cities  which  in  1918  were  crowded  with  refugee 
children  and  the  Red  Cross  opened  a  dispensary  there  on 
February  21,  1918,  and  continued  its  maintenance  for  ten 
months.  Dr.  Bertha  B.  Stuart,  of  Portland,  Oregon,  was  in 
charge  of  the  activities  of  the  Children's  Bureau  and  with  the 
aid  of  specialists  who  came  down  from  Paris,  she  organized 
eye,  ear,  nose  and  throat  and  dental  clinics.  ^Irs.  ]\Iargaret 
P.  Church,  an  American  Red  Cross  nurse,  assisted  in  the  dis- 
pensary and  gave  anesthetics.  ]\Irs.  Church  was  a  graduate  of 
the  Lee  Private  Hospital,  Rochester,  New  York,  and  had  had 
post-graduate  work  at  St.  Luke's  Hospital,  New  York  City. 
She  joined  the  stall"  of  the  Children's  Bureau  in  February, 
1918,  and  instructed  risifcii.'^es  d'cnfapis  attending  the  Paris 
classes.     Sh(»  was  tlicn  assianied  to  Blois. 

The  visiting  nursing  at  Blois  was  at  first  done  by  visifcuscs 
cVenfanis.  In  her  monthly  report  for  June,  1918,  Dr.  Stuart 
wrote : 

At  iho  (lispon-^ary.  ^v('  ]inv(>  trrnwn  :  we  now  liavo  over  TOO 
on  our  books.     \V('  liavc  establi.-lu'd  a  separate  clinic  for  the 


798   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

feeding  cases;  each  Saturday  morning;  the  mothers  bring  in 
the  babies,  have  them  weighed  and  have  their  feeding  super- 
vised. .  .  .  We  have  a  French  visiting  nurce,  a  vohmteer  who 
does  nothing  but  look  after  the  small  babies.  She  has  a  list 
of  all  babies  born  since  January,  1917;  she  visits  the  homes, 
tells  the  mothers  of  the  clinics  and  gets  them  to  promise  to 
bring  their  children.  If  the  mother  does  not  report  the 
folloM'ing  Saturday  morning,  she  goes  again  to  see  why  she 
did  not  come.  .  .  . 

Miss  Zimmerman,  an  "enfant  visiteuse"  from  the  May 
classes  in  Paris,  has  been  added  to  our  staff  and  she  is  doing 
fine  work  both  in  the  visiting  nursing  and  in  the  social 
work.  .  .  . 

Early  in  the  summer  of  1918,  the  Red  Cross  established  a 
pleasant  summer  home  for  children  in  a  house  loaned  by  the 
Marquise  de  Poitou,  in  the  village  of  Chitnev,  just  outside  of 
Blois. 

In  August,  1918,  Miss  Ashe  assigned  Agnes  R.  Lenihan 
(Elizabeth  General  Hospital,  Elizabeth,  iSTew  Jersey)  to  Blois 
to  assist  Mrs.  Church.  Miss  Lenihan  did  general  visiting  nurs- 
ing and  educational  work.  Early  in  August  two  visiteuses  d'eii- 
fants  from  the  Paris  classes  also  were  assigned  to  Blois. 

There  was  need  in  Blois  for  a  children's  hospital,  but  the 
American  Expeditionary  Eorces  had  taken  over  all  the  hospitals 
in  the  city  and  all  vacant  buildings  suitable  for  use  as  tem- 
porary hospitals.  However,  officers  of  the  Army  Medical  Corps^ 
were  generous  in  aiding  child  welfare  work  and  without  their 
assistance  the  Children's  Bureau  could  have  accomplished  little. 
"They  took  the  X-ray  pictures,"  wrote  Miss  Gilder,  "did  the 
laboratory  work,  operated  on  the  general  surgical  patients,  as- 
sisted with  the  orthopedic  cases  and  loaned  ambulances  and 
camions."  ^^  The  establishment  of  a  permanent  children's  hos- 
pital at  Blois  was  made  possible,  however,  in  1919,  by  American 
generosity  ;  the  War  Service  Committee  of  the  American  ^[edical 
Women's  Xational  Association  donated  through  the  American 
Red  Cross  a  sum  of  $25,000  which  was  used  to  erect  a  permanent 
children's  hospital. 

A  quaintly  interesting  and  typical  demonstration  of  the  work 
of  the  Children's  Bureau  was  developed  early  in  1918  at 
Corbeil,  a  small  manufacturing  town  situated  some  twenty 
miles  south  of  Paris  on  the  Seine  River.    Here  as  in  other  cities, 

*•■•  Gilder  Re))ort,  Vol.  Til.  p.  Gl. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     799 

a  dispensary  was  the  entering  wedge ;  it  was  authorized  by  the 
Children's  Bureau  on  February  0.  Dr.  Margaret  \V.  Farwell, 
whose  original  and  energetic  personality  was  reflected  in  breezy 
reports  to  Dr.  Lucas,  was  placed  in  charge.  Dr.  C.  D.  Mosher, 
one  time  assistant  professor  of  Hygiene  at  Leland  Stanford 
University  and  in  1918  one  of  the  staff  of  the  Children's  Bu- 
reau, and  Mrs.  Farrand,  wife  of  the  American  health  specialist. 
Dr.  Livingston  Farrand,  took  an  important  part  in  the  de- 
velopment of  the  lied  Cross  child  welfare  work  at  Corbeil. 

The  beginnings  of  the  dispensary  service  are  pleasingly  re- 
counted in  the  following  report  written  by  Marion  Postte- 
thwaite  Greene,  of  Xew  York  City,  an  assistant  to  Dr.  Farwell : 

.  .  .  "We  walked  about  the  streets  of  the  quaint  little  town, 
gathering  groups  of  mothers  and  children  on  the  street  cor- 
ners to  listen  to  simple  talks  on  hygiene,  to  invite  them  to 
come  to  the  dispensary  when  in  need  of  help  and  to  urge  them 
to  hriiig  their  babies  there  for  weekly  weighing  and  inspection. 

The  dispensary  was  opened  on  ]\ray  '20  and  there  was  never 
a  moment  when  it  was  idle.  Nearly  all  the  French  doctors 
had  been  mobilized;  the  few  who  remained  were  overworked 
.  .  .  and  the  poor  of  the  town  were  in  misery  and  despair. 
News  from  the  front  was  always  bad ;  air  raids  harassed 
Paris  by  niglit  and  "Bertha"  dropped  her  messages  of  death 
by  day.  Shortly  after  the  dispensary  was  opened,  Corbeil 
suH'ered  an  air  raid  and  six  people  were  killed  and  several 
wounded. 

One  Amorican  nurse  was  assigned  to  us,  but  stayed  only  a 
week  be'nrc  she  was  called  to  the  front.  For  some  time 
Dr.  Farwell  and  I  worked  on  alone,  1  ignorant  of  nursing  but 
doing  wliat  I  could  under  her  instruction.  We  soon  had 
another  nurse. 

The  first  nurse  to  go  to  Corbeil  was  Amy  F.  Lowe,  whose 
later  work  at  the  milk  station  at  ^larseilles  has  already  been 
mentioned.  She  arrived  on  'May  2  but  was  recalled  on  May  30 
for  work  at  the  Tent  Hospital  at  Auteuil.  ^Niolly  B.  Smith 
(Chicago  Baptist  Training  School)  was  the  second  nurse  men- 
tioned above.     She  wrote: 

.  .  .  T  was  assigned  to  the  l>ed  Cross  Dispensary  at  Corbeil. 
wliere  my  work  consisted  in  doing  visitiuir  nursinir  among 
the  civilians.  Tlicrt^  were  only  two  old  doctors  in  the 
villasre.  so  we  eidnrirccl  our  ficbl  fo  include  older  cliildrcn.  but 
our  Work  then  became  so  great  that  we  were  forced  to  put  an 


800   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

age  limit  on  children,  admitting  only  those  below  sixteen 
years  of  age.  The  town  itself  had  about  20,000,  but  we  also 
nursed  in  five  other  villages  nearby.  Our  clinic  had  begun 
with  only  one  patient,  but  it  soon  became  so  famous  that  we 
had  sixty-five  cases  in  an  afternoon.  We  emphasized  three 
vital  points :  fresh  air,  personal  hygiene  and  daily  washing  of 
the  hands  and  face.  At  night  we  took  walks  and  noted  the 
windows  that  were  or  were  not  opened  and  spoke  of  it  the 
next  day.  .  .  . 

We  encouraged  bobbing  the  children's  hair.  It  facilitated 
cleaning  the  children's  heads  from  scurvy  and  other  diseases. 
We  did  not  empbasize  its  use  as  a  prophylactic  measure,  but  it 
became  the  style  and  was  called  the  Jeanne  d'Arc  cut. 

A  further  extract  from  Miss  Greene's  report  follows: 

We  soon  had  another  nurse,  organized  a  "Baby  Day,"  car- 
ried on  two  afternoon  clinics  a  week,  did  dressings  every 
morning  from  ten  to  twelve  and  between  times  visited  from 
house  to  house  preaching  the  gospel  of  fresh  air  and  simple 
hygiene,  cheering  discouraged  and  war-weary  women  and 
trying  to  put  a  little  joy  into  the  drab-hued  lives  of  the 
children,  born  and  brougbt  up  under  the  sbadow  of  war. 

Frequent  visits  to  the  dispensary  from  tlie  poilus  on  leave, 
to  thank  us  for  our  work,  made  us  always  fresh  and  eager  to 
do  more  and  more,  regardless  of  fatigue  and  long  hours. 
"We  fight  with  more  courage  now  tliat  we  know  you  are 
taking  care  of  our  children,"  said  one  soldier  in  faded  blue. 
And  a  mother  who  had  carried  her  bal)y  many  kilometers  on 
a  suffocating  August  day  said  trustingly:  "The  babies  of 
Corbeil  do  not  die  any  more  since  the  American  ladies  came, 
so  I  bring  mine  to  be  cured,  too." 

The  dispensary  treated  refugees  and  rapafries  on  presenta- 
tion of  their  cards  of  identity ;  these  cards  were  the  ones  which 
they  had  received  at  Kvian-les-Bains.  All  children  under  sixteen 
years  of  age  and  all  persons  who  presented  a  special  card  issued 
by  the  mayor  of  (Jorbeil  were  also  admitted.  During  the 
months  from  June  through  October,  191.S,  11,988  consultations 
were  held.  Eight  risUensrs  d'enfanfs'  were  eventually  assigned 
to  Corbeil  to  carry  on  the  home  visiting  and  clinics  were  opened 
at  neighboring  towns,  Saintry  and  h]ssr)nnes.  A  unique  phase 
of  the  Corbeil  dispensary  work  dealt  with  the  care  of  American 
soldiers  from  the  American  Coffee  I'lant  at  Ivssonnes ;  when- 
ever the  doughbcys  were  ill  in  hotels  at  Corbeil  or  were  taken 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    801 

sick  at  the  station,  as  frequently  happened  during  the  influenza 
epidemic  of  October,  1918,  thej  were  brought  to  the  Red  Cross 
dispensary. 

Another  appealing  outgrowth  of  the  service  was  the  Red  Cross 
playground  which  Miss  Greene  organized  in  the  fair  grounds 
outside  the  city ;  play  afternoons  were  held  twice  a  week.  In 
some  of  the  districts  of  Corbeil,  the  houses  were  built  directly 
on  the  streets  and  the  children  had  no  place  where  they  might 
play  except  on  the  cobblestones.  "After  school  closed,"  wrote 
Dr.  Farwcll  in  an  August  report,  "we  spent  most  of  our  morn- 
ings picking  pieces  of  flint  and  gravel  out  of  the  hands  of  small 
boys  and  bandaging  the  legs  of  small  girls  who  had  lost  much 
epidermis  through  falling  on  stone-paved  streets."  Miss  Greene 
wrote  of  the  playground : 

Our  sole  equipment  was  three  rubber  balls  and  boundless 
enthusiasm.  A  "gouter"  was  served,  which  consisted  of  a 
piece  of  bread  and  a  tiny  bit  of  chocolate  or  a  bandful  of 
raisins.  At  that  time  children  under  thirteen  were  allowed 
only  200  grammes  of  bread  a  day.  Dr.  Farwell  and  I  each 
had  four  hundred  and  we  were  able  to  save  about  one  hundred 
a  day  on  our  allotment  and  we  begged  tickets  from  any  and 
every  Red  Cross  acquaintance  we  saw  and  were  able  to 
accunnilate  tlie  necessary  number  of  tickets  from  Tbursday  to 
Thursday.  A  friendly  baker  often  gave  me  more  bread  tban 
my  tickets  called  for,  asking  me  to  say  nothing  or  "the  whole 
town  would  be  upon  my  back  !*' 

Paris  was  the  heart  of  the  American  Red  Cross  in  France 
and  it  sent  life-^i>'iving  aid  to  the  Army  in  the  form  of  supplies 
and  medical,  imrsing,  hospital  and  social  service;  to  refugees 
in  the  form  of  food,  clothing  and  temporary  shelter;  to  midUes 
through  rci'ducation  ;  and  to  so  many  other  typos  of  war  workers 
and  war  sutterers  in  so  nuinv  different  forms  that  its  organization 
webbed  France  like  a  capillary  system.  Paris  was  also  the 
heart  of  child  w(>lt'ar('  work  and  Am(>rican  Red  (h'oss  medical 
nursing  and  social  service  was  woven  into  the  fabric  of  existence 
in  many  of  the  arrnndisscmotls  of  the  city. 

In  addition  to  its  norinal  population,  I'aris  in  the  winter 
months  of  l!»17-l!tlS  was  crowded  with  aliens,  refug(>es  and 
industrial  wc^rkers  brought  tliere  in  the  wake  of  war.  'I'hc  iiativc 
population  of  tbe  poorer  classes  sufTered  most  from  this  influx 
of  newcoiners ;   thev  were  sustainecj  (>n  lcar\  rations,  lived  in 


802   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

cramped  quarters,  often  worked  beyond  the  point  of  exhaustion, 
were  harrassed  by  shells  in  the  day  time  and  by  air  raids  at 
night,  suffered  disease  and  death  from  natural  and  war  causes 
and  were  disheartened  by  the  grave  military  situation  on  the 
Western  Front,  The  children  of  this  population  were  least 
able  to  withstand  the  strain  of  these  conditions,  so  the  Children's 
Bureau  worked  out  an  extensive  program  of  medical  and  nurs- 
ing service  in  an  effort  to  save  their  lives.  Pre-natal  and  infant 
welfare  work  was  also  undertaken.  "It  seems  the  custom  has 
been  to  send  babies  to  the  country  for  the  first  few  months  of 
their  lives,"  wrote  Mary  B.  Ross,  a  child  welfare  nurse  of  the 
Bureau.  ''There  they  are  nursed  by  a  wet-nurse  or  given  a  bottle. 
This  allows  the  mother  to  go  out  to  work.  And  many  babies 
die." 

The  aim  of  the  Children's  Bureau  to  "save  the  babies"  found 
expression  in  the  establishment  and  maintenance  of  fourteen 
dispensaries  in  Paris.  In  these  dispensaries  were  conducted 
consultations  in  pre-natal  care  for  mothers ;  clinics  for  the  care 
of  tubercular  children  and  those  in  contact  with  tuberculosis ; 
dental,  nose  and  throat  clinics ;  a  diagnostic  clinic ;  a  children's 
hospital ;  an  organization  for  the  care  and  protection  of  the  new 
born ;  and  a  social  service  center. 

Dr.  John  B.  Manning,  of  Seattle,  Washington,  was  the  first 
chief  of  the  Paris  dispensary  work.  In  a  report  written  May 
1,  1918,  Dr.  Manning  stated  the  method  by  which  the  Children's 
Bureau  set  to  work : 

The  first  plan  was  one  of  cooperation  with  the  Rockefeller 
Commission  in  the  19th  Arrondissement. 

We  began  by  operating  dispensaries  jointly  with  it.  The 
medical  work  in  those  clinics  is  supplemented  by  courses  in 
Avhich  French  women  are  trained  as  home  visitors  by  Ameri- 
can nurses.  It  soon  became  evident  that  owing  to  unavoidable 
difficulties  in  securing  labor  under  existing  conditions,  it 
would  take  months  to  carry  out  this  program  in  the  19th 
Arrondissement.  The  Bureau  then  looked  to  other  parts  of 
Paris,  from  which  numerous  urgent  requests  for  aid  in  the 
form  of  dispensaries  liad  already  come.  Without  in  any  way 
interfering  witli  the  Iioekefeller  Commission,  careful  consid- 
eration A\as  given  to  these  requests  with  an  idea  of  placing 
dispensaries,  as  far  as  possible,  in  established  French  oeuvres 
where  no  dispensary  liad  previously  existed,  or  where  because 
of  the  mobilization  of  its  staff  a  dispensary  had  been  aban- 
doned. 


NURSING  SERVICE  TO  CIVILIAN  TOPULATION    803 

What  we  hoped  to  accomplish  in  our  Paris  work  was :  first, 
to  supply  equipment  and  personnel,  doctors,  nurses  and 
nurses'  aides,  drugs  and  surgical  dressings  for  these  dispen- 
saries; second,  to  establish  relations  as  far  as  possible  with 
competent  French  nursing  women  and  com])etent  dispensary 
management;  tiiirdly,  to  develop  a  system  of  medical  social 
service,  including  a  program  which  has  as  its  object  the 
demonstration  that  competent  visiting  in  the  home  in  con- 
nection with  thorough-going  dispensary  work  is  absolutely 
essential  in  any  attem])t  to  lower  the  rate  of  infant  mortality. 

Marie  Pholan  was  head  nurse  of  the  Paris  dispensary  system. 
Her  staff  consisted  of  public  health  nurses  from  the  United 
States.     Dr.  ^Fanning  wrote  in  his  May  (1918)  lleport: 

The  steady  grind  of  the  work  of  our  doctors  and  nurses 
gives  no  opportunity  for  spectacular  service,  but  I  am  firmly 
convinced  that  it  is  bringing  renewed  hope  to  hundreds  of 
poor  homes  in  Paris  and  is  laying  a  permanent  foundation  of 
health  and  hygiene  for  the  future  of  the  city.  Too  much 
stress  cannot  be  laid  on  the  value  of  the  work  of  home  visiting 
by  the  nurses.  Their  tact  and  sympathy  have  brought  to 
many  homes  the  peace  of  mind  and  cleanliness  of  living  that 
are  the  first  aids  to  health.  .  .  . 

The  first  dispensary  was  opened  on  December  5,  1917,  in 
connection  with  a  settlement  house  in  Lcvallois,  a  large  munition 
district  just  outside  of  Paris.  Dr.  ^^Fahel  H.  Bancroft  was  in 
charge  of  it.  Pre-natal  care  was  an  important  phase  of  tlie 
Levallois  Dispensary  work.  The  nurses  visited  the  home,  in- 
structed the  expectant  mother  in  the  care  of  herself  and  in  the 
preparation  of  a  layette  and  recommended  that  the  Ked  Cross 
supply  various  necessities.      Dr.  Bancroft  wrote: 

We  have  had  some  very  delightful  results,  especially  in 
families  where  there  liave  been  a  miml)er  of  ])revi()us  (U'uths 
among  the  babies.  In  all  cases.  1  seiul  them  to  the  hospital, 
thus  avoiding  Ibe  complication  of  tlie  midwife,  which  is  a 
great  evil.  1  have  tried  to  make  the  idea  of  hospital  care 
])o])ular.   .  .  . 

Once  a  wcM'k  1  have  a  conference  of  mothers.  An  average^ 
of  twenty-livt"  attend  and  we  take  up  some  one  subject  ]nT- 
taining  to  motluu'  or  baby,  as  baths,  clotbing,  exercises.  They 
express  great,  appreciation  of  what  wo  try  to  do  .  .  .  and  I 
tell  them  that  whenev(>r  ihev  think  of  the  Croi.r  h''Jii'/f  Antrri- 


804   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

caine  to  tliink  "open  your  windows  and  nurse  your  babies !" 
I  have  a  feeling  that  we  have  been  very  close  to  these  simple 
folk  and  they  have  received  open-heartedly  our  attempts  to 
make  life  brighter  for  them. 

The  next  Red  Cross  dispensary  to  be  opened  was  the  Grenelle 
Dispensary,  17  Rue  de  I'Avere,  in  the  15th  Arrondissement. 
Quarters  were  offered  the  Children's  Bureau  by  the  McCall 
Mission,  a  social  settlement  which  had  been  conducted  for  some 
years  by  a  group  of  American  women.  The  American  Red 
Cross  took  over  the  parsonage,  reequipped  it  as  a  dispensary 
and  on  December  1  received  the  first  patients. 

I^ellie  Reed  (Garfield  ]\[emorial  Hospital)  was  a  public 
health  nurse  assigned  to  the  Grenelle  Dispensary.  She  wrote 
on  March  6,  1918 : 

.  .  .  Madame  Gallinlau,  the  wife  of  the  minister  who  for- 
merly ran  this  ]\IeCall  Mission  but  who  is  now  at  the  front, 
carries  on  his  work.  She  has  organized  a  Mothers'  Club  of 
150  members,  froin  among  whom  I  hope  to  get  my  babies. 
...  I  had  my  first  baby  conference  to-day. 

"Follow-up"  work  is  not  so  simple  as  it  sounds.  The 
French  are  so  formal  that  there  is  no  casual  dropping  in  to 
see  a  baby.  Every  visit  is  almost  a  ceremonial;  there  are 
always  two  or  three  to  receive  us  and  it  seems  as  if  I  spend 
most  of  my  time  shaking  hands.  All  school  children  must 
and  will  shake  hands  and  their  little  fists  are  like  all  other 
little  fists.  Some  of  the  homes  look  imposing  from  the 
windows;  almost  all  of  them  have  the  loveliest  lace  or  scrim 
curtains,  but  behind,  just  what  we  find  at  home,  except  tbat 
the  setting  is  usually  more  artistic.  I  am  entirely  truthful 
when  I  say  that  1  like  the  work  very  much  and  especially 
the  French.  The  babies  wear  about  the  same  kind  of 
clothing  that  ours  do  and  the  mothers  manage  with  little  or 
much  as  the  case  may  be. 

^larch  13.  This  letter  was  interrupted  by  a  raid.  The 
Boche  planes  come  frequently  now,  and  when  they  are  not 
actually  here  Ave  are  expecting  them,  so  it  is  ratlier  much  the 
same  thing.  Naturally  the  people  are  very  mucli  frightened 
and  they  literally  ])aek  themselves  like  sanHnes  into  the 
cellars.  1  think  the  average  cellar  is  more  dangerous  than  tlie 
second  or  third  floor.  There  is  mucli  discussion  upon  this 
subject  and  we  liear  nothing  else.  The  raids  are  very  upset- 
ting and  disorganize  everything:  tliis  week  they  had  gotten 
the  whole  dispensary  into  a  very  nervous  state. 


A  group   i)t    patienta   at   an   American   Red   Cross   children's  dispensary   in 

Paris. 


An 


American   Red  Cross  cliildreii's  .jispcnsary   in  a  small   town   in   France. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     805 

The  Grenellc  Dispensary  developed  extensive  cooperation 
with  French  welfare  organizations.  Frances  S.  Hoppen,  a  vol- 
unteer who  had  helped  to  organize  the  dispensary,  wrote : 

.  .  .  Patients  needing  special  treatment  were  sent  to  Red 
Cross  clinics  for  tuberculosis,  throat  and  dentistry  work  and 
to  the  French  llopital  des  Enfants  Malades  and  other  French 
institutions.  Our  nursery  cared  for  the  children  who  needed 
special  feeding.  We  had  such  satisfactory  results  that  the 
work  increased  to  such  an  extent  that  we  added  an  American 
volunteer  aide  and  two  excellent  French  ones  (paid)  to  the 
staif. 

We  worked  in  complete  harmony  with  the  local  Frencli 
authorities  and  charities,  the  tnaire,  the  Protestant  Mission, 
the  Catholic  Sisters,  J)rs.  ^Marfan  and  Iloudre  from  the 
French  Children's  Hospital  and  about  fourteen  other  homes 
and  institutions  and  met  everywhere  cordial  help  and  co- 
operation. The  idea  of  a  neighborhood  house  and  district 
nursing  in  connection  with  dispensary  work  greatly  inter- 
ested the  French  doctors.  We  trained  two  social  workers  foi 
the  Children's  Hospital  and  had  many  French  visit  eases 
d'cnfanfs  sent  to  us  to  observe  and  learn.  .  .  .  We  gave  little 
money  directly;  our  entire  expenses,  including  the  salaries  of 
the  French  aides  and  the  servants,  came  to  about  $300  a 
month. 

On  December  20,  1017,  the  third  American  Red  Cross  dis- 
pensary was  opened  at  20  Rne  Censicr,  in  the  5th  Arrondissc- 
mcnt.  This  dispensary,  which  was  known  as  the  Censier  Dis- 
pensary, was  established  in  response  to  a  reqnest  from  ^llle. 
do  Rose,  who  had  for  some  years  maintained  a  large  private 
charity  there.  U'he  settlement  consisted  of  a  home  for  work- 
ing girls,  a  school  for  children  and  a  largo  apartment  house  for 
families.  F>eda  AI.  CatKn  (French  Hospital,  Xcw  York  City) 
was  assigned  to  duty  there.     She  wrote : 

.  .  .  Dr.  P)lair  wa-  in  charge  and  Miss  Phelan  was  lu'ad 
nurse.  V\\]o  ('(Misicr  hold  clinics  for  children  of  all  ages,  for 
women  and  also  two  night  clinics  for  working  girls  and 
women.  TIk^sc  later  ones  had  to  he  discontinued.  howe\er.  on 
account  of  the  raids:  it  seemed  that  the  Boche  always  chose 
clinic  nights  to  cover  ov(M'.  About  the  end  of  March  the 
French  women  who  had  taken  the  course  for  the  ri-^itms)'.^ 
d'rnfiinlx  began  to  arriv(\  two  at  a  time,  for  instruction  in 
clinic  work  and  home  visitinir.     Thev  staved  two  weeks, 


806   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Another  American  Red  Cross  public  health  nurse  on  duty  at 
Rue  Censier  Dispensary  was  Margaret  F,  McLeod. 

A  fourth  dispensary  to  receive  aid  from  the  Children's  Bu- 
reau was  La  Coumeuve  Dispensary,  which  had  been  maintained 
for  some  time  by  the  Mutualiie  Matemelle,  an  extensive  and 
powerful  French  charity  organization,  which  was  described  by 
Dr.  Manning  in  his  monthly  report,  February,  1918: 

Mutualite  Matemelle  de  France  gives  to  women,  in  return 
for  three  francs  a  day,  care  during  confinement  and  other  aid 
in  the  form  of  a  woman  to  do  housework  for  nine  days,  also 
laundry,  milk  at  reduced  rates,  layettes  as  needed  and  medical 
service  both  to  mother  and  child.  They  have  thirty-two  sta- 
tions in  Paris,  forty-three  in  the  suburbs  and  others  through- 
out France.  They  have  50,000  babies  in  their  Consultations 
de  Nourissons — and  there  is  the  explanation  of  our  baby  free 
clinics.  Mr.  Proussineau  was  extremely  willing  to  cooperate 
with  the  Children's  Bureau  and  assured  us  we  could  in  turn 
do  nothing  in  Paris  without  their  assistance,  which  we  know 
to  be  true. 

An  American  doctor  and  nurse  were  assigned  to  the  Dis- 
pensary at  La  Courneuve  and  the  Children's  Bureau  finally  built 
a  temporary  barracks  to  take  the  place  of  the  old,  mouldy  build- 
ing. Dr.  Reed,  the  physician  then  in  charge  of  the  La  Cour- 
neuve Dispensary,  wrote  in  the  Weekly  Report  of  the  Children's 
Bureau  ending  August  31,  1918: 

Most  of  the  equipment  is  now  in  place  and  the  walls  are 
covered  with  pictures  explaining  child  welfare  work.  Xot- 
withstanding  the  holes  in  the  roof  and  the  cracks  in  the 
floor,  some  good  work  Avill  be  done  here  within  the  next 
month  or  six  weeks.  In  tlie  old  dispensary,  there  were  from 
eighty-five  to  ninety  women  and  children  each  week;  here 
there  shoidd  be  at  least  a  third  more  than  that.  We  have 
permission  to  go  to  the  factories  and  tell  about  the  dis- 
pensary. 

Many  children  came  to  the  various  Red  Cross  dispensaries 
who  were  in  need  of  operative  Avork.  On  January  18,  1918, 
V Ilopifdl  Mnr'u'-IIcJcuc,  77  line  Arago,  Puteaux,  a  French  hos- 
pital of  twenty-seven  bt^ds  which  had  been  closed  since  1914  on 
account  of  lack  of  funds,  was  reopened  and  patients  needing 
operation  were  sent  tlicre  from  the  dispensaries.     The  American 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     807 

Red  Cross  paid  five-eighths  of  the  running  expenses.  An  Ameri- 
can surgeon  did  the  adenoid  and  tonsil  work  there  and  an  Ameri- 
can dentist  conducted  a  dental  clinic. 

A  second  small  French  hospital  to  receive  aid  from  the  Red 
Cross  was  Vllopital  Bicetre,  19  Rue  du  Pasteur.  An  American 
Red  Cross  nurse  was  assigned  to  this  small  municipal  hospital 
and  later,  when  the  French  doctor  who  directed  its  management 
was  called  to  the  front,   an  American  doctor  took  his  place. 

The  Rockefeller  Commission  for  the  Prevention  of  Tubercu- 
losis in  France  and  the  American  Red  Cross  opened  their  first 
combined  dispensary  on  February  15,  1918,  at  the  corner  of 
the  Rue  des  Mignottes  and  the  Rue  des  Solitaries  in  the  Quar- 
tier  d' Amerique  of  the  19th  Arrondissement.  The  rate  of  infant 
mortality  in  this  section  of  Paris  was  350  per  every  1000  births, 
the  second  highest  rate  in  the  city.  This  joint  dispensary, 
which  was  called  the  Dispensary  des  Mignottes,  was  opened  late 
in  February,  1918. 

Another  French  oeuvre  to  receive  assistance  from  the  Ameri- 
can Red  Cross  was  Dispensaire  Mari-e-Lannelongue,  129  Rue  de 
Tolbiac.  This  dispensary  held  consultations  for  nursing  moth- 
ers each  week  under  the  direction  of  a  French  physician,  and 
the  Children's  Bureau  assigned  to  it  two  public  health  nurses 
to  aid  in  the  clinics  and  to  do  visiting  nursing.  In  the  Report 
of  the  Children's  Bureau,  for  ^farch,  1918,  Dr.  Manning  wrote : 

Tliis  dispensary  received  daily  assistance  from  our  Bureau 
during  the  winter  in  the  form  of  condensed  milk  for  40 
bottle-fed  babies  and  food  for  forty  mothers  who  are  nursing 
their  l)abi('s.  Oiico  a  week,  (>()  bal)ies  are  l)rought  to  this 
clinic  and  weiglied.  about  30  each  clinic  day.  Those  wlio  are 
ill  or  underweight  arc  seen  by  the  French  physician  in  charge. 

Kach  day  tlie  milk  is  sterilized  at  tlie  dispensary  and  given 
in  bottles  to  tlie  mothers.  At  a  conference  lield  this  week, 
the  ])resident  of  tlie  Oeuvre  consented  to  permit  our  nurses, 
provided  they  would  take  over  the  handling  of  the  babies,  to 
go  into  the  homes  aiui  try  to  teach  the  mothers  baby 
liygiene.  .  .  . 

The  MxitiudUe  ^InferneJle  had  maintained  a  dispensary  in 
the  19th  Arrondissement  at  Xo.  9  Rm^  Kdouard  Pailler(»n. 
which  was  known  as  th(>  Kdouard  Paillenui  I)isp(Misary.  'i'he 
Children's  Bureau  took  over  its  maint(>nance  in  Ajiril,  1918, 
and  held  weeklv  consultations  for  nursini'-  mothers. 


808   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  next  Children's  Bureau  dispensary  was  opened  in  April 
G,  1918,  at  41  Rue  de  Poteau  in  a  settlement  house  maintained 
by  Mile.  Doillard.  It  was  called  the  Poteau  Dispensary.  A 
special  phase  of  this  institution,  which  had  been  established  by 
French  women,  was  the  garderie  schoJaire,  where  children  of 
working  women  were  kept  between  school  hours  and  the  time 
when  their  mothers  returned  from  the  factories.  The  Poteau 
Dispensary  came  in  direct  contact  with  some  five  hundred  chil- 
dren. 

The  dispensary  located  at  40  Rue  de  Pre-Saint  Gervais,  also 
in  the  19th  Arrondissement,  which  was  maintained  by  the 
Assistance  Puhlique,  was  one  of  the  largest  of  the  dispen- 
saries aided  by  the  Children's  Bureau.  One  of  the  American 
Red  Cross  nurses  assigned  to  this  dispensary,  Juliet  Snyder, 
described  the  nature  of  the  work: 

This  dispensary  was  conducted  entirely  by  French  per- 
sonnel and  it  was  in  the  nature  of  a  concession  that  we  were 
allowed  to  attend  the  clinics.  At  first  we  took  names  and 
addresses  of  only  the  worst  cases  and  visited  them,  treating 
skin  diseases  and  doing  general  public  health  and  social 
service  work.  The  dispensary  was  admirably  conducted  from 
a  medical  point  of  view. 

After  several  weeks,  the  French  physician,  who  was  at  first 
not  at  all  interested  but  always  polite,  began  to  ask  us  to  visit 
certain  liomes  and  do  special  things  whicli  he  recommended. 
After  a  few  more  weeks,  he  requested  us  to  visit  and  instruct 
all  new  cases  admitted,  as  a  matter  of  daily  routine.  .  .  . 
After  four  months,  the  French  physician  declared  that,  to 
him,  the  work  of  the  nurses  was  indispensable. 

Located  in  the  Rue  de  I'Argonne,  19th  Arrondissement,  was 
one  of  the  pioneer  dispensaries  of  the  Rockefeller  Commission. 
Here  Dr.  Manning  conducted  clinics  for  children.  He  wrote 
in  his  report  for  the  week  ending  January  5,  1918,  that  the 
outlook  is  depressing  unless  the  Red  Cross  is  in  a  position  to 
establish  and  maintain,  together  with  or  independent  of  the 
local  school  authorities,  canteens  for  these  children.  ''They  need 
food,  not  tonics."  This  recommendation  of  Dr.  ^lanning's 
was  the  beginning  of  a  project  by  which  the  American  Red 
Cross  supplied  a  supplementary  daily  feeding  to  27,812  school 
children,  ^lany  French  mothers  worked  all  day  in  the  fac- 
tories and  the  noon  meal,  the  most  substantial,  was  given  to 
the  children  at  school  canteens.     But  it  was  not  ample,  so  the 


NURSING  SERVICE  TO  CIVILIAN  TOPULATION    809 

Children's  Bureau  supplied  extra  food  to  the  amount  of  35,873 
kilos  each  month  to  the  canteens.  *'In  the  arrondissement 
where  t)050  children  eat  daily  in  the  school  canteen,"  wrote  Dr. 
]\ranning,  ''fifty  per  cent  of  the  food  is  supplied  by  the  Red 
Cross." 

The  American  Red  Cross  cooperated  with  the  Rockefeller 
Commission  and  on  September  23,  1918,  a  joint  dispensary 
was  opened  at  21  bis,  rue  d'  Argonne.  This  was  also  used  as  a 
teaching  center  for  students  who  were  taking  the  courses  for 
risifciLses  d'enfants  which  the  Children's  Bureau  conducted. 

The  work  of  the  Children's  Bureau  in  the  19th  Arrondisse- 
ment thus  included  in  the  winter  of  1918-1919  the  maintenance 
of  three  large  dispensaries, — at  Rue  des  Migiiottes,  Rue 
Edouard  Pailleron  and  Rue  d'Argonne  and  the  Social  Service 
(Vnter  at  3  Rue  Clarel.  Dr.  William  J.  French  had  been 
appointed  director  of  the  work  in  this  district  in  September, 
1918,  and  Nellie  Reed  supervising  nurse.  One  of  the  nurses 
on  her  staff  wrote  that  ''lliss  Reed  proved  an  agreeable  and 
capable  head,  welding  the  work  and  the  personnel  together  into 
a  good  whole." 

The  child  welfare  program  as  finally  worked  out  in  the  19th 
Arrondissement  included  clinical  work,  instructive  nursing  in 
the  homes,  school  nursing,  pre-natal  work  and  social  service. 
Olive  Simons,  Helen  ]\1.  Spalding,  Juliet  Snyder,  Jeanette 
Hays,  Katherine  J^.  ^Mackenzie,  Donalda  Lanctot,  Anna  M. 
Sundberg,  Florence  IsL  Peters,  Lotetta  C.  Quinn,  Edith  Young 
and  ^fiss  Fearn  formed  the  nursing  staff.  They  were  assisted 
by  two  American  nurses'  aides,  Katharine  D.  Exton  and  Alma 
A.  Clark,  and  numerous  French  visiteiises  d'enfants.  Social 
service  work  was  done  under  the  direction  of  Frances  Stern,  of 
Boston.  ]\nie.  A.  ^I.  Ciodot,  secretary  to  Dr.  French,  rendered 
enthusiastic  service.  Dr.  French  wrote  of  her,  "'Always  my 
tongue  and  ears  when  dealing  with  the  French  people,  ]\nie. 
Godot  has  frequently  been  my  mind  as  well  and  her  judgment 
has  been  unerring." 

The  last  American  R(>d  Cross;  dispensary  in  Paris  was  opcMied 
in  Jannary,  l!»19,  at  12<i  Poulevard  Belleville.  Two  mirses, 
Ethel  V.  Race  and  Felici(>  Manget,  were  assigned  th(M-e. 

When  the  (Miildrcirs  ]-)nr(nni  closed  its  program  in  the  spring 
of  1919,  a  French  committee,  of  which  ^Madame  Raynioiid 
Poincare  was  president,  was  <u-<:anized  to  carry  on  the  work  in 
the    ll'tli    Arrondissement;    Mile   Godot   was   secretarv.      Fiftv 


810   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

thousand  francs  were  subscribed  and  the  basis  of  the  French 
organization  established. 

A  large  dispensary  to  which  the  Children's  Bureau  furnished 
personnel  and  supplies,  was  located  at  Bobigny,  Seine,  some 
miles  from  Paris.  Cora  Kinney,  the  nurse  assigned  to  duty 
there,  wrote: 

My  aide,  who  acted  also  as  an  interpreter,  and  I  were  taken 
Decenilier  G  in  a  Eed  Cross  camionette  to  Bobigny.  .  .  ,  The 
people  are  very  poor  .  .  .  but  the  dispensary  has  been  a  dire 
necessity  and  there  are  many  to  be  cared  for.  They  are 
factory  people  and  laborers  and  owing  to  the  extremely  higli 
cost  of  living  they  have  barely  the  necessities  of  life.  Their 
houses  are  made  mostly  by  themselves  of  wood,  mortar  and 
canvas;  some  have  no  windows  or  floors  but  are  resting  on 
the  bare  ground.  In  rainy  weather,  of  which  there  is  a 
plenty,  the  place  is  so  deep  in  mud  that  they  have  to  wade  in 
it.  Most  of  them  have  no  water  nearer  than  the  canal,  which 
means  that  some  of  them  have  to  carry  it  as  far  as  a  half  a 
mile. 

Our  hours  are  from  nine  to  twelve  in  the  morning  and  from 
two  to  five  in  the  afternoon,  but  our  dispensary  more  often 
than  not  keeps  us  until  about  one  o'clock  at  noon.  In  the 
afternoon  we  call  at  the  homes  to  instruct  mothers  in  general 
hygiene  and  the  care  of  children.  We  were  warned  when  we 
first  came  to  be  very  tactful  if  we  made  calls,  as  the  people 
would  countenance  no  interference  and  we  might  be  rebufi'ed, 
so  we  liave  not  made  a  house  to  house  canvas  but  have  selected 
our  calls  and  tried  to  gain  their  confidence.  .  .  .  Xow  they 
come  to  us  for  advice  many  times. 

The  statistics  for  the  Paris  dispensaries  show  that  their 
time  of  greatest  activity  was  in  the  early  spring  of  1918.  Dur- 
ing January,  only  500  cases  were  treated  and  in  February  a 
few  more  than  a  thousand,  but  in  ]\larch  the  cases  treated  in 
the  fourteen  principal  dispemsaries  numbered  2383  and  in 
April  2^^)Ck~^  In  IMarcli,  the  visits  paid  to  homes  by  the  nurses 
totalhnl  732;  in  April  1204,  an  unusually  high  figure  in  view 
of  the  fact  that  home  visiting  had  to  be  discontinued  for  two 
wof^ks.-'*  These  were  the  days  when  tlie  Germans  were  shelling 
Paris  in  the  daytime  and  making  raids  with  bombing  planes 
at  night.  IMo^reover,  it  w'as  a  time  of  intense  activity  on  the 
Western  Front. 

=^(;il(lcr  Report,  \'ol.   IIL  p.   114. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    811 

In  this  history  it  is  impossible,  from  lack  of  space,  to  list  all 
the  French  oeuvres  to  which  the  Children's  Bureau  gave  assist- 
ance. The  dispensaries  described  above  were  the  principal 
units  of  the  Paris  child  welfare  program.  Full  details,  how- 
ever, regarding  these  and  allied  projects,  may  be  found  in  the 
Gilder  Keport. 

One  of  the  most  constructive  and  enduring  phases  of  Ameri- 
can Ked  Cross  child  welfare  work  in  Paris  was  the  training  of 
French  women  as  visi tenses  d' en f ants.  Mention  has  already 
been  made  of  similar  courses  ottered  in  Lyons,  Marseilles  and 
Bordeaux,  but  those  given  at  Paris  were  the  most  numerous 
and  the  most  extensive. 

^liss  Leete  organized  and  developed  the  first  courses  of 
instruction  in  Paris,  On  ^lay  1,  11)18,  she  was,  however,  as- 
signed as  chief  nurse  of  the  Auteuil  Tent  Hospital  and  ^liss 
Ashe  took  over  the  general  direction  of  this  work.  Mademoiselle 
]\Iarie  Diemer,  a  French  woman,  was  asked  by  the  Children's 
Bureau  to  serve  as  direetrice  des  Visiteuses  d'Enfants.  In  her 
final  report  to  Dr.  Lucas,  she  wrote : 

The  visiteuses  d'enfants  were  part  of  a  big  scheme  elab- 
orated by  Dr.  Lucas  to  insure  children's  welfare  in  France. 
They  were  to  have  their  first  experiences  under  American 
nurses  especially  trained  in  home  visiting  and  then  to  carry 
on  the  work. 

liCt  us  remember  tliat,  although  for  many  centuries  Sisters 
of  Charity  have  taken  care  of  the  poor  and  suffering,  the 
"visiting  nurse''  and  "health  visitor"  as  known  in  America 
or  England  are  quite  new  in  France. 

A  few  montlis  before  the  war,  1  had  been  one  of  the  pro- 
moters in  Fraiu-e  of  visiting  nursing  and  with  ^Ille.  de  ]\Iont- 
mort  created  the  Infirmieres  Visiteuses  de  France.  In  the 
spring  of  1917,  I  lielped  to  organize  I'Ecote  Sociale  des 
iSurinteiidantes  d'Usiiies — the  surintendnntes  or  ''ladies' 
superintendents"  having  in  charge  the  health  and  welfare  of 
women  emi)l<)yes  in  factories,  more  especially  in  niiinitiDii 
factories.  1  have  also  during  four  months  acted  as  executiNc 
secretary  to  ilie  French  Conmiittee  of  tlie  Fatherless  Children 
of  France,  which  1  left  for  the  more  active  work  entrusted  me 
by  tlie  American  IJed  Cross. 

The  Frcncli  women  who  applied  to  take  the  courses  were 
sel(>ctcd  by  ^Illc.  Dienicr.  "A  few  of  th(>  candidates  had  had 
experience  as   French   Med  Cross  nurs(>s,''  ^Ill(>.   Dicnicr  wrote. 


812    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"Others  had  already  taken  care  of  young  children.  Several  had 
suffered  from  the  war,  being  refugees,  war  orphans  or  war 
widows.  All  were  eager  to  do  their  best  and  were  grateful  to 
the  Croix  Rouge  Americaine  which  enabled  them  to  earn  their 
living  as  well  as  to  help  the  suffering  babies  of  their  own 
country." 

The  first  lecture  of  the  first  course  was  given  on  February  20, 
1918,  at  the  Fondation  Bvdin,  the  memorial  erected  to  the 
founder  of  child  welfare  work  in  France ;  the  lecturer  was  Dr. 
Lesage,  then  executive  secretary  of  the  Ligue  contre  la  Mortallte 
Infantile.  Twenty-six  candidates  had  been  accepted.  The 
course  consisted  of  lectures,  all  given  at  the  Fondation  Budin, 
on  maternity  by  Dr.  Devraigne,  Dr.  Weill-Halle,  Dr.  Lesage, 
Dr.  Dora  Mantoux  and  Dr.  Loude ;  on  children's  hygiene,  tu- 
berculosis and  contagious  diseases  by  Dr.  Guinon  and  Dr. 
Besson;  and  on  social  laws  and  social  charitable  organizations 
for  mothers  and  children  by  Madame  Weill-Raynal,  Dr.  Lesage, 
M.  Emile  Leven,  Mile.  Bassot  and  Mile.  Diemer.  These  lec- 
tures were  given  in  the  afternoon.  The  following  outline  of  the 
lectures,  an  outline  which  appeared  in  the  syllabus  issued  by 
the  Children's  Bureau,  gave  the  general  scope  and  subject  mat- 
ter of  the  lectures: 

History  (one  hour)  :  Brief  review  of  child  welfare  conditions 
and  influences  ancient  and  modern,  showing  the  chang- 
ing attitude  towards  the  child;  infant  mortality,  its 
causes  and  remedies.  .  .  . 

Motherhood  (seven  lessons):  Pregnancy;  lactation;  confer- 
ences with  practical  demonstrations. 

Simple  Anatomy  and  Physiology  (two  hours)  :  A  study  of 
the  parts  of  the  body  and  their  functions.  .  .  . 

Infarits  (seven  hours)  :  (a)  The  normal  infant,  its  rest, 
exercise  and  food;  lactation;  bathing  and  clothing; 
proper  handling;  weights;  special  symptoms,  their  recog- 
nition and  treatment;  (b)  the  abnormal  infant,  diseases 
of  respiration  .  .  .  and  intestinal  disturbances  .  .  . 
care  of  excreta,  ear,  nose  and  throat  complications;  ))rain 
and  nervous  system.  .  .  . 

Childrciv  (seven  hours)  :  Child  life,  the  need  for  examina- 
tion, guidance,  protection,  recreation,  food  and  rest  .  .  . 
special  diseases  of  importance,  contagious  infectious, 
.  .  .  tuberculosis  .  .  .  venereal  .  .  .  respiratory  ...  of 
special  organs. 

Hygiene  and  Sanitation  (four  hours).  ,  .  . 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    813 

Social  Leylslalioti  (two  hours)  .  .  .  Oeuvres  d* Assistance; 
Loi.s  d' Assistance. 

Social  Organization  (one  hour).  .  .  . 

Practical  Sociology  (tliree  hours).  .  .  . 

II ou-seliold  Economics  and  Dietetics  (three  hours).  .  .  . 

Practical  Demonstration  in  the  preparing  of  artificial  foods; 
varieties  of  artificial  foods;  milk  and  control  of  milk 
supply;  milk  modifications  and  mixed  feeding. 

Statistiml  Methods  (three  hours).  .  .  . 

Child  Welfare'  (three  hours).  .  ,  . 

Practical  instruction  was  given  by  American  Red  Cross 
public  health  nurses  at  French  institutions  and  American  Red 
Cross  dispensaries.  These  nurses  were  IMarie  Baurle,  Mary  E. 
Bailey,  (Airs. ) 'Margaret  P.  Church,  Marie  C.  Ells  and  Eliza- 
beth G.  ^Mitchell.  Each  of  these  nurses  had  under  her  care 
five^or  six  pupils.     ^Ille.  Diemer  wrote: 

The  pupils  went  in  groups  to  I'llopital  des  Enfanis 
Malades,  Creche  de  Convalescence  des  Infirmieres — Visiteuses 
de  France,  Dispensaire  de  la  Nouvelle  Etoile,  Jardin  d'En- 
fants  de  V Amelioration  des  jardin  oeuvres  and  others.  Dur- 
ing the  third  month  they  went  to  the  American  Red  Cross' 
own  children's  dispensaries  and  accompanied  the  nurses  in 
home  visiting. 

An  examination  followed  the  course  of  lectures  and  practical 
instruction.  Of  the  twenty-six  candidates  who  entered  the  first 
course,  seventeen  were  graduated.  Three  of  these  joined  the 
Association  des  Injirmieres  de  France  and  eleven  entered  the 
service  of  the  Children's  Bureau  and  were  assigned  to  duty  at 
Porchefontaine,  Plessis-Piquet,  Levallois,  Bicetre,  Blois  and 
the  American  Red  Cross  Dispensary  in  the  Rue  des  Mathurins. 
The  nanu'S  of  these  first  visiteuses  d'enfanis  to  be  entered  as 
French  aides  on  the  rolls  of  the  American  Red  (^ross  were 
Helene  Desbons,  Mile.  Devingtmuid,  ^Mlle.  Duprat,  ^Mme. 
Etcheberrv,  Alice  Frency,  Alme.  Henri-Jean,  ]\rnie.  Langlois, 
Edmee  Plenelist,  Alarie  T.  Plenchol,  Jeanne  Zimmerman  and 
Mile.  JSTouchet. 

The  facilities  for  the  practical  instruction  of  the  risilenses 
had  not  been  wholly  satisfactory,  so  early  in  April,  ll>l.s.  the 
Children's  Bureau  crt'ected  an  arrangement  whereby  part  of 
the  Pouponnicre  de  Porcliefoniaine,  in  the  little  town  of  Ver- 
sailles, was  secured  as  a  teaching  center  for  the  pupils.     The 


814    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Pouponniere  was  a  large  French  sanatorium  to  which  unmarried 
mothers  were  sent  for  treatment  and  care  on  the  condition  that 
each  of  them  nurse  her  own  child  and  an  orphaned  baby  as 
well.  Many  difficulties  attended  the  maintenance  of  the  Pou- 
ponniere. Versailles  was  in  the  heart  of  the  bombing  belt  and 
was  also  under  fire  from  "Big  Bertha."  There  were  no  modern 
conveniences  such  as  Americans  were  accustomed  to,  in  the 
buildings.  The  stables  where  the  cows  were  kept,  were  connected 
with  the  house.  Because  of  the  scarcity  of  food  and  the  result- 
ing exorbitant  prices,  the  diet  for  the  mothers  was  hardly  ade- 
quate and  the  babies  were  as  a  result  anaemic  and  sickly. 

Marie  Baurle,  one  of  the  nurses  who  had  instructed  visiteuses 
d'enfants  during  the  first  course  in  Paris,  was  sent  out  to 
Porchefontaine  to  take  charge  of  the  pavilions  secured  by  the 
Children's  Bureau  as  a  teaching  center.  Of  her  work  there, 
Miss  Ashe  wrote: 

Miss  Baurle,  a  graduate  of  the  Boston  Children's  Hospital 
and  one  of  the  few  nurses  of  the  Bureau  who  spoke  French 
fluently,  was  put  in  charge.  When  Miss  Baurle  took  over  the 
management  of  these  two  houses,  each  contained  twenty-eight 
babies  and  seventeen  wet-nurses.  The  conditions  were  most 
discouraging.  The  babies  were  colorless  and  flabby  and 
though  thoy  were  bathed  regularly  they  were  not  kept  clean. 
.  .  .  Tlie  windows  were  never  opened  and  the  odors  in  the 
building  almost  unbearalde.  ^liss  Baurle  found  children  as 
old  as  eighteen  months  being  fed  from  seven  to  nine  times  a 
day  on  soup  and  diluted  milk. 

The  difficulties  of  bringing  about  a  change  in  this  regime 
were  great  .  .  .  but  ]\Iiss  Baurle  was  able  to  change  the  diet, 
open  the  windows  and  get  the  babies  out  of  doors.  The  im- 
jV'ovement  in  their  appearance  after  a  short  time  was  quite 
remarkable.  They  practically  lived  outdoors  and  had  a  fine, 
rosy,  robust  mien  wliich  rejoiced  one's  eye  and  heart  to  see ! 

^liss  Baurle  was  not  able  to  bring  about  one  very  necessary 
reform  which  she  felt  was  vital  to  the  well-being  of  the 
babies.  She  l)elieved  that  tlie  nursing  mothers  were  not 
])roper]y  fed.  Each  one  of  these  women  who  was  an  unmar- 
ried mother  nursed  one  ])aby  besides  her  own  and  the  food 
was  very  inadequate  to  sujjply  the  nourishment  required  by 
two  baljies.  Intil  ]\liss  Baurle  took  possession,  nothing  what- 
ever was  being  done  for  the  mental  or  moral  betterment  of 
these  women.  She  met  with  a  good  deal  of  opposition  when 
she  essayed  to  introduce  simi)le  anuisements  for  their  leisure. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     815 

.  .  .  From  a  tca(lii!i<r  point  of  view,  tlie  experiment  at  the 
Pouponniere  was  tliought  to  be  a  great  success. 

Later,  the  American  Red  Cross  took  over  the  entire  manage- 
ment of  Porchefontaine.  The  divided  responsibility  had  made 
many  difhciilties,  so  on  September  14,  1918,  an  agreement  was 
entered  into  between  the  Pouponniere  of  Porchefontaine  and 
the  American  Red  Cross  by  which  the  American  Red  Cross 
assnmed  the  complete  control  of  and  responsibility  of  all  ex- 
penses in  running  the  institution  for  three  months  after  the 
cessation  of  hostilities.  The  Red  Cross  also  agreed  to  provide 
medical  and  nursing  service.  In  November  and  December,  the 
diet  for  the  nursing  mothers  was  improved  and  the  general 
hygiene  and  sanitation  at  the  Pouponniere  bettered.  Of  par- 
ticular value  were  the  services  of  a  group  of  Quakers.  The 
establishment  was  turned  back  to  the  French  authorities  on 
April  2,  1919. 

To  return  to  the  visUeuses  d'enfants,  the  second  course  was 
opened  on  May  1,  1918.  Owing  to  the  fact  that  the  Foiulation 
Budin  was  then  under  fire  by  Big  Bertha,  the  lectures  were 
given  at  the  Lyceum  Club  by  Mrs.  Devagiie,  Drs.  Weill-Halle, 
J^esage,  Aviragiiet,  Renault,  Guinon  and  Besson  and  by  Madame 
Budin,  M.  Leven,  ^ladame  Devouge  and  Allies.  Bassot  and 
Diemer.  The  five  American  Red  Cross  nurses  who  had  had 
charge  of  the  practical  instruction  had  been  called  into  military 
service,  so  a  French  nurse,  ]\rile.  Oelker,  acted  alone  as  moni- 
trice.  Fifteen  visiteuses  were  graduated ;  thirteen  of  these  en- 
tered the  Children's  Bureau  and  were  assigned  to  Red  Cross 
child  welfare  institutions. 

A  third  course  was  organized  to  begin  early  in  July,  but  owing 
to  the  military  crisis  was  postponed  until  October.  This  proved 
to  be  a  large  class ;  there  were  twenty-eight  candidates.  Pro- 
fessor Pinard,  Drs.  Weill-Halle,  Guinon,  Mery,  Collin,  Besson 
and  Donet,  and  Mnio.  Dcvougc  and  ]\Illes.  Raub  and  l)i(nner 
gave  the  theoretical  instruction.  Practical  demonstrations  took 
place  at  Porchefontaine.  Upon  graduation,  nine  risitcuses 
entered  the  service^  of  the  C^hildren's  Bureau. 

In  evaluating  the  work  of  the  American  Red  Cross  in  Paris, 
the  preparation  of  those  risitcuses  d'enfanis  stands  out  as  a 
major  accomplishnient.  The  thirty-two  graduates  who  (Mit(M-ed 
Red  Cross  service^  formed  practically  tlu^  principal  inirsing 
strength  of  the  Children's  l^ureau  at  the  time  when  tlu^  niilitarv 


816    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

crisis  made  necessary  the  withdrawal  of  American  Red  Cross 
nurses  from  civilian  work  to  engage  in  care  of  the  wounded  of 
the  American  Expeditionary  Forces.  Moreover,  these  courses 
introduced  the  idea  of  public  health  nursing,  as  developed  by  the 
American  nursing  profession,  into  France.  The  last  phase  of 
accomplishment  was   summarized   by   Mile.    Diemer: 

In  creating  the  "visiting  of  infants"  the  Children's  Bureau 
not  only  secured  trained  health  visitors  who  proved  useful  in 
American  Eed  Cross  organizations,  not  only  helped  to  save 
the  lives  of  babies  in  poor  crowded  towns  or  among  the 
refugees,  but  gave  a  living,  an  aim,  to  French  girls  heart- 
broken by  the  war.  I  have  seen  some  of  them  who  had  looked 
once  so  despairing,  come  back  in  their  blue  uniforms,  with 
rosy  cheeks  and  brilliant  eyes,  happy  to  talk  about  their 
babies,  eager  to  tell  of  the  welcome  they  found  in  dark  lodg- 
ings and  suburb  huts. 

Some  of  the  visiteuses  d'enfanis  have  learned  more  than 
the  lessons  their  four  months'  course  could  give  them.  They 
have  learned  from  "their  American  family"  the  great  lesson 
of  social  work ;  work  that  requires  not  only  good  abilities  and 
special  training  but  the  utter  gift  of  one's  self. 

During  the  German  offensives  of  the  spring  of  1918,  the  city 
of  Rouen,  northwest  of  Paris,  was  crowded  with  refugees  from 
Belgium.  The  condition  of  these  refugees  and  especially  of  the 
children  was  pitiful,  so  the  Children's  Bureau  sent  up  a  physi- 
cian and  nurse  to  organize  a  dispensary  where  acute  cases  might 
be  treated.  The  maire  of  Rouen  donated  a  building  and  the 
American  Red  Cross  held  clinics  there  where  from  twenty  to 
forty  children  were  examined  daily.  Social  service  work  was 
extensively  developed.  The  dispensary  also  established  co- 
operation with  the  Syndicate  de  Sage  Femmes  and  periodic 
instruction  on  questions  pertaining  to  child-welfare  was  given 
to  midwives. 

Dijon,  in  the  Department  Cote  d'Or,  was  the  location  of  the 
Camouflage  Camp  of  the  40th  Engineers,  American  Expedi- 
tionary Forces.  ]\lany  French  women,  however,  were  employed 
here ;  they  spread  the  yards  of  burlap  out  on  the  ground  and 
applied  the  water  colors  with  brooms.  The  strips  of  burlap 
wore  then  carried  into  long  sheds  and  hung  on  racks  to  dry. 
"The  ground,  the  workers,  the  buildings,  the  very  sky  itself," 
wrote  ]\lrs.  Lucas,  "seemed  covered  with  green,  yellow,  bro\Mi, 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    817 

yellow  and  green  mixtures,  terrible  stuff  to  work  with,  so  wet, 
so  messy  and  so  smelly.''  ''^ 

At  the  Camouflage  Camp  the  need  for  a  creche  where  mothers 
could  nurse  their  babies  was  very  great,  so  the  Children's  Bu- 
reau established  one  there  in  July,  1918,  and  sent  an  American 
Red  Cross  nurse,  Mary  E.  Mather,  to  run  it.    Miss  Ashe  wrote: 

Tlie  creche  was  a  simple  affair,  but  it  was  made  wonder- 
fully attractive  for  the  children  by  camouflage  artists  who 
donated  their  Sunday  rest  to  the  decoration  of  the  walls  with 
marvelous  Mother  Goose  figures.  The  American  boys  sta- 
tioned at  the  Camoufhige  Camp  took  the  greatest  pride  and 
interest  in  the  bal)ies  and  were  joyful  whenever  a  case  of  tiny 
garments  or  toys?  arrived.^" 

The  creche  had  a  capacity  of  one  hundred  and  fifty  babies. 
Miss  Mather  wrote : 

The  babies  and  children  varj'ing  from  one  week  old  to  eight 
years  were  brought  to  us  at  seven  in  the  morning  and  were 
taken  home  at  seven  at  night.  During  the  day  they  were 
clothed  and  fed  at  the  creche  or  nursed  by  their  mothers.  For 
the  older  cliildren  we  had  first  grade  school.  I  had  nine 
French  aides  to  help. 

Some  time  during  August  the  hospital  at  Dijon  became 
overcrowded  and  was  unable  to  take  any  more  patients.  The 
boys  at  tlie  Camouflage  Camp  began  to  come  home  ill  with 
influenza,  so  with  the  permission  of  ^fr.  Walsh,  the  American 
Eed  Cross  representative  at  Dijon,  I  made  a  hospital  of  part 
of  the  crl'clie.  Here  we  cared  for  sick  boys  from  the  Camp. 
We  had  one  hundred  beds  and  our  total  number  of  patients 
was  over  450.  To  make  room  for  the  children  I  had  three 
more  rooms  built  on  to  the  creche,  so  we  were  able  to  take 
care  of  everybody. 

The  derivation  of  the  French  word  creche  is  a  pleasing  one. 
The  word  originally  meant  "manger"  and  creche  is  now  sym- 
bolic of  the  rude  crib  in  which  the  Infant  Jesus  lay  in  Bethle- 
hem. 

Early  in  1917,  the  War  Council  appointed  the  American  Red 
Cross  Commission  for  Belgium,  with  Dr.  ffohn  van  Sdiaick, 
one  of  Major  Murpliy's  original   staff,   as  commissioner.      Dr. 

^  "The  Children    of  France  and  the  Red  Cross."  J.  R.  Lucas,  pp.  Kili-KJT; 
Frederick   A.    Stokf's   Coinpanv.   New   York   Citv.    liUS. 
''Ciilder    Report,   Vol.    Ill,  p.   01. 


818    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

J.  Mason  Knox,  associate  chief  of  the  Children's  Bureau  at 
Paris  headquarters,  was  appointed  by  the  Commission  for 
France  as  medical  chief  and  Miss  Ashe,  chief  nurse  of  the 
Commission  for  Belgium. 

The  children  of  Belgium  suffered  much  during  the  war. 
One  of  the  earliest  projects  which  the  American  Red  Cross 
undertook  in  1917  to  alleviate  their  pitiable  condition  was  to 
furnish  nursing  service  to  a  colony  of  Belgian  refugee  chil- 
dren at  Le  dandier,  in  the  Departemeyit  Correze,  in  central- 
southern  France.  This  colony,  which  was  called  I'Ecole  de 
8.  M.  la  jReine  was  under  the  special  patronage  of  Queen 
Elizabeth  of  Belgium.  Dr.  Charles  Xeeleman,  an  eminent 
Belgian  child  specialist,  was  medical  director. 

In  October,  1917,  the  Commission  for  France  sent  two  Ameri- 
can Bed  Cross  nurses,  Martha  Hower  and  Sara  Jane  Boyle,  to 
Le  Glandier  to  assist  Dr.  Neeleman.  Miss  Hower  later  became 
head  nurse  of  the  colony.  She  was  a  Pennsylvanian  by  birth 
and  was  graduated  from  the  Jefferson  Medical  College  School 
for  Xurses.  She  did  public  health  nursing  in  the  Stock  Yards 
District  in  Chicago  and  later  was  superintendent  of  the  Louise 
Home  for  Babies,  Pittsburgh,  Pa. 

Miss  Boyle  wrote  of  the  establishment  of  the  colony  at 
Le  Glandier: 

On  October  26,  1917,  I  was  sent  to  Le  Glandier,  Correze, 
to  care  for  Belgian  children.  An  old  monastery  had  been 
assigned  to  ns,  but  as  it  had  been  unoccupied  for  twelve 
years,  it  was  in  a  fearful  state  of  decadence.  Sanitary  con- 
ditions were  absolutely  nil.  The  water  supply  was  poor  and 
unfit  for  drinking  purposes.  Xo  fuel  was  to  be  had  near  or 
in  Le  (Jlandier. 

Our  first  days  were  devoted  to  eloaning  the  monastery. 
Our  next  problem  was  beds.  These  had  to  be  made  of  strips 
of  wood  and  canvas.  This  proved  quite  a  task,  as  there  were 
only  Belgian  women  and  us  two  nurses  to  make  them.  By 
tbe  end  of  three  weeks  we  had  made  a  thousand  ])eds  and 
mattres^^cs.  the  latter  of  ticking  filled  with  straw.  Tlien  wliat 
a  time  we  had  finding  space  where  we  could  put  tliem  all! 
When  word  came,  however,  for  us  to  proceed  to  ftvian-les- 
Bains  to  meet  the  children  then  on  their  way  to  us,  everything 
was  in  readiness. 

Ten  Px'lgian  women.  Miss  Hower  and  I  went  to  fivian. 
The  chilfh'cn  arrived  there  at  four  a.  m.  At  the  Casino  they 
were  ijivcii  a  Ix-artv  lireakfast.  were  batliod  bv  American  IJed 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    819 

Cross  nurses  and  then  examined  by  American  Red  Cross 
doctors.  All  were  {)ronounced  able  to  proceed  on  their  jour- 
ney to  Le  (Jlandier. 

The  following  afternoon  twelve  coaches  were  provided  and 
each  of  us  women  took  charge  of«a  coach.  They  were  very 
crowded.  The  trip  took  fifty-six  hours  and  it  poured  rain  all 
the  time.  The  children  were  fed  en  route  at  each  station  by 
canteen  workers.  At  tlie  end  of  the  journey  two  cases  of 
diphtheria  and  one  of  scarlet  fever  had  developed. 

Upon  the  arrival  of  the  convoy  at  Pompadour,  the  nearest 
station  to  Le  Glandier,  children  were  taken  in  lied  Cross  otirs 
to  the  monastery.  When  they  reached  their  destination  they 
were  instriicted  to  remove  their  old  clothing  and  new  Ked  Cross 
garments  were  provided.  The  sick  children  were  taken  imme- 
diately to  the  snuill  Eed  Cross  infirmary  previously  equipped 
for  such  an  emergency. 

In  spite  of  all  these  precautions,  an  epidemic  of  measles 
developed.    Miss  Boyle  wrote : 

Almost  in  every  instance  these  cases  developed  into  pneu- 
monia. We  soon  found  it  necessary  to  have  an  addition  to  the 
infirmary.  As  ^liss  Hower  and  I  were  the  only  nurses  there, 
we  worked  night  and  day,  until  two  other  nurses  [Freda 
Caffin  and  Irene  Jennings]  arrived  from  Paris  in  response 
to  our  wire  for  help.  They  took  care  of  the  children  in  the 
general  hospital.  Not  having  sutBeient  medicines  or  equip- 
ment for  the  work.  Dr.  La  Bonte  went  to  Paris  and  returned 
in  a  few  days  with  some  medicines,  equipment  and,  to  our 
great  joy,  two  aides  (Hazel  ilallory  and  ^larjory  Vaudling). 
L'pon  their  assignment  to  duty,  I  was  able  to  take  my  first 
night's  sleep  in  fourteen  days.  We  had,  however,  fought  the 
disease  desperately  and  been  able  to  save  all  but  one  child. 

Irene  Jennings,  one  of  the  relief  nurses  sent  down  from  Paris 
wrote  of  the  pressure  of  the  work : 

Le  (ilaudicr  was  in  the  midst  of  a  measles  eindomic  wlion 
we  arrived.  Some  of  the  children  wor(>  o.xtrcnicly  ill  with 
pneumonia.  Tlie  otlier  nurses  were  worn  out,  so  were  very 
glad  to  see  Miss  Callin  and  me. 

The  doctor,  a  Belgian  oHicer,  decided  to  keep  the  measles 
cases  in  the  iniinnary  already  running  and  to  put  the  other 
cases,  thirty-live  in  number,  in  an  impro\isi'(l  infirmary.  1 
was  alone  on  dutv  here   for  a  week,  wliile   Mis<  Catlin  took 


820  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

night  duty.  It  was  mighty  hard  work  to  take  care  of  thirty- 
five  children  in  so  many  different  rooms,  with  a  scarlet  fever 
case  thrown  in.  I  went  on  duty  at  six  in  the  morning.  j\Iiss 
Cafiin  stayed  on  until  about  ten  o'clock,  so  that  we  eould  have 
the  rooms  half  way  fit  for  the  doctor's  morning  inspection. 
After  she  came  on  at  night,  I  would  wash  towels  and  such 
other  things  as  any  woman  with  such  a  family  has  to  do. 
The  diet  was  also  a  problem^  but  with  all  the  dressings  on 
frozen  feet  and  sore  eyes,  to  say  nothing  of  new  patients, 
possibly  nine  at  a  time,  all  of  them  having  to  be  bathed  before 
they  could  be  put  to  bed  and  their  clothes  tagged,  it  was 
"right  smart"  work  for  one  pair  of  hands,  without  extra 
cooking.  Anyone  who  has  ever  tried  to  boil  a  bucket  of 
water  on  those  French  stoves  which  refuse  absolutely  to  do 
anything  but  smoke,  will  appreciate  how  we  felt ! 

The  children  at  Le  Glandier  numbered  about  seven  hundred. 
As  soon  as  the  measles  epidemic  subsided,  Miss  Caffin  was  re- 
called to  Paris,  but  Miss  Jennings  was  assigned  to  a  nose  and 
throat  clinic  which  was  opened  in  the  permanent  infirmary. 
Dr.  Wiggin,  w^ho  was  later  assigned  to  Lyons,  operated  for 
tonsils  and  adenoids,  and  his  wife,  Mrs.  Wiggin,  gave  anesthe- 
tics. An  American  Red  Cross  physician,  Dr.  Lillie  A.  Arnett, 
was  also  on  duty  at  Le  Glandier.  She  wrote  of  the  dispensary 
there : 

Each  morning  we  began  work  at  7  :30.  There  was  a  daily 
average  of  about  65  or  70  patients.  Many  of  them  were  old 
ulcer  cases,  the  results  of  frozen  feet  or  hands,  others  were 
indigestion,  aural  abscesses,  skin  diseases  of  different  sorts, 
afflicted  scalps  and  scabies.  It  was  necessary  to  finish  with 
the  children  who  attended  morning  school  by  nine  o'clock, 
and  care  for  the  children  after  nine  who  attended  afternoon 
school.  After  we  had  finished  with  all  the  children,  we 
treated  members  of  the  personnel  who  were  ill.  Nearly  every 
day  two  or  three  peasants  from  the  neighborhood  would  come 
to  the  dispensary  for  consultation,  and  often  there  would  be 
calls  to  be  made  in  their  homes,  perhaps  three  such  visits  a 
week. 

Tlio  life  at  T>e  Glandier  was  pleasant.  It  was  very  interest- 
ing to  live  with  the  Belgian  people  and  to  know  them  inti- 
mately. They  realized  and  often  said  that  without  doubt  had 
it  not  been  for  tlie  American  Eed  Cross  many  of  the  six 
hundred  children  of  tlie  colony  would  have  died;  instead  they 
now  promise  to  develop  into  healthy  and  useful  citizens. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    821 

Mrs.  Laura  Wiggiii  wrote  of  the  children: 

They  tell  me  many  little  stories  about  their  homes  and  in 
their  turn  ask  questions  about  America.  Two  asked  me  to- 
day if  the  savage  red  men  with  plumes  on  tlieir  heads  lived  in 
the  woods  near  my  house.  They  had  seen  Buffalo  Bill  in  a 
circus  at  Liege  ami  Ihouglit  America  still  full  of  Indians. 
They  know  of  liulfalo  Hill's  death  and  spoke  of  it  with  regret. 

Bread  cast  upon  the  waters,  or  a  rumor  of  it,  came  back  to 
me  when  one  little  girl  announced  that  she  would  not  return 
to  Belgium  after  the  war  "because,"'  she  said,  "I  had  not 
enough  to  eat.  Madame/'  she  confided,  "we  had  but  three 
hundred  grams  of  bread  each  day,  with  no  butter  nor  con- 
fiture, and  for  dinner  we  had  but  potatoes  or  turnips,  with 
almost  always  no  meat  nor  bread.  For  supper  we  had  soup, 
but  it  had  not  much  in  it,  only  the  soup  and  nothing  else. 
But  les  Americains,  ^ladame,  they  sent  us  milk  in  cans,  so 
that  children  might  have  a  cup  extra  each  day,  and  in  the 
afternoon  at  the  end  of  school  they  served  a  cup  of  chocolate 
with  the  milk  to  eacli  child.  Mais,  it  w'as  good  !"  Hereupon 
the  children  chimed  in  with  smacking  of  lips  and  rubbing  of 
stomachs  and  began  to  sing  a  song:  "Vivent  les  Ameri- 
cains." Many  of  the  children  have  referred  to  the  fact  of 
Americans  sending  them  gifts  and  food  and  the  proudest 
thing  any  of  them  can  seem  to  procure  is  something  with  a 
Eed  Cross  uj)on  it.  Sonu^  of  them  have  cut  Ked  Cross  from 
envelopes  and  ])apers  and  have  pinned  or  sewed  them  to  their 
clothes  in  conspicuous  places. 

In  January,  11)11),  the  colony  of  children  was  returned  to 
Belgium.  From  Xovembcr  28,  1917,  to  January  13,  1919, 
133G  children  were  cared  for  by  the  American  lied  Cross  at  Le 
Glandier.  When  it  canu'  time  for  them  to  be  sent  home,  Queen 
Elizabeth  asked  that  Miss  llower  be  alhnved  to  escort  them 
and  to  enter  her  service.  "The  real  benefit  to  the  children," 
wrote  ^Miss  llowei",  "could  be  seen  upon  their  ai-rival  in  their 
home  city,  Lirgc.  They  had  rosy  cheeks  and  were  well  and 
hardy  looking,  ^riie  Red  Cross  had  dressed  each  child  com- 
fortably and  given  it  an  e.xtra  sup})ly  of  clothing. 

The  Aniei-ican  Red  Cross  furnished  aid  to  the  Fi'ench-Ameri- 
can  Committee  foi-  the  Protection  of  Childi'cn  at  the  Frontier. 
Two  of  the  largest  colonies  which  were  maintained  by  this 
committee  were  located  at  Oulins  and  at   Morangis. 

The  Aniei'icaii   Red  ('ross  Coniniission  broui:ht  one  liundred 


822   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  thirty-two  children  from   Switzerland  and  sent  them  to 
their  parents  or  relatives  in  various  parts  of  France. 

The  Commission  for  Belgium  developed  extensive  public 
health  nursing  and  dispensary  service  for  Belgian  refugee  chil- 
dren at  Le  Havre,  in  the  Salle  Franklin.  Mabel  I.  Wilcox  was 
chief  nurse.     Miss  Ashe  wrote: 

In  January,  1918,  Dr.  Edwards  Park  was  put  in  change  of 
the  medical  work  at  Le  Havre.  Miss  Wilcox  and  an  aide  who 
acted  as  interpreter  accompanied  him.  This  work  with  the 
Belgian  refugees  was  so  much  appreciated  that  the  French 
Kefugee  Committee  asked  them  to  extend  it  to  the  French 
children. 

The  Salle  Franklin  was  an  old  theater  which  was  converted 
into  a  hospital  and  dispensary.  They  had  in  August,  1918,  a 
twenty-bed  hospital  and  a  large  out-patient  department.  Ex- 
cellent social  service  work  was  done  here,  and  a  small  class  of 
French  women  were  trained  as  public  health  visitors. 

On  August  1,  intensive  work  against  infant  mortality  was 
begun  in  the  poorest  district  of  Le  Havre.  The  maire  re- 
ported each  day  the  births  in  the  quarter.  The  visiting  nurse 
immediately  called  and  the  baby  was  kept  under  close  sur- 
veillance until  it  was  a  year  old."^ 

The  Report  of  the  Work  of  the  American  Red  Cross  during 
the  time  the  society  was  operated  by  the  War  Council  stated 
that  at  Le  Havre  a  total  of  14,010  patients  were  treated  at  the 
dispensary,  2523  house  visits  were  made  by  doctors  and  nurses 
and  195  hospital  patients  treated. 

At  Lille  and  at  Cambrai,  the  American  Red  Cross  undertook 
extensive  projects  in  school  nursing  for  the  benefit  of  children 
who  had  been  living  in  these  areas  through  the  German  occupa- 
tion and  whose  health  had  suft'ered.  Miss  Fitzgerald  made  a 
trip  from  Paris  headquarters  to  these  cities  in  June,  19 19, 
and  she  wrote : 

The  work  here  has  been  the  establishment  of  school  canteens 
and  the  maintenance  of  public  health  nursing  for  the  children 
in  these  areas.  In  Lille,  Elmira  Bears,  the  nurse  in  charge, 
has  done  a  remarkai)]e  piece  of  organization  work.  There 
were  about  sixteen  thousand  school  children  in  the  city  and 
when  I  was  tliere  nine  thousand  of  them  had  already  been 
examined. 

^UHl.lcr   Itcport.  \\>\.  III.  p.  92. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     823 

The  method  followeJ  is  that  employed  in  America,  Tlie 
children  receive  a  thorough  examination  which  is  given  in  co- 
operation with  the  French,  who  have  entered  into  the  scheme 
most  whole  heartedly.  The  children  needing  convalescence  are 
sent  to  the  seashore,  or  to  mountain  resorts,  through  the  help 
of  different  committees;  those  needing  hospital  care  are  sent 
to  the  hospitals  in  the  locality  wherever  possible. 

The  canteen  work  consists  in  serving  cocoa  to  all  children 
and  a  meal  to  those  needing  extra  food.  This  meal  is  served 
in  the  afternoon,  after  school  hours,  and  consists  of  soup, 
meat  or  fish,  vegetables  and  fruit.  The  Commission  for 
Relief  in  Belgium  and  Northern  France  has  endowed  this 
work  to  the  extent  of  nine  million  francs,  which  will  enable 
the  French  people  to  carry  it  on. 

One  very  interesting  part  of  the  work  consists  in  the  care 
they  have  had  to  give  to  the  many  children  suffering  from 
scabies.  They  have  been  able  to  secure  a  portion  of  the  public 
baths  of  the  city,  and  here  from  early  morning  till  late  at 
night  the  children  are  bathed  and  scrul)l)ed  and  treated;  they 
now  have  the  situation  well  under  control. 

At  Cam])rai,  ^liss  Baurle  is  in  charge  of  similar  work  and 
has  again  shown  herself  to  be  most  efficient  and  competent. 

In  the  previous  chapter  it  has  been  shown  how  during  the 
sj)ring  of  1!>18,  the  needs  of  the  American  Expeditionary 
Forces  engiilfed  American  Red  Cross  activities  for  the  French 
civilian  population,    ^fiss  Ashe  wrote: 

Following  the  first  call  for  help  from  ^lilitary  Affairs  in 
March,  1!)1S.  the  strain  on  the  nursing  force  was  very  severe. 
.  .  .  Within  the  next  two  weeks,  forty  nurses  and  aides  were 
loaned  to  the  Department  of  ^lilitary  Affairs  by  the  Chil- 
dren's Bureau.  A  hospital  was  opened  at  Beauvais,  the 
personnel  of  which  was  composed  entirely  of  nurses  from  tlie 
Department  of  Civil  Affairs.  In  July,  the  nursing  force  was 
again  called  u])()n  to  helj)  when  the  advance  of  the  enemy  to 
the  ^larne  entirely  disrupted  for  a  time  the  ^ledical  Service 
of  the  Army  and  the  Ked  Cross  .  .  .  rushed  nurses  to  llie 
front.  A  h(is])ital  was  established  at  Jouey-sur-^lorin.  with 
a  personnel  conqiosed  almost  exclusively  of  infant  welfare  and 
public  health  nurses  and  aides. 

The  adajitability  of  these  nurses  to  war  needs  was  a  sur- 
prise to  e\eryone.  Their  training  in  the  poor  homes  \v]ier(> 
they  had  been  obliged  to  make  the  best  of  what  was  at  liand. 
was  of  value  to  them  in  this  emergency  woi'k.  where  they 
were  conipelled  to  do  manv  thinirs  with  which  a  re^Milar  bos- 


824  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

pital  nurse  is  not  accustomed  to  work.  The  Children's  Bu- 
reau felt  much  pride  in  them  and  great  happiness  in  that  it 
had  been  able  in  the  time  of  need  to  make  vital  contribution 
to  the  care  of  American  wounded.^* 

August,  1918,  marked  a  crucial  month  in  the  history  of  the 
Children's  Bureau  in  France.  Dr.  Knox,  Dr.  Manning  and 
Dr.  Baldwin,  three  of  its  strongest  pediatricians,  returned  to 
America.  The  organization  of  the  entire  Paris  headquarters 
was  also  effected  and  the  Children's  Bureau  became  a  part  of 
the  newly-created  Medical  and  Surgical  Department  of  which 
Colonel  Fred  Murphy  was  director.  September  and  October 
were  months  spent  in  definition  of  future  policies  and  readjust- 
ment of  present  actiyities  of  the  Children's  Bureau. 

Miss  Gilder  in  the  official  report  of  the  Bureau,  summarized 
the  close  of  the  work : 

By  the  middle  of  January,  1919,  the  personnel  of  the 
Bureau  numbered  228  against  541  of  the  preceding  August, 
the  highwater  mark  of  the  staflf.  This  was  approximately  the 
minimum  with  which  the  Bureau  could  operate  and  was  only 
slightly  reduced  before  the  final  wind-up  of  the  work  on 
May  1.  This  was  to  occur  after  the  hospitals  at  Limoges  and 
at  St.  fitienne  were  turned  over  to  the  French ;  after  the 
dispensaries  at  St.  fitienne,  Blois  and  Corbeil  were  taken  over 
by  French  doctors  wlio  were  demobilized ;  and  after  the  per- 
manent child  welfare  organization  in  Paris  was  completed. 

On  January  1,  1919,  Dr.  Lucas  received  a  cable  from  Eed 
Cross  Headquarters  confirming  a  gift  of  $100,000  from  the 
American  Junior  Ked  Cross  to  the  children  of  France.  The 
gift  came  as  a  memorial  of  the  sympathy  that  expressed  itself 
in  small  gifts,  the  dimes  and  quarters  out  of  children's 
pockets,  and  was  used  to  endow  a  hospital  and  health  center 
in  Paris,  to  be  inscril)ed  "From  the  Children  of  America  to 
the  Children  of  France"  and  to  be  administered  by  a  French 
Committee  composed  of  the  ]\Iedieal  Faculty  of  Paris  and  of 
representatives  of  the  leading  child  relief  and  child  welfare 
organizations  of  France. 

On  January  1,  1919,  the  Children's  Bureau  completed  a 
little  over  sixteen  months  of  work  in  France.  It  had  in  thia 
period  given  assistance,  in  medical  service,  money  and  relief 
materials  to  at  least  250.000  children.  .  ,  . 

"When  the  Children's  Bureau  closed  its  books  on  May  1, 
1919,  it  left  behind  it  four  permanent  hospitals,  in  St, 
*  Gilder  Report,  Vol.  Ill,  p.  92. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     825 

fitienne,  Fou<{,  Kouen  and  Paris,  and  four  important  Franco- 
American  child  welfare  organizations  whose  object  it  was  to 
carry  on  the  training  school  for  nurses  which  the  Bureau  had 
inaugurated,  and  to  do  general  child  welfare  and  public 
health  work.  It  had  established  at  least  twenty-eight  per- 
manent institutions;  and  by  turning  over  the  equipment,  sup- 
plies and  "good  will"  of  its  dispensaries  to  French  manage- 
ment it  had  naturally  helped  and  made  lasting  its  work  in  71 
other  medical  estaldishnients.^'' 

A  list  of  these  principal  hospitals  and  dispensaries  may  be 
found  in  the  Appendix. 

In  the  Keport  issued  by  the  War  Council  on  the  Work  of  the 
American  Ked  Cross  during  the  period  beginning  May  10,  1917, 
and  ending  February  28,  1919,  it  is  stated  that  the  Children's 
Bureau  operated  25  hospitals  and  convalescent  homes  for  chil- 
dren and  in  them  treated  10,346  patients;  operated  99  dispen- 
saries and  clinics  and  in  them  treated  189,111  patients;  served 
32,000  children  in  school  canteens ;  taught  27,000  children  how 
to  play  (in  organized  recreation  centers)  ;  held  7  child  welfare 
expositions  which  were  attended  by  a  total  of  625,000  people 
and  aided  519  children's  institutions  or  societies.^'' 

And  the  comfort  and  happiness  which  this  phase  of  Ameri- 
can Red  Cross  nursing  and  general  relief  service  brought  ? 
"The  women  and  children  who  came  to  our  clinics,"  wrote  Mar- 
garet Wood,  an  American  Red  Cross  nurse,  "have  had  little 
glory,  yet  they  endured  almost  unbelievable  hardships  without 
a  murmur.  Poor,  little,  neglected,  underfed  and  silent  children, 
whose  seemingly  small  ailments  had  gone  uncared  for  during 
years,  were  at  last  able  to  be  treated  through  the  American  Red 
Cross."  JMiss  Leete  summarized  as  follows  this  nursing  service 
of  the  Children's  Bureau:  "Our  nurses  touched  all  parts  of 
France,  deft  tender  fingers  seeking  out  and  easing  pain." 

One  of  the  five  major  opportunities  for  service  which  ofTen^d 
themselves  to  tlu>  American  Red  Cross  in  France  in  July,  1!»17, 
was,  it  will  be  remembered,  work  for  tlie  alleviation  of  the 
suffering  of  F'rench  and  liJelgian  refugees.  This  service  was 
first  cari-ied  on  through  tlu^  Bureau  of  Ri^fugees  and  Relief 
in  Paris,  one  of  the  five  principal  bureaux  of  the  Department 
of   Civil   Atfaii's.      ^largaret    (Hirtis,    of   Boston,    was    its   tirst 

"For  complete  details  see  the  Cilder  Report,  pp.  131-14('). 
*"'Tlie  WOrk  of  the  Ainerieaii   lied  Cross  During'  the  War:    A   Statement 
of   Financfs   and   Aeeomplislimenls,''   p.   (i3. 


826   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

director  and  she  initiated  varied  phases  of  social  service  work 
for  the  refugees  in  Paris.  In  September,  1917,  Dr.  Edward 
r.  Devine,  of  New  York,  was  appointed  chief  of  the  bureau  and 
directed  the  service  work  for  refugees  throughout  all  of  France, 
except  the  war  zone  and  Paris.  Dr.  Devine  had  been  pro- 
fessor of  Social  Economy  at  Columbia  University,  director  of 
the  New  York  School  for  Philanthropy  and  for  twenty  years 
secretary  of  the  New  York  Charity  Organization.  He  had  done 
emergency  relief  work  for  the  American  Red  Cross  during  the 
San  Francisco  fire  and  the  Dayton,  Ohio,  floods. 

The  French  Ministry  of  the  Interior  stated  that  the  number 
of  destitute  refugees  in  March,  1917,  was  four  hundred  thou- 
sand. The  problem  of  furnishing  housing  facilities  and  means 
of  earning  a  livelihood  to  these  numbers  was  one  with  which 
many  French  and  American  charity  and  war  relief  organiza- 
tions had  been  working  since  1911.  The  American  Red  Cross 
Commission  for  France  early  adopted  a  policy  of  cooperation 
under  which  substantial  gifts  of  funds,  supplies  and  personnel 
were  donated  to  these  already-existing  organizations  and  they 
were  urged  to  continue  and  further  develop  their  own  machinery 
for  relief  work.  "Do  all  the  work  you  can  in  an  efficient  man- 
ner," the  American  Red  Cross  practically  said  to  these  organ- 
izations, ''and  we  will  provide  the  funds."  ^^  In  addition  the 
Bureau  established  and  maintained  hospitals,  dispensaries, 
colonies  and  homes  for  refugees  and  developed  a  system  whereby 
a  trained  social  service  worker  was  sent  as  an  American  Red 
Cross  delegate  to  the  different  departements  where  large  num- 
bers of  refugees  had  been  placed. 

The  British  and  American  Societies  of  Friends  blazed  the 
way  in  France  for  relief  work  among  the  refugees.  The  British 
Society  of  Friends  had  begun  volunteer  relief  work  in  the  Marne 
in  Se])tember,  1914,  and  the  American  Society  of  Friends  had 
iiiven  them  generous  contributions  of  funds  and  clothing.  In 
June,  1917,  a  unit  of  one  hundred  American  Friends  went  into 
training  for  foreign  service  at  a  camp  at  Haverford,  Pennsyl- 
vania, and  tlie  society  sent  two  representatives  to  France  to 
make  a  field  survey.  These  men  sailed  on  the  same  ship  as  did 
]\rajor  Murphy  and  his  staff  and  were  appointed  to  membership 
in  the  American  Red  Cross  (\)mmission  for  France.  The  plan 
of  cooperation  which  was  later  developed  is  stated  in  the 
Report  of  the  First  Year  of  the  American  Red  Cross  in  France: 

"Sec   "The    First   Year  of  the   American    Red    Cross   in    France,"   p.    13. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     827 

lender  the  ori^Miial  plan  of  work,  it  was  decided  that  Ameri- 
can Friends  desiriii*,^  service  in  France  shouhl  not  form  a  new 
unit  hilt  sliouhl  unite  themselves  with  the  Rritisli  organiza- 
tion which  already  had  heen  in  the  field  nearly  three  years. 
The  result  was  a  compact  group  under  tlie  control  of  a  single 
executive  committee  with  a  common  treasury.  The  Ameri- 
cans, however.  l)ecame  memhers  of  the  American  lied  ('ross, 
while  the  Britisli  Friends  retained  their  connection  with  the 
French  Eed  Cross.  ...  To  the  common  treasury  of  the 
American  and  British  Friends  the  American  Red  Cross 
donated  money,  transportation  and  equipment;  it  facilitated 
the  movement  of  workers  and  the  shipment  of  goods  and 
supplies.  The  Friends,  on  the  other  hand,  presented  plans 
for  extension  of  their  work  and  new  developments  to  the  Red 
Cross  for  approval,  thus  enahling  their  personnel  to  cooperate 
directly  with  Red  Cross  workers. 

This  plan  was  put  into  effect  early  in  Septemher,  1917. 
The  American  Friends  arriving  then  found  that  the  British 
Friends  already  had  estahlished  three  medical  relief  institu- 
tions for  refugees  in  the  department  of  the  ^larne  at  Chrdons- 
sur-Marne,  where  there  was  a  maternity  hospital  of  twenty- 
eight  heds ;  at  Bettancourt,  where  a  convalescent  home  was 
being  operated  for  fifty  children,  and  at  Sermaize,  where 
there  was  a  chihlren's  and  local  hospital  of  twenty  beds. 

Early  in  the  fall  of  1017,  the  numbers  of  volunteers  among 
the  American  Friends  began  to  exceed  the  immediate  needs  of 
the  British  Friends;  so  a  second  unit  was  formed  which  worked 
independently  of  the  l^ritish  Society.  This  unit  was  designated 
as  Unit  Xo.  2  whUc  the  earlier  unit  was  known  as  Unit  Xo.  1. 
On  September  20,  1017,  a  bureau  called  the  T3nreau  of  Friends 
was  established  in  the  Department  of  Civil  Affairs  of  the  Com- 
missi(ui  for  France  and  .1.  Ilenrv  Scattergood,  one  of  the  two 
rc^presenta fives  who  had  gone  to  France  to  make  field  survey 
for  the  American  F'l'iends,  was  appointed  director  and  Charles 
Evans,  of  Ixiverfon,  Xew  Jersey,  assistant  director.  Tlie  per- 
soniu^l  of  Unit  Xo.  2  worked  entirely  under  the  direction  of  the 
chief  of  the  Fi-icnds  Ihircaii  and  they  aided  in  ihv  ''construc- 
tion of  hospitals,  the  refitting  of  buildings  for  dispensary  pur- 
poses, the  repair  of  house's  in  devastated  areas,  child  welfare 
campaigns,  varied  relief  activities  for  refugees  and  in  the  wliole 
American  Ived  C^ross  program  for  the  relief  of  civilians  in 
F^rauce."  ^'-     As  many  of  these  young  men  had  had  sjx'cial  tra';i- 

■■^  "'llio  First  Year  of  tlu'  Aiiiorieaii  Red  Cross  in  Friuice,"  p.  48. 


828   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ing  in  automobile  work,  carpentry  and  agriculture  and  as  their 
attitude  toward  service  was  one  of  earnest  enthusiasm,  it  may 
indeed  be  said  of  them  that  no  task  was  too  hard,  no  emergency 
too  trying  to  chill  their  unfailing  cheer  and  good-will. 

After  some  months,  Mr.  Evans  became  chief  of  the  Bureau 
of  Friends  and  in  the  First  Annual  Report  of  the  American 
Friends  Service  Committee,  Bulletin  No.  18,  he  wrote: 

We  now  liave  one  hundred  and  fifty-eight  men  and  the 
twenty-six  women  in  Unit  No.  1  and  eighty-three  men  in 
Unit  No.  2,  making  a  total  of  two  hundred  and  forty-seven 
American  workers.  At  least  one  hundred  and  fifty  more 
men  have  been  favorably  passed  upon  for  this  service  by  our 
Philadeli)hia  Committee  and  will  sail  as  soon  as  passports  and 
sailing  accommodations  are  available.  In  giving  these  figures 
it  seems  api)ropriate  to  mention  the  loan  of  workers  to  other 
Bureaus  of  the  American  Eed  Cross,  quite  apart  from  the 
plan  of  Unit  No.  2.  In  addition  to  the  work  of  o.ur  Mission 
it  has  been  our  ])leasure  to  cooperate  with  various  bureaus  in 
the  American  Ked  Cross  by  lending  temporarily  to  them  men 
and  women  whose  qualifications  clearly  fitted  them  for  the 
work  desired.  We  mention  the  following  instances:  Belgian 
Conmiission,  one;  Italian  Commission,  four;  Children's 
Bureau,  Luneville  one,  Toul  two;  Bureau  of  Refugees  and 
Relief,  Aube  (delegate)  one,  Eaux  Bonnes  four,  Eure  and 
Mayenne  three;  Bureau  of  the  War  Zone,  two  (chauffeurs)  ; 
Bureau  of  Reeducation  of  JSIutiles,  one;  Historical  and  Edi- 
torial Division,  two;  jManufacture  of  Artificial  Limhs,  one. 

American  Red  Cross  nursing  service  for  refugees  was  carried 
on  chiefly  under  the  direction  of  Miss  Ashe;  although  she  was 
called  chief  nurse  of  the  Children's  Bureau,  she  also  served 
as  chief  nurse  of  the  entire  Department  of  Civil  Affairs,  in  that 
public  health  nurses  assigned  to  her  by  Miss  Russell  were  sent 
to  do  tuberculosis  and  infant  welfare  w(U'k  and  visiting  nursing 
among  \\w  adult  civilian  population  of  France  as  well  as  among 
the  children. 

Early  in  the  fall  of  1!)1Y,  the  commission  made  a  grant  of 
993,000  francs  to  the  Friends'  Society  and  with  part  of  this 
fund  a  hospital  home  for  sick  babies  was  opened  at  (^halous- 
sur-Marne,  in  connection  with  the  Friends'  Maternity  Hospital 
already  establislied  there.  This  home  was  located  at  St.  Remy- 
en-Bouzemont,  Marne,  and  "was  needed,"  wrote  ]\lr.  Evans  in 
his    First   Aniuuil    Report,   ''for  bnlu'es  iKtru   at  the   ^laternity 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     829 

Hospital  at  Chrilons-siir-Marno  whose  mothers  were  ineapable 
of  takinjr  care  of  them.  A  suitable  house  to  the  south  of  Vitry- 
le-Franqois  was  oifered  rent  free.  The  cost  of  fitting  and  equip- 
ment has  practically  all  been  paid  by  the  American  lied  Cross." 
Miss  Ashe  assigned  nurses  and  aides  both  to  the  Maternity 
Hospital  and  to  the  Babies'  Home. 

A  similar  baby  hospital  was  established  at  Chalons-sur-j\larne 
and  rent  and  equipment  expenses  were  met  by  the  American 
Red  Cross. 

A  general  surgical  hospital  was  next  opened  at  Sermaize- 
les-Bains.  Dr.  James  H.  Babbitt,  a  member  of  the  Friends' 
Unit,  was  director.  The  French  civilian  hospital  at  J5ar-le-I)uc 
had  been  evacuated  on  account  of  severe  air  raids  and  the  women 
and  children  of  the  district  in  need  of  medical  care  were  left  in 
dire  straits.  The  American  Red  Cross  hospital,  which  was 
called  the  Chateau  Hospital,  had  at  first  a  capacity  of  sixty 
beds,  but  by  the  spring  of  1918  this  was  raised  to  one  hundred 
beds.  Several  barracks  were  erected  to  house  contagious  cases 
and  to  afford  acconnnodations  for  the  staff;  electric  lights,  im- 
proved water  supply,  a  drainage  system  and  X-ray  and  other 
apparatus  were  installed.  "Practically  the  whole  expense  of 
this  hospital,"  wrote  Mr.  Evans  in  his  First  Annual  Report, 
"has  been  carried  by  the  American  Red  Cross." 

The  Chateau  Hospital  was  partially  staffed  by  American  Red 
Cross  nurses  and  aides.  Dr.  Babbitt's  report  for  the  week  end- 
ing ^lay  11,  1918,  showed  that  an  extensive  surgical  service 
was  maintained  here  for  the  Sermaize-Chalons  district. 

The  report  of  the  past  week  will  be  given  as  combined 
report  of  the  two  hospital  staff  physicians  and  will  thus  in- 
clude the  out-patient  service  at  the  Source  Hospital,  Bcttan- 
court  and  Chauniont.  as  well  as  the  general  visits  in  the 
villages.  There  are  forty-two  patients  in  the  Ciiateau  Hospi- 
tal and  twonty-thrce  operations  have  been  jierformed  there 
this  week,  'i'lie  staff  has  seen  or  visited  seventy  new  patients 
and  the  coniljined  out-patients  service  numbers  one  luindred 
and  thirty-nine  cases.  On  May  first  there  were  twenty-eight 
patients  in  La  Source  Hospital  and  fifty-three  at  Bettaneourt. 
Since  December  27,  we  have  performed  three  hundred  and 
seventy-nine  operations. 

Refugee  relief  work  in  Paris  fell  under  two  principal  heads, 
economic  n^habilitation  and  medical  social  service.     The  latter 


830   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

phase  of  work  (and  the  only  one  of  which  an  account  belongs  in 
this  history)  was  first  developed  in  1917  under  the  Accueil- 
Franco-Americain,  with  Dr.  Richard  C.  Cabot  as  director.  The 
development  of  this  service  was  described  by  Julia  B.  Norton, 
a  nurses'  aide  and  social  service  worker: 

December  1,  1917,  found  me  in  Paris,  starting  medical 
social  work  under  the  great  master,  Dr.  Richard  C.  Cabot, 
Major,  U.  S.  ^M.  E.  C,  Avho  had  been  loaned  to  the  American 
Red  Cross  to  start  a  program  of  good  medical  social  service 
in  connection  with  a  refugee  dispensary.  ]\Iedical  attention 
for  the  refugees  was  greatly  needed.  The  out-patient  clinics 
of  the  Paris  civilian  hospitals  were  so  overcrowded  that  for 
the  most  part  the  refugees  had  little  attention.  The  need  for 
a  central  dispensary  to  which  all  refugees  could  go  and  be 
welcomed  was  very  apparent. 

L'AccueU  Franco- Am cricain  had  started  in  a  small  dis- 
pensary at  12  rue  Boissy  d'Anglas  to  take  care  of  the  medical 
cases  which  presented  themselves  along  with  general  relief 
cases.  Dr.  Cabot  took  over  this  dispensary  and  started  it  on 
a  much  larger  scale  with  the  following  staff:  one  children's 
specialist,  one  tuberculosis  specialist,  three  general  medical 
men,  one  dentist,  some  six  or  seven  nurses  and  as  many  more 
social  service  workers.  .  .  .  The  dispensary  grew  from 
seventy-five  to  one  hundred  cases  a  week  and  when  it  was 
moved  to  its  new  home  at  32  Rue  ^lathurins,  to  six  hundred 
cases  a  week.  The  new  location  was  more  or  less  ideal,  cen- 
tral, quiet  and  conveniently  divided  as  to  space  into  small 
consultation  rooms,  each  with  natural  light  and  good  air,  and 
a  few  big  reception  rooms. 

The  dispensary  was  essentially  a  temporary  proposition, 
started  as  a  temporary  service  to  fill  in  chinks  where  the 
French  lacked  funds  or  personnel,  so  it  will  naturally  be 
closed  on  !March  1,  1919,  with  the  return  of  the  refugees  to 
their  former  homes. 

Tbere  was  a  great  amount  of  actual  relief  done  through  the 
dispensary.  Besides  free  medical  consultation  and  free  medi- 
cine [and  public  hcaltb  nursing  service]  for  tubercular 
anaemic  patients,  we  gave  extra  food,  the  kind  of  food  con- 
taining carbohydrates  and  oils  which  they  could  not  get  for 
themselves  and  for  which  there  was  absolutely  no  existing 
French  organization  to  supply  them.  Clothes  we  gave  and 
medical  appliances  aiul  furniture  too.  hut  only  after  thorough 
home  investigation  through  central  oruvres  of  the  American 
Eed  Cross  established  to  fill  individ^ial  needs.  Besides  the 
six  hundred   medical   cases  a  v/eek.  we  gave  material  aid  to 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    831 

about  two  liundred  others  a  week.  .  .  .  Let  me  cite  an 
example.  On  iS'ovembor  18,  1918,  a  delegate  of  the  Croix 
Kose  came  to  the  dispensary  and  asked  for  two  hundred  and 
fifty  kilos  of  medical  supplies  to  take  up  in  a  camion  to 
destitute  Lille.  Lille  had  then  plenty  of  doctors  but  no  medi- 
cines. The  American  lied  Cross  had  the  medicines  but  no 
transportation  from  Paris  to  Lille  for  the  moment.  The 
Croix  ]{ose  furnished  the  camion,  the  American  Ked  Cross 
the  medicines  and  within  two  days  the  doctors  of  Lille  were 
at  work. 

The  Bureau  of  Refugees  through  its  departmental  delegates 
undertook  extensive  relief  work  for  the  refugees  in  central  and 
southern  France.  Food  and  clothing  were  issued  in  large  quan- 
tities, farming  implements  were  supplied  and  positions  secured 
for  trained  workmen. 

The  entire  refugee  problem  was  dependent  upon  the  military 
situation.  On  ]\Iarch  21,  1918,  the  Germans  launched  the 
first  of  their  five  major  oifensives  and  the  refugee  problem  im- 
mediately assumed  enormous  proportions.  Amiens  did  not 
fall,  but  the  civilian  population  of  the  city  and  the  surrounding 
villages  and  countryside  fled.  Annie  S.  Rathbone,  the  Ameri- 
can Red  Cross  nurse  stationed  at  the  child  welfare  station  at 
Amiens,  wrote : 

For  five  nights  previous  to  the  evacuation  of  Amiens,  the 
enemy  had  systematically  tried  to  break  the  city's  morale  by 
air-raids.  ^leaiiwhile,  Ifed  (*ross  workers  and  members  of  the 
Friends  uiid  the  Smith  College  units  kept  coming  in  from 
points  further  east.  Dr.  Baldwin  brought  three  small  sick 
children  from  the  Red  Cross  Hospital  at  Xesle,  whom  he  had 
not  been  able  to  return  to  their  parents.  .  .  . 

On  March  "3(1  Dr.  Baldwin  took  Miss  Flanagan  and  the  two 
Nesle  cliil(lrci\  to  Paris;  tlu^y  were  afterwards  reunited  with 
their  parents.  I  started  across  the  city  to  return  the  Amiens 
bal)y  to  its  mother.  An  American  soldier  carried  her.  I  soon 
heard  a  (ierman  plane  overhead,  so  we  dodged  to  shelter. 
Later,  we  tried  again.  The  night  was  beautiful,  with  a  i)hicid 
full  moon.  We  gave  the  bal)y  to  her  mother,  who  was  half- 
mad  with  anxiety,  supplied  her  with  money  and  condensed 
milk  and  dodged  l)a(k. 

The  next  morning  1  made  rouiuls  among  mv  sick.  Some 
had  already  gone.  Everywhere  those  remaining  asked  help- 
lessly: "Shall  we  fly  or  shall  we  stay?""  In  my  ignorance  of 
the  militarv  situation,  I  could  not  answer  them,  could  not  tell 


832   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

them  whether  to  risk  death  from  the  German  shells  or  from 
exhaustion  on  the  road.  .  .  .  The  streets  were  already 
jammed  with  refugees  staggering  along  under  the  weight  of 
their  bundles.  .  ,  . 

At  noon,  shells  began  to  fall  on  a  distant  part  of  the  city 
and  it  was  time  to  go.  While  waiting  at  headquarters  to  get 
off,  we  women  distributed  Eed  Cross  chocolate,  condensed 
milk,  cheese,  biscuits  and  blankets  to  some  five  hundred 
British  soldiers  who  had  lost  their  equipment.  As  the  only 
nurse  in  our  party,  I  was  given  the  care  of  a  young  French 
girl  who  had  an  extensive  shell  wound  in  the  lumbar  region. 
She  had  come  from  the  east,  fleeing  with  her  mother  in  front 
of  the  advancing  Germans.  Girls  of  the  Smith  College  Unit 
had  found  her.  I  packed  her  in  a  stretcher  with  rolls  of 
material  and  used  my  umbrella  as  a  sort  of  splint  for  her  body. 

The  actual  evacuation  of  Amiens  was  a  tremendous  sight, 
a  city  of  100,000  emptying  itself  frenziedly  in  one  direction. 
The  road  to  Poix  was  packed  with  refugees  of  every  age  and 
condition,  tottering  old  people  and  young  girls;  women  with 
babies  and  children  scarcely  able  to  walk  hanging  to  their 
skirts;  automobiles,  wheelbarrows,  smart  equipages,  donkey 
carts  and  baby  carriages;  animals  of  all  kinds,  cattle,  sheep, 
dogs,  poultry  and  rabbits ;  domestic  possessions  of  infinite 
variety,  carried  in  an  infinite  variety  of  ways,  a  swollen  stream 
of  traffic  which  formed  a  dark  unending  line  of  misery  over 
the  unconscious  smiling  earth. 

Beauvais  lay  immediately  south  of  Amiens,  on  the  direct 
route  to  Paris  and  to  this  bombed  and  congested  city  the  refugees 
fled.    Miss  Rathbone  wrote : 

Late  in  the  evening  we  pushed  on  our  journey  and  reached 
Beauvais,  where  the  Sisters  at  the  Hotel  Dieu  took  charge  of 
our  wounded  and  invited  us  to  rest  that  night  in  their  deli- 
ciously  clean  hospital  beds.  We  women  workers  from  Amiens 
and  those  who  had  joined  us  from  points  further  east  filled 
two  wards.  It  was  the  first  night's  sleep  we  had  had  for 
nearly  a  week. 

In  tlie  morning,  Captain  Van  Kemen  of  the  American 
Eed  Cross  arranged  for  the  use  of  a  freight  shed  near  the 
Beauvais  station.  There  a  canteen  was  started  at  one  end  by 
the  Smith  College  Unit;  mattresses  thrown  on  the  sanded 
floor  at  the  other  end  served  as  resting  places  for  the  sick  and 
wayworn.  Later  in  the  day,  we  nurses  were  joined  there  bv 
other  nurses  and  doctors  sent  from  Paris  headquarters  and 
two  days  later  we  moved  into  a  house.     This  was  the  begin- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     833 

ning  of  the  Emergency  Hospital  for  Refugees,  which  was 
carried  on  for  about  two  months.  Then  the  nurses  and  equip- 
ment were  transferred  to  tlie  Red  Cross  military  hospital  later 
established  in  the  town  |  American  Red  Cross  Hospital  No. 
104:  L'Ecole  Frofessionale], 

One  of  these  nurses  sent  up  from  Paris  headquarters  was 
Anastasia  Miller,  who  became  head  nurse  of  the  Refugee  Hos- 
pital.    She  wrote : 

During  the  spring  offensive  .  .  .  the  refugees  were  pouring 
in  from  Amiens,  Arras  and  the  surroimding  villages.  They 
suffered  not  alone  from  maladies  but  from  shock  and  injuries 
received  from  shell  fire  before  reaching  places  of  safety. 
Families  came  in  with  one  or  two  of  their  numbers  missing; 
a  child  was  brought  to  us  who  had  been  found  in  a  cellar 
where  she  had  stayed  three  days  without  food,  her  dead 
mother,  who  had  been  killed  before  her  eyes,  lying  beside  her. 
Horrors  such  as  these  we  had  to  cope  with,  so  it  required  a 
great  deal  more  than  nursing  care. 

The  food  for  the  refugees  was  prepared  by  French  soldiers 
and  consisted  of  the  usual  boiled  meat,  with  rice  or  potatoes 
in  the  gravy  and  a  piece  of  hard  bread.  We  undertook  to 
supplement  this  by  what  we  could  cook  ourselves  on  a  two- 
burner  gas  plate.  Tlie  Red  Cross  had  supplied  us  abundantly 
with  evaporated  milk,  sugar,  cocoa,  rice,  oatmeal,  dried  prunes 
and  figs,  gelatine,  rggs  and  fresh  vegetables.  With  these 
extra  rations,  we  managed  to  keep  them  nourished  and  happy, 
although  many  a  night  1  was  cooking  when  the  alcrte  of  an 
air  round  sounded. 

For  a  month  we  continued  the  work  undisturbed.  We  held 
dispensary  clinics  every  morning  from  ten  to  twelve,  treating 
principally  children.  They  were  infected  with  scabies,  ver- 
min or  inijietigo.  We  became  ade|)ts  in  hot  baths  given  in  a 
tin  washtul)  and  followed  by  suli)hur  inunctions,  softening 
and  removing  the  crusts  of  im})etigo  with  the  subject  almost 
in  spasms  meanwhile  and  the  envelojmient  of  hundreds  of 
heads  in  kerosene  with  shampoo  following.  It  was  all  so 
worth-while!  To  see  babies'  faces  coming  out  pink  and  soft 
from  under  the  unsightly  crusts  of  impetigo  and  the  soft 
fluffy  hair  again  free  of  vermin,  with  the  attendant  relief  in 
those  little  ones'  eyes,  brought  all  the  satisfaction  in  the 
world. 

Towards  the  end  of  ^lay,  the  Cantigny  Drive,  in  which 
Americans  first  figured,  began  and  simultaneously  the  Ger- 
mans started  to  hunib  Beauvais.     Tlie  American   Red  Cross 


834    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

military  hospital  which  was  then  being  equipped  to  receive 
the  wounded  was  not  yet  ready  for  occupancy;  the  medical 
and  nursing  stalT  available  for  it  consisted  then  only  of  three 
nurses  and  three  surgeons.  The  wounded  were  then  on  their 
■way  to  Beauvais  from  the  front,  so  in  order  to  help  over  the 
emergency  I  sent  down  from  the  Refugee  Hospital  all  the 
nursing  help  I  had,  prepared  myself  a  corner  in  the  ward  and 
stayed  with  my  refugees  on  almost  twenty-four  hour  duty  for 
another  month.  Owing  to  the  bombing  which  took  place 
during  this  time,  not  a  piece  of  glass  was  left  in  our  windows 
and  the  low  tongue-and-groove  partitions  which  separated  the 
beds  were  knocked  apart  by  the  concussion.  I  gathered  up  a 
candy  box  of  shrapnel  in  the  wards  after  the  raids  were  over. 
Aside  from  slight  glass  wounds  which  I  dressed  after  each 
raid,  there  were  no  injuries,  a  remarkable  thing  because  the 
majority  of  patients  were  unable  to  go  to  the  cave  for  shelter. 
One  night  a  dog  went  mad  during  a  raid  and  bit  several 
people,  tearing  one  man's  hand  severely.  These  I  dressed  by 
the  light  of  a  taper  while  a  priest  held  a  blanket  up  to  block 
off  its  rays.  Without  windows  or  shutters,  any  spark  of  light 
was  a  risk. 

Finally,  as  the  German  advance  continued,  it  was  thought 
wise  to  evacuate  our  refugee  hospital  in  the  Ecole  Normale, 
so  the  refugees  and  patients  were  moved  further  south. 

Paris  was  the  next  stop  for  the  refugees  on  their  journey 
southward.  The  American  Red  Cross  established  rest  stations 
in  the  railroad  stations  of  the  city  and  gave  the  refugees  food, 
clothing,  medical  and  nursing  care  and  a  night's  lodging  and  in 
the  morning  sent  them  on  their  way  to  the  Midi.  Dr.  Mabel 
H.  Bancroft  wrote  of  the  general  phases  of  this  work : 

We  assisted  with  the  refugees  who  in  April  and  May  were 
pouring  in  at  all  times  at  the  various  gnres.  Sometimes  they 
would  come  in  all  night  long,  old  people,  children,  mothers 
with  babies,  many  ill  and  half  clothed,  all  hungry  and  tired 
and  heart-sore.  We  gave  a  little  medical  attention  to  the 
most  urgent  cases,  but  what  was  most  needed  was  food  and 
rest.  We  fitted  ourselves  into  any  work  which  came  to  hand, 
whatever  the  need  happened  to  be. 

I  often  wished  that  those  at  home  who  have  worked  so  hard 
for  the  l^ed  Cross  and  given  so  liberally  could  have  seen  the 
light  come  into  those  forlorn  faces  when  tliey  heard  that  it 
was  tlie  American  Red  Cross  that  was  taking  care  of  them. 
They  wanted  to  give  you  all  that  they  liad,  their  pet  hen  or 
goose  which  they  liad   picked   up  in  their  liasty  flight,  the 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     835 

most  precious  thing  they  possessed.  We  sent  those  who  were 
too  ill  to  travel  further  to  hospitals  and  put  on  the  train 
those  who,  in  hope  of  hnding  friends,  lodgement  and  work, 
were  going  further  south.  The  number  of  names  on  our 
books  were  about  twenty-three  luuulred. 

Le  Gare  du  Nord  was  the  scene  of  the  first  extensive  Red 
Cross  relief  activity  of  this  type.  Katharine  W.  Holmes,  a 
graduate  of  Smith  College  and  of  the  Kewton  (Massachusetts) 
Hospital  School  for  Nnrses,  was  one  of  the  first  Red  Cross 
nurses  to  be  assigned  to  duty  at  this  station.  ^liss  Holmes  had 
done  nursing  at  Henry  Street  Settlement  and  for  seven  years 
before  her  assignment  to  France,  had  been  in  charge  of  the 
boarding-out  department  of  the  New  York  Nursery  and 
Children's  Hospital.  After  her  return  from  France,  she  be- 
came assistant  to  the  director  of  the  P)iblic  Health  Nursing- 
Service  at  National  Red  Cross  Headquarters.  Miss  Holmes 
wrote  of  the  Gare  du  Nord: 

The  last  of  ^Fareh  the  refugees  began  to  come  through 
Paris  in  great  trainloads.  One  day  late  in  March,  after  our 
work  in  the  Children's  Rureau  was  over  for  the  day,  Mrs. 
William  11.  Hill  and  1  went  over  to  the  Gare  du  Nord  to  see 
if  the  Hed  Cross  could  be  of  any  use  in  handling  the  large 
numbers  that  were  pouring  in.  We  found  the  directrice  of 
the  French  Military  Canteen  distracted  l)y  the  double  care  of 
the  French  soldiers  on  the  main  floor  and  the  hordes  of 
refugees  who  had  no  ])lace  to  go  except  to  a  dark  basement 
once  used  as  a  freight  depot. 

Huiulreds  were  streaming  down  the  narrow  stairs  from 
the  crowded  trains,  with  their  children,  baggage  and  animals, 
everything  that  they  could  take  with  them  in  their  hurried 
fliglit  from  their  homes.  Some  of  them  had  been  frightfully 
luirt  by  (icrman  bombs.  Children  were  brought  in  strapped 
to  boards  because  their  legs  had  been  broken  by  bombs.  Tiny 
babies  a  few  days  old  were  being  carried  by  exhausted 
mothers.  Old.  old  ])eople  had  walked  sometimes  58  kilo- 
meters before  they  could  even  get  to  a  train.  After  several 
days  traveling  under  uns])eakable  conditions,  there  was  no 
complaining,  no  weeping,  just  a  courageous  acce])tance  of  it 
all  aiul  gratitude  for  what  little  was  done  for  them. 

The  Freiu-h  Canteen,  whose  rcsoui'ct's  wei'c  e\liauste(l  by 
four  years  of  war  and  by  feeding  thousamls  of  soldiers  and 
refugees,  had  only  lu'ead  and  beer  to  gisc  the  refugees.  They 
gladly  accepted  the  American  oH'cr  of  help.     Those  who  scotf 


836   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

at  the  cumbersomeness  of  a  large  organization  like  the  Red 
Cross  would  have  done  well  to  have  been  present  at  the  Gare 
du  Nord  and  to  have  watched  the  establishment  of  that  emer- 
gency canteen. 

Through  Mrs.  Hill's  initiative,  Red  Cross  trucks  were 
immediately  sent  to  the  warehouses  for  supplies  and  a  com- 
plete personnel  of  volunteer  workers  was  secured.  In  a  few 
hours'  time,  the  refugees  were  receiving  steaming  hot  choco- 
late and  coffee,  American  corned  beef  and  their  own  beloved 
sausage,  cheese,  figs,  beer,  milk,  sandwiches,  eggs  for  the 
delicate  and  best  of  all,  sterilized  milk  in  sterilized  bottles  for 
the  babies  who  up  to  that  time  had  had  only  the  choice  of 
water  or  beer. 

IMedical  care  for  those  who  needed  it  was  given  under  the 
direction  of  Drs.  Lucas,  Knox,  Manning;  between  profes- 
sional ministrations,  they  washed  cups  and  yjassed  sandwiches. 
I  shall  not  soon  forget  the  face  of  Dr.  Knox,  usually  so  digni- 
fied and  at  times  almost  austere,  then  shining  with  hajipiness 
over  the  menial  task  of  washing  tin  cups  in  a  basin  on  the  top 
of  an  upturned  beer  barrel ! 

That  niglit,  two  thousand  refugees  passed  through  the 
station  and  all  of  them  were  fed.  Those  who  needed  changes 
of  clothing  were  given  it.  The  Red  Cross  personnel  was 
divided  into  night  and  day  shifts;  everyone  gave  as  much  time 
from  their  own  particular  work  as  possible.  Everyone  wanted 
to  help  in  the  canteen.  We  had  workers  from  the  Friends, 
the  Y.  ]M.  C.  A.,  the  American  Fund  for  French  Wounded, 
British  canteeners  and  many  others.  The  second  night,  five 
thousand  refugees  went  through  and  the  Emergency  Canteen 
became  a  fixture  of  the  Gare  du  Nord. 

A  temporary  barrack  was  built  to  house  the  Emergency  Red 
Cross  Canteen  at  tin;  (lare  du  Nord.  It  took  only  eight  days  to 
erect,  equip  and  put  it  in  running  order. 

Great  need  existcid  for  ternporary  quarters  in  which  the 
refugees  could  spend  a  night.  They  could  not  all  wait  in  the 
stations.  Lcjdgings  and  hotel  accommodations  in  Paris  were 
well  nigh  impossible  to  secure  tliroughout  the  period  of  the  war. 
Moreover,  prices  were  exorbitant. 

In  the  early  days  of  the  war  Lc  Sero^trs;  de  (hicrro  liad  taken 
over  the  old  seminary  of  St.  Sulpice,  05  rue  Bonaparte,  in  the 
Sixth  Arrondissement  and  tlie  police  officers  converted  it  into 
a  model  hospice.  When  tlu^  great  influx  of  refugees  from  tlie 
Aisne  and  Marne  occurred  in  the;  spring  of  1018,  the  American 
Red  Cross  offered  tlie  French  police  assistance  in  the  form  of 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     837 

supplies  and  personnel.  Doctors  and  nurses  and  vast  quantities 
of  linen  and  food  were  sent  to  St.  Sulpice ;  l)eds  were  set  up  in 
every  corner;  halls  and  auditoriums  were  used  for  dormitories, 
nurseries  and  information  bureaus. 

In  his  report  for  June,  11)18,  rej^arding  the  activities  of  the 
Department  of  Civil  Affairs,  Mr.  Homer  Folks  wrote  of  Saint 
Sulpice : 

The  difficult  problem  of  lodging  refugees  who  liad  to  re- 
main in  the  city  overnight  was  solved  by  aiding  Saint  Sul- 
pice, which  since  the  outbreak  of  tlie  war  has  been  used  as  a 
stopping  place  for  soldiers  en  pertnission  and  as  a  refuge  for 
Belgian  and  French  families  made  homeless  by  the  war. 
Beds,  blankets  and  otlier  supplies  in  large  quantities  were 
hurried  from  the  warehouses,  increasing  the  accommodations 
so  that  2500  persons  could  be  housed  at  a  time.  ...  A  hos- 
pital infirmary  of  twenty  beds  was  installed  and  also  a  special 
infirmary  where  babies,  besides  receiving  medical  treatment, 
were  bathed  and  fitt"d  out  with  clean  new  clothing.  Here  an 
average  of  seventy  children  were  cared  for  daily. 

Emergency  canteens  were  also  established  in  the  stations  at 
the  Gares  de  VEst,  Orleans,  Mont  par  nasse,  and  d'Auterlitz  and 
Miss  Ashe  assigned  teams  of  nurses  and  nurses'  aides  to  duty 
there. 

After  a  night's  rest  and  refreshment  in  Paris,  many  of  the 
refugees  continued  on  their  way  southward.  Limoges  was  the 
next  large  city  where  they  stopped,  either  for  rest  or  to  seek 
quarters  and  employment  until  they  could  return  to  their  former 
homes  in  the  invaded  northern  provinces.  Dr.  !May  E.  Walker 
conducted  a  dispensary  there  during  the  sunnner  of  1018  for 
refugees,  but  great  need  also  existed  for  a  children's  hospital. 
A  project  to  (establish  an  institution  of  this  type  was  undertaken 
jointly  in  July,  1918,  by  the  Chiblren's  and  Refugees'  P)ureaus, 
but  difficulties  in  construction  debiyed  its  (Opening  until  I)e- 
cemb(>r.  Dr.  Walker  was  placed  in  charge  of  it  and  V(Mia  ]\1. 
Woods,  an  American  lied  (^rpss  nurse,  was  sent  down  from  Paris 
as  supervisor.     She  wrote: 

Tlie  American  Kod  Cross  Clijldren's  TTos]ntal  at  Liniogos 
was  of  fifty  bed  caparity  and  also  mniiitaiiuMl  n  large  (lis])('n- 
sary  service  for  refuuees.  Between  Xoveinber  fS  and  Hectnu- 
ber  2(1,  we  ])ra(ticallv  fed  and  clothed  three  hundred  families, 
little  children  blue  with  cold  and  sick  from  hunger.    The  city 


838   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

could  not  care  for  all  the  refugees  and  had  it  not  been  for  the 
quickness  with  which  the  Eed  Cross  furnished  first  aid,  manj' 
would  have  died. 

Our  hospital  was  ready  on  December  2G  and  then  our  real 
work  began  and  continued  until  April  1,  1919.  The  Ameri- 
can Ked  Cross  then  gave  50,000  francs  and  the  city  of 
Limoges  raised  50,000,  the  hospital  building  was  purchased 
and  was  operated  as  a  Hospital  for  Children.  The  building 
was  four  stories  high  and  was  fully  equipped — for  instance, 
three  hundred  children's  dresses,  two  hundred  and  fifty 
gowns,  one  liundred  and  fifty  complete  layettes,  three  sheets 
and  other  supplies  in  like  proportions.  Thus  the  work  done 
by  American  mothers  through  the  American  Eed  Cross  will 
not  stop  but  its  influence  will  be  felt  for  years  to  come.^^ 

Xot  onh'  was  our  work  in  Limoges  done  for  the  benefit  of 
French  and  Belgian  refugees,  but  we  supplied  hundreds  of 
sweaters,  mufflers,  socks  and  other  articles  to  American  boys 
returning  from  the  devastated  districts.  Men  of  the  Ameri- 
can Expeditionary  Forces  were  constantly  coming  in  and  we 
never  had  a  meal  without  some  of  them  joining  us.  .  .  . 

Southwest  of  Limoges  was  the  city  of  Angouleme  in  the 
Charente  Department  and  here  the  American  Red  Cross  estab- 
lished and  maintained  an  extensive  dispensary  service  for  the 
many  refugees  who  crowded  the  city.  Dr.  Lillie  Arnett,  the 
American  Red  Cross  physician  who  had  formerly  been  on  duty 
at  Le  dandier,  was  transferred  to  Angouleme.  She  wrote  of 
the  establishment  of  the  dispensary: 

On  August  20,  T  arrived  at  Angouleme  and  met  the 
refugee  delegate,  Mrs.  Goodale,  who  had  been  in  the  city 
since  April.  The  same  day  Drs.  Knox,  Planning  and  Baldwin 
stopped  in  the  city  a  few  hours  on  their  way  to  America  and 
Dr.  Knox  gave  me  his  usual  brief  instructions:  "Open  a 
dispensary  tlic  following  ^londay."  It  was  then  Wednesday. 
I  returned  to  Le  Glandier,  packed,  said  good-by  and  reached 
Angouleme  again  Friday  noon. 

^Irs.  Goodale  had  requisitioned  a  splendid  residence  in  the 
best  location  of  the  city,  biit  the  house  was  absolutely  empty. 
A  cor])s  of  scrub  women  cleaned  it  up,  but  my  hopes  of  open- 
ing on  ]\ronday  were  blasted  because  the  women  were  then  in 
full  pc)ssossioii.  We  did  o])en.  though,  on  Wednesday.  I  had 
piirc'hased    a    few    need(>d    ])harmaceuticals   at   a   local   place. 

"For  details  of  afrrccincnt  bctweon  \h.Q  city  of  TJmofxos  and  llio  Ainori- 
can  I?f'd  Cross  regarding  the  Children's  Hospital,  see  the  Gilder  Report, 
Vol.   Ill,  pp.  79-80, 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     839 

Mrs.  Goodale  sent  in  a  table,  chairs,  towels,  etc.,  and  I  had 
my  own  instruments,  so  Mile.  LeGrand,  my  French  nurses' 
aide,  and  1  went  to  work  and  had  seven  patients  on  our  first 
day. 

The  dispensary  was  conducted  in  a  beautiful  sun-parlor 
about  fifty  feet  long,  with  a  mosaic  floor  and  great  windows 
which  gave  us  ideal  light.  Each  day  saw  an  increase  in  the 
attendance. 

On  September  20,  we  took  in  our  first  hospital  patient,  a 
baby  very  sick  with  indigestion  and  auto-intoxication.  Other 
patients  came  and  our  household  increased.  Each  morning  I 
went  about  the  city  making  calls  and  every  afternoon  con- 
ducted the  dispensary  service.  Our  maximum  daily  attend- 
ance was  thirty-four.  In  all,  we  cared  for  fifty  patients  in 
the  hospital.  We  tried  to  keep  a  cai-d  system  of  the  dispen- 
sary cases,  but  I  could  not  always  get  the  names  of  my  morn- 
ing calls  recorded.     Our  cards  showed  575  patients. 

South  of  xVngoulenic,  Limoges  and  Lyons  lay  the  provinces 
rich  in  agricultural  and  industrial  activities.  To  these  provinces 
the  French  Governnient  sent  large  convoys  of  refugees  to  live 
and  work  until  the  military  situation  permitted  their  return  to 
the  Somme,  Aisne  and  Marne  Valleys. 

Many  of  the  refugees  who  were  assigned  by  the  French  Gov- 
ernment to  these  southern  provinces  were  the  rapatries  whose 
reception  at  Evians-les-Bains  has  already  been  described.  The 
psychology  of  the  rapaUne,  an  important  factor  in  the  refugee 
problem,  was  described  in  a  French  journal : 

After  those  of  the  arrival  at  Evian  who  are  fortunate 
enough  to  have  friends  or  relatives  awaiting  them  and  those 
who  are  sick  and  feeble  are  disposed  of,  there  still  remains  a 
crowd  varying  from  four  hundred  to  six  hundred  ])ersons  wlio 
are  absolutely  without  resources,  ])Ians  or  any  ability  whatso- 
ever to  help  themselves.  They  are  sent  by  a  separate  convoy 
into  the  interior.  The  arrival  at  I*]vian  brings  to  each  train 
the  joyous  certainty  that  it  is  France  that  awaits  them,  that 
they  will  hv  able  to  speak  their  native  tongue  again  and  to 
greet  their  brothers.  The  second  stage  of  their  journey,— 
the  arrival  in  an  unknown  jn'ovince. — often  works  a  reaction, 
a  sensation  of  excessive  melancholia,  caused  ])y  the  idea  of 
being  alone  in  tlxMr  own  country,  so  near  and  yet  so  far  from 
their  homes. 

The  rdpafrif.-^  are  people  from  the  lowlands  of  the  north, 
deseeiulants  for  the  most  part  of  l-'lemish  ancestors.  For 
them.  France  is  svniboli/ed  in  the  lonir  stretches  of  roads  and 


840   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

highways  of  commerce,  populous  villages  and  fields  of  wheat 
and  beets,  the  ground  rich  in  iron,  the  mines,  as  dear  to  them 
as  the  little  Breton  port  into  which  come  red-sailed  boats — 
the  vine-covered  hills  of  Touraine  or  the  Pyrenees  Moun- 
tains. .  .  . 

The  arrival  of  these  people  for  whom  Germany  has  no  use 
.  .  .  has  been  for  the  French  communes,  impoverished  by  the 
drain  of  forty-two  months  of  war,  a  heavy  burden.  Two  epi- 
sodes of  the  villages  of  the  Midi  will  show  this :    La  G 

is  a  little  village  composed  of  a  score  of  thatched  cottages 
situated  far  from  the  main  highway.  The  mayor  is  a 
"reforme."  .  .  .  When  the  first  dozen  rapatries  arrived-  in  his 
commune  and  saw  the  land,  encircled  by  low  hills  and  trav- 
ersed by  deep  valleys  with  here  and  there  small  pieces  of 
fertile  ground,  threaded  with  rocky  roads  along  which 
ambled  on  market  days  droves  of  cattle  and  sheep,  they 
returned  at  once  to  the  city  from  which  they  had  been  sent. 
The  mayor  declared  to  a  Red  Cross  delegate  that  they  had 
only  glanced  at  the  banquet  that  the  little  village  had  pre- 
pared for  them.  Xo  one  was  to  blame.  They  had  done  what 
they  could.  The  rapahnes  had  decided  that  there  was  nothing 
for  them  to  do  there  "and  that  idleness  would  never  help  them 
forget  even  for  a  moment  their  incurable  homesickness  for  the 
plains  of  Flanders ! 

At  T the  mayor  is  an  amiable  man  with  white  hair 

and  of  courteous  manners.  .  .  .  Since  the  beginning  of  the 

war,  T has  organized  five  ambulances,  has  supported 

the  French  Red  Cross  in  the  way  of  gifts  of  sheets,  clothing, 
bed  linen,  etc.,  and  now  came  the  rapatries  and  the  refugees. 
When  the  mayor  found  this  new  duty  thrust  upon  him,  he 
could  not  sleep  for  eight  days.  Xo  place  to  put  them,  no 
work  to  give  them !  The  only  place  available  was  a  hospital 
ward  filled  witli  beds  without  covers !  ^* 

In  nearly  all  the  principal  cities  of  the  southern  departements 
the  Bureau  of  Refugees  and  Relief  sent  delegates  to  establish 
headquarters  for  refugee  relief.  Sometimes  these  delegates 
were  nurses  who  had  had  social  service  training  but  they  were 
generally  social  service  workers.  During  the  summer  of  1918 
there  were  more  than  TO  delegates  and  assistants  and  their 
work  covered  fifty-eight  of  the  sixty-six  uninvaded  departe- 
ments in  France.  The  nature  of  the  service  rendered  by  them 
was  described  by  Katharine  Holmes : 

^  La  Croix-Rrmge  Amrrirainc  ft  />a  Popuhtion  Civile  Francaise,  Jour- 
nal (Ics  Ourraycs  dc  Danufi.  October  1,  1918,  pp.  198-109. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     841 

On  May  1,  1918,  I  went  as  delegate  for  the  Bureau  of 
Refugees  to  the  Department  of  the  Drome  in  southern  France, 
where  twelve  thousand  refugees  had  been  placed.  The  refu- 
gee work  in  that  department  had  already  been  unusually  well 
organized  by  Miss  Dewson,  who  gave  up  that  department  to 
become  zone  delegate.  There  was  a  warehouse  well  stocked 
with  all  the  different  kinds  of  furniture  needed  by  tiie  refugees 
in  starting  new  homes — beds,  tables,  chairs,  bullets,  blankets, 
sheets,  quilts,  stoves,  mattresses,  pillows  and  garden  tools  and 
seeds. 

Cordial  relations  already  existed  with  the  prefets  du  police 
and  the  mayors  and  various  committees  of  French  volunteers 
which  had  already  been  started  in  many  of  the  bigger  towns. 
Coal  was  being  given  out  to  the  needy  and  knitting  to  mothers 
who  wished  to  make  money  at  home.  Plans  were  on  foot  for 
the  establishment  of  an  American  dispensary  which  was  much 
needed. 

My  work  for  the  last  eight  months  has  been  to  carry  on  this 
work  so  admirably  begun  and  to  meet  new  situations  and 
needs  as  they  arose.  About  two  hundred  families  a  month 
have  been  provided  with  the  furniture  necessary  for  the 
establishment  of  a  new  home.  This  has  meant  that  they  have 
also  had  each  one  the  friendly  counsel  and  visits  in  their  home 
of  one  of  our  committees  in  whatever  part  of  the  department 
they  lived.  One  hundred  and  fifty-three  volunteer  French 
"home  visitors"'  whom  we  have  trained  help  us  in  the  Drome. 

Two  American  dispensaries  have  been  started,  one  at 
Eomans  and  one  at  Valence.  .  .  .  They  are  run  by  Dr. 
Wright  of  California  and  two  Eed  Cross  nurses,  ^liss  Freda 
^r.  Caffin  and  ]\Iiss  O'Connell.  They  have  a  staff  of  French 
assistants  who  help  with  the  home  visiting  and  dispensary 
routine.  About  forty  people  are  treated  at  each  day's  clinic 
and  very  careful  work  is  done  by  the  aides  in  following  up 
w^ork  for  all  cases.  On  the  doctor's  order  we  furnish  extra 
food  for  all  those  whose  physical  condition  demands  it.  We 
send  each  month  ten  of  the  most  anemic  children  to  ^liss 
Frick's  country  home  at  Chanay  in  the  mountains  of  Ain. 

Three  playgrounds  were  started  in  the  sunnner,  two  at 
Valence  and  one  at  Komans.  a  crowded  center  for  shoe  manu- 
facturers. This  idea,  new  to  France  .  .  .  was  taken  up  en- 
thusiastically by  the  French.  .  .  . 

One  of  our  most  satisfactory  activities  was  in  finding  sejia- 
rate  lodgings  for  families  who  had  Ix'cn  lionlod  togctlier  in 
the  big  "cfntrcs  dc  truigrs"  where  the  French  were  forced  to 
put  them  on  account  of  their  sud(UMi  and  <)\crwhclniing 
arrival.    The  French  committees  in  the  different  towns  would 


842    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hunt  up  tlie  empty  buildings,  we  would  pick  out  the  families 
most  needing  a  separate  home,  see  that  they  got  permission 
to  leave  from  the  prefet  and  then  send  on  furniture  ^^  in 
advance  so  that  their  home  would  be  ready  for  them.  On 
their  arrival,  our  representative  met  them,  helped  them  with 
their  luggage,  took  them  to  the  mayor  to  secure  bread  tickets, 
and  other  services  of  like  nature. 

The  development  of  playgrounds,  a  project  new  to  the 
French,  was  carried  out  at  Valence.  Six  American  normal 
school  graduates  were  sent  to  Lyons  for  an  intensive  course  and 
then  assigned  to  different  Valence  schools.  So  successful  was 
their  work  that  when  the  American  Red  Cross  withdrew  the 
French  school  authorities  retained  the  services  of  two  of  these 
workers  permanently. 

Miss  Caffin  wrote  of  the  establishment  of  the  Red  Cross 
refugee  dispensary  at  Valence : 

On  May  22  Dr.  Wright  and  I  arrived  at  Valence  and  found 
nothing.  In  twenty-four  hours  a  building  was  located  and 
arrangements  for  having  it  painted  and  having  plumbing 
installed  were  begun.  On  May  31  we  received  our  first 
patient,  a  young  girl  of  twenty  who  had  tuberculosis. 

Our  clinics  were  held  on  Monday  and  Thursday  mornings 
from  nine  to  10  :30  for  children ;  on  ^londays  and  Thursdays 
from  6  to  7 :30  for  tuberculosis  patients  and  men  from 
Valence;  on  Tuesdays  and  Saturdays  from  1:30  to  3  for 
women.  The  infirmieres  made  2492  home  visits  and  visited 
110  patients  in  the  cantonments. 

On  August  29  the  second  dispensary  in  Valence,  at  Bourg 

''  This  single  item  of  furniture  illustrates  one  of  a  wealth  of  interesting 
incidents  which  from  lack  of  space  must  be  omitted  from  this  history. 
When  the  refugees  were  pouring  into  Paris  and  the  southern  provinces, 
Dr.  Devine  asked  the  Finance  Committee  for  some  two  million  francs  with 
which  to  buy  furniture.  The  members  of  the  Committee  responded  with 
the  statement  that  he  would  not  be  able  to  buy  furniture  in  France  and 
that  lack  of  tonnage  made  impossible  its  importation  from  the  United 
States.  He  answered  that  the  refugees  could  not  begin  to  build  even  tem- 
porary homes  without  beds  and  chairs  and  asked  for  a  provisional  appro- 
priation with  which  to  buy  furniture,  provided  it  could  be  secured.  This 
provisional  sum  was  granted  liim. 

Dr.  Devine  then  turned  the  entire  problem  over  to  ^Martha  Spence,  of 
Cleveland,  a  lay  worker,  and  she  and  her  assistants  combed  the  small  shops 
all  over  France,  buying  here  a  half  dozen  chairs,  there  a  bed  or  two.  A 
fahrifjuc  too  small  to  manufacture  war  essentials  yet  large  enough  to  offer 
some  facilities  for  tlie  manufacture  of  simple  furniture,  was  taken  over 
and  it  turned  out  many  tables  and  chairs.  From  this  central  supply,  the 
departmental  delegates  drew  furnitiu'e  for  the  refugees.  This  incident 
is  also  a  pleasing  example  of  women's  ingenuity,  especially  in  the  face  of 
men's  dictum  that   "it   could   not   be  done." 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     843 

de  Peage,  was  opened.  This  dispensary  was  for  all  poor 
children  under  the  age  of  sixteen.  .  .  .  On  closing  the  Ameri- 
can Eed  Cross  work  at  Bourg  de  Peage  the  French  lied  Cross 
took  over  the  work  of  the  dispensary  and  are  continuing  it 
along  the  same  lines.  Arrangements  have  also  heen  made 
whereby  the  Societe  de  Secours  aux  Blesses  Militaires  will  take 
over  the  dispensary  at  Valence,  thus  leaving  our  work  in 
sympathetic  hands.  The  Children's  Bureau  in  cooperation 
with  the  Bureau  of  Refugees  maintained  a  small  hospital  of 
25  beds  for  children  of  Valence. 

The  nvirsing  ssrvice  of  the  Bureau  of  Refugees  was,  like  that 
of  the  Children's  Bureau,  limited  and  largely  curtailed  in  the 
late  spring  and  summer  of  1918  by  the  nursing  needs  of  the 
American  Expeditionary  Forces.  Public  health  and  child  wel- 
fare nurses  were  recalled  from  refugee  dispensaries  and  as- 
signed to  Red  Cross  military  hospitals.  During  the  twenty 
months  between  May  10,  1917,  and  February  28,  1919,  the 
American  Red  Cross  in  France  aided  1,726,354  refugees ;  pro- 
vided 99G  dwellings ;  operated  67  hospitals  and  dispensaries 
where  190,575  refugees  received  medical  and  nursing  service; 
operated  five  dispensaries  jointly  with  the  French,  in  which 
66,419  refugees  were  cared  for;  opened  8  refugee  canteens  and 
in  them  fed  66,419  refugees,  and  operated.  68  workrooms.^** 

The  third  major  phase  of  the  work  undertaken  by  the  Com- 
mission for  France  for  the  civilian  population — and  the  last  one 
of  which  the  nursing  service  formed  a  substantial  and  vital 
part — was  the  work  done  by  the  Bureau  of  Tuberculosis.  Much 
has  been  written  regarding  the  tuberculosis  situation  in  France 
during  the  European  War,  so  the  treatment  of  this  subject  in 
this  history  will  be  brief.  Only  such  phases  of  it  as  touch  upon 
American  Red  Cross  nursing  service  will  be  included. 

Tuberculosis  was  a  potent  foe  of  all  the  Allied  armies  in 
France.  In  1916  the  American  press  published  many  stories, 
some  exaggerated,  others  veracious,  of  the  decimation  of  the 
French  forces  by  this  disease.  Other  armies  suffered  in  much 
the  same  way,  though  little  was  said  regarding  them  save  in 
technical  publications.^'^ 

'""Tlie  Work  of  the  American  Red  Cross  During  tlie  War:  A  Statement 
of  Finances  and  Accomplishments,"  p.  62. 

"See  "Tile  Worl<;  of  tlie  I5ureau  of  Tuberculosis  in  France."  W.  C. 
White:  The  American  Journal  of  the  Medical  t^cienccs,  Vol.  CTA'I.  No.  3, 
p.  41G. 


844.    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

At  the  beginning  of  the  twentieth  century  the  French  De- 
partment of  the  Interior  had  formed  a  permanent  committee 
charged  with  the  problem  of  controlling  tuberculosis.  The 
French  form  of  government  divided  France  into  departments, 
each  department  with  its  several  arrondissements ;  in  every 
arrondissement  was  located  at  least  one  large  city  supporting  a 
general  hospital  of  considerable  size.  Many  of  these  hospitals 
had  special  wards  or  pavilions  for  tuberculosis  cases. 

Following  the  declaration  of  war,  these  and  all  other  existing 
facilities  for  the  care  of  tuberculosis  patients  were  immediately 
utilized  for  tuberculous  soldiers  and  new  and  beneficent  laws 
were  passed  to  supplement  these  provisions.  After  a  year  of 
war,  the  French  Government  established  a  new  and  more  power- 
ful central  committee  to  collect  and  distribute  funds  to  care 
for  discharged  soldiers  suffering  from  tuberculosis  and  also  tx) 
coordinate  the  work  of  the  departmental  committees  which  had 
direct  charge  of  these  soldiers  after  they  had  been  released 
from  hospitals  of  the  Army  and  the  Department  of  the  Interior. 
In  the  third  year  of  the  war,  the  Service  de  Sante  established 
numerous  special  hospitals  for  soldiers  suffering  from  tubercu- 
losis ;  these  were  largely  private  sanatoria,  convents  and  schools 
which  were  requisitioned  and  equipped  as  hospitals.  They  were 
called  Hupitaux  Sanitaires.  In  the  fall  of  1915,  the  Depart- 
ment of  the  Interior  established  a  fund  from  which  thirty 
Stations  Sanitaires  were  maintained  to  receive  soldiers  dis- 
charged from  the  Ilopitaux  Sanitaires  of  the  Army.  This 
fund  was  also  used  to  assist  the  departmental  committees  in  the 
home  care  of  patients  who  had  been  discharged  from  the  Sta- 
tions Sanitaires. 

This  extensive  federal  organization  was  supplemented  by  a 
private  organization  known  as  the  Tuberculeux  de  la  Guerre. 
Mrs.  Edward  Tuck  was  the  president,  Mrs.  Edith  Wharton  the 
vice-president  and  ]\Ir.  Blair  Fairchild  the  secretary.  The 
special  aim  of  the  Committee  was  to  provide  sanatoria  for 
soldats  reformes. 

Late  in  1*.)1G  the  Rockefeller  Foundation  sent  Dr.  Herman 
Biggs,  Health  Ofheer  of  New  York  State,  to  France  to  investi- 
gate the  tuberculosis  situation  and  to  report  whether  or  not  the 
Foundation  should  undertake  an  anti-tuberculosis  campaign 
in  France.  Dr.  Biggs'  report  resulted  in  the  formation  of  the 
Kockefeller  Commission  for  the  Prevention  of  Tuberculosis 
in  France,  with  Dr.   Livinirston  Farrand  as  director  and  Dr. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     845 

James  A.  Miller  and  Dr.  Selskar  M.  Gunn  as  associate 
directors. 

The  members  of  the  War  Council  and  of  the  Commission  to 
France  had  early  felt  that  one  of  the  vital  phases  of  service 
which  the  American  lied  Cross  could  render  lay  in  the  care  of 
tuberculous  soldiers  and  civilians.  Upon  the  creation  of  the 
Department  of  Civil  Atfairs  at  Paris  headquarters,  Mr.  Folks 
appointed  on  August  13,  1917,  as  chief  of  the  lied  Cross  Bureau 
of  Tuberculosis,  Dr.  William  Charles  White,  who  had  come  to 
France  several  months  before  to  serve  as  director  of  the  Tuber- 
culeux  de  la  Guerre.  Dr.  White  was  also  appointed  as  an 
associate  director  of  the  Kockefeller  Commission. 

Elizabeth  Crowell  was  chief  nurse  of  the  Ilockefeller  Com- 
mission for  the  Prevention  of  Tuberculosis  in  France.  Early 
in  the  fall  of  1917,  a  nursing  committee  consisting  of  Miss 
Crowell,  Miss  Russell,  Miss  Ashe  and  Miss  Leete  was  appointed 
by  the  Commission  to  coordinate  the  nursing  activities  of  the 
Rockefeller  Commission  and  the  American  Red  Cross. 

Dr.  White  wrote  of  the  subsequent  alignment  of  work : 

The  first  task  was  a  division  of  labor  between  the  Red 
Cross  and  the  Kockefeller  Foundation,  so  that  their  efforts 
would  contemplate  a  uniformity  of  results.  The  Rockefeller 
Commission  undertook  a  study  of  the  conditions  existing,  the 
provision  of  dispensary  service,  an  educational  campaign  and 
the  selection  of  two  units — one  an  arrondissement  of  Paris 
and  anotlier  a  de])artment  of  France — in  which  it  would  pro- 
vide a  model  organization  to  be  used  as  an  object  lesson  in 
American  methods. 

The  lied  Cross  Bureau  of  Tuberculosis  undertook  the  more 
innuediate  fields  of  the  work,  such  as  the  provision  of  hospi- 
tals, improvements  of  conditions  in  temporary  hospitals,  as- 
sistance to  French  organizations  dealing  with  tuberculosis 
and  a  careful  study  of  the  whole  tuberculosis  situation  in 
France,  which  miglit  be  used  in  conjunction  with  the  Founda- 
tion's work  for  a  permanent  program  and  lasting  evidence  of 
the  work  of  America.^* 

Clara  L.  Shackford  was  the  first  supervising  nurse  of  the 
Bureau  of  Tuberculosis.  A  gTaduate  of  the  University  of 
Pennsylvania  School,  Miss  Shackford  was  for  some  time  super- 
intendent of  nurses  of  St.  Luke's  Hospital.  St.  Louis,  and 
superintcnd(Mit  of  the  John  Scaly  Hospital,  (Talv('st(Ui,  Texas. 

**'"T1k>  Work  of  the  IJureau  of  Tuborculosis  in   Kianci'."   p.  417. 


846    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

She  went  to  France  in  December,  1917,  and  was  appointed  as 
executive  nurse  of  the  Tuberculosis  Bureau.  During  the  spring 
of  1918  she  developed  tuberculosis,  returned  to  this  country 
and  spent  some  months  at  Saranac;  there  the  disease  was  ar- 
rested, and  in  November,  1918,  she  entered  the  Army  Nurse 
Corps  and  was  assigned  to  Camp  Devens. 

For  some  months  Miss  Ashe  carried  the  work  of  the  Tubercu- 
losis Bureau  and  in  October,  1918,  Sarah  Adams  Crawford 
was  appointed  as  supervising  nurse.  Following  her  graduation 
from  the  Framingham  (Massachusetts)  Training  School,  Miss 
Crawford  had  had  executive  experience  in  various  New  Eng- 
land institutions  and  for  three  and  a  half  years  was  superinten- 
dent of  nurses  and  also  dietitian  of  the  Massachusetts  State 
Sanatorium  for  Tuberculosis.  Although  she  was  enrolled  in 
1911,  Miss  Crawford's  first  work  for  the  American  Red  Cross 
began  in  1917,  when  she  taught  classes  in  Home  Hygiene  and 
Care  of  the  Sick.  She  went  overseas  in  the  summer  of  1918 
and  upon  her  return  in  1919  to  the  United  States  did  school 
nursing  under  the  Visiting  Nurse  Association  at  Wilmington, 
Delaware.  She  was  later  appointed  as  a  Red  Cross  public 
health  nurse  for  the  Wilmington  Chapter.  She  died  there  on 
February  7,  1920,  from  double  pneumonia  contracted  in  line 
of  duty. 

Both  Miss  Shackford  and  Miss  Crawford  typify  the  great 
rank  and  file  of  Red  Cross  nurses,  women  who  have  given  the 
best  years  of  their  lives  in  unobtrusive  service  to  others  and 
many  of  whom  have  died  in  harness. 

The  nursing  staff  of  the  Tuberculosis  Bureau  numbered 
about  sixty  nurses.  They  were  chosen  by  National  Head- 
quarters by  reason  of  special  training  and  experience.  Upon 
arrival  in  France  they  reported  to  the  chief  nurse  of  the  com- 
mission and  were  by  her  assigned  to  tuberculosis  work.  Miss 
Ashe  in  her  capacity  of  chief  nurse  of  the  Children's  Bureau 
had  general  supervision  of  this  phase  of  nursing  service  to  the 
civilian  population ;  ]\riss  Stimson's  time  was  almost  entirely 
occupied  with  the  military  service. 

One  of  the  earliest  expressions  of  the  Red  Cross  anti-tubercu- 
losis program  lay  in  the  provision  of  new  beds  in  existing 
French  institutions.  In  1914  the  French  had  undertaken  the 
construction  of  a  model  sanatorium  at  Bligny,  Briis-sous- 
Forges,  near  Paris,  and  had  completed  buildings  in  wliich  two 
hundred  patients  could  be  cared  for.     The  declaration  of  war 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     847 

arrested  further  construction  and  the  timbers  and  structural 
iron  still  lay  on  the  grounds  in  1917  where  the  workmen  had 
left  them  three  years  before.  The  Bureau  of  Tuberculosis 
arranged  for  a  grant  from  the  American  lied  Cross  by  means 
of  which  the  other  buildings  of  the  sanatorium  were  completed 
during  the  spring  of  1918  and  some  three  hundred  and  fifty 
additional  beds  were  thus  made  available.  The  new  pavilions 
of  the  Bligny  Sanatorium  were  staffed  for  a  time  by  American 
Ked  Cross  nurses  and  aides. 

The  Board  of  Managers  of  VHopital  St.  Joseph,  which  was 
located  in  the  Fourteenth  Arrondissement  and  which  was  one 
of  the  largest  and  most  progressive  hospitals  in  Paris,  had  pur- 
chased a  convent  adjoining  the  hospital  buildings,  which  they 
planned  to  reconstruct  to  hospitalize  men  and  women  suffering 
from  tuberculosis.  An  arrangement  was  finally  made  whereby 
the  Ilopital  St.  Joseph  contributed  208,000  francs  and  the 
American  Bed  Cross  285,000  francs  for  this  reconstruction 
work  and  some  two  hundred  and  fifty  additional  beds  were 
thus  secured  in  Paris.  The  American  Red  Cross  later  made 
an  additional  grant. 

The  tuberculous  soldiers  and  reformes  presented  a  picture 
of  genuine  pathos.  ''Xothing  is  sadder,"  stated  the  Annual 
Report,  1918,  of  the  Tuberculosis  Bureau,  ''than  a  ward  of 
tuberculous  reformes.  A  young  soldier  told  us  that  he  was 
alone  in  Paris ;  that  his  parents  had  remained  in  invaded  terri- 
tory ;  that  he  received  no  letter,  no  remembrance  from  anyone. 
He  asked  earnestly  for  some  clothes.  In  giving  this  assistance 
to  him,  wo  know  that  he  will  never  have  the  strength  to  put 
them  on — his  hour  had  come — but  we  hope  to  see  in  his  already 
dim  eyes  a  longing  satisfied."  In  the  same  report  a  reforme 
wrote,  ''We  arc  plague-stricken — nobody  comes  to  see  us.  If 
only  we  had  lost  an  arm  or  a  leg,  then  we  should  have  a  lot  of 
people  around  us.     We  are  the  badly  wounded  of  the  war." 

The  Assistance  Puhlique  of  Paris  had  constructed  seven  sets 
of  barracks  in  connection  with  large  hospitals  and  almshousea 
of  the  city,  with  a  potential  capacity  of  1052  beds,  but  only 
174  of  these  bods  wore  in  general  use.  The  American  Red 
Cross  completed  necessary  construction,  added  diet  kitchens 
and  recreation  rooms,  su])pli(Ml  additional  clothing,  bod  covers 
and  flowers  and  brightened  up  the  general  aspect  of  tlio  wards; 
the  number  of  patients  was  as  a  result  increased  to  ^57.  Ameri- 
can Red  Cross  nurses  were  assigned  to  duty  in  these  barracks 


848   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  the  non-professional  phases  of  the  work  were  directed  with 
marked  success  by  Mile.  Moufflard,  a  French  woman.  In  addi- 
tion to  affording  an  increased  number  of  beds  for  reformes, 
these  barracks  also  afforded  hospitalization  to  tuberculous 
rapatries  and  refugees. 

Hopital  Benevole  lO"'^  was  a  small  hospital  of  twenty-eight 
beds  which  was  operated  in  Paris  by  the  American  Red  Cross 
for  French  soldiers  in  the  incipient  stages  of  tuberculosis. 

Financial  assistance  was  given  by  the  Bureau  of  Tubercu- 
losis to  many  other  French  institutions.  On  April  15,  1916, 
V Hopital  Ormesson,  a  hospital  for  tuberculous  children,  had 
undertaken  the  care  of  150  tuberculous  soldiers.  The  Service 
de  Sante  in  return  for  this  hospitalization  gave  the  institution 
an  allowance  per  patient  of  three  francs  a  day,  but  a  deficit  of 
nearly  10,000  francs  a  month  had  resulted  from  this  arrange- 
ment. L'Hopital  Ormesson  consequently  notified  the  French 
Army  that  the  beds  would  have  to  be  discontinued.  This  fortu- 
nately did  not  happen,  as  the  American  Red  Cross  agreed  to 
appropriate  the  necessary  funds. 

Assistance  of  this  type  was  also  given  to  Mile.  Chaptal  for 
the  development  of  a  hospital  of  forty  beds  for  tuberculous 
women.  To  the  Sanatorium  Lege,  the  departmental  institution 
of  the  Gironde,  two  hundred  thousand  francs  were  given.  To 
the  Societe  de  Secours  aux  Blesses  Militaires  a  similar  gift 
was  made  which  was  added  to  a  fund  of  one  hundred  and  fifty 
thousand  francs  furnished  by  this  organization ;  the  aggregate 
sum  was  used  to  purchase  a  property  at  Tours  for  a  depart- 
mental sanatorium  of  the  Indre-et-Loire.  A  total  of  847  insti- 
tutions for  the  care  of  tuberculosis  cases  were  aided  by  the 
American  Red  Cross  during  the  European  War  and  a  total  of 
2078  new  beds  were  added  to  already  existing  organizations.^'^ 

Early  in  the  summer  of  1917  the  organization  Les  Tuhercu- 
leux  de  la  Guerre  had  undertaken  to  remodel  the  Chateau  de 
la  Fontaine  Bude  at  Yerres,  near  Paris,  as  a  tuberculosis  sana- 
torium. \Vhen  the  American  Red  Cross  took  over  the  activities 
of  this  organization,  it  carried  on  the  work  contemplated  at 
Yerres  and  there  maintained  80  beds  for  French  men  civilians 
in  the  early  stages  of  the  disease.     Mary  C.  Ewing,  a  social 

^  "The  Work  of  the  American  Red  Cross  during  the  War :  Finances  and 
Accomplishments."  p.  64.  For  a  list  of  these  institutions,  see  Annual 
Report,  July  1,  1918.  of  the  Bureau  of  Tuberculosis,  p.  22,  Chart  4,  sup- 
plements 1-10.     Red  Cross  Library. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    84.9 

service  worker  and  a  nurses'  aide,  organized  the  sanatorium 
at  Yerres.  She  arrived  in  Paris  in  November,  1917,  to  work 
under  the  auspices  of  Les  Tuherculeux  de  la  Guerre  and  was 
immediately  sent  up  to  Yerres.     She  wrote: 

In  this  hospital,  we  eventually  had  ten  French  nurses  and 
the  original  plan  was  to  make  it  as  nearly  like  a  French  hos- 
pital as  possible.  All  our  patients  were  Frenchmen,  save  for 
a  few  American  soldiers.  The  hospital  was  opened  the  middle 
of  January,  but  from  about  December  l"2th  I  thad  been  the 
only  American  there,  so  you  might  well  say  that  I  assisted  in 
the  equipment  of  the  hospital  and  in  establishing  the  routine 
which  was  afterwards  carried  out. 

Miss  Ewing  was  next  assigned  to  Miss  Leete's  staff  at  the  Tent 
Hospital,  was  later  placed  in  charge  of  the  various  nurses' 
homes  in  and  near  Paris  and  finally  went  to  Koumania  with 
Miss  Patterson.  Her  service,  a  long  and  responsible  one,  is 
typical  of  that  of  many  American  laywomen  who  served  in  a 
semi-nursing  and  executive  capacity  with  the  American  Red 
Cross  Nursing  Service  in  France,  but  who  were  classed  as  aides 
because  they  were  not  professionally  trained  nurses.  Of  Miss 
Ewing,  Miss  Leete  wrote :  "She  came  to  No.  5  before  it  was 
opened  and  slie  remained  there  until  the  line  w^as  far  enough 
removed  from  us  so  that  the  responsibilities  were  not  so  gi-eat. 
She  first  took  charge  of  the  kitchen  and  when  that  was  turned 
over  to  the  x\rmy  cook  she  took  charge  of  the  diet  kitchen  and 
later  of  the  nurses'  home  and  the  doctor's  quarters.  When  off 
duty  she  went  into  the  wards.  She  rendered  unusually  effect- 
ive service,  fitting  herself  into  any  department  which  required 
assistance." 

Even  greater  than  the  need  for  hospitalization  for  tubercu- 
lous soldiers  was  that  for  tuberculous  rapatries,  refugees  and 
members  of  the  French  civilian  population.  All  the  private 
sanatoria  and  wards  of  the  Assistance  Puhlitjue  were  being 
utilized,  it  will  be  remembered,  principally  for  tuberculous 
soldiers  and  reformes.  The  Bureau  of  Tuberculosis  chose  the 
two  largest  cities  in  France,  Lyons  and  Paris,  as  the  theater  of 
activities  in  their  behalf  and  established  in  each  of  these  cities 
large  hospitals  and  sanatoria  for  tuberculosis  patients. 

Lyons,  immediately  behind  I^]vian-les-Bains.  was  tlu^  first 
stopping-place  of  the  rapatries.  The  General  Hospital  P)oard 
of  Lyons  had  in  its  possession  a  central  building  given  to  Them 


850    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

by  the  Empress  Eugenie  and  they  turned  it,  and  five  newly 
erected  barracks  adjacent  to  it,  over  to  the  American  Red  Cross 
early  in  the  fall  of  1917  for  use  as  a  tuberculosis  hospital  for 
women  and  children  rapatries.  The  Hospital  Board  provided 
all  equipment,  linen,  food  and  other  articles  and  factors  of 
maintenance ;  the  American  Red  Cross  paid  a  per  capita  rate 
per  patient  to  the  Hospital  Board,  for  which  the  French  Gov- 
ernment partially  reimbursed  the  American  Red  Cross.  The 
Bureau  of  Tuberculosis  supplied  all  medical  and  nursing  serv- 
ice and  medical  supplies.  The  hospital,  which  was  called  the 
Asile  Ste.  Eugenie,  was  opened  on  December  5,  1917,  and  on 
the  first  of  April,  1918,  was  maintaining  beds  for  one  hun- 
dred and  twenty-eight  patients.  This  hospital  worked  in  close 
cooperation  with  the  children's  hospitals  and  convalescent 
homes  developed  at  Lyons  by  Miss  Nelson,  Miss  Butler  and 
Dr.  Grulee. 

Madelaine  Evans  was  the  first  chief  nurse  at  the  Asile  Ste. 
Eugenie.  She  was  loaned  to  the  Tuberculosis  Bureau  by  the 
Army,  but  only  for  three  months,  and  was  recalled  to  her  unit. 
Base  Hospital  No.  2,  early  in  March,  1918.  Anne  Carney 
was  then  placed  in  charge  of  the  nursing  service  at  the  Asile. 
Her  staff  consisted  of  one  American  nurse,  three  Swiss  nurses 
and  one  French  aide.  Lieut,  (later  Major)  G.  L.  Bellis,  who 
had  been  transferred  in  September,  1917,  from  Colonel 
Winter's  staff,  was  in  charge  of  the  hospital  and  later  directed 
an  extensive  dispensary  service  at  Lyons  for  tuberculous  rapa- 
tries and  refugees. 

The  lieadquarters  of  this  dispensary  service  was  at  87  Cours 
Gambetta.  Lillian  Bell  Stuff  was  the  public  health  nurse  in 
charge  and  she  was  assisted  by  a  Swiss  nurse  and  an  American 
nurse.  An  idea  of  the  cooperation  which  existed  between  all 
bureaus  of  the  American  Red  Cross  organization  in  Lyons  is 
contained  in  the  following  statement  written  by  Miss  Stuff: 

Our  daily  routine  consisted  of  dispensary  duty,  of  visiting 
sick  refugees  in  their  liomes  and  instructing  them  in  sanita- 
tion, of  furnishing  lielp  wliere  needed  for  bedside  care  in 
advanced  cases  and  of  arranging  for  ambulances  to  take  them 
to  hospitals  if  hospitalization  was  considered  necessary. 
When  patients  were  found  poorly  nourislied.  the  physician  in 
charge  of  the  dispensary  ordered  food  supplies  such  as  cocoa, 
sugar,  pnuies,  rice,  canned  milk  and  macaroni  and  these  were 
furnished  by  the  American  lied  Cross.     Lnsuitable  housing 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    851 

condition?  were  reported  to  the  Bureau  of  Refugees  and  co- 
operation with  all  other  departments  of  Eed  Cross  service  was 
established  wherever  it  was  needed. 


This  dispensary  was  transferred  on  December  1,  1918,  to  the 
Rockefeller  Foundation.  Like  many  other  American  Red 
Cross  hospitals  and  dispensaries,  it  also  served  individual  sol- 
diers of  the  American  Expeditionary  Forces. 

At  Plessis-Rohinson,  six  miles  from  Paris,  the  Tuberculosis 
Bureau  established  the  largest  of  its  institutions,  the  Edward 
T.  Trudeau  Sanatorium.  Previous  to  1914,  the  Department 
of  the  Seine  had  purchased  two  chriteaux,  Hachette  and  Mala- 
bry,  which  were  located  just  outside  the  city:  on  these  estates, 
houses  for  working  people  were  to  be  constructed  under  a  plan 
known  as  the  ''Garden  City  Plant."  The  declaration  of  war 
arrested  the  development  of  the  project,  but  its  originator, 
Henri  Sellier,  was  so  interested  in  the  tuberculosis  problem 
that  he  offered  the  two  estates,  rent  free,  to  the  Bureau  of 
Tuberculosis. 

The  two  chateaux  and  their  adjacent  buildings  and  grounds 
covered  one  hundred  and  fifty  acres.  Reconstruction  work  was 
begun  in  aSTovember,  1917,  by  a  group  of  British  and  American 
Friends  working  under  the  direction  of  Dr.  James  L.  Gamble, 
of  Johns  Hopkins  Hospital.  Four  additional  houses  of  con- 
siderable size  were  secured  in  the  vicinity  and  on  Christmas 
Day  the  first  patients  were  admitted — three  refugees  suffering 
with  tuberculosis.  The  institution  was  named  after  the  pioneer 
expert  in  tuberculosis,  Dr.  Trudeau,  an  American  of  French 
origin  whose  name,  the  Commission  hoped,  would  help  estab- 
lisii  a  bond  of  unity  and  s\inpathy  between  the  two  nations. 

The  Trudeau  Sanatorium  was  soon  developed  into  a  model 
project  for  tli(>  treatment  of  tuberculosis.      Dr.  White  wrote : 

The  future  plans  for  this  whole  property  eontem})late  the 
following  (lilfcrent  ij;roiipings  of  {)eo])le :  a  sanatorium  for 
women;  a  detention  house  for  entering  children;  a  hospital 
for  tuberculous  children;  a  preventorium  for  children  of 
tuberculous  parents;  a  colony  for  families  with  a  tuberculous 
member  from  which  the  sick  one  cannot  be  separated.  With 
the  completion  of  the  ])roject.  approximately  two  thousand 
persons  in  which  tuberculosis  is  a  common  factor,  will  be  cared 
for.  The  work  is  b(>ing  carried  out  in  cooperation  with  the 
Department  of  the   Interior  of  the   French  (lovernnient.  the 


852   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

dispensary  service  is  of  the  Eockefeller  Foundation  and  our 
own  Hospital  Admission  Bureau.*" 

Inez  Louise  Cadel,  a  Johns  Hopkins  graduate,  was  head 
nurse  of  the  Trudeau  Sanatorium,  until  the  military  crisis  in 
May,  1918,  made  necessary  her  assignment  to  the  Auteuil  Tent 
Hospital.  In  March,  1918,  the  nursing  staff  at  Plessis-Robin- 
son  numbered  five  American  Red  Cross  nurses,  one  graduate 
English  nurse,  one  graduate  Australian  nurse,  one  French 
nurse  and  two  American  Red  Cross  nurses'  aides. 

The  Women's  Hospital  accommodated  some  eighty  patients, 
the  Children's  Hospital  about  seventy.  Miss  Crawford,  second 
supervising  nurse  of  the  Tuberculosis  Bureau,  wrote  of  the 
observation  hospital: 

The  patients  are  assigned  to  us  through  the  Paris  dispen- 
saries. About  thirty  children  are  admitted  at  a  time  to  a 
building  quite  distant  from  the  hospital  and  there  they  are 
kept  for  about  two  weeks.  During  this  time  they  receive  the 
necessary  attention  from  our  dentist  or  our  throat  specialist 
and  they  are  under  the  constant  observation  of  the  doctor 
and  nurse.  At  the  end  of  two  weeks,  they  are  either  trans- 
ferred to  the  Children's  Hospital  or  to  the  Preventorium  and 
thirty  more  children  are  brought  in  to  the  Eeceiving  Hospi- 
tal. AVe  have  children  of  all  ages  at  the  hospitals,  babies  and 
children  to  ten  years  of  age,  but  the  older  ones  are  transferred 
to  the  Preventorium  as  soon  as  possible. 

In  some  cases  we  will  have  the  mother  at  the  Women's 
Sanatorium  and  her  children  in  the  Children's  Hospital  and 
in  the  Preventorium. 

One  of  the  American  Red  Cross  nurses  who  was  assigned  to 
the  Children's  Hospital  was  Laura  Blanche  Bingham.  She 
wrote : 

I  went  to  Chateaux  Hachette-Pobinson  on  August  16, 
191 S.  for  general  duty  at  the  Children's  Hospital.  There  our 
work  was  arduous,  but  we  were  all  willing  to  do  our  bit  for 
those  half-starved  suffering  children  of  France.  Wo  began 
bathing  children  at  eight  o'clock  in  the  morning;  next  came 
medical  treatment,  surgical  dressings,  irrigations,  massage 
and   bandaging.      Then    all   patients   were   carried   outdoors, 

^'"Work    of   the    liiiri-au    of    Tuberculosis    in    France,"    Dr.    White.     The 
American  Journal  of  the  Medical  Hcicnces,  Vol.  CLVI,  No.  3,  p.  423. 


A  tuberculous  refugee  child  who  died  in  an  American  Red  Cross  children's 
liospital  in  France. 


A    c'hiia    who   lived. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     853 

some  on   their   beds,  others   in   chaises-longues.     We  nurses 
were  assisted  by  Frencli  maids. 

We  had  eight  bottle-fed  babies,  each  of  whom  had  six 
bottles  apiece,  so  forty-eight  bottles  to  be  sterilized  every  day 
is  quite  a  task.  We  were  terribly  understaffed  all  summer 
and  the  work  at  times  seemed  overwhelming,  but  we  loved  the 
children.  During  those  strenuous  months  of  August  and 
September,  bombing  raids  were  of  daily  occurrence  and  the 
effect  of  them  on  those  little  mites  was  terrorizing.  One 
night  we  had  a  tremendous  thunderstorm.  In  one  moment, 
it  was  pandemonium  let  loose;  they  thought  the  thunder  was 
the  Boclie  again.  The  panic  among  the  little  ones  during  our 
last  hideous  raid  in  September  was  pitiful. 

South  of  Paris  lay  the  old  city  of  Blois  and  here  the  Tu- 
berculosis Bureau  established  a  small  Women's  Hospital,  of 
seventeen  beds.  A  large  Franco-American  dispensary  located 
here  was  also  maintained  by  Dr.  White's  bureau. 

To  sumnuirize,  the  Ilopital  Benevole,  19  his,  at  Paris;  the 
Edith  Wharton  Sanatorium  at  Ycrres ;  the  Asile  8te.  Eugenie 
at  Lyons ;  the  Edward  Trudeau  Sanatorium  at  Plessis-Robin- 
son  near  Paris ;  and  the  small  Women's  Hospital  at  Blois  were 
the  hospitals  maintained  by  the  Bureau  of  Tuberculosis  for  the 
civilian  population.  These  hospitals  provided  G()75  beds  and 
nuiintained  17'2,\)A:-2  patient  days.  The  two  American  Red 
Cross  dispensaries  for  tuberculosis  were  those  located  at  Lyons 
and  at  Blois. 

The  Bureau  of  Tuberculosis  developed  extensive  co<")peration 
with  the  Rockefeller  Foundation  in  its  two  model  demonstra- 
tions. The  joint  dispensaries  of  the  two  organizations  in  the 
Nineteenth  ArrondissenuHit  in  Paris  have  been  described.  In 
the  Department  Kure-et-Loir,  the  Rockefeller  Foundation  with 
assistance  from  the  American  Jied  Cross  maintained  tuberculo- 
sis dispensaries  at  Chai'tres,  Chateaudun,  Dreux,  St.  Ivcniy- 
sur-Avre  and  Nogent-le-Rotron.  The  Bureau  of  Tuberculosis 
provided  hospital  facilities  at  Dreux,  at  Chateaudun  and  at 
Chartres  for  advanced  cases. 

The  two  organizations  also  carried  on  an  extensive  anti- 
tuberculosis and  infant  welfare  campaign.  Three  traveling 
eqiiipcs  were  organized  and  sent  out  through  the  various  de- 
partnu'uts.  Dr.  Frances  Sage  Bradley  was  at  one  time  in 
chary-e  of  t)ne  of  these  units.     She  wrote: 


854    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

This  equipe  consisted  of  an  advance  agent  who  arranged 
dates  and  suitable  publicity,  secured  a  building,  hotel  accom- 
modations, etc. ;  a  speaker  from  each  organization ;  a  young 
woman  who  gave  practical  demonstrations  of  bathing  the 
baby;  a  mechanician.  The  exhibit  material  included  several 
cinema  on  tuberculosis  and  the  care  of  children ;  a  series  of 
panels  on  each  subject;  a  small  model  of  tuberculosis  dis- 
pensary and  a  life-sized  baby  doll  used  for  the  bathing  demon- 
stration; and  much  literature  for  distribution. 

American  Red  Cross  nurses  were  assigned  to  this  publicity 
work  until  the  military  crisis  of  1918  made  necessary  their 
withdrawal  and  reassignment  to  Red  Cross  emergency  hos- 
pitals. Then  visiteuses  d'enfants  or  French  nurses  carried  on 
the  nursing  demonstrations. 

The  Bureau  of  Tuberculosis  undertook  extensive  relief  work 
for  tuberculosis  patients  among  the  colonies  of  Serbian  refugees 
in  France.  The  American  Red  Cross  also  provided  liospitaliza- 
tio2i  for  acute  cases  among  the  American  Expeditionary  Forces. 

The  fourth  principal  bureau  of  the  Commission  for  France 
was  the  Bureau  of  the  War  Zone,  which  provided  material 
relief  of  civilians  still  living  in  the  fighting  zones  and  assisted 
in  making  possible  the_  return  of  refugees  to  the  devastated 
regions  and  the  areas  evacuated  by  the  forward-moving  Allied 
troops.  The  fifth  and  last  bureau  of  the  Paris  headquarters 
was  the  bureau  for  the  Reeducation  of  French  Mutiles.  The 
American  Red  Cross  Xursing  Service  did  not  share  in  the 
activities  of  either  of  these  two  bureaus. 

Italy  declared  war  on  Austria-Hungary  on  May  23,  1015. 
The  American  Red  Cross  immediately  ofl'ercd  to  her  the  serv- 
ices of  a  unit  of  surgeons  and  nurses,  as  it  had  to  the  other 
belligerents,  but  the  offer  was  declined.  George  B.  ^IcClellan, 
one  time  mayor  of  Xcw  York  City,  described  in  a  personal 
letter  addressed  May  27,  1015,  to  ]\Iiss  Boardman  and  Miss 
Delano,  the  popular  feeling  then  prevalent  in  Italy: 

There  seem  to  be  very  few  trained  nurses  (in  our  sense)  in 
the  country.  Since  the  Avar  began  last  August,  most  of  the 
Italian  women  have  taken  .  .  .  courses  in  mirsing.  All  are 
called  I'ed  Cross  nurses  and  are  very  enthusiastic  ami  willing. 

The  work  at  the  actual  front  is  to  be  done  by  men.  but  the 
hospitals  bcliind  the  lines  and  in  tlie  base  are  to  be  stalfed  by 
the  few  real  trained  nurses  there  are  and  bv  these  amateurs. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    855 

...  I  have  talked  with  a  great  number  of  Italians  and  with 
a  few  Americans  who  know  Italy.  With  one  accord,  they 
have  all  discouraged  the  idea  of  sending  American  and  Eng- 
lish nurses  to  Italy  at  the  ])resent  time.  The  Italians  do  not 
want  our  help.  They  are  convinced  that  they  are  quite  able 
to  take  care  of  themselves  and  do  not  want  us  to  send  them 
either  nurses,  surgeons  or  advice.  All  agree  that  supplies  will 
be  welcome. 

The  nursing  system  in  Italy  resembled  in  many  respects  that 
which  prevailed  in  France  and  other  continental  countries. 
The  Sisterhoods  had  many  nursing  members.  These  nuns  were 
seldom  trained  according  to  the  Nightingale  system,  but  long 
experience  had  made  them  able  administrators  and  skilled 
nurses.  They  gave  medicines,  assisted  in  the  operating  rooms 
and  had  general  supervision  of  the  wards ;  but  they  did  very 
little  bedside  nursing  and  they  rarely  nursed  men. 

The  economic  advantages  of  this  type  of  nursing  service  were 
summarized  by  ^Mary  S.  Gardner,  a  pioneer  American  public 
health  nurse  who  in  1918  undertook  a  special  mission,  to  be 
described  later,  for  the  American  Rod  Cross  in  Italy : 

Their  employment  offers  a  number  of  advantages;  per- 
haps most  im[)ortant  is  the  fact  that  the  spirit  of  service 
actuates  their  work.  It  is  also  an  inexpensive  and  convenient 
form  of  nursing  service,  for  if  a  religious  order  staffs  a  hospi- 
tal the  management  is  at  no  further  trouble.  There  is  usually 
an  adequate  STi])])ly  and  if  one  nun  is  sick  another  appears  to 
take  her  place  innnediately.  The  complete  laicization  in  Italy 
would  undoubtedly  be  a  calamity.  It  would  seem  wise  to 
offer  a  better  and  more  general  training  to  nuns.  Even 
though  a  secular  body  of  trained  nurses  may  later  be  de- 
velo])ed,  the  nuns  must  continue  to  occupy  an  important  place 
in  the  nursing  economy  of  the  country. 

Monks  also  care  for  the  sick.*'^ 

The  actual  bedside  nursing  of  the  patient  was  left  to  un- 
trained attendants  of  the  servant  ty])e,  called  inferm'wre.  Of 
this  type  of  nurse  !Miss  Gardner  wrote : 

This  group,  a  large  one.  presents  few  possibilities  for  im- 
provement. Hours  of  work  are  too  long,  living  conditions 
too  hard  aiul  salaries  too  low  to  attract  a  fine  ty}ie  of  woman. 

^^  General  Report  of  tlie  Commission  for  Tuberculosis.  American  Red 
Crop;*  in  Italy,  pp.  40-r)0. 


856   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nor  does  the  work  stimulate  ambition.  The  doctors  give  most 
of  the  treatments  usually  given  by  nurses  in  England  and 
America  and  little  attempt  is  made  either  to  increase  the 
skill  of  the  infermiere  or  to  secure  a  type  of  woman  capable  of 
such  improvement.  It  may  be  generally  stated  that  few 
infermiere  would  be  capable  of  receiving  a  nurse's  training, 
even  were  requirements  reduced  to  the  lowest  possible  mini- 
mum. One  unfortunate  custom  also  prevails  which  is  de- 
moralizing to  the  infirmieras  ethical  standard  and  which  does 
much  to  prevent  a  uniform  and  disinterested  care  of  the  sick. 
In  many  hospitals  fees  are  taken  by  infermiere,  which  inevi- 
tably leads  to  neglect  of  the  poorer  patients  who  are  unable 
to  "tip"  their  nurses.  The  infermiera  may  perhaps  have  a 
place  in  the  economy  of  hospital  management,  but  she  can  be 
looked  upon  as  nothing  but  an  unmixed  evil,  if  regarded  as  a 
substitute  for  a  graduate  nurse  or  pupil  of  a  well  adminis- 
tered training  school. 

Nursing  is  also  done  by  men  infermieri,  who  are  of  about 
the  same  type  as  the  women.*^ 

The  infermiere  were  organized  into  a  "union"  called  the  Asso- 
ciazione  Nazionale  Italiana  tra  Infermiere,  with  headquarters 
at  Rome. 

Midwifery  was  in  a  much  more  advanced  stage  in  Italy  than 
in  the  United  States.  Every  midwife  was  required  by  law  to 
have  had  two  years  of  training  and  one  year  of  practice  before 
she  was  permitted  to  follow  her  profession.  "In  some  of  the 
small  towns,  particularly  in  Tuscany,"  wrote  Miss  Gardner, 
"midwives  act  as  operating-room  nurses." 

The  modern  profession  of  nursing,  as  developed  to  a  high 
degree  in  the  British  Empire  and  in  the  United  States,  was 
non-existent  in  Italy.  Very  few  foreigii-trained  nurses  were 
there  and  practically  no  modern  training  schools  had  been  es- 
tablished. Potent  economic  and  social  factors  were  at  the 
bottom  of  this  situation. 

"Many  have  said,"  Miss  jSJ'oyes  often  affirmed,  "that  thirty 
years  ago  in  the  United  States  girls  entered  schools  of  nursing 
for  three  principal  reasons :  to  forget  personal  sorrow ;  to  bet- 
ter their  matrimonial  prospects;  or  to  earn  their  living  in  the 
only  way  then  open  to  women  except  school-teaching." 

Three  similar  reasons,  however,  cannot  be  said  to  have  in- 
fluenced Italian  girls  to  become  professional  nurses.  As  for 
Miss  Xoves'  first  reason,  Italian  women  who  wished  to  forget 
*^  General    Report  of  the  Commission   for  Tuberculosis,  p.   50, 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    857 

personal  sorrow  in  altruistic  service  entered  the  nursing  Sister- 
hoods. As  for  Miss  Noyes'  second  reason,  Italian  girls  did  not 
consider  becoming  nurses  to  better  their  social  condition 
through  advantageous  marriage  because  the  social  position  of 
infermiere  was  inferior  to  that  occupied  by  student  nurses  in 
American  schools  of  mirsing.  Infermiere  were  classed  as 
servants  and  young  Italian  physicians  were  not  apt  to  chose 
their  brides  from  among  them.  In  the  United  States,  student 
nurses  occupied  a  status  which  placed  them  on  social  equality 
with  the  internes  in  tlu;  hospital.  As  to  !Miss  Noyes'  third 
reason,  nurses  in  Italy  received  a  wage  similar  to  that  of  the 
servant  classes,  not  the  thirty-five  dollars  a  week  and  more 
which  American  nurses  received  for  highly  trained  service. 

These  economic  and  social  conditions  which  existed  in  Italy 
greatly  inhibited  the  development  of  a  professional  nursing 
personnel.  In  addition,  "the  hospital  authorities,"  wrote  Miss 
Gardner,  "are  not  hospitable  to  the  training-school  idea.  It  is 
considered  too  expensive  a  form  of  nursing  and  a  woman  super- 
intendent with  proper  authority  is  thought  undesirable.  Even 
were  plenty  of  pupils  available,  few  hospitals  are  ready  to  open 
schools  to  receive  them.   .  ,  ."  "^^ 

Italian  military  nursing  service  was  largely  intrusted  to  the 
volunteer  nurses  of  the  Croce  Rossa  Italiana,  the  Scuola  Sa- 
maritana  and  similar  patriotic  organizations. 

The  Italian  Ived  Cross  maintained  a  large  body  of  volunteer 
nurses  whose  training  covered  intermittently  a  period  of  three 
years.     ]\[iss  Gardner  described  the  courses : 

In  the  first  year  not  less  than  twenty  lessons  and  at  least 
one  montli  in  the  hospitals  with  eight  hours'  daily  duty  are 
required.  In  the  second  year  not  less  than  twenty  lessons 
and  at  least  one  month  in  tlie  hosj)ital  or  amhulaiorio  are 
required.  The  third  year  is  a  repetition  of  tlie  second.  Tlie 
second  and  third  year  may,  under  certain  conditions,  be  com- 
bined. Diplomas  are  given  after  theoretical  and  practical 
examinations.  Nurses  holding  diplomas  must  have  at  least 
two  months'  experience  in  a  hospital  each  year,  otherwise  their 
grade  is  lost.  .  .  .** 

The  Scuoln  Samarifana  oflFered  two  courses,  one  in  First  Aid, 

which  was  composed  of  tliirty  lessons  and  covered  a  period  of 

"(u'Tipral   Report  of  tlio  Commission  for  Tuborculosis,   p.    ~)\. 
**  Ihid.,  p.  52. 


858    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

two  months,  and  another  in  nnrsing  the  sick  and  wounded, 
which  inchided  fifty-four  lessons  and  covered  six  months.  The 
instructors  who  gave  these  courses  were  volunteers  and  any 
person,  either  man  or  woman,  could  take  them  upon  the  pay- 
ment of  a  small  fee. 

The  Italian  volunteer  nurses  were  both  devoted  and  able, 
as  may  be  seen  from  a  letter  written  February  4,  1918,  to  Miss 
Xoyes  by  Sara  E,  Shaw,  then  representative  of  the  American 
Red  Cross  Nursing  Service  in  Italy: 

The  people  of  northern  Italy  are  very  capable  and  their 
organization  is  really  wonderful.  They  are  proud — and  justly 
so — of  what  they  have  done,  but  their  nurses  are  also  keenly 
interested  in  new  methods.  .  .  .  The  Italian  women  make 
splendid  nurses.  The  volunteers  really  work  and  after  two 
years  of  steady  service  are  almost  "'trained  nurses."  A  defi- 
nite time  schedule  is  kept  for  each  volunteer  on  duty  so  they 
give  really  long  hours  of  service.  Their  hearts  are  in  the 
work. 

It  is  very  important  that  our  nurses  who  come  here  should 
not  be  critical.  We  need  most  capable  women  for  this  service, 
nurses  wlio  can  do  not  only  the  technical  skilled  work  but 
women  of  good  personal  appearances.  Our  nurses  are  watched 
with  critical  eyes.  .  .  .  Knowledge  of  Italian  is  almost 
imperative. 

Three  hospitals  maintained  upon  the  British  and  American 
system  were  mentioned  in  letters  and  reports  to  National  Head- 
quarters from  American  Red  Cross  nurses  in  Italy.  One  w^as 
at  Florence  and  was  directed  by  an  English  nurse.  Miss  Baxter. 
A  small  American  hospital  had  also  been  organized  and 
financed  at  Florence  by  an  American  teacher.  Miss  Sheldon. 
The  third  was  the  Ospedale  Yolanda  at  Milan,  which  had  ten 
pupil  nurses. 

Previous  to  1017  the  American  Bed  Cross  conducted  practi- 
cally no  relief  activities  in  Italy.  During  the  summer  of  that 
year  the  collapse  of  Russia  permitted  the  transfer  of  many 
German  divisions  from  the  eastern  to  the  western  and  southern 
theaters  of  war.  On  October  21,  1017,  the  Austrian  forces, 
reenforced  by  tlie  Germans,  struck  at  the  Italian  lines  on  the 
northeastern  boundaries  of  Italy,  broke  through  at  Plezzo  and 
Tolmino,  took  Udine  on  October  30  and  were  advancing  on 
to  the  Venetian  phiins.  The  Italian  Army  withdrew  to  the 
Fiave  River  and  tlicrc  durinir  November  and    I)eceml)er  dog- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    859 

gedlj  held  strong  defensive  positions  in  some  of  the  bitterest 
and  most  gallant  lighting  of  the  European  War. 

The  Italian  Retreat  to  the  Piave  River  in  the  fall  of  1917, 
caused,  however,  the  evacuation  of  the  civilian  population  from 
the  entire  northeastern  thumb  of  Italy.  Half  a  million  refu- 
gees fled  in  complete  demoralization  to  the  central  and  southern 
provinces  and  to  Sicily.  From  the  invaded  territory  went 
208,213  refugees ;  from  the  areas  cleared  for  the  new  lighting 
zone  went  87,552  others  and  from  the  districts  in  constant 
danger  from  enemy  air  raids  went  131,009  more.  Among 
these  homeless,  sick  and  often  wounded  old  men,  women  and 
children  was  opportunity  for  the  American.  Red  Cross-  to 
render  assistance  which  was  needed. 

During  the  summer  of  1917  the  American  Red  Cross  had 
sent  a  commission  to  Italy  under  George  F.  Baker,  Jr.,  of  New 
York  City,  to  ascertain  whether  or  not  American  relief  would 
be  welcomed.  This  commission  returned  to  Washington  in 
October  with  a  report  which  the  military  situation  rendered  out 
of  date  almost  before  their  boat  landed. 

When  word  of  the  Piave  Retreat  reached  Rome,  Mr.  Page, 
then  American  Ambassador  to  Italy,  cabled  to  the  War  Council 
and  wired  Paris  headquarters  for  help.  National  Headquar- 
ters immediately  placed  half  a  million  dollars  at  his  disposal 
and  Major  Murphy,  commissioner  for  Europe,  dispatched  to 
Italy  an  emergency  commission  under  Major  Carl  Taylor, 
one  of  the  original  deputy  commissioners  for  Europe.  This 
commission  immediately  undertook  temporary  relief  measures; 
in  the  United  States  the  organization  of  a  permanent  commis- 
sion which  had  already  been  initiated  with  Colonel  Robert  P. 
Perkins,  of  New  York  City,  in  command,  w^as  speeded  up. 

American  Red  Cross  relief  to  Italy  was  confined  chiefly  to 
hospital,  ambulance  and  canteen  service  to  the  Italian  Armies 
at  the  front  and  to  the  relief  of  refugees  from  the  Venetian 
plains.  To  the  ^Military  Establishment  the  Italian  (\immis- 
sion  distributed  Or)l,000  articles  of  supplies,  including  ten 
complete  field  hospitals  and  more  than  one  hundred  field  ambu- 
lances and  drivers.  Thirty-three  canteens  were  operated  in 
Italy  for  the  benefit  of  Italian  and  Allied  troops.  In  the  field 
of  civilian  relief,  five  refugee  colonies  were  established  in  which 
2774  persons  were  cared  for;  three  hospitals  and  throe  dis- 
pensaries were  maintained;  SS  workrooms  were  oporati^d  in 
which    9057    persons   were   given   employment    and    1,411,105 


860    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

garments  were  produced ;  50  food  kitchens  were  set  up  and  an 
average  of  28,664  rations  were  daily  served  from  them.  Un- 
cooked food  supplies  were  furnished  to  424,600  persons.  This 
work  extended  to  141  Italian  towns  and  to  thousands  of  villages 
from  the  Alps  to  Sicily,"*^ 

American  Red  Cross  nursing  service  in  Italy  was  confined 
chiefly  to  work  of  an  educational  nature.  Even  if  Italy  had 
welcomed  emergency  nursing  relief,  the  supply  of  American 
nurses  was  too  limited  to  have  rendered  possible  any  extensive 
development  of  such  a  service. 

Early  in  November,  1917,  the  temporary  commission 
called  upon  Paris  headquarters  for  "an  executive  nurse  for 
Italy"  and  j\Iiss  Russell  assigned  Pauline  Jordan,  then  in 
Paris  awaiting  a  problematical  assignment  to  Roumania.  Miss 
Jordan  was  a  graduate  of  the  New  York  Hospital  and  had 
served  as  anesthetist  with  the  Carrel  Mission  to  Roumania 
early  in  1917,  an  account  of  which  will  appear  later. 

Miss  Jordan  arrived  at  Rome  on  December  2,  1917,  and  five 
days  later  wrote  Miss  Delano : 

From  the  nursing  standpoint  there  is  much  work  to  be 
done.  This  includes  the  manufacture  of  surgical  dressings 
and  the  opening  up  of  new  workrooms  for  this  purpose ;  a  cer- 
tain amount  of  hospital  and  day  nursery  work ;  the  establish- 
ment of  a  hospital  at  Rimini  for  refugees  threatened  with 
various  mild  epidemics ;  canteen  work  and  visiting  nursing 
among  the  refugee  population. 

I  expect  to  leave  at  once  for  Florence  and  Genoa  to  open 
surgical  dressings  workrooms.  I  have  been  allowed  to  tele- 
graph to  Paris  for  two  nurses  to  take  charge  of  these  and  we 
expect  them  in  a  few  days.  Whether  we  shall  be  sent  to 
Rimini  in  connection  with  the  establishment  of  the  Refugee 
Hospital  remains  to  be  seen. 

The  policy  of  the  acting  American  Red  Cross  officers  is 
against  the  introduction  of  American  nurses.  Up  to  the 
present  time,  the  policy  has  been  to  donate  money  and  sup- 
plies to  the  various  Italian  women  who  are  the  nominal  heads 
of  Italian  organizations. 

Alice  Fitzgerald,  whose  name  has  already  appeared  many 
times  in  this  history,  was  sent  from  Paris  to  open  the  Rimini 
Refugee  Hospital.     She  wrote  : 

"For  further  details  see  "The  Story  of  the  American  Ked  Cross  in 
Italy."  Charles  M.  Bakewell.  The  "Macmillan  Company.  1020:  also  "The 
Work  of  the  American  Red  Cross  Durinnr  the  War:  A  Statement  of  Finances 
and  Accomplishments,"  pp.  ()8-72,  Red  Cross  Lihrary. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     861 

On  December  19,  with  three  other  nurses,  I  started  for 
Rome.  Eight  days  later  another  nurse  and  I  proceeded  to 
Rimini,  a  town  on  the  Adriatic  Coast  where  the  American 
Red  Cross  was  carrying  out  an  interesting  experimental  piece 
of  work  among  the  V^enetian  refugees. 

The  broad  general  lines  of  this  work  consisted  in  trying 
to  keep  families,  relatives  and  friends  together  as  much  as 
possible  and  to  remove  with  them  their  tools,  looms  or  what- 
ever equipment  or  implements  were  necessary  to  their  par- 
ticular means  of  earning  a  livelihood.  These  people  were  to 
be  settled  in  such  a  way  that  they  could  continue  as  nearly 
uninterruptedly  as  possible  their  work — as  if  they  were  still 
at  home  in  Venice.  When  the  military  situation  was  so 
altered  that  they  could  return  to  their  home,  they  would  thus 
not  have  lost  touch  with  their  families,  relatives,  friends,  and 
particularly  their  work. 

N^umerous  committees  had  this  scheme  in  hand  and  distri- 
bution of  food  and  clothing  was  being  made  to  them.  The 
care  of  the  sick  was  just  beginning  to  take  form  and  the 
Commission  for  Italy  planned  to  start  at  Kimini  a  health 
center  from  which  care  could  be  sent  to  outlying  districts 
either  through  visiting  nurses  and  doctors  or  by  the  establish- 
ment of  small  dispensaries  and  infirmaries.  My  particular 
mission  in  the  city  was  to  help  organize  and  start  the  Ameri- 
can TJed  Cross  Hospital  for  Venetian  Eefugees. 

When  we  arrived  in  Rimini  in  the  early  morning,  the  snow 
was  thick  on  the  ground.^*'    The  next  morning  we  were  driven 
out  to  the  hospital  which  we  found  had  been  established  in  a 
large    building   on   the   seashore.      This   building   had   been 
erected  as  a  summer  home  for  tuberculous  children  from  the 
mountain  regions  of  Italy  ,  .  .  and  was  nothing  but  windows 
and  doors.     The  cold  poured  in  from  all  sides.     There  was 
absolutely  no  means  of  heating  the  rooms,  either  by  stoves  or 
fireplaces,  and  the  patients  already  in  the  hospital  were  actu- 
ally blue  with  cold  in  their  beds.    Hot-water  bags  did  not  re- 
main hot  long  enough  to  take  off  the  chill  and  the  piling  on  of 
blankets  scarcely  added  to  the  comfort  of  the  sick  man  or 
woman  or  child.     Conditions  were  indeed  desperate  and  our 
very  first  effort  was  to  obtain  stoves  and  have  them  put  up  in 
as  many  of  the  wards  as  we  could.    The  one  other  nurse  was 
wonderfully  })lucky  and  did  not  complain,  but  I  know  she 
suffered  as  much  as  all  of  us  did. 
■"Tliis   tremendous   ami   for   the   Allies    providential    snowfall   closed   tlie 
open  winter  which  had  preatly  aided  the  Teutonic  offensives,  impaired  the 
German  lines  of  communications  and  prevented  the  enemy  from  capturing 
vital    new    passes    and    emptyinjr    their    armies    onto    the    Venetian    plains 
through  strategic  positions  already  held. 


862    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Little  by  little  conditions  adjusted  themselves.  The  hos- 
pital ran  to  full  capacity  and  our  work  spread  to  many  miles 
around.    On  February  13,  1918,  I  was  recalled  to  Paris.  .  .  . 

The  Rimini  Hospital,  which  was  known  as  the  Ospizio  Co- 
masco,  had  a  capacity  of  one  hundred  and  fifty  beds.  American 
Red  Cross  nurses  served  as  supervisors  and  fourteen  Italian 
girls  who  had  been  employed  in  the  Venice  Civil  Hospital  for 
some  months  acted  as  aides.  Five  male  infermieri  were  on 
duty  in  the  men's  wards.  On  May  1,  1918,  the  professional 
staff  was  increased  to  seven  American  Red  Cross  nurses  and  a 
nurses'  home  was  opened  in  the  Villa  Tonti.  The  Rimini 
Hospital  had  many  acute  cases,  especially  during  the  influenza 
epidemic,  and  about  one  hundred  and  fifty  patients  died.  Dur- 
ing the  year  of  its  operation,  Ospizio  Comasco  received  1533 
patients. 

The  permanent  Commission  for  Italy  arrived  in  Rome  on 
December  20,  1917.  Colonel  Perkins  had  appointed  Sara  E. 
Shaw  to  membership  on  his  staff.  She  had  been  in  charge  of 
the  tuberculosis  division  of  the  social  service  department 
at  Bellevue  Hospital  and  he  wished  to  utilize  this  previous 
experience  in  connection  with  giving  temporary  relief  in 
Italy.  However,  the  ISTursing  Service  at  National  Head- 
quarters was  loath  to  allow  a  nurse  to  serve  at  this  particular 
period  in  any  but  a  professional  capacity,  so  Miss  Shaw  was 
appointed  chief  nurse  of  the  Italian  Commission  and  Miss 
Jordan  was  recalled  to  Paris  headquarters  and  assigned  to 
duty  in  France.  Miss  Shaw  was  a  graduate  of  the  Bellevue 
School  and  had  served  as  a  Red  Cross  nurse  on  the  Lampasas 
Expedition  and  also  six  months  in  Manila  during  the  Spanish- 
American  War. 

In  a  final  letter  of  instructions  written  November  28,  1917, 
to  ]\liss  Shaw,  Miss  Noyes  outlined  the  policies  which  were 
to  govern  the  development  of  American  Red  Cross  nursing 
service  in  Italy: 

Italy  is  a  big  country  .  .  .  and  we  do  not  know  how  you 
will  approach  a  study  of  nursing  conditions  with  a  view 
toward  making  recommendationp  to  us  in  this  country.  You 
must  liear  in  mind,  liowevpr,  that  the  demands  now  facing  the 
Eed  Cross  Nursing  Service — to  meet  all  the  military  needs 
of  the  base  hospitals  in  France,  the  (antonnient  hospitals  in 
this  country  and  the  public  health  work  we  are  doing  in  for- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     863 

eign  countries,  with  the  least  possible  disturbance  to  civilian 
hospitals  and  other  forms  of  nursing  work  in,  this  country, 
puts  no  small  task  upon  our  shoulders.  It  would  be  quite 
im})ossible,  of  course,  for  the  American  Ked  Cross  to  assume 
the  nursing  in  civilian  hospitals  in  foreign  countries.  They 
might  take  up  a  definite  piece  of  public  health  work,  in  con- 
nection with  directors  and  supervisors  of  institutions,  but 
there  are  not  enough  nurses  in  America  to  supply  other  coun- 
tries of  the  world  with  a  professional  nursing  staff. 

During  the  first  weeks  of  January  Miss  Russell  sent  nine 
nurses  to  assist  Miss  Shaw  in  Italy.  National  Headquarters 
organized  a  unit  of  sixteen  others  and  they  sailed  from  New 
York  in  April.  Katherine  C.  DeLong,  a  Canadian  woman  and 
a  graduate  of  the  Johns  Hopkins  School,  was  head  nurse  of  this 
detachment.  Previous  to  the  Italian  assignment,  Miss  DeLong 
had  filled  many  executive  positions  at  the  Johns  Hopkins  Hos- 
pital and  had  been  superintendent  of  residence  both  at  the 
Johns  Hopkins  and  at  the  Bellevue  Schools.  Other  nurses 
were  sent  to  Italy  from  the  United  States  and  Paris  Head- 
quarters until  Miss  Shaw's  staff  finally  numbered  thirty-seven 
nurses. 

Miss  Shaw's  first  major  project  in  Italy  was  the  establish- 
ment of  a  Nurses'  Center  in  Milan.  On  April  22,  1018,  she 
wrote  ]\Iiss  Noyes: 

My  activities  have  been  varied.  I  have  visited  many  mili- 
tary hospitals  and  liave  been  very  cordially  received.  The 
^Marchesa  Cnstelnuovo,  who  is  at  the  head  of  the  Italian  Kcd 
Cross  for  this  section  of  the  country,  has  been  a  good  friend 
and  advisor  to  me  and  so  also  have  some  of  the  Italian  medi- 
cal ofliccrs. 

The  need  seemed  to  be  more  for  hospital  supplies  than  for 
nurses.  The  volunteer  nurses  are  well  organized  and  are 
really  doing  excellent  work.  There  seems  no  place  suitable 
for  our  trained  women  to  render  definite  emergency  service. 
^riiis  is  the  reason  for  our  plan  of  a  Nurse's  Center  and  I  have 
secured  a  peiisionc  which  is  now  in  the  throes  of  being 
cleaned  and  remodeled  for  this  purpose. 

Tji  one  se[)arate  division  we  have  fifteen  private  hospital 
rooms  and  an  operating  room  where  we  can  efliciently  care 
for  our  own  American  force  or  where  we  can  have  facilities 
readv  for  any  special  emergency. 

We  have  one  floor  for  servants,  linen  and  sup|dy  rooins  and 
a  beautiful  cellar  where  food  can  be  stored.     Another  floor 


864   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

is  used  for  the  nurses.  We  have  a  reception  room,  lecture 
hall  and  library,  demonstration  room  and  dining  rooms. 
There  are  balconies  on  each  floor. 

We  do  not  say  we  are  establishing  a  training  school;  this 
would  be  objectionable  to  Italians  who  were  prone  to  organ- 
izing work  like  this  before  the  war.  But  the  idea  of  confer- 
ences appeals  very  much,  so  we  are  to  have  conferences  and 
lectures  by  prominent  doctors.  Tlie  Italian  women  who  are 
supervisors  and  heads  of  each  hospital  will  come  to  the 
conferences.  The  demonstration  room  will  always  be  open 
for  demonstrating  various  American  methods  of  caring  for 
the  sick. 

This  plan  for  conferences  will  aid  in  the  distribution  of 
hospital  supplies.  Many  things  of  which  they  do  not  under- 
stand the  use  are  made  in  our  workrooms  and  we  will  dem- 
onstrate the  use  of  these  dressings.  By  this  plan  it  seems 
to  us  that  we  can  be  of  greater  help  than  if  we  were  lost  in 
one  little  hospital. 

The  American  nurses  at  Milan  undertook  many  other  types 
of  war  service  in  addition  to  that  at  the  Teaching  Center.  Miss 
Shaw  described  them  in  her  letter  of  April  22 : 

There  is  also  big  work  to  be  done  in  the  distribution  of 
hospital  supplies.  We  have  cleaned  up  several  rooms  in  a 
famous  old  palace  and  there  seventeen  Italian  women  sort 
dressings  and  fill  hospital  requisitions;  two  of  our  American 
Eed  Cross  nurses  are  on  duty  here.  Each  of  our  nurses  is 
now  preparing  a  suitcase  of  sterile  dressings  and  necessary 
instruments  and  if  a  call  comes  for  nurses  for  an  emergency 
service,  they  can  pick  up  their  case  and  run.  Xone  of  us 
have  wasted  time  waiting  for  work ;  we  have  certainly  found 
plenty  to  do.  We  make  up  gift  packages  and  distribute  them 
in  hospitals  and  every  month  we  meet  the  prisoners  of  war 
returned  on  exchange  from  Austria. 

The  uniforms  of  the  American  nurses  were  a  source  of  keen 
interest  to  the  Italians.  The  nurses  had  white  tailored  dresses 
made  after  the  pattern  of  the  one-piece  serge  dress  and  wore 
them  with  the  cape  and  cap  for  dress  parade,  a  combination 
which  greatly  appealed  to  the  color-loving  Italians.  ''Our 
boots,"  wrote  Miss  DeLong  to  Miss  Noycs,  "seem  an  unending 
source  of  amusement  to  the  natives  and  they  cross  the  streets 
to  read  the  lettering  on  our  brassards." 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     865 

From  the  Nurses'  Center  at  Milan,  the  influence  of  Miss 
Shaw  and  her  nurses  extended  to  other  parts  of  Italy.  In  view 
of  the  attitude  of  the  Italians  and  the  limited  number  of  Ameri- 
can nurses,  they  were  placed  only  in  hospitals  and  dispensaries 
where  they  would  have  a  wide  radius  of  influence. 

The  Commission  for  Italy  established  and  maintained  six 
hospitals,  two  of  them  for  refugees;  the  Nurses'  Center  and 
Hospital  at  Milan ;  a  hospital  of  twenty  beds  at  Padua  for  the 
Air  Forces  of  the  American  Expeditionary  Forces  in  Italy; 
and  an  American  Red  Cross  Hospital  in  Rome. 

The  first  refugee  hospital  which  was  established  at  Rimini, 
has  already  been  described.  The  other  was  situated  at  Cani- 
cattini  Bagni,  in  Sicily. 

This  drowsy  old  town  of  fifteen  thousand  inhabitants  was 
situated  fifteen  miles  from  Syracuse  and  received,  as  did  all 
the  cities  and  villages  of  Sicily,  immediately  following  the 
Piave  Retreat,  large  numbers  of  refugees  from  the  Venetian 
plains.  Need  had  arisen  for  a  hospital,  so  the  mayor  of  Syra- 
cuse asked  an  American  woman  physician,  the  wife  of  an 
Italian  surgeon  then  at  the  front,  to  take  charge  of  it.  She 
moved  into  the  improvised  building,  named  it  the  Martha 
Washington  Hospital  and  on  March  1,  1918,  the  institution 
came  under  the  direction  of  the  commission.  Additional 
equipment  was  given,  the  director  was  appointed  as  the  Ameri- 
can Red  Cross  representative  for  that  district  and  the  commis- 
sion maintained  it  for  a  year,  during  which  time  two  hundred 
and  seventy-two  patients  were  received.  No  American  Red 
Cross  nurses  were  assigned,  however,  to  the  hospital. 

The  American  Jlvd  Cross  Naval  Hospital  at  Genoa  was 
situated  in  a  villa  at  Lido  d'Albaro.  Four  American  Red 
Cross  inirses,  three  nuns  and  seven  naval  hospital  attendants 
were  assigned  to  duty  there.  Early  in  September,  191 S,  the 
hospital  was  taken  into  the  ^lilitary  Establishment.  During 
the  period  of  its  operation  as  a  Red  Cross  hospital,  forty-nine 
patients  were  received. 

The  American  Red  (^ross  at  Padua,  which  was  operated  for 
American  aviators  from  the  various  camps  near  Padua,  was 
situated  in  a  wing  of  an  old  university  building.  ]\Iiss  Shaw 
sent  a  nurse  to  organize  and  operate  it  in  October,  1918,  but 
the  influenza  became  virulent  in  the  camps  and  six  additional 
nurses  were  placed  on  duty  to  care  for  the  hundred  patients 
sent  in  from  the  aviation  centers  and  the  '332nd  Reii'iment  of 


866  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  American  Expeditionary  Forces.  The  hospital  was  operated 
nntil  April  1,  1919,  and  received  a  total  of  one  hundred  and 
thirty-two  patients.  Additional  American  Red  Cross  nurses 
were  detailed  to  service  in  aviation  and  hydro-aviation  camps 
at  Foggia,  Bolsena  and  Porta  Corsini. 

The  American  Red  Cross  Hospital  at  Rome  was  established 
to  care  for  all  American  workers  in  Italy  who  needed  hospi- 
talization. It  was  beautifully  situated  on  the  two  upper  floors 
of  a  large  building  fronting  the  Pincian  Gardens,  and  had  a 
thirty-five  bed  capacity.  Four  American  Red  Cross  nurses 
and  two  Italian  aides  composed  the  nursing  staff.  During  the 
three  months  of  operation  following  its  opening  on  August  22, 
1918,  fifty-six  patients  were  admitted. 

A  convalescent  home  for  sick  children  with  a  capacity  of 
twenty-eight  beds  was  established  at  Taormina  and  was  known 
as  the  Casa  dei  C onvalescenti.  It  was  staffed  by  American  Red 
Cross  nurses  and  Italian  aides.  A  local  Italian  physician 
attended  to  the  medical  needs. 

The  Commission  for  Italy  operated  nine  dispensaries  which 
were  nuclei  for  public  health  nursing  service  and  child  wel- 
fare work.  These  dispensaries  were  located  at  Cesanatico, 
Bellaria,  Chioggia,  Genoa,  Florence,  ISTaples,  Avellino,  Villa 
San  Giovanni  and  Taormina.  In  the  establishment  and  main- 
tenance of  these  dispensaries  the  American  Red  Cross  worked 
entirely  through  local  Italian  committees.  Each  of  the  mem- 
bers of  the  Died  per  Uno,  the  organization  which  sponsored 
the  dispensary  at  Genoa,  assumed  responsibility  for  the  care 
of  ten  children.  At  Florence,  the  dispensaries  took  the  form 
of  three  Aiuti  Matcrni.  American  Red  Cross  public  health 
nurses  were  in  charge  and  did  •  district  visiting,  distributed 
eggs,  milk,  broth  and  layettes."*^ 

In  June,  1918,  the  Italian  Armies,  strengthened  by  reen- 
forccments  from  the  British  and  French,  launched  a  counter- 
offensive  against  the  Teutons  which  resulted  on  November  3  in 
the  complete  collapse  of  Austria-Hungary.  With  the  changing 
fortunes  of  war  came  a  substantial  lessening  of  the  need  for 
emergency  relief.  The  American  Red  Cross  Commission  for 
Italy  then  looked  ahead  toward  the  formulation  of  a  more  con- 
structive program. 

"  For  a  complete  list  of  the  various  assij^nnients  of  American  Red  Cross 
nurses  in  Italy,  see  "Reports  of  the  Departments  of  Military  and  Civil 
AflFairs,  American  Red  Cross  in  Italy,  January,  1918-April,  1919,"  Red 
Cross  Library. 


(AIi(i\-(>'i  Ospizii)  Miirliio.  an  Ainrrii'aii  llcil  (ro^H 
Tlo-pital  fdi-  cliildrcii  ^ullVriiiL;-  trinn  Imuu'  tuiicrru- 
l(isi<.   a!    \"al(l(iltra.    near   ■Iric-lc.    Italx". 

(l!('l(i\\i    A   patient    ut   the  Ospizin    Mtirivo. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    867 

During  the  '^'pring  of  1918,  Dr.  Farrand,  director  of  the 
Rockefeller  Commission  for  the  Prevention  of  Tuberculosis  in 
Franco,  and  Dr.  William  Charles  White,  director  of  the  Tu- 
berculosis Bureau,  American  Red  Cross  in  France,  made  a 
health  survey  of  Italy  with  a  view  toward  the  inauguration  of 
an  anti-tuberculosis  campaign  in  Italy  similar  to  that  under- 
taken in  France.  Also  Dr.  Joseph  Collins,  Major,  Medical 
Corps,  U.  S.  A.,  and  director  of  Medical  Aifairs  of  the  (\)m- 
mission  for  Italy,  made  an  independent  study  of  health  condi- 
tions. As  a  result  of  the  recommendations  of  these  men,  Na- 
tional Headquarters  appointed  in  September,  1918,  the  Ameri- 
can Red  Cross  Committee  for  Tuberculosis,  with  Dr.  White 
as  the  director  and  Mary  S.  Gardner  as  chief  of  the  Section 
of  Public  Health  Nursing. 

Miss  Gardner  needs  no  introduction  at  this  point  in  this 
history.  Full  biographical  material  regarding  her  signal  con- 
tribution to  the  American  nursing  profession  may  be  found  in 
the  chapter  on  American  Red  Cross  Public  Health  Nursing 
Service — a  more  appropriate  field  for  such  an  account  than 
this  section,  which  deals  primarily  with  American  Red  Cross 
military  nursing  service.  However,  the  military  program  in 
Italy  was  closed  by  the  demonstration  made  by  Miss  Gardner 
of  American  methods  of  public  health  nursing  service. 

Miss  Gardner  and  fifteen  public  health  nurses  sailed  for 
Italy  early  in  September  and  initiated  a  special  educational 
project.  The  emergency  nursing  activities,  such  as  the  opera- 
tion of  hospitals,  surgical  dressings  workrooms,  were  gradually 
broiTght  to  a  conclusion.  Miss  Shaw",  Miss  DeLong  and  many 
of  l^lie  first  detaclinients  of  American  Red  Cross  nurses  in 
Italy  returned  to  the  United  States  during  the  spring  of  1919. 

The  specialized  phase  of  nursing  service  known  as  public 
health  nursing  was  a  development,  purely,  of  the  British  and 
American  luirsing  professions.  It  did  not  exist  in  Italy.  In 
the  supplementary  Report  on  Nursing,  General  Report  of  the 
American  Red  Cross  Commission  for  Tuberculosis  in  Italy, 
Miss  Gardner  wrote  of  the  Italian  situation: 

Home  vii^iting  is  done  to  a  small  extent  by  nuns  and  in 
some  instances  nursing  care  is  given  Ijy  them  to  the  ]ialients 
in  their  hdinos.  rsually  such  care  is  made  secondary  to  the 
dispensing  of  material  relief  and  the  giving  of  spiritual  com- 
fort or  instruction.  Home  visiting  is  also  carried  on  from  a 
number   of   dispensaries   by   groups   of   volunteers,    many   of 


868  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

whom  do  excellent  individual  work.  Knowledge  and  skill 
are,  however,  gained  only  by  experience  and  in  all  these  efforts 
which  have  been  studied  the  usual  limitations  of  volunteer 
work  Tiave  been  evinced :  namely,  an  insufficiency  of  time 
spent,  an  absence  of  training  and  a  lack  of  work  caused  by 
the  call  of  other  duties.  In  one  group  dealing  with  tubercu- 
losis patients,  all  work  stopped  during  the  influenza  epidemic 
(a  time  when  an  added  vigilance  was  required),  not  because 
the  workers  themselves  were  ill  but  because,  being  mothers 
and  wives,  it  seemed  unwise  to  run  the  risk  of  contagion  for 
themselves  and  their  families. 

The  general  policy  of  the  Commission  for  Tuberculosis  was 
that  it  should  work  only  with  Italian  committees  and  only 
upon  request  from  Italian  communities  and  organizations  de- 
siring American  cooperation.  The  Section  on  Public  Health 
JSTursing  followed  this  policy.  Italian  and  American  public 
opinion  hung  on  the  outcome  of  the  Peace  Convention  of  Ver- 
sailles. Although  enthusiasm  for  America  and  American  ideas 
then  ran  high  in  Italy,  the  entire  situation  was  one  of  extreme 
delicacy  and  continued  so  until  the  close  of  the  Italian  pro- 
gram. 

"The  problem,"  wrote  Miss  Gardner,  "seemed  two-fold,  the 
creation  of  a  desire  for  the  work  and  the  creation  of  a  group 
of  workers.  The  former  involved  the  stimulation  of  groups  of 
Italians  to  a  consciousness  of  the  need  for  public  health  work,  a 
stimulation  which  must  be  carried  to  the  point  of  formation  of 
committees.  The  latter  involved  the  training  of  a  few  carefully 
selected  Italian  women  to  act  as  pioneers  and  teachers  in  the 
new  field." 

In  the  selection  of  these  Italian  women  who  should  act  as 
pioneers,  three  fields  of  supply  were  open  to  the  Commission — 
the  nuns,  the  infermiere  and  the  Italian  Red  Cross  and  Samaria 
tana  nurses. 

Among  the  volunteer  nurses  then  being  demobilized  after  a 
war  service  of  from  one  to  three  years,  however,  there  were 
many  women  who  had  loved  their  work  as  nurses  and  who 
were  glad  to  continue  it  upon  a  remunerative  basis. 

Miss  Gardner  summarized  the  work  involved  in  the  training 
of  these  women : 

In  the  first  place  an  enlightened  Italian  committee  must 
be  formed,  willing  to  work  hard  and  capable  of  sufficient 
elasticity  of  thought  to  permit  the  grasping  of  unfamiliar 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    869 

ideas ;  a  committee  also  from  whom  permanency  of  work  could 
be  expected.  A  single  course  offered  by  American  nurses, 
with  no  hope  of  successive  courses,  would  avail  but  little. 

In  the  second  place  a  group  of  workers  must  be  found 
possessed  of  the  pioneer  spirit  and  the  type  of  ability  likely  to 
insure  success. 

In  the  third  place  Italian  doctors  and  other  lecturers  must 
be  secured  and  interehted  in  the  new  idea. 

In  the  fourth  place  a  field  for  practical  instruction  must 
be  developed  by  the  American  nurses  under  wholly  Italian 
auspices. 

In  the  fifth  place  the  market  for  the  product  must  be 
stimulated  that  positions  might  be  ready  .for  the  newly  edu- 
cated workers. 

Under  these  plans,  three  courses  were  initiated,  the  first 
at  Rome  through  a  committee  organized  under  the  auspices  of 
the  Federation  of  Women's  Chibs ;  a  second  at  Genoa  through 
a  sub-committee  of  the  Lega  Antitubercolare  della  Provincia 
dl  Genova;  and  a  third  at  Florence.  The  school  at  Rome 
opened  on  March  17,  1918,  with  sixteen  students  and  the  school 
at  Genoa  on  April  2  with  fifteen.  A  plan  for  a  school  at  Pa- 
lermo was  initiated  but  later  was  given  up.  The  school  at 
Florence  was  begun  on  ISTovember  10  but  the  course  was  not 
completed. 

The  instruction  covered  a  period  of  four  months.  The  first 
three  were  given  up  to  lectures  and  to  field  and  practical  work ; 
the  last  month  was  spent  entirely  in  field  work.  Miss  Gardner 
described  the  nature  of  the  instruction  given: 

One  American  nurse  is  in  charge  of  each  school  while  six 
others  in  each  city  act  as  instructors  in  dispensary  work, 
school  and  home  visiting.  All  the  educational  work  is  under 
the  direction  of  one  educational  head.  Lectures  are  given  by 
Italians,  though  American  doctors  also  lecture  through  an 
interpreter.  Conferences  are  held  by  American  nurses.  Die- 
tetics and  invalid  cooking  are  taught  by  l)oth  American  and 
Italian  teachers,  the  Italian  teacher  being  lent  by  the  Minis- 
try of  Industry.  The  courses  of  study  differ  somewhat  in 
the  different  cities,  but  the  following  subjects  are  taught  in 
all:  history  of  ])ublic  health  nursing;  theory  and  methods 
of  public  health  work;  tuberculosis  nursing:  child  wel- 
fare nursing;  school  hygiene  nursing;  dietetics;  obstet- 
rical nursing;  diseases  of  the  skin,  of  the  eye,  of  the   ear. 


870  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nose    and    throat ;    sanitation ;    housing,    with    one    or    two 
lectures  on  Italian  mortality  and  morbidity  statistics. 

...  In  Eome  the  course  is  held  in  two  simple  rooms  for- 
merly stores,  and  in  Genoa  at  the  Tuberculosis  Institute  and 
at  the  University.  .  .  . 

An  interesting  comment  upon  the  courses  in  Rome  was  con- 
tained in  the  following  letter,  written  by  Winifred  Terni  de 
Gregory,  president  of  the  Lombard  Branch,  National  Associa- 
tion of  Italian  Nurses,  which  was  published  in  the  open  col- 
umns of  the  British  Journal  of  Nursing: 

.  .  .  Usually  foreign  Red  Cross  societies,  while  giving  their 
nurses  excellent  scientific  training  and  a  great  deal  of  prac- 
tice in  operation  theater  and  surgical  wards,  have  so  far  never 
given  real  systematic  teaching  in  the  art  of  practical  nursing. 

What  our  excellent  Italian  Red  Cross  nurses  know  on  the 
subject,  they  have  found  out  for  themselves  or  learned  from 
English  books,  never  having  had  professional  Matrons  or  Sis- 
ters to  teach  them,  and  until  lately  the  subject  of  practical 
nursing  was  not  included  in  the  Red  Cross  curriculum.  Now 
I  am  happy  to  say,  a  new  curriculum  has  been  compiled  at 
Red  Cross  Headquarters  which  gives  a  prominent  place  to 
the  teaching  of  practical  nursing.  But  most  foreign  nurses 
(except  those  trained  in  English  training  schools)  know  very 
little  on  the  subject  and  when  a  public  health  course  for 
Italian  Red  Cross  and  other  nurses  was  arranged  in  Rome  by 
the  American  Red  Cross,  at  my  suggestion  a  great  many  les- 
sons on  bed-making,  washing  of  patients  and  other  nursing 
details  were  included  in  the  course,  with  great  benefit  to  the 
students  and  ultimately,  I  hope,  to  the  patients. 

The  possibility  of  developing  public  health  nursing  in  the 
small  Italian  hill  towns  was  a  project  in  which  the  American 
Red  Cross  took  keen  interest,  owing  to  the  pioneer  work  done 
in  the  United  States  in  this  field  by  Miss  Clement,  Miss  Gard- 
ner and  ]\Iiss  Fox. 

A  study  was  made  of  two  typical  Italian  towns,  Sezze  and 
Piperno,  situated  fifteen  miles  apart  above  the  Pontine 
]\rarsh('s.  ]\Iiss  Gardner  summarized  the  results  of  these 
studies : 

If  Sczze  and  Piperno  are  at  all  ty])i(al  of  other  small  Ital- 
ian towns — iiiid  we  have  reason  to  b^'licNc  that  such  is  the  case 
—it  seems  probable  for  the  small  towns  '^f  Italy, 


NURSING  SERVICE  TO  CIVILIAN  POPULATxOX    871 

That  the  services  of  a  good  public  liealth  nurse  would  be 
"Warmly  welcomed  by  the  people. 

That  there  is  great  need  for  such  service  for  bedside  nurs- 
ing, for  dispensary  and  school  work  and  for  general  home 
instruction  on  health  matters,  also  for  assisting  the  people 
to  obtain  for  themselves  more  modern  health  advantages  along 
various  lines-. 

That  it  is  going  to  be  difficult  to  induce  an  Italian  nurse 
to  acce])t  the  limitations  and  discomforts  of  small  town  life. 

That  the  community  as  a  whole  would  probably  be  quite 
as  ready  as  the  more  backward  American  towns  to  cooperate 
in  the  nurse's  efforts  for  improvement,  though  in  this  state- 
ment an  understanding  of  the  difference  between  Italian  and 
American  standards  must,  of  course,  be  taken  into  account. 
The  doctors  will,  as  in  America,  prove  the  importance  of  the 
personal  equation.  Some  will  be  found  cooperative,  the 
others  the  reverse. 

That  the  average  small  town  will  not  readily  understand 
the  necessity  of  paying  a  sufficient  salary  to  secure  the  right 
type  of  woman  for  public  health  nursing  work. 

As  may  he  scon  from  these  results,  the  possibility  of  develop- 
ing rural  public  health  nursing  in  Italy  in  1910  was  not  a 
promising  one.  ''For  the  moment  probably  the  most  effective 
expenditure  of  money  and  effort  for  public  health  work,"  cx)n- 
cluded  Miss  Gardn(>r,  "will  be  in  the  cities  and  larger  towns. 
Later  the  small  town  work  in  Italy  can  undoubtedly  he  de- 
veloped as  has  been  rural  and  county  nursing  in  England  and 
America,  bush  nursing  in  Australia  and  back  block  nursing  in 
New  Zealand.  ]\reanwliilc,  nothing  can  be  done  without  the 
worker.  The  heart  of  the  difficulty  would,  therefore,  seem  to 
be  in  the  problem  of  nursing  education." 

In  ,Iune,  1919,  ^liss  Gardner  returned  to  the  L^'nited  States 
and  Edna  Foley  took  her  place  as  chief  nurse  of  the  American 
Rvd  C^ross  Tulxu-culosis  Commission  for  Italy.  ]\Iiss  Foley  was 
released  from  the  superintendency  of  the  Instructive  Visiting 
Nurse  Society  of  (^hicago  to  undertake  this  foreign  service. 
As  a  member  of  the  National  Committee  she  had  for  nuiny 
years  taken  a  keen  interest  in  American  lied  Cross  nursing 
service. 

During  ^liss  Foley's  term  of  office,  the  school  at  Floi'cnce 
was  opened  and  a  second  course  at  the  Rome  and  (Jcnoa  schools 
was  completed.  I'ublic  health  nurses  were  assigned  to  duty  in 
Perugia,  Sjjczia  and  Palermo.     The  work  at  Palerino  was  cim- 


872  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ducted  bj  the  Lega  Antiivhercolare,  a  local  society  organized 
by  Dr.  White's  commission.  Mary  Gallagher  and  Isabelle 
Hall  were  on  duty  at  a  tuberculosis  clinic  there.  "Dr.  Lazzaro, 
the  chief  of  this  clinic,"  wrote  Miss  Foley  in  her  report  of 
September  12-October  25,  1919,  to  the  Commissioner,  "said  he 
considered  the  work  of  these  two  Red  Cross  nurses  the  biggest 
gift  of  the  American  Red  Cross  to  Sicily."  Miss  Foley's  re- 
port continued : 

Late  in  August  Miss  Hall  succeeded  in  establishing  a  clinic 
for  well  babies.  .  .  .  There  were  more  than  forty  babies  the 
opening  day  and  a  large  attendance  at  every  clinic.  Miss  Hall 
left  a  young  half-trained  Italian  girl  in  her  place.  She  was 
much  afraid  that  the  clinic  would  not  survive,  for  its  Com- 
mittee, like  all  other  organizations  for  social  endeavor,  is 
poor.  We  have  seen  poverty  all  over  Italy,  but  that  in 
Palermo  seems  to  haunt  the  streets.  The  babies  are  par- 
ticularly starved  and  sickly  looking. 

A  visiting  nurse  was  employed  in  a  country  district  near 
Perugia  and  her  round  of  duty  covered  three  small  villages. 

The  American  Red  Cross  completed  its  nursing  activities 
in  Italy  on  December  31,  1919,  and  withdrew  from  the  coun- 
try. A  final  gift  of  36,000  lire  was  made  to  carry  on  the 
schools;  9000  lire  each  was  given  to  the  Scuola  Infermiere 
Visitatrice  at  Rome,  the  Lega  Antitubercolare  delta  Provincia 
di  Genova  and  the  Scuola  Infermiere  Visitatrice  at  Florence; 
4800  lire  to  the  Lega  Antitubercolare  di  Palermo  and  2400  to 
the  Lega  Antitubercolare  delV  Umbria  at  Perugia. 

In  a  letter  addressed  on  j^ovcmber  11,  1919,  to  the  American 
Red  Cross  Commission  to  Europe,  Miss  Fitzgerald,  then  chief 
nurse  of  the  Commission  to  Europe  and  herself  a  resident  for 
many  years  in  Italy,  summarized  the  schools  of  nursing  which 
were  organized  by  the  American  Red  Cross ; 

The  work  done  by  ]\Iiss  Foley  and  her  staff  consisted  of 
carrying  on  the  course  of  instruction  established  by  Miss 
Gardner  for  tlie  purpose  of  training  young  women  in  visiting 
nursing  and  the  care  of  patients  suffering  from  tuberculosis. 
It  has  been  very  up-hill  work  to  obtain  the  cooperation  neces- 
sary for  successfully  carrying  on  these  courses,  particularly 
from  the  medical  profession,  which  in  Italy  is  still  opposed  to 
the  hij^her  education  of  nurses. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     873 

Committees  of  prominent  women  have  been  formed  in 
Rome,  Florence  and  (Jenoa  and  these  have  fulfilled  their 
obligations  ...  to  the  extent  of  providing  class  rooms  for 
the  course  and  interesting  themselves  generally  in  the  work. 
However,  this  interest  is  not  strong  enough  to  influence  the 
medical  profession  sufficiently  to  obtain  for  tiiese  students  the 
field  work  necessary  to  complete  their  training.  Some  dispen- 
saries have  been  willing  to  take  these  students  for  a  certain 
number  ot  days  a  week,  hut  the  doctors  have  refused  to  allow 
the  nurses  or  the  students  to  do  any  follow-up  work  oi*  to 
visit  the  patients  in  their  homes.  This  the  doctors  claim 
w^ould  never  be  tolerated  by  the  people,  but  as  a  concession 
they  admit  that  later  on  an  Italian  nurse  might  be  allowed 
to  do  the  visiting  work. 

This  lack  of  cooperation  from  the  doctors  necessarily  limits 
the  scope  of  the  training  and  this  has  been  conspicuous  in 
Eome.  In  Genoa  the  doctors  have  been  more  helpful  and 
the  graduates  of  the  first  course  have  found  positions  in  dis- 
pensaries, clinics  and  schools.  .  .  . 

From  October,  1918,  we  have  had  in  Italy  Miss  Gardner, 
Miss  Thompson  and  IMiss  Foley,  all  three  of  them  women 
who  rank  high  in  our  nursing  profession  and  who  are  special- 
ists along  public  health  lines.  They  have  worked  hard  and 
have  been  deeply  interested  in  their  work.  I  feel,  however, 
that  educational  work  of  this  kind  has  not  found  appreciation 
in  Italy,  but  I  hope  I  may  be  mistaken  in  this.  So  far  the 
work  has  resulted  in  educating  less  tlian  twenty  women  .  .  . 
and  the  great  difficulty  is  to  obtain  positions  for  them  after 
their  studies  are  completed.  The  medical  profession  is  not 
ready  for  associates  of  this  kind  and  naturally  the  demand  for 
such  workers  must  come  from  them. 

Miss   Fitzgerald   summarized   the   long   struggle   which   had 
taken  place  in  Italy  for  the  higher  education  of  nurses: 

The  history  of  the  attempts  to  educate  nurses  in  Italy  is 
one  of  great  discouragement.  .  .  .  Attempts  to  run  training 
schools  along  the  lines  of  American  and  F>rilish  training 
schools  have  been  made  by  British  nurses  in  Floreiu'e;  by  the 
Queen  of  Italy  herself,  at  a  big  hospital  in  l^ome  where  sev- 
eral wards  were  given  over  to  an  English-trained  nurse;  by  a 
graduate  of  the  Johns  Hopkins  School,  in  Xaplcs ;  and  ijy  the 
Italian  Ked  Cross  in  Milan.  .  .  .  The  results  are  practically 
the  same  in  ev(M-y  case.  The  opposition  of  the  doctors  has 
continued;  to  this  has  been  addeil  the  ill  will  of  both  men  and 
women  of  the  servant  class  of  nurses  who  now  do  the  nursing]: 


874)   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  Italian  hospitals;  and  the  well-established  control  by 
nurses.  This  opposition  is  represented  by  a  very  large  body 
of  people,  none  of  whom  wish  the  reform  as  each  one  fears  a 
personal  loss  of  prestige  and  privileges. 

It  has  been  suggested  at  different  times  that  the  approach 
to  the  nursing  problem  in  Italy  and  in  France  should  come 
through  the  religious  body.  It  is  interesting  to  note  that  this 
was  attempted  in  Florence;  two  nuns  were  sent  to  the  train- 
ing school  in  Eome  for  the  full  three  years'  course.  Upon 
their  return  to  Florence,  they  immediately  took  sides  against 
the  trained  women  and  went  back  to  the  opposition,  thereby 
showing  the  uselessness  of  this  mode  of  approach. 

The  only  ray  of  hope  I  can  see  is  in  the  Italian  Eed  Cross, 
which,  I  believe,  intends  to  start  training  schools  and  has 
already  placed  on  a  salary  basis  nurses  who  are  now  acting  in 
an  official  capacity  for  that  organization.  This  is  already  a 
step  in  the  right  direction,  as  the  Italian  Eed  Cross  formerly 
insisted  that  all  nursing  should  be  voluntary  and  in  no  way 
did  the  society  recognize  the  necessity  for  trained  and  salaried 
personnel. 

It  is  very  apparent  that  Italy  needs  no  help  from  us  in  this 
line. 

Thus  was  ended  the  work  of  the  American  Red  Cross  in 
Italy.  The  seed  of  modern  nursing  which  the  American  Red 
Cross  attempted  to  plant  in  Italy  at  great  cost  fell  into  barren 
soil,  but  may  in  the  future  take  root  and  bear  fruit.  Promise 
of  this  future  development  is  contained  in  the  following  notice 
which  appeared  in  the  Foreign  Department  of  the  October, 
1920,  issue  of  the  Aniei'ican  Journal  of  Nursing: 

The  three  courses  in  public  health  nursing  established  by 
the  American  Ked  Cross  Tuberculosis  Commission  in  Italy 
are  meeting  with  well-deserved  success.  When  the  American 
nurses  were  withdrawn  in  January,  people  prophesied  that  the 
courses  might  be  closed,  but  the  carefully  selected  and  organ- 
ized Italian  committees  have  proved  themselves  more  than  able 
to  meet  any  emergencies  and  the  shorter  courses  in  Eome  and 
Florence  are  both  to  be  repeated.  A  new  course  is  being  opened 
this  month  in  IMilan  by  the  Italian  director  of  the  Eome 
course  and  tlie  more  ambitious  ten  months'  course  which  is 
being  offered  in  Genoa  closes  this  October.  Letters  from  Italy 
tell  us  that  the  graduates  of  all  three  courses  are  in  such 
demand  that  tlicre  are  constantly  more  positions  than  candi- 
dates.    The  nurses  who  saw  the  hardships  of  the  primitive 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    875 

life  in  tlie  southern  part  of  the  jx^ninsula  will  be  interested 
in  knowing  that  one  nurse  has  been  placed  in  Calabria,  three 
in  Sicily  and  more  will  be  sent  south  as  soon  as  they  have 
completed  the  s|>ecial  training.  .  .  . 

Miss  Gardner  epitomized  the  Italian  situation :  "Italy  must 
work  out  her  own  nursing  salvation  and  it  must  be  an  Italian 
salvation  worked  out  by  Italians  in  an  Italian  way." 

Roumania  perhaps  suffered  more  during  the  European  War 
than  did  any  other  nation,  with  the  exceptions  of  Serbia  and 
Siberia.  She  was  faced  on  the  south  by  the  Bulgarians,  who 
were  smarting  under  the  outcome  of  the  Second  Balkan  War 
and  desired  to  recover  the  lands  of  Dobrudja  lost  under  the 
Treaty  of  Bucharest ;  on  the  west  by  powerful  Austria-Hungary  ; 
and  on  the  north  by  Russia,  an  ally  in  whom  Roumania  had 
little  confidence.  For  two  years  she  had  remained  an  island  in 
a  whirlpool  of  war,  but  on  April  28,  lUlG,  she  joined  the  Allies. 

The  kingdom  of  Rounuinia  then  occupied  the  great  plain 
which  sloped  from  the  Carpathian  Alps  to  the  Black  Sea,  a 
plain  covered  with  rich  alluvial  deposits  similar  to  the  famous 
Russian  "black  earth."  The  shape  of  the  country  resembled 
the  letter  "Y."  The  province  of  Dobrudja  occupied  the  leg  of 
the  letter  and  fronted  on  the  Black  Sea.  The  principality  of 
Wallachia  formed  the  left  arm  and  extended  westward.  The 
principality  of  Moldavia  formed  the  right  arm  of  the  letter  and 
extended  north  between  Austria-Hungary  and  Russia. 

The  country  was  chiefly  agricultural.  In  1900  Roumania 
was  the  third  largest  grain-growing  nation  In  the  world.  She 
possessed  rich  oil  and  coal  deposits  and  Iron,  copper,  lead, 
nickel,  mercury  and  other  metals  In  quantities  sufficient  to 
make  mining  profitable.  However,  the  Roumanian  tempera- 
ment did  not  Incline  toward  Industrial  life.  The  oil  fields 
of  Wallachia  had  been  developed  to  considerable  extent  by 
foreigii  capital.  Roumania's  chief  exports  were  timber  from 
the  oak,  pine  and  beech  forests  of  the  Carpathian  mountain 
slopes,  petroleum  and  grain.  She  Imported  metals,  machinery, 
textiles  and  other  manufactured  necessities  of  modern  life. 

In  1U14:  the  population  of  Rounuinia  numbered  ai)[)r(txi- 
mately  seven  and  a  half  million  people,  of  which  six  uiilliou 
were  Rounuuiians  and  the  others  Jews,  Tartars,  Magyars,  S(m-1>s, 
Bulgars  and  Armenians.     The  Roumanian  ch'mcnt  was  sharply 


876   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

divided  into  two  classes:  the  wealthy  land-owning  aristocracy 
who  possessed  a  culture  similar  to  and  largely  derived  from 
the  French,  and  the  peasant  group  who  were  made  up  for  the 
most  part  of  simple  uneducated  folk  who  tilled  the  grain  fields 
and  herded  the  flocks.  A  middle-class  industrial  or  merchant 
group  similar  to  that  in  the  United  States  did  not  exist. 

In  1914  Eoumania  found  herself  in  an  extremely  difficult 
political  position.  She  had  gone  in  1877  to  the  rescue  of  Rus- 
sia, then  hard  pressed  by  the  Turks  at  Ple\^ia,  but  was  re- 
warded by  the  deprivation  of  the  province  of  Bessarabia  and 
was  given  a  part  of  worthless  Dobrudja  as  compensation.  Rou- 
mania's  independence  from  Turkish  sovereignty  was,  however, 
established,  and  in  1881  the  country  was  proclaimed  a  king- 
dom. Prince  Charles  of  Hohenzollern-Sigmaringen  was 
crowned  King  under  the  title  of  Carol  I.  During  the  thirty 
years'  reign  of  Charles  and  his  poetess-queen,  ''Carmen-Sylvia," 
the  era  was  one  of  national  prosperity  and  economic  and  civil 
development. 

During  the  first  Balkan  War  of  1912-1913,  Roumania  re- 
mained neutral.  When  peace  negotiations  were  begun,  Rou- 
mania claimed  that  she  was  entitled  to  territorial  compensa- 
tion from  Bulgaria  for  her  neutrality  and  demanded  cession 
of  the  town  of  Silistria,  realignment  of  the  frontier  of  Do- 
brudja and  cession  of  a  strip  of  coast  territory  on  the  Black  Sea 
to  permit  her  to  develop  a  naval  base.  The  Second  Balkan 
War  was  declared  before  these  claims  had  been  settled.  Rou- 
mania put  her  armies  in  the  field,  occupied  Silistria  and  by 
July  13,  1913,  had  approached  within  twenty  miles  of  the 
Bulgarian  capital.  An  armistice  was  then  signed  and  by  the 
Treaty  of  Bucharest,  Roumania  obtained  what  she  had  claimed 
but  also  the  enmity  of  her  southern  neighbor,   Bulgaria. 

When  tlie  European  War  broke  out,  King  Charles  desired  to 
join  the  Central  Powers,  but  Roumanian  public  opinion  was  in 
sympathy  witli  the  Allies,  so  the  country  remained  neutral. 
King  Charles  died  on  October  10,  1911-,  and  two  years  later, 
his  queen  died.  Tlie  successor  to  the  throne  was  Ferdinand,  a 
nephew  of  Charles  and  a  younger  brother  of  Prince  William 
of  Hohenzollern-Sigmaringen.  Ferdinand  had  married  Marie, 
daughter  of  the  Duke  of  Saxe-Coburg  and  Gotha  and  grand- 
daughter of  Queen  Victoria,  a  woman  of  unusual  beauty  and 
strength  of  character  who  had  won  the  love  and  sympathy  of 
the  Roumanian  people. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    877 

Roiimania  declared  war  in  April,  1916,  and  in  the  summer 
her  First  Army  invaded  Transylvania,  captured  Kronstadt  and 
Hermannstadt  and  by  September  9  were  holding  nearly  one- 
fourth  of  Transylvania.  General  Von  Hindenburg  with  450,- 
000  veteran  troops  was  then  sent  by  the  German  High  Com- 
mand to  crush  Koumania.  The  opposing  armies  met  at 
Hermannstadt  and  in  four  days  of  fighting  the  Roumanian 
First  Army  was  annihilated.  General  Von  Falkenhayn  made 
a  rapid  enveloping  movement,  came  up  in  the  Roumanian  rear 
and  cut  off  their  retreat  through  the  Red  Tower  Pass.  The 
Roumanian  forces  were  thrown  into  disorganization  and  re- 
treated in  complete  disorder  and  with  great  losses. 

On  the  south  the  Bulgar  and  German  forces  were  also  press- 
ing forward.  General  Von  Mackensen  entered  the  Dobrudja. 
Russian  reenforcements  failed  to  arrive  and  Roumania  was 
then  ''like  a  nut  in  the  jaws  of  a  nutcracker."  ^^  Von  Falken- 
hayn was  pushing  down  from  the  north  and  Von  Mackensen 
up  from  the  south.  By  August,  1917,  the  Teutons  were  in 
complete  possession  of  all  of  Roumania  except  Moldavia. 

In  little  more  than  a  year  Roumania  had  lost  her  two  richest 
provinces  and  at  least  two  hundred  and  fifty  thousand  men, 
forty  per  cent  of  her  original  army.  ^luch  of  its  equipment 
and  ordnance  had  been  captured  by  the  enemy. 

Government  and  Army  Headquarters  and  the  Court  evacu- 
ated Bucharest  and  fled  to  Jassy,  the  former  capital  of  Moldavia. 
This  city  was  also  the  headquarters  for  the  Russian  Armies 
operating  on  the  Roumanian  Front.  Jassy  had  nonnally  a 
population  of  about  seventy  thousand;  this  in  1917  was  more 
than  doubled.  As  also  the  refugees  from  the  two  occupied 
provinces  had  fled  to  ]\roldavia,  this  least  rich  of  the  Rou- 
manian provinces  thus  was  called  upon  to  support  the  Govern- 
ment officials,  the  R(uimanian  Army  of  four  hundred  thousand, 
the  refugees  who  numbered  about  half  a  million  and  the  Rus- 
sian Armv  which  at  one  time  agaregated  about  one  million  men. 
The  winter  of  191G-1917  was  one  of  the  most  severe  on 
record;  the  thermometer  often  registered  thirtv  degrees  below 
zero.  Cattle,  horses  and  sheep  died  for  want  of  food.  P('o])le 
were  found  dvdd  from  starvation  and  exposure  in  the  streets 
of  the  cities  and  in  dugouts,  stables  and  huts  in  the  country.  In 
December,  typhus  began  to  spread  among  the  devitalized  popu- 

*"'A  Ri'foronec  Tlistorv  of  the  War,"  T.  S.  Guernsov,  p.  162.  Dotld.  Mead 
&.  Co.,  New  York,  1!»20.  ' 


878   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

lation.  During  the  winter  and  spring  230,000  persons  died  of 
disease  and  by  the  summer  of  1917  Roumania  had  lost  from 
war  casualties  and  diseases  seven  per  cent  of  her  entire 
population. 

Both  from  an  economic  and  professional  point  of  view,  Rou- 
mania was  not  prepared  in  191G  to  give  to  her  sick  and  wounded 
soldiers  and  to  her  typhus-ridden  civilians  sanitary  service  com- 
parable to  that  which  prevailed  in  the  British  Empire  and  the 
United  States.  Three  types  of  hospitals  existed  in  Roumania : 
those  established  by  the  Roumanian  Red  Cross;  those  by  the 
Roumanian  Army,  and  those  by  Queen  Marie. 

The  hospitals  of  the  Roumanian  Red  Cross  maintained  the 
highest  standards  in  caring  for  the  wounded.  They  were  usu- 
ally of  five  hundred  bed  capacity  and  were  generally  located 
in  a  school  building  which  had  been  taken  over  for  use  as  a 
hospital.  The  equipment  was  the  most  liberal  and  the  food  the 
most  adequate  of  any  hospitals  in  the  country.  This  superiority 
was  due  to  the  fact  that  the  Roumanian  Red  Cross  was  a  well- 
established  and  generously-supported  organization.  Also,  the 
most  prominent  surgeons  were  associated  with  this  group  of 
hospitals.  The  nursing  service  was  rendered  by  Red  Cross 
volunteer  nurses,  untrained  according  to  the  English  and 
American  standards,  but  devoted  and  tireless  in  their  ministry. 

The  hospitals  established  by  the  Roumanian  Army  were  gen- 
erally located  in  newly-constructed  wooden  barracks.  The  beds 
were  of  wood,  the  mattress  of  straw  and  one  sheet  and  two 
blankets  were  furnished  to  each  patient.  The  capacity  of  the 
hospitals  located  at  important  strategic  points  ran  as  high  as 
2000  beds.     Xo  women  luirses  were  employed  in  this  group. 

The  hospitals  of  Regina  Maria  were  usually  to  be  found  in 
the  smaller  villages  and  towns.  They  had  been  established  and 
were  supported  by  the  resolute  Queen  ]Marie. 

In  September,  191G,  a  French  medical  unit  under  the  direc- 
tion of  L)r.  Dehelley  was  sent  at  the  request  of  the  Roumanian 
Government  to  Jassy,  to  demonstrate  the  Carrel  trcatmen.t  of 
wounds.  One  of  the  nurses  was  Pauline  Jordan,  the  American 
Red  Cross  nurse  who  was  later  sent  to  Italy;  she  had  been  on 
duty  since  1914  at  the  American  Ambulance  at  ISTeuilly.  The 
Carrel  ^lission  arrived  in  Bucharest  in  the  fall  of  19 IG  and  a 
letter  written  by  ]\riss  Jordan  on  April  22,  1917,  to  Miss 
Delano,  gave  an  excellent  picture  of  conditions  existing  in  many 
Roumanian  hospitals: 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     879 

We  were  given  a  pavilion  of  the  best  hospital  at  Bucharest 
but  it  was  hardly  ready  for  patients  when  the  city  was  evacu- 
ated. Arrivin<j  at  J  assy,  we  were  placed  in  a  Roumanian 
hospital. 

There  were  no  "nurses"  here,  only  ladies  who  came  in  to 
see  that  the  domestics  did  their  work  properly.  During  the 
six  weeks  that  we  were  in  the  Roumanian  Hospital  at  J  assy, 
we  did  most  of  the  dressings  under  great  difficulty.  The 
dressing  room  was  crowded  with  Sisters  of  Charity,  boy 
scouts,  medical  students  and  many  young  girls.  As  we  had 
over  six  hundred  patients  and  about  four  sets  of  instruments 
and  only  one  alcohol  stove,  the  work  was  never  completely 
finished. 

There  was  no  heat  and  the  food  was  very  poor.  Our  prin- 
cipal diet  was  corn  meal  mush  and  goats'  cheese,  black  bread 
and  occasionally  beans.  Once  a  day  we  had  tea  and  twice  a 
week  meat.  During  the  winter  we  cared  for  patients,  whose 
feet  had  been  completely  frozen  while  lying  in  bed. 

The  Carrel  Mission  was  soon  moved  into  their  own  hospital, 
a  building  formerly  used  as  a  school  for  orthodox  priests.  Miss 
Jordan  wrote : 

We  found  it  unbelievably  dirty  and  with  the  poorest  of 
sanitary  arrangements.  The  wounded  were  alive  with  ver- 
min and  we  had  no  supplies.  When  the  severely  wounded 
came  in  we  bad  almost  nothing  to  work  with.  They  lay  on 
straw  mattresses  without  rubber  sheets  and  the  straw  quickly 
became  contaminated  with  pus  and  blood,  but  we  had  no  fresh 
straw  A  great  many  of  them  died  from  exposure  and  septic 
infection.  I  remember  the  amputation  of  the  arm  of  two 
patients,  which  was  caused  by  bandages  applied  too  tightly 
before  they  came  to  us. 

There  are  one  or  two  huge  Roumanian  stoves  in  each  ward, 
but  we  have  had  almost  no  wood  or  coal  to  burn  in  them.  We 
have  had  biting  Russian  winds  and  icicles  hung  from  the 
windows  in  the  wards  all  winter  and  the  wounded  used  to  cry 
to  us:  ''Give  us  a  fire,  we  are  freezing,  we  are  dying  of  cold  I"' 
We  have  operated  for  days  when  our  breath  almost  confjoaled 
in  the  cold  air.  Of  course  we  have  had  a  great  many  cases  of 
pneumonia.  Tliere  rarely  was  ever  more  than  one  blanket  to 
each  bed. 

There  are  no  l)asins  for  the  patients  to  wash  themselves  in, 
no  towels  and  they  have  been  without  nightgowns  for  weeks. 
There  simply  isn't  anything  in  the  (ountry  and  the  suj^jilios 
which  have   been  ordered  have  either  been  sunk   or  lo?t   in 


880   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Eussia.  The  food  for  the  patients  consists  of  thin  soup  twice 
a  day,  black  bread  and  occasionally  beans.  From  time  to 
time  we  have  had  a  little  condensed  milk  and  macaroni  for  the 
sickest  patients.  Our  food  is  the  same,  with  the  addition  of 
potatoes  and  meat  twice  a  week.  As  French  officers,  we  are 
permitted  to  buy  meat  once  a  week.  The  Queen  sent  us  some 
rice,  macaroni,  sugar  and  tea  and  the  American  Legation  has 
been  very  kind  to  us  indeed  so  we  have  managed  to  live 
through  the  winter.  The  patients  are  all  suffering  from 
malnutrition. 

No  doubt  you  have  read  of  the  frightful  typhus  epidemic. 
The  hospitals  are  full  and  at  present  the  authorities  are 
building  rude  barracks  on  the  outskirts  of  the  city  for  them. 
People  have  died  by  the  thousands  and  all  the  hospitals  are 
overcrowded.  .  .  . 

Upon  admission,  the  blesses  are  bathed,  shaved  and  rubbed 
with  petrol.  \Yhen  they  came  to  us,  they  received  a  second 
petrol  bath  on  the  stretcher  before  being  put  in  bed.  The 
floors  are  washed  with  petrol  once  a  week  and  beds  and  mat- 
tresses scrubbed  regularly,  but  on  account  of  the  dirty  maids 
and  militia,  one  never  feels  safe.  Life  here  is  a  continual 
fight  against  the  vermin.  In  spite  of  precautions  we  find 
them  occasionally  on  our  clothing.  They  are  absolutely 
colorless  and  have  tiny  black  crosses  on  their  backs. 

In  a  letter  written  to  Miss  Delano  on  August  5  from  Jassy, 
Miss  Jordan  commented  again  on  the  nursing  situation  in 
Roumania : 

The  Eoumanian  offensive  has  started  brilliantly,  but  has 
been  forced  to  stop  owing  to  the  Russians.  .  .  .  Hospitals 
have  beeii  organized  all  along  the  line  of  the  prospective 
offensive,  some  of  them  only  five  kilometers  from  the 
trenches.  .  .  . 

There  are  five  of  us  graduates  now  and  we  sit  day  after 
day  making  surgical  supplies  .  .  .  mattresses  all  neatly 
tucked  in.  envelo])e-fashion,  while  many  other  hospitals  have 
neither  the  supplies  nor  the  people  to  make  or  use  them. 
This  is  our  great  trial.  A  imit  will  come  out  and  take  over 
the  direction  of  a  hospital  of  one  hundred  to  three  hundred 
beds.  In  that  one  hospital,  everything  will  be  as  nearly  per- 
fect as  existing  conditions  will  allow,  down  to  the  smallest 
compress,  while  in  the  rest  of  the  country  the  very  essentials 
of  life  and  death  are  overlooked  and  all  is  confusion.  We 
have  so  often  regretted  having  been  able  to  do  so  little  good 
in  a  country  where  tlic  need  is  so  great. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    881 

The  greatest  lack  seems  to  be  nurses.  There  seems  to  be 
none  except  a  few  who  have  come  out  with  .sf>ecial  units  and 
cannot  leave  them.  In  these  Roumanian  hos{)itals,  practically 
any  woman  wiio  wears  a  cap  is  allowed  to  do  surgical  dressings 
and  operating-room  work.  All  other  work  is  considered  un- 
interesting and  is  left  to  servants.  One  wishes  that  the 
nurses  could  be  scattered  about  where  the  need  is  greatest. 

The  Koumanians  seem  to  have  a  profound  respect  for  our 
training  and  look  upon  us  as  a  new  sort  of  doctor. 

The  intense  cold  from  which  Roumania  had  suffered  had 
been  replaced  by  equally  intense  heat.  Miss  Jordan's  letter 
continued : 

At  the  present  time,  the  heat  is  almost  unbearable,  107 
degrees  in  the  sliade  yesterday  afternoon  at  live  o'clock.  There 
has  been  an  epidemic  of  dysentery  and  many  people,  enfeebled 
by  disease  and  malnutrition,  have  died.  Typhus  has  practi- 
cally disappeared  and  tlie  body-louse  also,  but  the  flies  have 
taken  their  place  and  are  an  abomination. 

Of  the  hospitals  established  in  Roumania  by  foreign  units, 
Miss  Jordan  wrote : 

We  have  been  able  to  visit  some  prison  camps,  also  a  few 
well-equipped  hospitals.  One  was  managed  by  a  French 
doctor  who  designed  and  arranged  a  splendid  mechano- 
therapy room,  also  a  home-made  sterilizer  made  of  cement  and 
heated  by  wood,  for  quilts  and  mattresses.  The  British  lied 
Cross  has  a  very  good  hospital  at  Roman.  Xearly  all  their 
furniture,  beds,  tables,  chairs  and  sandals  have  been  made  by 
convalescent  patients  under  the  doctor's  direction.  At  the 
present  time  his  ])atients  are  building  a  sort  of  rough  swim- 
ming tank.  He  was  far-seeing  enough  to  plant  a  garden  in 
the  spring  and  now  their  own  table  is  well  supplied  with 
green  vegetables,  a  rare  luxury. 

Of  the  military  situation  in  August,  1917,  Miss  Jordan 
wrote : 

For  the  past  week,  we  have  been  ready  to  leave  on  an 
hour's  notice.  The  Russians  are  refusing  to  fight  and  are 
rapidly  retreating  from  Bukovina,  which  endangers  our  line 
of  communication  to  Kief  and  Fetrograd.  The  rest  of  Rou- 
mania will  then  be  captured,  we  fear.  A  train  left  yesterday 
with  the  I-higlisli  civilian  colony  and  one  is  leaving  to-morrow 


882   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

with  the  French.  The  legations  and  the  Court  expect  to 
leave  in  three  or  four  days.  We  have  received  the  order  to 
stay  on  for  a  few  more  days  and  will  evacuate  with  the  Army, 
by  rail  if  possible. 

The  authorities  have  begun  to  give  us  the  food  supplies  for 
distribution  to  the  population.  The  greater  part  of  the 
civilians  have  decided  to  stay  in  the  country,  preferring  to  be 
prisoners  rather  than  to  live  with  the  Russians.  .  .  . 

To  such  a  situation,  the  American  Red  Cross  sent  its  first 
Roumanian  relief  unit  in  September,  1917.  The  American 
Red  Cross  Commission  for  Roumania  had  been  under  process 
of  organization  in  the  United  States  since  early  that  summer, 
under  the  leadership  of  Lieutenant  Colonel  Henry  W.  Ander- 
son, of  Richmond,  Virginia.  Dr.  Francis  Peabody,  an  expert 
on  internal  medicine,  Bernard  Flexner,  a  sociologist,  Dr.  Gid- 
eon Wells,  a  pathologist,  Dr.  Robert  C.  Bryan,  an  expert  in 
surgery,  Dr.  Roger  G.  Perkins,  a  sanitarian  and  Arthur  G. 
Glasgow,  an  engineer,  were  the  principal  new  members  of  the 
commission.  It  was  the  intention  of  the  War  Council  that 
these  men  should  make  a  survey  of  Roumania  and  then  return 
to  the  United  States  with  a  report  on  W'hich  to  base  future  Red 
Cross  relief  work. 

The  medical  and  nursing  unit  was  to  remain  in  Roumania 
for  emergency  relief  work.  Dr.  Kirkpatrick,  who  served  wdth 
Dr.  Ryan  at  Belgrade  in  1915,  was  the  director.  Florence  M. 
Patterson  was  chief  nurse.  ]\Iiss  Patterson's  name  has  al- 
ready appeared  in  this  history  in  connection  with  American 
Red  Cross  nursing  service  in  Great  Britain  and  France,  but 
her  Roumanian  assignment  marked  the  beginning  of  her  subse- 
quently long  and  valuable  field  service. 

The  nursing  unit  was  composed  of  eleven  nurses  in  addition 
to  Miss  Patt(n-son  and  contained  among  its  members  many  re- 
markal)lc  women  whose  names  stand  high  upon  Red  Cross 
rolls — Rachel  Torrance,  Linda  K.  Meirs,  Katherine  Olmstead 
and  Alma  Foerster.  Other  nurses  of  the  unit  were  Adelaide 
Rowland,  3Iarv  Mcliitire,  Beatrice  Gosling,  Alice  Gilbourne, 
Mary  Brownell  and  Jennie  Doiuild. 

The  Roumanian  Commission  mobilized  in  Chicago  on 
July  28,  1917,  and  sailed  from  Vancouver  five  days  later  for 
Yokohama,  Japan.  From  -lapan  the  unit  proceeded  to  Vladi- 
vostok, thence  to  Harbin  and  westward  by  special  train  over 


NURSING  SERVICE  TO  CIVILIAN  POPn.ATION     883 

the  Trans-Siberian  Railroad  to  Moscow  and  tlionce  to  Jassy. 
Thoy  arrived  in  tiie  Ivonnianian  capital  on  September  10,  l'.)17, 
after  a  journey  of  fifty-two  days. 

Supplies  were  sent  by  the  American  Red  Cross  via  the 
Pacific  route  and  a  second  considerable  consignment  to  Archan- 
gel, Russia,  for  shipment  southward  to  Roumania. 

After  a  month  spent  in  surveying  ^loldavia,  live  of  the  com- 
missioners returned  to  the  United  States  and  submitted  de- 
tailed reports  to  the  War  Council  of  the  economic  and  sanitary 
situation  of  Roumania.  Colonel  Anderson  and  the  members 
of  the  commission  who  remained  in  Jassy  immediately  under- 
took emergency  relief  work.  This  fell  into  five  general  groups- 
hospital  service,  public  health  and  sanitation,  civilian  relief, 
transport  service,  and  miscellaneous  relief.  Carloads  of  food 
were  brought  down  from  Archangel,  Petrograd  and  Moscow 
and  were  distributed  to  the  Roumanian  population.  In  Putna, 
Tekuchin  and  Bocan,  40,000  persons  were  fed  daily  by  the 
American  Red  Cross,  and  a  canteen  was  opened  in  Jassy  where 
for  two  months  meals  were  daily  given  to  2000  persons.'*'^ 

The  Commission  for  Roumania  maintained  a  hospital  at 
Roman  and  dispensary  service  at  Roman  and  at  Jassy.  The 
hospital  at  Roman  was  the  former  British  Red  Cross  Hospital 
described  by  Miss  Jordan  and  was  known  as  the  Prince  Mercea 
Hospital.  Major  Kirkpatrick,  director  of  the  medical  unit, 
gave  the  following  reasons  why  the  commission  took  over  this 
institution : 

Firstly,  the  lio.<pital  equipment  that  we  expected  from 
America  by  way  of  Archangel  had  failed  to  arrive  and  we 
were  unable  to  eqiiij)  a  new  hospital  with  the  limited  emer- 
gency supplies  we  had  brought  with  us  across  Siberia. 

Secondly,  the  l^ritish  Eed  Cross  were  giving  up  the  Prince 
Mercea  Hospital  l)ecause  of  an  overworked  staff.  This  hos- 
pital was  e(iuii)])('(l  sulliciently  for  good  surgical  service.  .  .   . 

Thirdly.  IJonian  was  so  located  in  relation  to  the  armies 
that  tlie  liospital  drew  from  a  large  section  of  the  front,  witli 
a  mininnnn  of  delay  in  traiisportation  of  the  wounded. 

Fourthly,  we  could  begin  work  at  once. 

Tn  her  final  report  to  !Miss  Xoyes,  ^liss  Patterson  wrotc^  of 
their  (»xperi(>nces : 

^^  "Tho  Work  of  tlic  Ainorican  Hod  Cross  during  tlie  War:  A  Statement 
of    Finances    and    Aceoinplisiinients,"    i).    80. 


884   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  took  over  the  Prince  Mercea  Hospital  on  October  6, 
1917,  and  until  March  8,  1918,  we  were  always  sitting  on  the 
edge  of  a  volcano  which  never  erupted.  We  had  to  be  ready 
to  move  within  an  hour  provided  the  Huns  came  or  if  the 
Russians  signed  peace  or  (much  more  probable)  if  the  Bol- 
sheviki  attacked  us  for  food  supplies.  We  had,  as  you  know, 
no  offensive  after  we  arrived  but  when  we  took  over  the 
hospital  from  the  British  Red  Cross,  we  "inherited"'  about 
400  patients  and  from  then  until  we  left  we  had  between  380 
and  500  cases.  Most  of  them  were  wounded  who  had  been 
evacuated  from  hospitals  nearer  the  front  (an  entirely 
imaginary  term  as  far  as  the  Eastern  Front  is  concerned!). 
Also,  we  had  civilians  and  even  women  and  children  when  we 
had  empty  beds. 

As  we  had  inherited  the  hospital  from  the  British,  it  was 
more  or  less  well  equipped  and,  indeed,  we  should  have  had  a 
sorry  time  except  for  the  unstinted  way  in  which  the  British 
and  Eussian  Red  Cross  helped  us  out  all  along.  The  equip- 
ment which  was  shipped  from  the  American  Red  Cross 
reached  Roman  the  latter  part  of  November  and  even  then  v/as 
quite  inadequate  for  any  sort  of  a  hospital. 

The  nurses  lived  in  two  small  wards  of  the  Roman  Hospital. 
Miss  Patterson  wrote: 

The  nurses  all  considered  their  quarters  quite  comfortable, 
although  they  had  nothing  except  their  beds  and  one  or  two 
small  tables  and  several  chairs.  The  beds  were  boards  with 
straw  mattresses,  but  not  at  all  bad. 

Of  course  the  food  proposition  was  much  the  most  diflficult, 
for  there  was  nothing  to  be  purchased  in  Roumania.  Fortu- 
nately the  potatoes  were  splendid  and  we  were  able  to  get  a 
good  supply  stored  away  for  winter.  We  were  able  to  get  no 
meat  after  December  1  and  had  no  canned  meats,  but  in  true 
Roumanian  fashion,  we  had  a  small  farm  in  our  back  yard, 
which  we  stocked  in  the  fall  with  several  pigs.  Consequently, 
we  went  on  mad  debauches  several  times  by  having  a  pig 
killed,  but  wc  always  ate  it  with  the  fear  that  we  might  need 
it  worse  later  on.  We  had  macaroni,  rice  and  plenty  of  but- 
ter which  came  from  the  Russian  Red  Cross  and  coffee  from 
the  V.  S.  A.  which  seemed  really  to  save  our  lives. 

There  was  practically  no  milk  in  the  country  ])ecause  there 
was  no  fodder  for  the  cows  and  during  the  last  few  months 
we  had  about  ten  quarts  daily  for  the  entire  hospital  and 
some  days  none  at  all.  We  probably  had  an  average  of  two 
dozen  eggs  for  the  entire  hospital.     The  patients  had  meat 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    885 

twice  a  week  hut  in  almost  infinitesimal  quantities  and  fear- 
fully bad,  simply  starved  animals.  Tiie  otlu^r  articles  of  food 
were  beans,  cabba^^e  and  potatoes.  How  those  patients  man- 
aged to  recover  on  that  diet  is  still  a  puzzle  to  us — for  we  had 
nothing  else  even  for  the  desperately  ill  men.  It  is  quite 
impossible  to  tell  how  absolutely  destitute  the  country  is, 
with  neither  food  nor  clothing. 

For  the  peasants  we  have  the  utmost  sympathy.  They  are 
splendid  and  are  tlie  one  hope  of  Roumaiiia,  except  Queen 
Marie,  who  is  wonderful.  She  and  Princess  Marie  had 
Thanksgiving  dinner  with  us  at  the  hospital  .  .  .  and  when 
we  left  she  asked  us  in  tears  to  tell  the  women  of  America  how 
she  had  tried  and  how  she  would  continue  to  fight  to  the 
end :    "We  English  never  give  up." 

Early  in  January,  1918,  the  commission  started  an  out- 
patient department  at  the  Roman  Hospital.  Miss  Patterson 
wrote : 

Our  most  interesting  work  was  the  out-patient  depart- 
ment for  civilians.  We  did  general  relief  work  in  connection 
with  it  and  also  some  nursing  in  the  homes,  an  unheard-of 
thing  there.  The  starvation  diet  and  complete  absence  of 
soap  among  the  civilian  population,  together  with  the  general 
prevalence  of  venereal  diseases,  soon  made  our  clinics  known 
as  the  S.  S.  S.  (soap,  sulphur  and  salvarsan). 

I  should  say  that  every  child  and  about  85  per  cent  of  the 
patients  had  scabies.  We  distributed  soap  in  small  pieces, 
but  of  course  the  whole  effort  was  futile  under  existing  con- 
ditions. The  peasants  had  practically  nothing  to  eat  except 
cornmeal,  which  constitutes  a  large  part  of  their  normal  diet, 
so  you  can  imagine  the  amount  of  resistance  to  disease  they 
had.  When  a  ])atient  would  seemingly  be  doing  well,  he 
would  without  any  apparent  reason  run  a  fearful  tempera- 
ture and  just  go  all  to  pieces.  So  wr  really  never  knew  until 
they  were  evacuated  whether  tliey  would  go  out  of  the  front 
door  or  be  carried  out  of  the  back  ! 

Witliin  three  days  at  Christmas  time,  we  had  ISO  hernia 
cases  come  in  for  operation  (1  never  did  make  out  whetlier  or 
not  it  was  an  epidemic),  but  these  were  ])ractically  tlie  only 
clean  cases  we  saw  while  there  and  many  of  these  weren't 
clean,  because  there  wasn't  enough  vitality  left  in  any  of 
them. 

Late  in  191 7  the  commission  developed  ])lans  for  establish- 
ing an  American  Red  (^ross  hospital  in  -lassy.     Several  nurses 


886   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  Miss  Patterson's  group  were  sent  from  Roman  to  organize 
it  in  a  building  loaned  by  the  Government.  Before  it  could  be 
equipped,  however,  the  Government  decided  to  utilize  it  for 
military  quarters.  ''That  project  was  ended  before  it  began, 
fortunately  for  us,"  wrote  Miss  Patterson,  "for  to  be  perfectly 
frank,  there  was  no  equipment  in  sight !" 

The  typhus  epidemic  in  1917  and  1918  was  thought  to  be 
somewhat  less  violent  than  during  the  preceding  years.  Though 
the  conditions  favoring  it — overcrowding,  filth,  lice,  exposure, 
starvation  and  lowered  vitality — persisted,  the  winter  was  less 
severe  and  this  one  factor  saved  many  lives.  The  body  louse 
continued  to  be  a  trying  pest.  "Bathing  facilities  in  a  Rou- 
manian village,"  wrote  Major  Kirkpatrick,  "are  almost  non- 
existent. If  you  ask  one  of  the  peasants  whether  he  has  lice, 
he  will  probably  look  at  you  in  surprise  and  say :  'Am  I  dead, 
that  I  should  have  no  lice  V  " 

In  October,  1917,  the  Russian  Government  under  Kerensky 
was  overthrown  and  the  Bolsheviki  came  into  power.  The 
Russian  Armies  in  Roumania  collapsed  and  in  December  nego- 
tiations were  opened  between  the  Central  Powers  and  the  Rus- 
sian authorities  with  a  view  toward  a  separate  peace.  Rou- 
mania was  violently  and  persistently  opposed  to  a  separate 
peace  but  national  annihilation  faced  her.  An  armistice  to 
continue  for  sixty  days  and  to  be  terminated  by  seventy-two 
hours'  notice  was  signed  on  December  9.  By  March  1,  1918, 
the  Russian  Army  had  gone  out  of  existence.  With  her  own 
small  forces  Roumania  could  not  hope  to  hold  her  extended 
battle-front.  General  _Mackensen  then  delivered  two  ultimatums 
to  Roumania :  cither  to  enter  into  a  separate  peace  or  to  be 
overrun  by  the  German  Armies  and  completely  destroyed  as  a 
state.  On  March  8,  1918,  Roumania  signed  a  preliminary 
treaty  of  the  humiliating  peace  which  was  subsequently  forced 
upon  her. 

One  of  the  terms  of  this  preliminary  treaty  was  that  all 
Allied  relief  missions  should  leave  Roumania ;  they  were  to  be 
given  three  days'  time  for  departure.  On  IMarch  9  the  Ameri- 
can Red  Cross  Commission  started,  in  a  train  composed  largely 
of  second-class  sleeping  cars,  on  their  long  journey  from  Jassy 
to  ^Murmansk.  During  the  flight  northward,  which  lasted  four 
weeks,  and  the  time — three  weeks  more — at  Murmansk  waiting 
for  a  ship  to  carry  them  to  England,  the  excellent  morale  of  the 
nurses  never  flagged.     Tliey  did  all  the  cooking,  the  cleuniug 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    887 

and  washing  and  met  the  situation  with  equanimity.     Miss 
Patterson  wrote: 

Our  experiences  sound  much  worse  than  they  really  were, 
for  we  had  the  nicest  people  in  our  car,  Colonel  Anderson 
and  ^lajor  Kirkpatrick  and  our  nurses.  .  .  .  We  have  lived 
in  a  peace  and  harmony  which  makes  any  hardship  tolerable 
and  every  one  has  seen  something  funny  in  it  all.  We  have 
had  a  wonderful  service  and  incidentally  a  splendid  school- 
ing in  adapting  ourselves  to  an  entirely  new  system  of  valua- 
tion, a  system  which  has  taught  us  that  one  can  be  healthy, 
happy  and  more  or  less  sane  with  very  few  of  the  commonly- 
accepted  necessities  of  our  normal  American  life.  ...  It  has 
been,  however,  most  disheartening  to  sit  by  and  watch  the 
steady  breakdown  of  the  Eastern  Front  and  at  the  same  time 
to  get  very  little  authentic  news  of  the  Western  Front  and 
none  from  the   United  States. 

The  commission  arrived  safely  in  England  in  April,  1918, 
and  the  majority  of  the  nursing  members  remained  for  duty 
there  or  were  transferred  to  France.     Miss  Patterson  wrote : 

We  are  all  feeling  quite  like  Eip  Van  Winkles,  yet  it  is 
certainly  nice  to  be  back  in  civilization  and  above  all  else  to 
find  some  of  our  Allies  with  the  bit  in  their  teeth.  Many 
people  here  seem  to  feel  that  they  are  in  rather  desperate 
straits  but  to  us  the  whole  of  England  is  a  fairy-land  and  the 
English  seem  to  realize  it  and  are  making  little  complaint. 
Their  spirit  is  splendid  and  gives  one  an  entirely  new  back- 
bone after  living  with  Orientals  for  so  long. 

Mary  ^[clntire,  another  nurse  of  this  unit,  wrote  Miss 
Xoyes : 

I  cannot  realize  I  am  back  where  we  have  plenty  of  food, 
English  literature  and  "green  grass  growing  all  around.*'  It 
was  wonderful  to  see  our  boys  reviewed  in  London,  to  watch 
the  convoy  of  twenty-three  American  ships  on  the  high  seas, 
to  see  the  French  dirigibles  hovering  over  us.  Never  have  I 
loved  the  l^uioii  Jack  so  much  as  when  we  saw  those  destroy- 
ers speeding  out  to  us  in  the  Xorth  Sea. 

This  is  a  terrible  time  to  live  and  the  whole  world  seems 
just  one  great  heartache,  yet  it  is  a  wonderful  time  When 
we  landed  in  luigland,  we  were  stnuk  by  the  silent  and 
earnest  enicieiuy  of  every  man  and  woman.  Eussia  and 
Eoumania  were  so  completely  disorganized.  .  .  . 


888   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Syria,  the  key  to  the  East  and  the  Turkish  province  in  which 
Palestine  was  situated,  occupied  in  1914  the  long  strip  of 
comparatively  habitable  land  lying  between  the  Mediterranean 
Sea  and  the  Arabian  Desert.  On  the  south  it  touched  Egypt, 
on  the  north  and  on  the  east  the  Turkish  provinces  of  Aleppo 
and  Mesopotamia.  For  almost  seven  centuries  Syria  had  been 
ruled  by  Turkish  masters  though  they  had  always  remained 
hated  strangers  to  the  polyglot  Syrian  population. 

Syria  in  1014  was  peopled  largely  by  Arabs,  Armenians, 
Maronites,  Druses,  Turks  and  Jews.  The  Arabs  numbered 
some  tliree  million  souls  and  occupied  the  whole  of  the  country 
except  for  a  few  mountainous  districts.  By  religion,  the  Arabs 
were  followers  of  Islam  and  had  absorbed  into  their  faith 
numerous  mongrel  tribes.  The  mountainous  regions  of  Syria, 
especially  Lebanon,  were  held  by  some  three  hundred  and  fifty 
thousand  Maronites,  They  were  Christians  and  as  Christians 
reconciled  with  Rome,  had  for  some  centuries  been  under  the 
protectorate  of  France ;  they  had  thus  absorbed  much  of  the 
French  culture.  Parts  of  the  Lebanon  and  Damascus  regions 
were  occupied  by  the  Druses,  a  fierce  and  predatory  Moslem 
sect  numbering  perhaps  two  hundred  thousand.  The  Jews  were 
to  be  found  in  Palestine. 

Syria  was  comparatively  a  poor  country,  the  soil  outworn, 
the  hills  deforested,  the  rainfall  meag(>r,  the  heat  intense.  She 
was  poor  in  minerals  and  water  power  and  the  native  indus- 
tries of  textile-making  had  been  practically  swallowed  up  by  the 
importation  of  cheap  European-made  products  which  had  also 
destroyed  the  foreign  market  for  the  Syrian  textiles. 

I^orth  of  Syria  lay  Kurdistan,  inhabited  by  wild  and  lawless 
semi -named  tribes,  Mohammedans  by  religion  and  shepherds 
and  robbers  by  trade.  Xorth  of  Kurdistan  were  the  lofty 
mountain  ranges  and  plateaus,  rich  in  undeveloped  mineral 
products,  and  the  fertile  hill  slopes  and  valleys  of  Armenia. 

Armenia  Proper,  as  this  mountainous  plateau  was  called, 
was  bounded  on  the  north  by  the  Black  Sea  and  Transcaucasia, 
on  the  east  by  Persia,  on  the  south  by  ]\resopotamia  and  Persia 
and  on  the  west  by  Asia  Minor.  The  Armenians  were  in  pre- 
historic ages  a  sliort,  dai'k,  non-Aryan  race.  In  modern  times 
this  strain  still  formed  the  basic  peasant  type,  though  Aryan 
conquerors  had  long  since  impressed  their  language  on  the 
country  and  their  blood  upon  the  upper  classes.  The  true 
Armenians  were  mostly  peasants  and  artisans,  possessed  of  in- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION 

telligence,  adaptability,  marked  commorcial  aptitude  and  a 
strong  instinct  for  maintaining  their  racial  integrity.  In  1914 
the  Armenians  living  in  the  Caucasian  regions  numbered  about 
one  million  two  hundred  thousand,  those  living  in  Persia  about 
fifty  thousand  and  those  living  in  Asia  Minor  under  Turkish 
rule  about  one  million. 

The  Armenians  had  suffered  from  massacres  by  the  fanati- 
cal Turks  since  189(1.  In  1914  the  Turkish  Government 
adopted  a  policy  of  wholesale  massacre  and  deportation  of  these 
people  to  the  coast  cities  of  Syria.  In  addition,  thousands  fled 
to  these  cities — Aleppo,  Beirut,  Acre,  Jaifa,  Jerusalem  and 
Port  Said.  Syria,  a  poor  land,  could  not  support  them  and 
they  died  in  great  numbers  from  exposure,  disease  and  starva- 
tion. At  the  same  time  the  native  population  suffered  to  an 
almost  similar  degree. 

Turkey  declared  war  on  Russia  on  October  30,  1914,  and  on 
England  on  ]N^ovember  5.  Turkey  occupied  a  position  of  stra- 
tegic importance  in  that  as  long  as  the  Central  Powers,  of 
which  she  was  one,  controlled  the  Dardanelles,  the  Allies  would 
be  unable  to  get  supplies  to  Russia  from  the  south.  Military 
activities  in  the  southeastern  theater  fell  into  five  principal 
campaigns — the  Turkish  offensive  in  the  Caucasus,  the  Gal- 
lipoli  Campaign  by  British  and  French  forces,  the  Turkish 
attack  on  the  Suez  Canal,  the  British  advance  on  Mesopotamia, 
and  the  collapse  of  Turkey.  Early  in  1917  the  British  began  a 
campaign  from  Egypt  northeastward  through  Syria.  On 
December  10,  1917,  General  Sir  Edmund  Allenby,  in  com- 
mand of  British,  Indian  and  "Anzac"  troops,  entered  Jeru- 
salem. 

In  1915  Dr.  Edwin  St.  John  Ward,  formerly  of  the  J\rcdical 
Department  of  th(>  Syrian  Protestant  College  at  Beirut,  was 
asked  by  the  Turkish  Government  to  make  a  survey  of  the 
Jerusalem  District  and  the  barren  regions  to  the  south  as  far 
as  Beersheba.  He  and  his  party  found  the  country  practically 
destitute  of  professional  medical  and  inirsing  service.  The 
importation  of  foreign  pnxlucts  had  practically  ceased  and  tlie 
resources  of  the  country  were  insufficient  to  support  tlu^  tre- 
mendously inflated  popuhition.  Slow  starvation  faced  both  the 
native  and  refuaee  })opulati()n,  esp(H'ially  in  Palestine. 

On  October  1,  1915,  relief  work  in  Asia  Minor  was  initiated 
by  a  strong  American  eonnnittee  calk'd  the  American  Connnit- 
tee  for  Armenian  and  Syrian  Relief.     This  comniitt(>e  appealed 


890   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  the  American  Red  Cross  during  the  early  summer  of  1917 
for  financial  aid  and  the  minutes  of  a  meeting  of  the  War 
Council,  July  23,  1917,  record  the  following  action: 

The  chairman  stated  that  in  a  letter  dated  July  18,  1917 
(D.  E.  P.  5()),  Mr.  R.  S.  Lovett,  chairman  of  the  Committee 
on  Cooperation,  had  presented  an  application  from  the 
American  Committee  for  x\rmenian  and  Syrian  Kelief,  dated 
July  5,  1917  (D.  E.  P.  59),  asking  that  the  Eed  Cross  War 
Council  appropriate  to  that  committee  for  its  relief  work  in 
Western  Asia,  the  sum  of  $300,000  per  month  for  the  re- 
maining six  months  of  the  calendar  year. 

He  further  stated  that  the  American  Committee  for  Ar- 
menian and  Syrian  Eelief  had  during  the  period,  October  1, 
1915,  to  April  1,  1917,  raised  $3,400,000  to  carry  on  its  work 
and  that  as  its  administration  expenses  were  met  privately, 
the  committee  was  unable  to  devote  to  distinctly  relief  work 
one  hundred  cents  on  every  dollar  received  for  the  purpose; 
that  at  a  conference  held  last  February  attended  by  Am- 
bassador oMorgenthau  and  the  foremost  authorities  on  Western 
Asia,  figures  were  presented  showing  that  there  were  no  less 
than  2,144,000  persons  in  Western  Asia  whose  death  could 
be  prevented  only  by  direct  and  continued  help  and  that  on  a 
minimum  allowance  of  ten  cents  per  day  for  food,  $6,000,000 
per  mouth  would  be  required  to  support  these  peo])le  until 
they  could  be  restored  to  their  homes  on  a  self-supporting 
basis. 

He  further  stated  that  Ambassador  Elkus  had  reported 
that  the  Eed  Cross  was  not  allowetl  by  the  Turkish  Govern- 
ment to  carry  on  relief  work  itself  within  the  Turkish  Empire 
and  that  the  American  Committee  for  Armenian  and  Syrian 
Eelief  was  the  only  organization  outside  of  the  Eed  Crescent 
(controlled  by  the  Turkish  Government)  in  a  position  to 
administer  relief  to  the  starving  Armenians  and  Syrians  and 
certain  portions  of  the  Greek  population  in  the  Turkish  Em- 
pire; that  Amljassador  Elkus  had  ascertained  from  the  State 
Department  tliat  there  was  apparently  no  danger  of  inter- 
ference by  the  Turkish  Goverimicnt  for  the  present  at  least, 
with  the  work  of  the  American  Committee  for  Armenian  and 
Syrian  Eelief,  and  that  in  order  to  safeguard  its  interests  the 
former  assistant  treasurer  and  three  members  of  its  Constan- 
tinople Commission  had  been  made  attaches  of  the  Swedish 
Legation  now  representing  American  interests  in  Turkey. 

He  further  stated  that  the  chairman  of  the  Committee  on 
Cooperati<ni  cxijlained  that  the  discrepancy  between  the 
amount    required,    namely,    $6,000,000    ])er   month,   and    the 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    891 

amount  asked  for  of  $300,000  per  month  was  due  to  the  fact 
that  many  of  the  needy  people  couhl  not  l)e  reached  and  the 
realization  that  demands  would  he  made  upon  the  American 
Red  Cross  for  so  many  other  worthy  ohjects.  The  chairman 
of  the  Committee  on  Cooperation  further  recommended  that 
the  grant  of  $300,000  per  month  to  he  made  from  month  to 
month  at  the  i)leasure  of  the  War  Council  instead  of  for  the 
remaining  five  months  in  the  calendar  year  as  requested  in  the 
application,  as  there  was  a  possibility  of  the  Committee's 
work  being  interrupted.  .  .  . 

At  this  meeting  the  War  Council  voted  that  the  sum  of  $300,000 
should  bo  appropriated  for  the  month  of  July,  1917,  for  use  by 
the  American  Committee  for  Armenian  and  Syrian  Relief. 
Similar  appropriations  were  made  each  month  for  the  re- 
mainder of  the  year  1917. 

During  the  period  from  July,  1917,  to  February  28,  1919, 
the  American  Red  Cross  contributed  to  the  American  Commit- 
tee for  Armenian  and  Syrian  Relief  $4,500,000  in  money  and 
$1,444,032.54  in  supplies.^*> 

The  taking  of  Jerusalem  by  the  British  in  December,  1917, 
opened  Palestine  to  the  Allies  and  removed  in  the  portions  of 
Syria  then  under  British  military  control  the  restrictions  which 
the  Turkish  Government  had  placed  upon  independent  Ameri- 
can Red  Cross  activities. 

In  a  letter  addressed  to  the  War  Council  on  January  23, 
1918,  the  American  Committee  for  Armenian  and  Syrian 
Relief  stated  that  ^'a  considerable  sum  of  money  had  recently 
b(H'n  contributed  to  the  above  committee  from  Sunday  schools 
for  use  in  Palestine  and  that  in  view  of  the  advantages  that 
Avould  accrue  from  having  the  work  behind  the  British  Lines 
conducted  in  cooperation  with  or  under  the  name  of  the  Ameri- 
can Red  Cross,  an  early  conference  with  that  society  was  re- 
quested to  consider  some  plan  whereby  the  best  results  could 
be  secured  in  relief  work  in  Palestine  and  other  countries." 
At  a  meeting  of  the  War  Council  held  on  January  29,  this 
letter  was  discussed  and  plans  were  approved  for  sending  an 
American  Red  Cross  commission  and  medical  units  to  Pales- 
tine under  the  leadership  of  Dr.  St.  ,Iohn  Ward,  then  serving 
as  a  member  of  the  American  Red  Cross  Commission  for  France 
at   ]'aris  headquarters.      The   Conunission  for  Palestine,   with 

■■"  "Tlic  \\'ork  of  tile  American  Rod  Cross  during  the  War:  A  Statoinent 
of   Finances  and   Accomplishments,"   p.   87. 


892   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Dr.  Ward  as  deputy  commissioner,  was  appointed  by  the  War 
Council  at  a  meeting  held  March  7,  1918.  On  April  17,  1918, 
Dr.  John  H.  Finley  was  appointed  commissioner  for  Palestine. 

The  personnel  of  the  commission  numbered  fifty-four 
people ;  ten  of  these  were  American  Red  Cross  nurses,  six  were 
surgeons,  three  were  sanitary  engineers  and  the  rest  were  social 
service  workers,  teachers  and  assistants  of  various  types. 
"Twenty-three  members  had  been  either  missionaries,  teachers 
or  persons  with  some  previous  experience  in  the  near  East," 
stated  the  Annual  Report,  1018,  of  the  Palestine  Commission, 
"and  sixteen  had  been  stationed  in  Syria,  Palestine  or  Egypt." 

The  nursing  staff  was  selected  by  the  Nursing  Service  at 
National  Headquarters.  Edith  Madeira  was  chief  nurse. 
Miss  Madeira  was  a  graduate  of  the  Hopkins  School  and  a 
woman  of  wide  travel  and  broad  interests.  She  had  gained 
administrative  experience  in  her  profession  as  superintendent 
of  nurses  of  the  Howard  Hospital  in  Philadelphia  and  at  the 
Mountainside  Hospital,  Montclair,  New  Jersey.  ]\Ioreover, 
she  was  a  public  health  nurse  and  had  served  as  Superintendent 
of  the  Visiting  Nurse  Associations  at  Harrisburg,  Pennsyl- 
vania, and  at  Watcrbury,  Connecticut. 

The  nurses  of  the  Palestine  Commission  were  Ellen  M. 
Hamilton,  Edith  M.  Haslam,  Katherine  Macklin,  Frances 
]\l('Quaide,  Anne  L.  O'Malley,  Jessie  G.  Patorson,  Olive 
Ranger,  Lillian  M.  Spolman  and  Emma  M.  Wood.  In  Sep- 
tember, 1918,  five  additional  nurses  who  had  all  had  service 
in  the  Near  East  and  spoke  Arabic,  joined  ]\riss  ^ladeira's  staff. 
They  were  (Mrs.)  Lillian  Cole  Scwny,  Beatrice  Archer,  a 
graduate  nurse  whom  the  British  Red  Cross  loaned  to  the  com- 
mission ;  Ruth  Eddy,  Sara  Kaisermann,  a  graduate  of  the  Col- 
lege Hospital,  Beirut,  and  a  Mrs.  Abramson,  another  British 
nurse. 

Relief  work  in  a  country  as  primitive  and  destitute  as  Syria 
in  1917  offered  difficulties  not  to  be  encountered  in  countries 
where  Occidental  methods  of  travel  and  standards  of  living 
prevailed.  In  addition  to  the  regulation  equipment  for  medi- 
cal and  nursing  service  and  general  relief,  the  supplies  of  the 
Palestine  Conuuission  inclndcd  twenty  motor  transport  vehi- 
cles, complete  macliincrv  for  road-making,  tra<'tf)rs,  steam 
pumps,  refrigerating  and  hoisting  machines,  plumbing,  air- 
coinj)ressiiig  and  el(!ctrical  materials,  machines  for  purifying 
water  and   thou.sands  of  feet  of  galvanized  and   steel   piping, 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     893 

sewing  machines,  plows,  hand-cultivators,  hoes,  rakes  and 
shovels. 

The  Commission  for  Palestine  sailed  from  New  York  City 
on  March  13,  1918,  on  their  long  journey  around  the  Cape  of 
Good  Hope  to  Ceylon,  then  across  the  Arabian  Sea  and  north 
through  the  Ked  Sea  and  the  Suez  Canal.  They  arrived  at 
Port  Said  on  June  11  and  entrained  for  Jerusalem. 

General  Allenby  made  his  headquarters  in  June,  1918,  at 
Ilamleh,  thirty  miles  west  of  Jerusalem.  General  Sir  Arthur 
]\Ioney,  formerly  chief  of  staif  under  General  Alaude  at  13ag- 
dad,  was  chief  of  the  Occupied  Enemy  Territory  Administra- 
tion and  Colonel  Ronald  Storrs  was  military  governor  of  Je- 
rusalem. Colonel  Storrs  turned  over  to  the  commission  the 
old  Russian  Hospital  with  its  annex  and  half  the  large  Men's 
Hospice  within  the  Russian  Compound  and  also  a  large  resi- 
dence, the  ''Lord  Bute  House,"  which  was  located  just  out- 
side the  south  gate  of  the  Compound.  These  buildings  had  been 
used  by  the  Turks  as  military  hospitals  but  had  been  unoccu- 
pied since  the  British  captured  the  Holy  City. 

The  members  of  the  commission  arrived  in  Jerusalem  on 
June  18  and  literally  ''dug  into"  the  accumulated  filth  of  their 
new  quarters.  The  "Lord  Bute  House"  was  used  for  adminis- 
trative headquarters  and  the  former  Men's  Hospice  for  the  liv- 
ing quarters  of  the  personnel  of  the  commission.  "This  is  a 
picturesque  old  building,"  wrote  Miss  Madeira  to  Miss  Noyes, 
"and  has  gardens  and  lovely  corridors." 

The  Russian  Hospital  was  opened  on  August  22  after  heroic 
labor.  The  engineers  of  the  commission  had  been  forced  to 
go  down  into  the  sewer  drains  themselves  to  show  the  amateur 
plumbers  how  to  work ;  the  skilled  mechanics  in  Jerusalem 
were  then  sei*\'ing  with  the  Turkish  Army.  Workrooms  were 
established  in  the  gardens  and  native  women  were  set  to  work 
pulling  out  the  stuffing  of  the  mattresses  for  disinfeetion,  then 
restuff'ing  and  resewing  them.  The  nurses  directed  the  work 
of  scrubbing  and  whitewashing  the  wards  of  the  hospital.  In  a 
report  sent  to  j\liss  Noyes  on  September  20,  Miss  Madeira 
wrote : 

The  hospital  ])uil(ling  is  two  stories  high  and  lias  huge 
halls  running  the  full  length  of  the  building  with  liigh, 
vaulted  ceilings,  'i'he  |)liarniacy,  disiiensarv.  doctor's  otlice 
and  a  library  are  on  the  tirst  floor,  also  two  private  rooms  with 


894.   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

bath  and  a  large  bathroom  where  all  patients  receive  their 
initial  scrubbing  on  admission  to  the  hospital  On  the  first 
floor  are  also  the  operating,  sterilizing  and  dressing  rooms. 
Wards  accommodating  fifty  patients  occupy  the  second  floor. 
Altogether  it  is  an  up-to-date  hospital  and  is  being  run  as 
such. 

Miss  McQuaide  is  in  charge  of  it.  Miss  Eddy,  Miss 
Kaisermann  and  Mrs.  Sewny  are  head  nurses.  Miss  Wood 
has  the  operating-room  and  Miss  Archer  is  night  supervisor. 
There  are  eight  native  nurses  and  three  orderlies. 

The  work  of  the  Russian  Hospital  was  almost  entirely  surgi- 
cal. Many  of  the  native  farmers  and  the  refugees  engaged  in 
agricultural  work  in  the  Jerusalem  District  were  injured 
through  the  accidental  explosion  of  shells  lost  or  left  by  the 
armies  in  the  open  warfare  which  was  carried  on  in  Palestine. 
This  method  of  warfare  as  opposed  to  trench  tactics,  prevented 
close  salvaging  of  the  battlefields.  During  the  seven  months 
of  its  existence,  the  American  lied  Cross  Surgical  Hospital  in 
Jerusalem  treated  a  total  of  668  patients,  of  whom  402  were 
surgical  and  266  medical  cases.  The  death  rate  was  3.7  per 
cent.  One  of  the  most  complete  and  valuable  phases  of  this 
hospital  service  was  the  bacteriological  department,  of  which 
Nancy  Hamilton  was  in  charge. 

The  British  Forces  had  laid  out  extensive  plans  for  the 
American  Red  Cross  commission,  even  before  Dr.  Finley  and 
his  staff  arrived.  The  work  dealt  entirely  with  the  civilian, 
population.  One  of  the  first  projects  undertaken  by  the  com- 
mission was  the  assignment  of  an  American  Red  Cross  nurse 
to  the  Turkish  Municipal  Hospital,  of  65  bed  capacity,  at 
Jerusalem.  Miss  Macklin  was  detailed  to  duty  there  on 
June  24  and  she  gradually  brought  order  out  of  chaos.  Miss 
Madeira  wrote : 

i\riss  ^lacklin  found  disorder  and  filth  to  be  the  principal 
difficulties.  Every  hall  and  corner  was  packed  full  of  rubbish 
intermixed  with  a  thin  layer  of  useful  things  that  had  to  be 
sorted  out.  Tlie  equipment  was  meager  but  has  been  su})ple- 
niented  slightly  by  requisitions  and  largely  by  the  redemption 
of  {)itcliers,  basins,  cups^  plates  and  similar  articles  picked  out 
of  these  rubbish  heaps. 

The  laundry  was  reported  to  be  a  week  behind  with  its 
work,  but  it  took  more  than  a  month  and  three  laundresses  to 
overtake  that  "week."     Tins   laundrv   should   be   seen  to  be 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    895 

appreciated.  It  is  a  room  in  the  basement.  There  is  a  device 
for  drawing  water  and  a  curious  depression  where  water  ac- 
cumulates. The  work  is  done  by  women  sitting  on  the  floor 
with  huge,  flat  copper  tubs,  like  round  English  bathtubs,  in 
front  of  them.  Here  they  dabble  the  clothes  around  in  a  little 
water  and,  from  all  ai)pearances,  have  never  been  in  the  habit 
of  rinsing  them.  Miss  ^Nlacklin  has  greatly  improved  con- 
ditions here  and  the  clothes  are  assuming  a  less  dusky  hue. 

Cleanliness  reigns  in  other  departments,  too,  and  the  pa- 
tients are  naturally  res}X)nding.  There  are  eight  native 
nurses,  with  no  training  to  speak  of  and  no  ideas  of  responsi- 
bility. Miss  Macklin  has  found  them  ambitious  to  learn  and 
very  teachable.     A  native  doctor  is  in  charge  of  the  hospital. 

Extensive  dispensary  and  public  health  nursing  service  was 
maintained  in  Jerusalem  and  the  outlying  regions.  Early  in 
July,  Red  Cross  physicians  were  assigned  to  visit  the  different 
deserted  convents  and  other  buildings  where  the  refugees  had 
taken  shelter.  Miss  Ellen  Hamilton,  one  of  the  nurses,  was 
assigned  to  go  with  one  of  the  doctors  on  his  rounds,  and  to- 
gether they  established  the  beginnings  of  a  traveling  dispensary 
service.  This  service  was  given  at  the  Carmelite  Convent  on 
the  Mount  of  Olives ;  the  Franciscan  ^lonastery  on  the  road  to 
Bethany ;  the  Bucharloa,  which  often  had  six  hundred  inmates 
at  one  time ;  the  Greek  Hospital  and  schools ;  the  Convent  of 
the  Holy  Cross ;  the  Russian  Convent ;  Bishop  Gobat's  school, 
and  David's  Tower. 

]\riss  ]\Iadiera  described  the  manner  in  which  this  service 
operated : 

The  ]\[ukhatar,  or  head  man  of  the  place  or  of  the  par- 
ticular group  of  refugees,  gathers  together  all  the  sick  at  a 
time  and  place  designated  by  the  doctor.  When  he  and  Miss 
Hamilton  arrive,  he  examines  them  and  prescribes  treat- 
ment. She  treats  the  eyes,  makes  the  dressings  and  assists 
him,  so  tliat  the  service  is  just  like  that  given  in  a  dispensary. 
Any  persons  wlio  are  too  sick  to  come  to  the  appointed  place 
are  visited  by  the  doctor  and  nurse. 

The  Bucliarlea,  a  large  group  of  buildings  in  the  Jewish 
Quarter,  is  one  of  the  principal  centers  of  this  type.  As  it 
seemed  in  a  worse  condition  than  the  others  and  was  over- 
crowded, we  un(l(n"t()ok  intensive  work  there.  Two  rooms 
were  selcrti'd,  a  (i)uple  of  chairs  and  tables  were  secured  and 
a  nicaucr  ('(|iii|)in('iit  ])lace(l  there.  The  social  service  de- 
partment lias  also  begun  work  and  has  large  plans. 


896   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  medical  and  nursing  service  provides  in  addition  to 
the  dispensary  service,  a  place  where  milk  can  be  prepared  and 
fed  to  babies,  thus  preventing  the  father  from  drinking  it 
himself  or  selling  it.  Miss  Haslam  has  been  appointed  to 
serve  here  on  full  time.  She  has  a  native  helper  who  also 
interprets  for  her.  She  distributes  quinine,  treats  eyes,  pre- 
pares milk  and  sees  that  the  babies  consume  it. 

At  the  Franciscan  Monastery  the  dispensary  service  was 
held  outdoors.  "There  was  no  suitable  place  inside,"  wrote 
Miss  Madiera.  "In  one  room  four  goats  and  a  donkey  were 
found  living  contentedly  with  a  large  human  family." 

One  of  the  most  ambitious  undertakings  of  the  commission 
in  Jerusalem  was  the  establishment  in  a  building  formerly  oc- 
cupied by  the  Russian  Consulate  of  a  general  dispensary,  a 
children's  hospital  and  a  home  for  native  nurses.  The  Chil- 
dren's Hospital  was  opened  late  in  September  and  was  of 
twenty  five  bed  capacity.  Miss  Spelman  was  placed  in  charge 
of  it.  The  daily  attendance  at  the  dispensary  ranged  from 
forty  to  one  hundred  patients,  largely  children  suffering  from 
malaria,  measles  and  diseases  due  to  malnutrition.  Of  the 
2331  cases  treated  1401  were  Moslems,  618  were  Greek  Ortho- 
dox, 138  were  Latin  Catholics  and  the  remaining  174  were  di- 
vided almost  equally  between  Armenians  and  Jews.  Of  the 
seventy-three  patients  who  died,  forty-three  succumbed  to 
malaria. 

Dental  clinics  were  maintained  at  the  Children's  Hospital 
and  by  January,  1919,  twelve  hundred  cases,  including  every 
type  of  patient  from  British  Army  officers  to  the  most  ema- 
ciated Moslem  child,  were  treated  there.  A  diet  kitchen  was 
established  and  milk  and  food  given  to  babies  and  undernour- 
ished children. 

The  final  report  of  the  Children's  Hospital  gave  a  vivid 
account  of  the  types  of  patients  treated: 

When  the  American  I?ed  Cross  came  to  Palestine  in  the 
hot,  dusty  days  of  June.  1918,  it  was  evident  to  the  workers 
that  a  second  slaughter  of  the  innocents  was  going  on  in  the 
land  of  the  Infant  (Mirist  ...  so  a  small  room  was  fitted  out 
as  a  clinic  for  cliildron  of  five  years  and  under. 

The  sun  blazed  down  on  the  open  court  which  the  waiting 
patients  sliared  with  fiftv  women  who  were  emptying  and 
disinfecting  a  legacy  of  Turkish  mattresses.  Each  long  fore- 
noon a  crowd  of  war-worn  mothers  came  to  us.     There  were 


Refunccs  waitiii''  at   thi'  dooi's  of  a   relief  statinn   in  JtTUsali'in. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    89T 

wives  of  Turkish  soldiers  who  had  vanished  in  the  retreat; 
there  were  wives  of  once  thrifty  artisans  and  tradesmen  now 
penniless  in  their  vain  effort  to  ward  off  the  draft;  there  were 
beggared  refugees  from  "beyond  Jordan"  and  "up  Nabulous 
way"  and  there  were  peasant  women  in  ragged,  quaintly- 
embroidered  costumes,  women  hunger  spent  and  exhausted 
from  a  three-mile  walk  along  stony,  dust-choked  roads,  their 
foreheads  chafed  raw  with  the  rope  of  the  saddle-bag  in  which 
were  carried  their  sick  children. 

These  mothers,  gaunt  from  starvation  and  malarial  poison- 
ing, would  lie  at  length  on  the  paving,  taking  what  comfort 
they  could  from  the  liot  stones  when  the  ague-fit  shook  them. 
The  children  and  babies  also  shivered  and  burned,  strangled 
in  paroxysms  of  whoo})ing-cough,  squirmed  imder  the  teas- 
ings  of  skin  diseases  or  burrowed  their  tiny  skull-like  faces 
against  the  mother's  empty  wrinkled  breasts  in  fruitless  search 
for  food. 

In  all  Jerusalem,  the  color  of  war  prevails — on  the  dust- 
peppered  olive  trees  of  the  gray  and  dusty  city,  in  the  haze 
which  envelops  the  lorries,  the  cavalry,  the  infantry  always 
on  the  move  northwards,  on  the  thousands  of  camouflaged 
tents  and  the  uniforms  of  the  Tommies  and  over  the  bare 
parched  hills  and  sterile  valleys. 

All  of  Palestine,  the  land  across  which  the  chariots  of  Alex- 
ander's warriors  had  swept,  and  which  in  turn  had  been  the 
province  of  Home,  the  Holy  ground  on  which  the  Crusaders 
had  pitched  their  gray-hued  silken  tents,  the  stronghold  of  the 
Turk,  was  again  in  1917  the  battle-ground  of  the  East  and  the 
West.     Miss  ]\Iadicra  wrote: 

The  whole  country  is  a  camp  and  war  the  main  business, 
yet  in  spite  of  the  fact  tliat  we  constantly  hear  the  guns  and 
that  air])hines  fly  overhead,  we  seem  to  have  lost  all  sense  of 
the  reality  of  war.  The  paraphernalia  of  war  seems  just  a 
]iart  of  the  day's  work  in  tliis  barren  land  of  stones  and  dust 
and  we  no  longer  think  of  it.  Of  course,  we  do  not  see  any  of 
the  wounded — oidy  the  civil  population,  but  in  traveling  about 
from  one  station  to  another  outside  of  Jerusalem,  one  is  again 
and  again  imjiressed,  almost  overwhelmed,  with  the  fact  that 
the  business  end  of  modern  warfare  is  tremendous. 

In  addition  to  tlio  relief  work  in  the  TToly  City,  the  British 
Forces  had  included  in  their  plans  an  extension  of  American 
Red  Cross  work  southward  as  far  as  Port  Said  and  later  north- 
ward as  far  as  the  advancing  front  permitted. 


898   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Refugee  Camp  at  Wadi  Surar  was  one  of  the  first 
places  outside  of  Jerusalem  to  which  American  Red  Cross 
nurses  were  assigned.     Miss  Madiera  wrote: 

Our  next  venture  was  to  take  over  the  Tent  Hospital  at 
Wadi  Surar,  where  the  refugees,  driven  from  their  homes 
near  the  firing-line,  and  the  Armenians  were  concentrated. 
When  we  first  saw  the  camp,  about  3500  people  were  there, 
half  of  them  Armenians.  Wadi  Surar  acted  only  as  a  deten- 
tion camp  for  Armenians ;  here  they  were  placed  under  obser- 
vation and  if  found  free  from  infectious  diseases,  were  sent  on 
to  the  Armenian  Refugee  Camp  at  Port  Said. 

All  the  refugees  at  Wadi  Surar  were  living  in  bell  tents  and 
sleeping  on  the  ground,  as  is  their  custom,  even  with  the 
sick.  The  first  impression  of  Wadi  Surar  was  of  sand  and 
tents;  tents  and  sand,  with  a  wonderful  view  of  the  hills  be- 
3'ond.  This  view  and  a  fine  breeze  redeems  the  situation,  for 
it  is  hot  and  cheerless  otherwise.  Among  the  tents  are  shel- 
ters where  the  refugees  in  their  picturesque  rags  assemble  to 
cook  and  eat.     Everything  is  very  primitive. 

Lillian  Spelman  and  Olive  Ranger,  both  of  them  nurses, 
were  sent  to  W^adi  Surar  on  July  9  and  found  that  the  camp 
was  being  run  by  a  young  English  doctor,  "in  appearance  not 
more  than  seventeen  years,"  wrote  Miss  Madiera,  "but  natur- 
ally he  is  much  older  and  is  doing  splendid  work."  There 
were  three  other  officers  and  the  American  nurses  took  with 
them  three  capable  native  women  and  two  orderlies,  also  tents 
and  full  camp  equipment. 

The  Camp  Hospital  was  composed  of  bell  tents  set  up  a  little 
distance  from  the  camp  proper.     Miss  Madiera  wrote : 

Here  patients  left  at  will,  babies  arrived  without  medical 
assistance  which  did  not  even  seem  to  be  expected ;  people 
died  without  the  doctor  being  sent  for.  The  hospital  equip- 
ment was  poor ;  there  were  no  clean  clothes  or  linen  and  very 
few  utensils.  Egyptian  tomargies  had  previously  done  what- 
ever nursing  had  existed  but  they  were  discharged  before  our 
nurses  arrived. 

The  work  was  divided.  Miss  Spelman  concentrated  on  the 
so-called  Hospital  and  ]\Iiss  Eanger  took  care  of  the  patients 
with  minor  ailments  who  did  not  need  hospital  care.  In  the 
Hospital,  native  nurses  were  instructed  in  proper  bathing  and 
the  care  of  the  patients,  with  special  emphasis  upon  gentle- 
ness.    Soon  the  kinder  care  made  the  hospital  much  more 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    899 

poi)ular.  With  tlie  advent  of  the  social  service  workers  and 
their  supplies,  the  refugee  women  were  given  sewing  to  do 
and  more  adequate  linen  and  garments  for  the  hospital  were 
supplied.  Then  camt'  the  larger  tents  and  the  whole  hospital 
was  moved  to  a  hetter  site  and  was  enclosed  by  a  barbed- 
wire  fence  witli  one  opening  at  which  a  guard  was  placed. 
He  prevented  the  continuous  visiting  and  mingling  of  sick 
and  well. 

The  prevalent  diseases  throughout  the  Palestine  area  were 
malaria,  dysentery,  ophthalmia,  trachoma  and  skin  diseases  due 
to  the  starvation  diet. 

In  September,  1918,  the  Armenians  at  Wadi  Surar  were 
sent  en  masse  to  Port  Said.  Military  activities  in  the  north 
were  resumed  and  as  the  ]3ritish  Forces  pressed  on  some  refu- 
gees returned  to  the  recaptured  territory.  Others  sent  to 
harvest  the  figs  and  grapes  which  were  ripening  in  the  groves 
near  Jerusalem.  Thus  the  population  of  the  Camp  on  the 
sands  diminished  to  eight  hundred  souls.  However,  the  Hos- 
pital continued  to  draw  its  average  of  one  hundred  patients, 
''due  largely  to  the  kind  care  they  receive,"  wrote  ^liss 
[Madiera. 

Northwest  of  Jerusalem  on  the  Mediterranean  sliore  was 
situated  the  sea-town  of  Jaffa.  During  the  first  years  of  the 
war  the  population  of  the  city  was  about  70,000.  In  March, 
1017,  the  Turks  had  ordered  the  entire  civilian  population  to 
evacuate  Jaffa,  on  the  grounds  that  it  might  suffer  from  British 
homhardmcnt.  The  Turkish  and  Teutonic  military  authorities 
loaded  the  poorer  people  into  railroad  trucks  and  started  them 
south  toward  Honis,  Ramleh  and  Ludd.  INFost  of  the  refugees 
remained  in  these  neighboring  towns  but  some  of  them  fled  as 
far  east  as  Jerusaknn,  Damascus  and  the  small  Palestine  vil- 
lages. Of  the  entire  civilian  population  of  Jaffa,  the  Turks 
allowed  some  seven  shopowners  to  remain  to  run  their  stores 
and  the  owner  of  an  orange  grove  to  stay  on  his  property.  This 
orange  grove  served  as  a  place  of  refuge  for  two  hundred  others. 
With  the  city  empty,  the  enemy  stripped  the  houses  and  stores 
of  timber  and  iron  for  defensive  works  further  south.  Looting 
was  rife. 

On  Xovember  Iti,  1917,  the  15ritish  took  Jaffa  and  in  a 
week  the  refugees  canie  streaming  back.  Hut  the  economic 
and  sanitary  recovery  of  the  city  was  slow.  The  P)ritish  au- 
thorities   gave    eni})loyinent    to    able-bodied    men    and    boys    in 


900   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

road-making  and  set  some  of  the  women  to  work  at  laundering 
and  mending  and  at  making  mattresses.  The  British  also  sup- 
plied food  to  the  destitute  until  they  discovered  that  at  least 
14  per  cent  of  the  recipients  were  professional  beggars.  Then 
they  ceased  and  turned  the  situation  over  to  the  American 
Relief  organizations. 

The  Commission  for  Palestine  undertook  extensive  social  serv- 
ice work  and  medical  relief  in  Jaffa.  On  July  2  Miss  Pater- 
son  was  sent  from  Jerusalem  to  Jaffa  to  take  over  the  Infectious 
Disease  Hospital.  The  building  had  been  used  by  the  Turks 
as  a  quarantine  station  and  was  located  on  the  beach.  Motors 
could  not  get  to  it  on  account  of  the  deep  sand.  Miss  Paterson 
waded  through  the  sand  to  the  hospital  and  found  there  the 
usual  dirty  buildings  and  tents.     Miss  Madiera  wrote : 

The  institution  was  absolutely  without  system.  Meals  were 
never  prepared  at  a  regular  time  and  the  dirty  dishes  lay 
around  from  one  meal  to  the  next.  The  washing  was  done 
at  the  pleasure  of  the  laundresses.  When  patients  were  dis- 
charged, the  bed  linen  was  not  changed  unless  it  was  unspeak- 
ably dirty  and  the  blankets  were  never  sterilized  or  aired. 
And  this  an  infectious  hospital ! 

There  was  not  a  single  clock  in  the  whole  place  and  no  one 
had  a  watch  that  kept  time.  Patients  were  admitted  in  a 
very  crude  way  by  the  ward  maid  or  male  servant.  Two 
young  and  untidy  Jewish  girls  acted  as  nurses.  The  em- 
ployees slept  in  any  vacant  bed  in  the  wards  and  ate  their 
meals  in  any  part  of  the  hospital. 

]\riss  Paterson  moved  into  the  hospital  as  soon  as  a  room 
could  be  furnished  for  her,  purchased  a  clock  and  started  in. 
The  laundresses  were  prevailed  upon  to  wash  five  days  and 
mend  one.  The  hospital  was  cleaned  and  the  kitchen  reor- 
ganized. Patients  were  admitted  by  the  nurse,  and  kept  in 
tents  until  definite  diagnosis  had  been  made.  A  time  schedule 
was  arranged  so  that  all  employees  were  getting  one-half  day 
off  duty  a  week  and  two  hours  daily.  Comfortable  sleeping 
quarters  were  provided  for  them  and  a  dining  room  for  the 
nurses,  wlio  were  taught  simple  nursing  care.  Every  one  was 
given  definite  work  and  was  held  responsiljle  for  that  work 
and  that  alone. 

On  September  13,  when  IMiss  Paterson  was  recalled  to  other 
work,  she  turned  over  a  well-organized  establishm(>nt  to  her 
successor.     The  question  as  to  how  long  it  would  remain  so  was 


NURSING  SERVICE  TO  CIVILIAN   POPULATION     901 

one  of  the  genuinely  discouraging  questions  which  all  Occi- 
dental workers  experienced  in  the  Near  East.  Nurses'  letters 
record  that  the  efficiency  of  the  professionally-trained  Ameri- 
can nurses  throughout  Palestine  was  a  source  of  amazement 
and  incomprehension  to  the  Oriental  mind. 

East  of  Jaffa  lay  Ramleh,  the  first  stopping-place  of  the 
refugees.  The  Commission  for  Palestine  sent  a  medical  unit  to 
Ramleh  on  July  15,  li)18.  They  pitched  their  tents  in  a  dust- 
gray  olive  grove  behind  the  Crusader's  Tower  and  went  to  work 
among  the  refugee  and  native  population  of  Ludd  and  Kamleli. 

Emma  Wood  was  the  nurse  of  the  unit  and  she  took  over  the 
direction  of  a  small  hospital  of  twelve  beds  at  Ramleh  and  a 
dispensary  at  Ludd,  both  of  which  had  been  started  by  ihe 
Medical  Department  of  the  British  Occupied  Enemy  Territory 
Administration.     ^liss  Madiera  wrote: 

The  hospital  deserves  description.  It  is  a  roof,  with  a 
number  of  rooms  around  the  outer  edge,  which  are  used  for 
patients,  nurses,  operating-room,  kitchen,  laundry  and  store- 
rooms. 

The  dispensaries  are  most  interesting  places.  A  room 
which  was  needed  for  one  of  them  had  been  the  lodging-place 
of  an  untidy  but  very  contented  donkey.  At  first  the  dispen- 
saries were  hard  to  manage  because  the  crowds,  eager  for  care, 
were  disorderly,  hut  eventually  system  was  estai)lislied  and 
they  now  draw  ])atients  from  Ramleh.  Ludd  and  many  sur- 
rounding villages.  The  natives  lay  their  sick  at  the  doors. 
One  man  dying  of  tuberculosis  was  found  lying  across  the 
threshold  in  extreme  exhaustion ;  he  had  walked  four  miles  to 
get  there,  as  he  had  lieard  there  was  a  great  healer  there.  It 
was  too  late;  he  died  that  night. 

North  of  Jaffa  was  the  seaport  of  Haifa,  where  on  October  14 
the  American  Red  (^ross  opened  a  hospital  for  civilians.  The 
building  was  the  former  German  Hospital  which  Inid  been 
used,  previous  to  its  occupation  by  the  American  Red  Cross 
staff,  by  the  French,  ^[iss  Paterson  and  ]\Iiss  Ranger  were  in 
charge  of  the  nursing  activities  and  the  general  re('(|uipment 
of  the  hospital.  Of  the  type  of  cases  treat(>d  at  Haifa,  Henry 
S.  Huntington,  a  Red  Cross  worker  assigned  there,  wrote: 

The  head  doctor  picked  up  flie  lamp  after  su]i]mt  to  rrive 
me  a  look  around.  We  came  into  the  woiju'ir.s  \\ard.  Two 
women  were  sitting  up  in  bed,  one  of  them  an  aircdiouate- 


902   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

faced,  hunch-backed  Jewess  suffering  from  tuberculosis  and 
Bright's  disease,  the  other  a  bomb  case.  In  another  bed  was 
a  woman  and  her  ten-year-old  son ;  they  had  walked  to  Haifa 
from  Beirut,  one  hundred  miles  away,  and  arrived  here  filthy 
and  covered  with  scabs  and  sores.  The  mother's  diet  had  to 
be  limited  and  she  cuffed  her  boy  one  day  because  he  refused 
to  give  his  food  to  her.  We  have  to  keep  them  in  one  bed — no 
room  for  a  children's  ward. 

In  the  men's  ward,  we  found  men  suffering  with  ^'amoebic 
dysentery,"  the  doctor  called  it,  cases  of  influenza  and  pneu- 
monia, wounded  with  their  arms  shattered  by  hand  grenades. 

An  out-patient  clinic  was  maintained  at  Haija  where  an 
average  of  one  hundred  and  fifty  cases  a  day  were  treated.  Mr. 
Huntington  wrote: 

Before  the  door  was  opened,  the  patients  had  gathered 
there,  mothers  with  gaunt,  paper-gray  babies;  children  with 
red-rimmed  eyes  sore  Avith  the  world-wide  diseases  of  bad 
parentage;  Armenian  refugees;  malaria  patients  by  the 
dozens;  people  with  bandaged  hands  or  feet.  The  costumes 
were  mostly  half  European,  but  of  course,  it  all  takes  one  back 
nearly  nineteen  hundred  years  to  other  clinics  held  in  Galilee. 
Jew  and  Gentile  and  Samaritan  were  still  here  in  effect. 

In  the  busy  room  where  the  Greek  doctor,  himself  a  nomi- 
nal prisoner  of  war,  prescribes  for  the  patients  and  our  Red 
Cross  nurse  attends  to  the  dressings  while  the  young  Armen- 
ian clerk  enters  the  cases  on  his  cards,  we  picked  out  a  man 
or  woman  to  talk  with.  One  family  were  Maronites  from  a 
Lebanon  village  formerly  of  one  thousand  people.  Half  of 
them  are  now  dead  of  starvation.  "Do  you  want  to  go  back 
to  your  home  country  ?"'  we  asked.  "There  is  nothing  there," 
the  man  answered.  "We  had  a  hotel.  One  regiment  came 
and  took  a  little,  another  regiment  came  and  took  a  little;  so 
it  went.     It  is  beautiful  here  compared  to  wliat  it  was  there." 

Another  man  to  whom  we  talked  was  Balthasar  Artin  of 
Marash.  1I(^  awaited  his  fate  witii  calmness.  "If  you  kill 
us,"'  he  said,  "you  kill  us.  If  you  save  us  alive,  we  live.  We 
are  your  property."  Xear  him  was  a  child  who  sat  down  on 
the  floor  and  cried,  for  the  ]iain  in  his  foot.  As  his  mother 
talked,  the  flics  gathered  on  the  dressings  of  the  child's  sore. 
The  mother,  too.  had  a  finger  to  l)e  treated.  Her  husband 
died  in  tlie  army.  The  ]iusl)ands  of  a  quarter  of  Haija  wives 
are  dead  or  missing. 

There  also  were  hhick-veiled  ^Moslem  women  who  nursed 
their  babies   as   they'  waited,   women  wearing  gold   bracelets 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    903 

and  variegated  necklaces  made  in  Beirut  out  of  gold  coin. 
They  pay  their  fee  of  five  piasters  (twenty-five  cents)  and 
nurse  their  babies  as  they  sit  waiting.  .  .  . 

In  one  corner  were  a  Mohammedan  husband  and  wife.  His 
name  was  Victory-of-God  Brass,  as  translated.  She  was  an 
orplian.  He  had  married  her  at  the  beginning  of  the  war, 
doworless  thougli  slie  was,  in  order  to  avoid  military  service; 
here  was  the  Turkish  law  for  the  protection  of  women.  How- 
ever, the  Turks  took  him  as  a  soldier  just  the  same  and  he 
came  back  from  Damascus  with  dysentery  and  hid  about  here 
to  avoid  going  back  to  the  army.  .  .  . 

"Why  do  you  think  we  come  here?"  we  asked  a  Moham- 
medan woman  carrying  a  baby  whose  head  was  covered  with 
sores  and  from  whose  small  ears  heavy  gold  rings  hung. 
"Because  we  needed  a  good  doctor  here  and  God  willed  it," 
she  answered. 

Across  the  bay  from  Haija  was  Acre.  There  the  American 
Red  Cross  established  a  hospital  and  clinical  service  in  the 
former  Bab's  house  which  overlooked  the  old  moat  built  by  the 
Crusaders.  The  staff  at  Haija  did  the  work  at  Acre  until  addi- 
tional doctors  and  nurses  arrived  in  1919. 

On  September  23,  1918,  General  Allcnby's  forces  took  Ti- 
berias. Several  days  later  cholera  broke  out  in  the  city  and 
the  Occupied  Enemy  Territory  Administration  called  upon  the 
American  Red  Cross  commission  to  assist  in  fighting  it.  Miss 
Madiera  wrote: 

On  October  4,  Colonel  Ward,  ]\[iss  Ellen  Hamilton  and  I 
went  up  to  Tiberias.  We  were  only  a  few  days  behind  the 
advancing  troops ;  the  dead  lay  imburied ;  the  shattered  lorries 
were  standing  just  where  they  had  been  bombed;  papers  and 
debris  wore  everywhere. 

We  went  first  to  Xablus  and  then  on  to  J ,  where 

we  stopped  in  an  empty  house  in  which  one  of  our  doctors 
had  been  working.  We  unpacked  our  cots  and  made  them  up, 
mosquito  netting  and  all,  and  in  the  morning  rolled  up  our 
beds  again  and  were  off.  The  Turkish  and  German  prisoners 
were  pouring  in  and  while  our  things  were  being  loaded  on 
our  truck  we  watched  them  receiving  their  rations.  Then  on 
we  went  to  Xazareth,  where  we  sto])pod  at  the  Churcli  of  tlie 
Annunciation  ;  it  was  Sunday  and  we  were  present  at  the 
first  service  since  the  occupation.     Then  on  to  Tiberias. 

Such  scenery  you  do  not  often  see.  The  color  was  matj- 
nificent  and  the  blue  sea  of  Tiberias  trulv  beautiful.     The 


904   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

heat  was  intense;  Tiberias  is  680  feet  below  sea-level  and  a 
sirocco  was  blowing. 

We  went  at  once  to  the  Governor's  and  he  asked  us  to 
luncheon.  He  had  been  there  three  days  and  his  table  equip- 
ment and  furniture  were  distinctly  sketchy.  The  [British] 
doctor  had  been  there  two  days  and  had  had  a  [British]  nurse 
one  day. 

In  the  afternoon  we  went  to  see  the  hospital.  Such  a  state 
of  affairs !  Men,  women  and  children  lay  on  the  beds  or 
mattresses  or  on  the  tile  floors,  all  mixed  up  and  all  half- 
naked.  The  filth  was  indescribable  and  there  was  no  linen,  no 
plumbing,  no  water  supply. 

Tlie  next  morning  we  took  charge,  sent  for  nurses  and 
supplies,  had  water  carried  in,  locked  up  the  brandy  which 
the  attendants  had  been  consuming  and  worked  like  dogs.   .  .   . 

Miss  Madiera  took  over  the  reorganization  of  the  hospital  and 
Miss  Hamilton  assisted  Captain  Clark,  the  British  military 
surgeon  who  was  then  spending  all  his  time  giving  saline  injec- 
tions which  is  the  first  treatment  for  cholera. 

Modern  sanitary  provisions  at  Tiberias  were  critically  inade- 
quate. "The  king  of  the  fleas  and  all  his  court,"  an  Arabian 
proverb  ran,  "live  in  Tiberias."  Supplies  of  all  kinds  were 
meager.  The  British  governor  commandeered  dishes  and  other 
essentials  for  the  patients  and  told  the  Red  Cross  workers  to 
"go  down  to  the  German  dump  and  help  yourselves."  Out  of 
these  stores  came  tables,  cupboards,  more  dishes  and  basins.  A 
lorry  was  sent  to  Jerusalem  for  lied  Cross  linen,  but  when  this 
linen  had  been  put  to  use  in  Tiberias,  it  began  to  disappear; 
finally  a  valuable  ring  was  found  missing.  So  a  search  was 
made  of  the  patients  and  under  the  loose  Oriental  clothes  the 
missing  sheets,  pillow  cases  and  towels  were  found  wound  about 
the  patients'  waists. 

The  British  themselves  took  active  steps  to  break  the  epi- 
demic. One  of  the  first  measures  was  to  forbid  the  use  of  the 
lake  water  and  a  Tommie  was  stationed  to  guard  each  of  the 
streets  that  h'd  down  to  tlu^  sea.  "Part  of  the  people  approved," 
wrote  ]\rr.  Huntington,  "part  of  them  sighed  and  by  night  went 
down  and  stole  the  water,  but  most  of  them  walked  up  to  the 
new  taps  or  to  the  places  where  safe  well-water  was  pumped  up 
to  the  roadside  and  awaited  their  turn  for  the  chlorine  water. 
Whenever  tlie  municipal  doctor  on  his  daily  rounds  discovered 
a  case,   the   stretcbcr-bearers   brought   the   patient   to   the  Red 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    905 

Cross  Hospital  and  the  inspector's  gan^  disinfected  the  house, 
burned  up  wooden  dishes  and  replaced  them  with  iron,  de- 
stroyed old  clothing  unlit  for  further  wear  and  disinfected  the 
rest."     City-wide  vaccination  was  also  carried  on. 

Within  five  days  after  the  arrival  of  Colonel  Ward's  first 
unit,  the  cholera  was  almost  in  hand  and  when  a  week  later  the 
hospital  was  turned  over  permanently  to  the  Zionists,  not  a 
single  case  existed. 

On  her  way  back  from  Tiberias  to  Jerusalem,  Miss  Madiera 
visited  the  two  American  Red  Cross  nurses  who  were  then 
working  in  Es  Salt,  an  isolated  hill-town  east  of  the  Jordan 
River.  Es  Salt  was  greatly  overcrowded  with  refugees  and  its 
population  was  seventeen  thousand  people.  Health  conditions 
existed  there  similar  to  those  at  Acre,  Haija  and  Jaifa,  so  the 
Commission  for  Palestine  had  sent  two  American  Red  Cross 
nurses  and  a  doctor  on  October  17  to  establish  a  small  hospital 
and  dispensary.  Mrs.  Sewny  was  the  nurse  in  charge.  Miss 
Madiera  wrote: 

The  trip  to  Es  Salt  was  a  very  beautiful  one — down  by 
Jericho  and  across  the  Jordan  and  up  the  mountains  for  a  six 
hours'  climb.  Although  Es  Salt  was  conquered  by  the  British 
with  the  help  of  the  Hejez  troops,  it  lies  outside  of  the  Occu- 
pied Enem}'  Territory  Zone  and  is  in  the  possession  of  the 
Arabs.  It  is  situated  on  the  steep  sides  of  two  high  hills.  Up 
to  the  very  top  the  paths  run  and  down  to  the  valley  below, 
through  which  a  stream  flows  briskly  along. 

Many  of  the  refugees  we  have  had  all  summer  in  Jerusalem 
came  from  Es  Salt  and  I  saw  numerous  old  friends  there. 
Many  of  the  houses  have  no  roofs,  windows  or  any  woodwork. 
[The  timber  has  Ijeen  carried  away  by  tlie  enemy  and  used  for 
defensive  works.]  The  hospital  is  high  upon  the  hillside 
and  is  readied  by  walking  over  the  roof  of  the  cluirch.  Doors 
and  windows  are  being  made  for  it  and  it  is  the  craziest- 
looking  place  imaginable.  Lumber  is  so  scarce  that  the  prices 
are  prohibitive,  so  doors,  windows,  shelves,  tables  and  otlier 
pieces  of  furniture  are  being  made  from  scraps.  The  l)e<lside 
tables  are  old  (ierman  music  stands  with  pieces  of  wood  for 
the  top.  I  painted  the  tops  of  such  tables  and  sbelves  for  the 
operating-room. 

!Many  of  the  women  who  came  to  the  clinics  at  Es  Salt  were 
of  the  spirited  Arabian  type.  Dr.  Laurence,  one  of  the  Red 
Cross  physicians,  wrote  of  them : 


906   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Salt  women  are  tall  and  upstanding,  with  a  lithe  swing 
and  well-cait  features  outlined  by  close  Madonna-like  head 
draperies.  They  are  ornately  tatooed  in  indigo,  a  heavy 
trellis  on  the  chin  and  neck,  a  cross  between  the  eyes  and 
beauty  spots  scattered  over  the  cheeks.  Their  beyond-Jordan 
Arabic  is  quaint :  "Our  bread  is  bitter ;"  "the  Turks  have 
toasted  us  like  meat  on  a  spit;"  "the  age  of  this  child  is  the 
count  of  my  fingers"  (five  years)  ;  "he  was  born  in  the  year 
of  the  visitation  of  the  locusts;"'  "I  live  near  the  gate  of  the 
Pillar  (Damascus)  under  a  fig  tree."  Indeed,  the  writing  of 
addresses  never  becomes  monotonous,  as  tliey  are  apt  to  be  the 
Mount  of  Olives,  the  Prison  of  the  Christ,  the  Via  Dolorosa. 

The  British  advance  had  opened  up  the  way  for  American 
Red  Cross  general  relief — and  medical  service,  -where  urgently 
needed — in  the  villages  north  of  Jerusalem,  villages  occupying 
historic  and  often  Holy  ground.  Red  Cross  work  was  under- 
taken in  twenty-two  such  towns:  in  Beit-In  which  was  ancient 
Bethal ;  in  Beit-ur-el-Foka  which  was  the  upper  Beth  Heron ; 
in  Yalo  which  was,  wrote  Lieutenant  G.  C.  Hunter,  a  Red  Cross 
worker,  the  Ajalon  "of  the  valley  down  which  Joshua  hid  his 
men,  where  Gallus  in  66  A.  D.  met  defeat,  where  Richard 
the  Lion-Hearted  gained  the  heights  and  where  the  last  great 
crusader  of  Richard's  race  drove  back  the  Turks  and  won 
Jerusalem."  Of  the  refugees  from  the  north,  who  in  the 
winter  of  1918  crowded  these  villages,  Lieutenant  Hunter 
wrote: 

They  are  the  most  homesick  lot  imaginable.  The  authori- 
ties provided  a  splendid  camp  for  them  with  abundant  food 
and  water  and  they  stuck  it  out  there  until  the  time  of  the 
big  harvest.  Then  they  dribbled  away,  a  hvmdred  in  a  night, 
some  on  donkeys  but  most  of  them  on  foot,  and  came  as  far 
north  as  the  white  stones  which  mark  the  line  over  which  they 
may  not  cross.  In  the  little  stone  towers  of  the  grape  and  fig 
orchards  on  the  mountain  sides,  they  sit  and  look  off  toward 
their  homes  in  the  north  where  the  shells  break  and  all  the 
British  tents  are  camouflaged. 

During  October,  1018,  General  Allenby  "was  pushing  north- 
ward through  Syria  and  at  the  same  time  the  British  Forces 
under  General  ^farshall  were  advancing  northwest  along  the 
Tigris  River  from  Bagdad.  With  the  capture  of  Kalch  Sher- 
ghat,  which  cut  the  Turkish-Teutonic  line  of  coiumunications 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    907 

with  Mosul,  and  the  fall  of  Aleppo,  the  chief  base  of  supplies 
of  the  Turkish-German  Armies  in  Asia  Minor,  supreme  dis- 
aster faced  the  Ottoman  Empire.  On  October  30,  Turkish  rep- 
resentatives accepted  the  British  terms  of  peace,  which  were 
practically  of  unconditional  surrender.  Thus  ended  the  bril- 
liant Syrian  and  ^Icsopotamian  Campaign  and  the  seven-cen- 
tury old  mastery  of  the  Turk  in  the  Holy  Land. 

Following  the  British  victories  in  Asia  Minor,  Turkey  in 
Asia  and  Caucasian  Russia,  where  thousands  of  destitute  men, 
women  and  children  wore  existing  as  best  they  could,  were 
opened  to  Allied  relief  organizations.  The  problem  was  too 
large  for  the  American  Red  Cross  alone,  and,  moreover,  the 
American  Conimittoe  for  Armenian  and  Syrian  Relief  had  been 
longer  in  the  field  and  had  no  other  responsibilities  such  as 
those  confronting  the  American  Red  Cross.  Extensive  plans 
for  relief  in  the  Xear  East  were  undertaken  early  in  1919  by 
the  American  Committee  for  Armenian  and  Syrian  Relief. 
One  of  the  first  steps  was  to  bring  about  its  incorporation  by 
Act  of  Congress  when  it  became  known  as  the  American  Com- 
mittee for  Relief  in  the  Near  East.  It  ultimately  absorbed 
in  1919  and  1920  the  activities  of  the  American  Relief  Ad- 
ministration and  the  American  Red  Cross  and  to  quote  from  its 
Annual  Report  for  1921,  was  ''the  only  American  relief  agency 
operating  extensively  in  Constantinople  and  the  adjoining  terri- 
tory in  European  Turkey,  Thrace,  Anatolia,  Armenia,  Cilicia, 
Kurdestan,  Syria,  Palestine,  JMesopotamia,  Persia  and  Trans- 
Caucasia  (Russia)  including  Russian  Armenia." 

This  committee  called  upon  the  American  Red  Cross  Nurs- 
ing Service  to  supply  nurses  to  work  under  its  own  auspices  in 
the  Near  East.  A  unit  of  fifty-four  nurses  was  supplied  with 
Anna  E.  Rothrock  as  chief  nurse,  and  sailed  on  Eobruary  10, 
1919,  for  Asia  ]\Iinor.  Eight  others,  among  them  Emma  Wood 
of  the  original  Red  Cross  Commission  for  Palestine,  sailed  on 
February  29,  1920,  and  four  more  on  March  16,  while  small 
units  of  from  two  to  four  nurses  also  accepted  this  service 
throughout  1919  and  1920. 

Stimulated  by  an  appreciation  of  the  needs  which  had 
brought  about  the  extension  of  the  work  of  the  Ani(n-iean  Com- 
mittee for  Armenian  and  Syrian  Relief,  Colonel  Finley  had 
gone  to  Paris  in  December,  1918,  and  there  had  recruited  from 
among  the  workers  then  being  released  by  the  diminution  of 
the  French  program,  a  large  unit  for  service  in  Palestine.  This 


908  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

unit  proceeded  to  Jerusalem  in  February,  1919.  Among  them 
were  twenty  nurses  and  Miss  Noyes  was  under  the  impression 
that  they  had  gone  out  to  work  under  Miss  Madiera  or  a  pos- 
sible successor  to  her,  for  early  in  December,  1918,  administra- 
tive difficulties  had  developed  among  various  members  of  the 
Palestine  unit.  Through  correspondence  with  Miss  Madiera, 
Miss  ^oyes  gained  the  impression  that  the  organization  was 
somewhat  weak  and  that  the  status  of  the  nurses  was  not  clearly 
defined.  Colonel  Ward  was  then  making  his  plans  to  return 
to  his  former  work  at  Beirut  and  was  closing  the  affairs  of  the 
medical  service  of  the  commission.  On  December  4,  he  wrote 
Miss  Koyes: 

.  .  .  Fundamentally  there  has  been  disagreement  between 
Miss  Madiera  and  the  commission  as  to  her  services.  .  .  . 
She  came  out  with  the  idea  that  she  was  to  direct  a  nursing 
unit  and  that  all  her  work  would  be  administrative. 

Even  before  we  reached  Palestine  it  seemed  unwise  to  keep 
all  the  nurses  together  in  a  distinct  section  as  we  would  have 
in  service.  Perhaps  if  we  were  more  thoroughly  under  mili- 
tary discipline,  this  would  have  been  the  natural  thing,  but 
with  a  large  number  of  social  workers,  secretaries  and  others, 
we  felt  it  much  better  to  mix  up  the  various  members  of  our 
larger  unit,  treating  them  all  on  a  par.  I  supposed  that  that 
was  the  truly  American,  democratic  way  of  looking  at  things. 
At  any  rate,  after  we  came  to  Palestine  and  began  to  realize 
the  nature  of  the  work  expected  of  ns,  we  saw  that  the  ten 
nurses  would  have  to  be  distributed  among  the  various  hospi- 
tals and  dispensaries  scattered  up  and  down  the  country.  It 
was  impossible  for  j\[iss  Madiera  to  control  all  this  work  and 
it  therefore  seemed  wisest  to  limit  her  functions  to  the  gen- 
eral functions  of  a  nursing  bureau  and  not  to  give  her  control 
of  the  nursing  service  in  the  field. 

In  this  capacity,  she  made  many  trips  here  and  there  and 
did  excellent  service  iu  helping  to  organize  the  work  in 
various  bos])itals.  For  a  time  we  gave  her  the  complete 
respoiisil)ility  of  directing  the  district  nursing  and  dispensary 
service  in  and  aljout  Jerusalem,  but  this  has  gradually 
diminished  until  practically  all  of  our  nurses  are  in  hospital 
work. 

Miss  ]\radiera  has  felt  repeatedly  that  there  was  not  scope 
for  her  activities  and  we  have  felt  repeatedly  the  difficulty  of 
giving  her  that  scope  even  when  it  came  to  the  matter  of 
nurses'  quarters.  ...  In  fact,  there  seems  no  place  here  for 
a  director  of  nursine:  service.     Our  work  is  too  small  and  is 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    909 

organized  on  an  entirely  different  plane  from  that  in  France. 
We  would  have  jjlace  for  a  nurse  who  would  be  a  chief  among 
the  nurses,  doing  regular  nursing  service  like  any  of  the 
others.  .  .  . 

Before  the  twenty  additional  mirses  from  Paris  head- 
quarters arrived  in  Jerusalem,  Miss  Madiera  had  left  the  city 
and  was  on  lier  way  home.  When  they  arrived,  they  were 
scattered  nnder  the  system  already  referred  to  by  Colonel  Ward 
to  various  dispensaries  in  the  Beirut,  Aleppo  and  Gaza  dis- 
tricts and  they  served  without  a  chief  nurse  or  nurse  representa- 
tion of  any  kind  on  the  (\)mmission  for  Palestine.  Miss  Noyes 
endeavored  to  secure  information  regarding  their  work  and 
the  possibility  of  appointing  a  new  chief  nurse,  but  on  April  11, 
Major  Storer,  then  one  of  the  new  commissioners  for  Palestine, 
cabled  National  IIead(juarters:  "Oflfice  of  chief  nurse  abolished 
with  Madiera's  department ;  statistical  report  following  by 
post."  Miss  Noyes  continued  to  remain  in  ignorance  of  the 
nursing  activities  in  Palestine  and  of  the  general  welfare  and 
efHcicncy  of  the  nurses. 

Thus  ended  organized  American  Red  Cross  nursing  service 
in  Syria.  The  luirses  continued  to  work  under  the  direction  of 
the  various  doctors  but  finally  returned  singly  or  in  groups  of 
one  or  two  during  the  sunnner  of  1919  to  the  United  States  or 
undertook  service  with  the  American  Committee  for  Relief  in 
the  Near  East. 

During  the  period  beginning  July  1,  1018,  and  ending  Febru- 
ary 28,  1919,  the  American  Red  Cross  in  its  twelve  hospitals 
and  sixteen  dispensaries  in  the  Jerusalem  District  treated 
127,000  men,  women  and  children,  furnished  milk  to  9500 
mothers  for  young  babies  and  cared  for  085  children  in  orphan- 
ages and  day  nurseries."^ 

On  ^NFarch  8,  1919,  a  plan  was  worked  out  by  the  American 
Committee  for  Relief  in  the  Near  East  and  tlu^  American 
Red  (^ross  C\)mniissi()n  for  Palestine  whereby  the  American 
Committee  for  Kelief  in  the  Near  East  took  over  iho  relief 
work  north  of  I'alestine  and  th(>  Anuu'ienn  R(h1  Cross  was  to 
continue  its  woi'k  in  Palestine  until  .Inly  1,  191  it,  when  all  its 
activities  and  unutilized  supplies  on  hand  were  to  be  turned 
over  to  the  American  Committee  for  lielief  in  the  Near  East. 

""The  Work  of  the  American  Pvcd  Cross  (luring'  tlu'  War:  A  Statfiiu'iit 
of   I'iiiaiH't's  and   Acconiplislinu'iits."    \).   87. 


910  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Thus  in  the  summer  of  1919,  American  Red  Cross  service  in 
the  Holy  Land  was  closed. 

Siberia,  a  land  of  magnificent  distances  held  together  only 
by  a  slender  thread  of  rail  and  telegraphic  communication, 
with  a  population  swollen  by  the  influx  of  refugees  from  Russia, 
harassed  by  guerrilla  warfare  between  the  Rod  Guard  and  the 
remnants  of  a  Czech  and  native  Army  and  devitalized  by  famine 
and  disease,  was  the  scene  in  1918  and  1919  for  extensive, 
albeit  at  first  somewhat  disorganized,  relief  operations  by  the 
American  Red  Cross. 

The  political  situation  in  Siberia  was  the  determining  factor 
of  American  Red  Cross  activity  there.  After  the  Treaty  of 
Brest-Litovsk  had  been  signed  in  December,  1917,  a  consider- 
able number  of  Czecho-Slovak  soldiers  who  had  been  fighting 
in  the  former  Russian  armies  against  the  Central  Powers  and 
who  were  anxious  to  reach  Vladivostok  and  rejoin  the  Allies 
on  the  Western  Front,  gained  permission  from  the  Bolsheviki 
to  cross  Siberia.  The  actual  number  of  this  Czech  Army  has 
never  been  definitely  determined,  but  a  conservative  estimate 
placed  the  number  at  about  fifty  thousand  men.^-  Early  in 
1918,  presumably  at  the  instigation  of  the  Central  Powers,  the 
Bolsheviki  ordered  the  Czechs  to  disarm.  This  the  Czechs 
refused  to  do  and  immediately  active  hostility  to  the  Bolshevik 
regime  broke  out  in  the  region  of  the  Ural  Mountains  and  later 
spread  eastward  along  the  line  of  the  Trans-Siberian  Railway 
to  the  eastern  provinces. 

The  Anti-Bolshevik  armies  were  led  by  General  Semenoff, 
Admiral  Kolehak,  General  Gaida,  Colonel  Orloff  and  others. 
In  addition  small  groups  of  native  soldiers  joined  the  forces  of 
these  leaders  or  operated  independently. 

In  ]\lay,  1918,  the  Bolshevik  forces  occupied  the  Trans- 
Baikalia  and  thus  cut  the  Czech  armies,  leaving  some  forty 
thousand  of  them  scattered  along  the  line  of  the  Trans-Siberian 
Railway  from  Irkutsk  westward  to  Samara  and  about  fifteen 
thousand  others  in  Vladivostok,  awaiting  transportation  to 
France.  The  situation  was  extremely  precarious,  because  a 
Bolslievik  offensive  in  the  west  was  daily  expected  and  the 
divided  Czech  armies  found  themselves,  with  only  the  most 
meager  supplies  of  food,  ordnance,  annnunition  and  sanitary 

'^"A  Reference  History  of   tlie  War,"  p.   142. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     911 

service,  facing  this  offensive  and,  within  a  few  months,  the 
severe  Siberian  winter. 

The  Allies  "determined  upon  a  certain  amount  of  military 
intervention  in  order  to  try  to  save  something  from  the  chaos 
which  existed  in  Russia"  ^^  and  forces  of  Allied  troops  were 
sent  in  the  summer  of  1918  to  Murmansk,  on  the  North  Rus- 
sian Front,  and  to  Vladivostok,  on  the  Siberian  side,  to  reen- 
force  the  Anti-Bolshevik  armies. 

The  reasons  for  the  despatch  of  American  troops  to  Siberia 
were  contained  in  a  statement  made  by  President  Wilson  on 
July  25,  1919,  in  reply  to  a  Senate  resolution  concerning  the 
American  Expeditionary  Forces  in  Siberia: 

.  .  .  The  decision  to  send  American  troops  to  Siberia  was 
announced  to  the  press  on  August  5,  1918,  in  a  statement 
from  the  Acting  Secretary  of  State. 

This  measure  was  taken  in  conjunction  with  Japan  and  in 
concert  of  purpose  with  the  other  Allied  powers,  first  of  all 
to  save  the  Czeeho-Slovak  armies  which  were  threatened  with 
destruction  by  hostile  armies  apparently  organized  by,  and 
often  largely  composed  of,  enemy  prisoners  of  war.  The 
second  purpose  in  view  was  to  steady  any  efforts  of  the 
Eussians  at  self-defense,  or  the  establishment  of  law  and  order 
in  which  they  might  be  willing  to  accept  assistance. 

Two  regiments  of  infantry,  with  auxiliary  troops — about 
8000  effectives — comprising  a  total  of  approximately  10,000 
men,  were  sent  under  the  command  of  General  William  S. 
Graves.  The  troops  began  to  arrive  at  Vladivostok  in  Sep- 
tember, 1918. 

Considerably  larger  forces  were  dispatched  by  Japan  at 
about  the  same  time  and  much  smaller  forces  by  other  of  the 
Allied  powers.  The  net  result  was  the  successful  reunion  of 
the  separated  Czecho-Slovak  armies  and  the  substantial  elimi- 
nation in  Eastern  Siberia  of  the  active  efforts  of  enemy 
prisoners  of  war.  A  period  of  relative  quiet  then  en- 
sued.'^* .  .  . 

The  determination  of  the  United  States  Government  to  send 
American  troops  to  Siberia  opened  up  the  way  for  the  American 
Red  Cross.  In  fact,  representatives  of  the  society  arrived  in 
Vladivostok  and  began  relief  operations  there  previous  to  the 
arrival  of  x\merican  troops. 

"  "A  Reference  History  of  the  War,"  p.  142. 

"See  "American  Assistance  in  tlie  Operation  of  the  Trans-Siherian  Rail- 
way. Russian  Series  No.  4."'  p.  5 ;  Department  of  State,  Government  Print- 
ing Office,   1919,  Washington,  D.  C. 


912  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  war  organization  at  National  Headquarters  included,  it 
will  be  remembered,  the  Foreign  and  Insular  Division,  the  so- 
called  Fourteenth  Division.  This  division  was  then  composed 
of  Red  Cross  Chapters  in  all  parts  of  the  world  outside  of  the 
United  States  and  Europe ;  among  these  Chapters  was  a 
strongly-organized  Chapter  with  ample  resources  at  Honolulu, 
the  Philippine  Islands,  and  another  at  Tokyo,  Japan.  Officials 
of  these  Chapters  were  in  constant  communication  with  J.  Otis 
Cutler,  manager  of  the  Fourteenth  Division  at  National  Head- 
quarters, who  kept  the  War  Council  informed  as  to  develop- 
ments in  the  Far  East. 

On  July  22,  1918,  the  American  Ambassador  called  a  meet- 
ing of  the  members  of  the  American  Red  Cross  Chapter  in 
Tokyo,  Japan,  to  discuss  the  question  of  furnishing  aid  to  the 
Czecho-Slovak  Army  in  Siberia.  Four  days  later,  a  formal 
conference  was  held  between  the  Ambassador  and  the  Executive 
Committee  of  the  Tokyo  Chapter,  and  Dr.  R.  B.  Teusler,  a 
Virginian,  who  was  then  superintendent  of  St.  Luke's  Hos- 
pital, Tokyo,  was  authorized  to  go  to  Vladivostok  to  investigate 
conditions  and  report  personally  to  the  Tokyo  Chapter  the 
situation  in  Siberia  and  the  opportunities  for  relief  service. 

In  company  with  two  American  business  men  who  were  also 
representatives  of  the  Tokyo  Chapter,  Dr.  Teusler  left  Tokyo 
on  July  16  and  upon  arrival  in  Vladivostok,  investigated  condi- 
tions in  that  city  and  along  the  Trans-Siberian  Railroad  as  far 
east  as  Nikolsk.  After  discussing  the  situation  with  repre- 
sentatives of  the  Czech  Army  and  of  the  American  Navy  and 
State  Departments  there,  he  returned  to  Tokyo  and  organized 
a  unit  of  Japanese  doctors  and  nurses  from  St.  Luke's  Hospital 
for  emergency  service  in  Vladivostok. 

The  nurses  were  under  the  direction  of  Alice  St.  John,  an 
enrolled  American  Red  Cross  nurse  who  was  then  superin- 
tendent of  nurses  at  St.  Luke's.  Mrs.  St.  John  was  graduated 
from  and  later  became  superintendent  of  the  Hackensack  (New 
Jersey)  Hospital.  She  was  a  Canadian  but  had  married  a 
New  York  physician,  Dr.  St.  John,  and  after  his  death,  had 
gone  out  to  Tokyo.  ]\Irs.  St.  John  was  a  woman  of  serene  and 
gracious  personality.  She  served  as  chief  nurse  of  the  Ameri- 
can Red  Cross  C\)nnnission  for  Siberia  from  the  early  inception 
of  the  work  until  the  close  of  the  program. 

Of  the  situation  in  Vladivostok  in  the  summer  of  1918,  Mrs. 
St.  John  wrote  Miss  Noyes: 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    913 


Early  in  June,  the  15,000  Czech  troops  collected  in  Vladi- 
vostok had  five  doctors  and  seven  trained  nurses  to  care  for 
all  their  wounded  and  they  were  entirely  without  medicines, 
hospital  equipment  and  surgical  supplies.  Owing  to  the 
blockading  of  the  remainder  of  ihe  Czech  Army  west  of 
Irkutsk  by  the  Kcd  Cuard,  the  Czech  authorities  in  Vladi- 
vostok decided  in  duly  to  send  their  contingent  of  15,000 
Czechs  back  over  the  Trans-Siberian  Railway  to  drive  out  tiie 
Bolsheviki  from  the  Trans-Baikalia.  Definite  ap])cals  for 
military  and  material  assistance  were  sent  to  the  American 
(Jovernment  by  the  Czechs.  .  .  . 

On  June  25,  street  fighting  broke  out  in  Vladivostok 
between  the  Czechs  and  tlie  local  Eed  Guard  and  several  were 
killed  on  botii  sides.  The  fight  continued  west  of  Vladivostok 
at  Xikolsk  and  Cssuri  in  early  July.  There  were  no  hospital 
facilities  in  Madivot-tok  for  the  care  of  the  wounded,  so 
emergency  slielter  was  provided  in  a  storage  shed  at  the 
disposition  of  the  U.  S.  Cruiser  BrookJyn.  This  shed  was 
temporarily  fitted  up  by  the  officers  and  men  of  the  Brookhjth 
to  care  for  about  one  hundred  patients. 

On  July  20,  a  building  capable  of  accommodating  two 
hundred  and  fifty  patients  was  secured  on  Russian  Island,  at 
the  entrance  of  the  Vladivostok  harbor.  Supplies  and  oqui])- 
ment  were  sent  over  from  Japan  and  China  by  the  American 
Red  Cross  and  a  unit  of  fifteen  Japanese  nur.scs  and  several 
doctors  from  St.  Luke's  in  Tokyo  were  sent  to  staff  the 
Russian  Island  liospital.  Dr.  Gill,  senior  surgeon  of  the 
Bruokhjn,  was  director  of  the  h()si)ilal  and  1  reported  on 
August  VI  for  duty  as  chief  nurse.  The  Czecho-Slovak 
wounded  who  had  been  in  the  Brookhjn'K  warehouse  were 
transferred  to  Russian  Island  and  several  French  and  British 
soldiers,  also  wounded  in  the  Ussuri  campaign,  were  brought 
to  us. 

Russian  Island  Hospital  was  thus  the  first  American  Red  Cross 
hospital  in  Siberia  and  the  Japanese  nurses,  in  the  face  of 
meagtn'  equipment  and  personal  privations,  kept  it  in  operation 
until  tiiey  wci'c  i-clieved  by  American  rei'iiforcenients.  Miss  lyo 
Araki,  for  fifteen  years  head  nurse  at  St.  Luke's,  was  the  leader 
of  the  -Japanese  unit. 

In  addition  to  the  Russian  Island  Hospital,  the  American 
Red  Cross  in  Siberia  assisted  in  the  ecpiipment  of  the  (Vjh'Ii 
Xaval  Hospital  and  gave  aid  to  the  Fortress  Hospital  in  Vladi- 
vostok,   where    three    hundred    Czech    patients    suii'ering    from 


914   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

venereal  diseases  were  being  cared  for  under  the  joint  manage- 
ment of  the  local  Russian  authorities  and  the  Czech  leaders. 
Early  in  August,  the  Czech  Army  in  Vladivostok  planned  to 
attack  the  Bolsheviki  at  Manchuria  Station  with  a  view  toward 
driving  them  out  of  the  Trans-Baikalia.  They  asked  Dr. 
Teusler  to  furnish  surgeons  and  nurses  and  to  assist  in  organiz- 
ing sanitary  trains.  Mrs.  St.  John  wrote  of  the  sanitary 
transport  situation  facing  the  Czech  Army: 

At  this  time,  many  of  the  wounded  were  being  brought  down 
from  Nikolsk  and  Ussuri  in  filthy  box-cars  with  no  provisions 
for  their  care.  Owing  to  the  disorganized  railroad  service, 
the  journey  as  a  rule  required  two  or  three  days.  The 
wounded  were  fed  with  food  purchased  from  the  peasants  at 
stations  along  the  way  and  were  without  tbe  service  of  either 
surgeons  or  nurses  during  the  two  or  three  days'  trip.  The 
Czechs  had  one  small  improvised  hospital  train  made  up  of 
third  and  fourth  class  cars  and  several  freight  cars,  but  the 
train  had  practically  no  equipment  for  handling  the  wounded 
and  was  without  drugs  and  surgical  dressings.  These  the 
Red  Cross  supplied  and  at  once  began  preparation  to  com- 
mission two  more  hospital  trains  for  service  on  the  Ussuri 
and  j\Ianchuria  fronts.  The  trains  were  to  be  supplied  with 
American  doctors  and  nurses  and  tiie  first  train,  intended  for 
service  in  the  Trans-Baikal  provinces,  was  ready  late  in 
August.  The  second  was  to  be  commissioned  by  Septem- 
ber 15.  .  .  . 

Early  in  August,  1918,  Dr.  Teusler  sent  telegraphic  appeals 
to  the  superintendents  of  American  mission  hospitals  in  ('hina 
and  Japan,  asking  surgeons  and  nurses  to  volunteer  for  service 
in  Siberia  and  to  mobilize  by  August  20  at  Harbin,  the  nearest 
point  of  safety  to  Manchuria  Station. 

The  response  of  the  nurses  was  immediate.  The  first  group 
of  American  nurses  to  arrive  in  Harbin  was  organized  from 
among  the  staff  of  the  IIunan-Yale  Hospital  at  Cliangsha, 
China.  One  of  these  was  Gertrude  P.  Carter,  a  graduate  of  the 
Hartford  (Connecticut)  School  and  formerly  night  supervisor 
of  the  p(>diatric  department  of  Johns  Hopkins  Hospital.  An- 
other group  was  organized  from  St.  Luke's  Hosjutal,  Shanghai, 
China,  and  included  Florence  Farmer,  a  Canadian  nurse  who 
had  been  a  member  of  Unit  C  of  the  Red  Cross  ^lercv  Ship 
Expedition  in  1014.     She  had  seen  service  at  Kief  and  later  at 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    915 

Khoi,  Persia.  After  her  release  from  Ked  Cross  assignment 
late  in  11)10,  Miss  Farmer  had  remained  in  China  and  had 
done  private  nursing  duty  among  the  English  colony  at  Pe- 
king and  Shanghai. 

Another  nurse  of  the  Shanghai  unit  was  Katherine  Steelman, 
a  graduate  of  the  Johns  Hopkins  School.  Among  ^liss  Steel- 
man's  papers  is  a  copy  of  the  original  mobilization  telegram  sent 
to  St.  Luke's  Hospital,  Shanghai,  by  Dr.  Teusler  and  it  is  of 
interest  in  that  it  shows  the  conditions  which  prevailed  in  this 
pioneering  period: 

Vladivostok. 
Dr.  Tucker,  St.  Luke's  Hospital,  Shanghai. 

Urgent  call.  Please  report  with  Dr.  Lee  to  American 
Consulate,  Harbin,  not  later  than  August  10.  Our  unit 
leaves  that  day.  Bring  fifty  pairs  of  blankets,  sheets,  pillows, 
two  hundred  towels ;  also  warm  clothing  for  own  use ;  our 
khaki  uniform  with  leggings  or  puttees;  canned  food  for 
personal  service.  Also  local  Red  Cross  Chapter  to  advance 
cost  to  be  repaid  later.  Bring  two  or  three  American  nurses 
with  you  if  possible.  This  is  important.  Have  full  authority 
Washington 

(signed)   Teusler. 

The  nurses  and  surgeons  reported  in  good  time  at  Harbin. 
Eight  of  the  nurses  were  assigned  to  a  surgical  pavilion  in  the 
Harbin  ^lilitary  Hospital;  the  other  seven  were  sent  to  Buch- 
aloo,  a  small  village  about  ninety  miles  east  of  ^lanchuria 
Station.  The  only  buildings  available  were  Russian  military 
barracks,  which  were  not  at  all  suited  for  hospital  purposes; 
but  with  tru<^  American  ingenuity  the  nurses  organized  a  hos- 
pital of  two  hundred  bed  capacity.  Later,  the  Buchaloo  Hos- 
])ital  was  maintained  as  a  convalescent  hospital  for  (^zech  sol- 
diers suffering  from  tuberculosis. 

The  political  situation  was  highly  unsettled  so  the  nurses 
W(>re  k(>pt  marking  time.  Gertrude  Carter  wrote  of  the  Buch- 
aloo Hospital : 

From  narl)in.  we  bad  gone  for  an  eighteen  hours'  ride  up 
the  railroad  to  Buchaloo  and  had  established  a  hospital  there, 
but  oidy  received  about  thirty  ])atients  in  all.  Fifteen  of  these 
were  Czechs.  The  Czech  Front  had  suddenly  changed  and 
all  troo])s  wvrv  moved  on  to  the  Fral  Mountain  region. 
ThrouLfh  unforeseen  reasons,  we  did  not  move  willi  them.  .   .  . 


916  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  a  report  submitted  June  30,  1919,  to  Miss  Noyes,  Mrs. 
St.  John  described  what  had  happened : 

Early  in  September,  1918,  General  Gaida  with  a  few  thou- 
sand Czechs  completed  his  remarkable  campaign  through  the 
Trans-Baikalia  from  Irkutsk  eastward  to  Chita  and  with  his 
staff  came  down  to  Olivinnaya.  This  expedition  completely 
cleared  out  the  Bolsheviki  in  the  Trans-Baikal  provinces  and 
reestablished  rail  communications  between  western  and  east- 
ern Siberia.  The  expected  campaign  between  Manchuria 
Station  and  Irkutsk  vanished  with  the  collapse  of  the  Bed 
Guard  resistance  and  the  entire  Trans-Siberian  Railroad  was 
thrown  open  from  Vladivostok  to  the  east-Eussian  fronts  near 
Samara  and  Perm,  nearly^  five  thousand  miles  away.  Every 
station  along  the  railway  was  in  the  hands  of  the  Czechs  and 
they  were  then  the  masters  of  the  situation  in  Siberia.  This 
campaign  of  General  Gaida  brought  to  an  abrupt  end  the 
arrangements  for  First  Aid  and  evacuation  hospitals  in  east- 
ern Siberia  and  made  necessary  complete  readjustment  of  all 
American  Eed  Cross  plans. 

At  this  juncture,  the  question  arose  as  to  whether  the 
American  Red  Cross  was  justified  in  undertaking  assistance 
on  the  east-Russian  fronts  beyond  the  Ural  Mountains.  The 
definite  policy  of  the  United  States  Government  stated  that  it 
should  assist  the  Czechs  only  to  leave  Siberia  and  aid  them  to 
get  to  France,  but  not  to  give  them  military  or  other  support 
along  an  east-Russian  front. 

With  the  approval  of  the  War  Council,  the  representatives 
of  the  Red  Cross  in  Siberia  decided  to  give  medical  assistance 
to  the  Czechs  in  western  Siberia  and  to  investigate  the  civilian 
refugee  situation  beyond  Lake  Baikal.  During  the  develop- 
ment of  these  plans,  the  nurses  and  surgeons  were  held  in 
Harbin  and  thus  closed  the  early  phases  of  the  pioneer  period 
of  American  Red  Cross  service  in  Siberia.  .  .  . 

The  second  period  in  the  development  of  American  Ked 
Cross  ISTursing  Service  in  Siberia  began  in  I\"ovcmber,  1918, 
and  was  characterized  bv  the  development  of  civilian  relief 
work  as  well  as  medical  service  in  the  Vladivostok  district 
and  tentative  expansion  of  Ived  Cross  activity  into  western 
Siberia. 

The  first  task  was  to  evacuate  the  wounded  Czechs  to  Prague. 
The  journey  was  a  long  one,  so  the  sick  and  wounded  men 
were  sent  from  Vladivostok  to  St.  Luke's  Hospital,  Tokyo, 
where  a  ward  in  a  building  belonging  to  the  hospital  had  been 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    917 

prepared  to  receive  tliem.  This  ward  was  staffed  by  two 
Japanese  nurses  and  two  aides,  with  an  American  Red  Cross 
nurse,  Marion  Doane,  as  head  nurse.  On  September  17,  1918, 
sixty  patients  were  received  and  from  time  to  time  others  came. 
On  April  9,  1919,  the  convalescent  Czechs  were  evacuated  on 
the  S.  S,  Madras  to  go  via  the  Indian  Ocean  and  the  Suez 
Canal  to  Trieste  and  thence  by  rail  to  Prague. 

Eight  thousand  destitute  refugees  were  known  to  be  living  in 
Vladivostok  in  the  summer  of  li)18  without  medical  or  nursing 
attention  of  any  kind.  To  care  for  the  casual  sick  among  these 
refugees,  the  American  Red  Cross  took  over  No.  7  Marine 
Barracks,  a  building  formerly  a  part  of  the  Russian  Submarine 
Base  at  Vladivostok,  and  e(iuipped  it  as  a  hospital  of  two 
hundred  and  fifty  bed  capacity.  It  was  opened  on  November 
15  and  was  staffed  largely  by  Chinese  nurses  who  worked  under 
the  direction  of  American  physicians  and  nurses.  Mary  Hood, 
a  graduate  of  the  Scarritt  Bible  and  Training  School  for 
Nurses,  Kansas  City,  was  chief  nurse ;  she  had  gone  out  to 
Foochow,  China,  to  serve  in  the  Mary  Black  Hospital,  had  been 
transferred  to  Shanghai,  and  had  subsequently  joined  the  Com- 
mission for  Siberia. 

Thus  in  the  fall  of  1918,  the  American  Red  Cross  was  main- 
taining in  Vladivostok  Russian  Island  Hospital,  the  Refugee 
Hospital  and,  in  Tokyo,  a  large  ward  at  St.  Luke's  Hospital. 
In  the  Harbin  district,  the  commission  was  maintaining  a 
surgical  pavilion  in  the  Military  Hospital  and  the  hospital  at 
Buchal()o«and  had  under  process  of  organization  extensive  relief 
activities  for  western  Siberia. 

In  October,  1918,  five  of  the  American  Red  Cross  nurses 
who  were  stationed  at  Harbin  were  started  westward  on  Sanitary 
Train  No.  1  to  establish  a  hospital  in  the  West-Siberian  prov- 
inces. Miss  Farmer  was  in  charge  of  the  unit.  The  trip  was  a 
long  one  and  during  the  journey  the  nurses  had  ani])le  oppor- 
tunity to  see  the  destitute  conditions  existing  throughout  the 
interior. 

Siberia  was  a  beautiful  country  and  to  the  luirses,  as  the 
sanitary  train  carrying  them  moved  w(^stward  through  ]\ran- 
churia  and  tlu^  Trans-Baikalia  and  stop])cd  at  the  diifcrent 
terminal  cities  along  the  line,  the  scenery  seemed  to  grow  more 
lovely,  but  the  govcrnmont  more  unstable  and  living  conditions 
more  wretched  1\\'  contrast.  Marauding  bands  of  BoLsh(>viki, 
made  up  of  freed  criminals,  German  and  Austrian  pi'isoners  of 


918   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

war  and  the  fierce  MagA'ars  held  up  the  hands  of  the  local  Red 
Guard.  Confiscation  and  re-division  of  property  and  livestock 
had  taken  place  and  production  under  the  new  regime  had  not 
begun.  The  educational  and  legal  systems  seemed  paralyzed 
and  starvation  and  disease,  especially  typhus,  was  abroad  in  the 
land. 

In  ]*»[ovember,  1018,  the  menace  of  a  typhus  pandemic  be- 
came so  threatening  that  an  Inter-Allied  Typhus  Commission 
was  formed  by  the  Allied  Armies  in  Siberia  and  a  complete 
anti-typhus  train,  consisting  of  seven  cars  devoted  to  apparatus 
for  bathing  persons  and  disinfecting  clothes,  of  twelve  box  cars 
carrying  supplies  and  three  personnel  cars,  was  sent  out  along 
the  Trans-Siberian  Railway  to  combat  the  spread  of  the  dis- 
ease. The  train  was  furnished  by  the  American  Red  Cross 
and  its  business  manager  was  Rudolph  Bukoley,  of  Honolulu. 
Captain  F.  A.  Dallyn,  of  the  Hydrological  Corps,  Canadian 
Expeditionary  Forces,  was  director  of  the  expedition  and 
commanding  ofiicer  of  the  train.  Captain  Bukeley  later  wrote 
a  report  now  on  file  at  jSTational  Headquarters,  from  which 
extracts  are  quoted  in  this  history  to  show  the  environment  in 
and  the  conditions  under  which  the  nurses  worked.  Of  the 
famous  tunnels  of  Lake  Baikal,  Captain  Bukeley  wrote: 

Now  we  are  going  through  tunnel  after  tunnel;  I  believe 
there  are  forty-nine  of  them,  mostly  short  ones,  so  we  have 
had  good  opportunity  to  see  the  beauty  of  this  Lake.  On  our 
left  are  the  slate  rocks  through  which  the  track  has  been  cut 
and  blasted ;  below  us  and  to  the  right  is  the  Lake,  at  this 
point  some  eighteen  miles  wide;  ahead  of  us  as  the  roadway 
winds  and  twists  we  can  see  the  next  tunnel.  To  our  riglit 
stretches  the  long  expanse  of  ice,  snow  swept  and  wind  driven, 
and  on  the  other  shore  the  undulating  mountain  range,  beau- 
tiful beyond  words  and  of  all  sorts  of  colors,  with  a  grayisli 
purple  predominating.  .  .  . 

In  the  tranquil  winter  landscape,  the  paraphernalia  of  war 
seemed   incongruous.      Captain  Bukeley  wrote : 

...  At  Verkhne-Tdinsk.  I  saw  my  first  armored  train; 
first  comes  a  flat  car  protected  on  cacb  side  by  arnior-})hite ; 
on  this  ear  is  mounted  a  ligbt  gun  swung  on  a  circular  car- 
riage so  as  to  be  able  to  swing  from  side  to  side.  Then  comes 
the   engine,   also   armor   protected,   two   ])asseiigc'r   cars   and 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    919 

fiually  a  box  car,  reeuforced  in  tlie  usual  maimer,  with  open- 
ings on  each  side  for  rapid-fire  guns  and  above  holes  for  rifle 
shooting.  .  .  . 

huudentally,  Ceneral  SemenofT,  from  what  I  can  gather, 
must  be  of  the  picturesque  bandit  type  and  one  who  is  doubt- 
less worshipi)ed  by  liis  soldiers.  ...  He  was  formerly  the 
colonel  of  a  Cossack  regiment  which  made  him  a  general. 
Now  he  travels  in  style  .  .  .  in  his  private  car  and  is  abso- 
lutely his  own  law  as  far  as  life  and  property  are  concerned. 
Usually  he  rides  in  his  train  de  luxe  with  an  armored  train  in 
front  of  him  and  another  behind  him,  .  .  .  dominating  the 
countryside  from  Harbin  and  Chita.  .  .  . 

Of  the  conditions   and  methods  of  travel  which  prevailed 
along  the  Traiis-Siberiaii  railroad,  an  American  engineer  wrote: 

.  .  .  This  Chinese  Eastern  Eailway  is  the  eastern  end  of 
the  Trans-Siberian  system  and  has  a  good  permanent  way 
and  good  ties,  with  concrete  bridges  and  tunnels,  all  built  as 
only  they  built  in  Russia  under  the  Czar.  ,  .  .  The  station 
buildings  all  along  the  line  are  stone,  or  brick  and  stone,  sub- 
stantial and  of  good  appearance;  the  platforms  of  gravel  with 
cut  stone  curl)ing;  the  station  house  situated  at  about  the 
centers  of  the  ])latform,  at  each  end  of  which  is  a  so-called 
toilet.  The  station  house  has  the  Chinese  architectural  roof, 
pleasing  to  the  eye  on  the  exterior  but  unspeakable  within.  .  .  . 
Then  there  is  a  building  in  which  is  a  great  kettle  full  of 
boiling  water :  from  this  the  passengers  fill  their  ever-present 
teapots.  ...  In  Siberia,  time  is  no  object.  There  is  also  at 
most  stations  a  Lavka  or  small  selling  store,  where  you  can 
get  the  usual  necessities,  the  chief  of  which  is  vodka.  .  .  . 

Every  station  has  also  a  military  barracks  and  at  every  one 
hundred  versts  are  long  military  unloading  platforms  and 
immense  barracks  with  small  private  buildings  and  parks  for 
the  officers,  and  even  now  can  be  seen  evidence  of  the  joyous 
life  which  existed  here  in  the  days  of  the  Czar  and  military 
predominance.  At  jtresent  thev  are  all  going  to  ruin  .  .  . 
and  the  former  trim  })arks  are  now  the  rendez-vous  of  the 
village  pigs.  .  .  . 

The  railroad  is  ollicered  from  highest  to  lowest  with  college 
men.  as  no  one  is  considered  intelligent  enough  unless  Ik^  has 
a  diploma  from  a  colh'ge  or  technical  institute;  it  seems  to 
matter  little  what  he  has  studied,  so  long  as  he  has  his 
diploma,  which  is  a  sort  of  oval  medal  and  is  always  worn  on 
the  man's  breast.    The  traveling  enirineer  is  often  a  irraduate 


920   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  Naval  college ;  the  master  mechanic  may  have  a  degree 
in  philosophy;  the  chief  executive  is  often  a  general.  In 
fact  they  seem  to  be  everything  except  railroad  men.  All  are 
so  scientific  that  they  are  overtrained.  .  .  .  This  is  coupled 
with  supreme  ego  and  the  remark:   "We  do  it  so  in  Russia." 

The  Trans-Siberian  Railway  was  in  1918  and  1919  the 
artery  through  which  the  demobilized  soldiers  and  refugees 
from  the  Ural  Mountains  and  the  western  provinces  flowed 
eastward  to  Irkutsk  and  Amur.     Captain  Bukeley  wrote: 

Siberia  has  almost  unsurmountable  conditions  to  face;  her 
towns  to-day  have  increased  in  population  more  than  four- 
fold, so  there  is  no  means  of  housing  the  people  except  by  the 
use  of  barracks,  concentration  camps  and  box  cars.  .  .  .  This 
enforced  crowding;  the  climatic  conditions  which  make  neces- 
sary the  use  of  heavy,  lice-carrying  clothing;  the  impossibility 
of  providing  sufficient  bathing  accommodations;  the  paralyz- 
ing of  her  railroad  so  that  she  is  unable  to  import  from 
Vladivostok,  all  help  to  make  Siberia's  problem  a  despairing 
one.  .  .  .  A\'e  feel  as  if  we  are  trying  to  put  out  a  fire  by 
means  of  a  teacup  of  water.  .  .  . 

Every  day  trains  come  in  with  released  war  prisoners  re- 
turning from  German  prison  camps,  gray,  gaunt  and  feeble 
from  the  privations  they  have  suffered.  .  .  .  They  are  travel- 
ing onward,  always  onward,  trying  to  find  the  loved  ones  they 
left  behind  and  who  to-day  are  scattered  somewhere  in  Siberia. 
Their  homes  are  gone,  their  families  disappeared  without  a 
trace,  and  on  they  go  themselves  from  station  to  station  look- 
ing and  searching  everywhere,  no  longer  soldiers  but  plain 
men  again,  worn  out  and  aged  in  the  service  of  the  most 
ungrateful  employer  of  all,  one's  own  country ;  fathers  seeking 
their  children  and  wives;  sons  seeking  aged  parents;  young 
men  looking  for  the  girl  whom  once  they  had  hoped  to  make 
their  wife. 

And  the  refugees:  those  countless  thousands  who  at  the 
approach  of  the  war  fled  on  a  moment's  notice,  some  just  as 
they  were;  others  carrying  in  a  bundle  their  all,  a  kettle,  a 
pillow  or  some  other  remnant  of  their  former  worldly  treas- 
ures. .  .  .  Their  past  life  has  vanished,  their  future, — hope- 
less days  of  wandering,  tired,  frozen  and  worn  out;  dazed, 
broken  and  s]iiri1less. 

A\'it]i  llif  arogariousjicss  of  tlie  human  being,  they  herd 
together,  in  box  cars,  those  few  who  are  fortunate  in  finding 
one;  they  crowd  the  fourth-class  waiting  rooms  of  the  sta- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    921 

tions.  The  sides  of  the  hox  cars — the  very  walls  of  the 
stations'  toilets — are  covered  with  messages  of  all  descrip- 
tions, in  some  instances  only  a  name,  in  other  cases  a  message, 
— simple  cries  flung  out  by  a  father  to  his  wife  and  daughter, 
by  a  mother  and  child  to  the  father,  written  in  the  hope  that 
some  day  the  loved  one  may  pass  through  that  station  and 
read  the  message. 

Individual  suffering  in  Siberia,  to  judge  from  the  reports 
on  file  at  National  llead(piarters,  was  more  acute  and  on  a 
broader  scale  than  that  which  the  American  Ked  Cross  found 
anywhere  except  in  the  devastated  areas  of  Serbia  and  Kou- 
mania  and  France.  One  of  the  most  tragic  cases  which  came 
to  the  attention  of  American  Ked  Cross  representatives  in 
Siberia  was  that  of  a  train  of  twenty-one  hundred  political 
prisoners  from  Samara,  men,  women  and  children,  who  had 
been  packed  into  box  cars  in  September,  1918,  and  had  been 
shunted  back  and  forth  along  the  Trans-Siberian  line  for  two 
months.  Thev  were  so  crowded  in  the  cars  that  they  often  had 
no  room  in  which  to  lie  down;  they  were  under  heavy  guard 
and  were  not  allowed  to  leave  the  cars.  For  food,  they  were 
largely  dependent  upon  the  charity  of  the  peasants  in  towns 
through  which  the  train  passed.  No  water  for  washing  them- 
selves was  furnished  the  prisoners,  nor  brooms  for  sweeping 
out  the  cars,  and  the  only  sanitary  provisions  in  each  car  was  a 
hole  from  six  to  eight  inches  in  diameter  which  had  been  cut 
in  the  floor.     Captain  Bukeley  wrote  of  this  train: 

I  have  seen  men  lying  on  the  floor  of  the  cars,  with  the 
death  rattle  in  their  throat,  half  naked,  with  lice  and  vermin 
crawling  over  them,  visible  to  the  naked  eye,  with  matted, 
knotted  hair,  unkempt,  filthy  beyond  description. 

Others  1  have  seen,  just  lying  there  on  the  boards,  half 
naked,  in  a  semi-conscious  stupor,  and  yet  others  .  .  .  who 
hold  out  clawlike  hands,  with  a  whining  ingratiating  grin  and 
beg  for  a  few  ku/ice.'i  or  a  cigarette,  grinning  and  chuckling 
.  .  .  Ti])on  I'cceiving  the  one  or  the  other  and  making  hor- 
rible, throaty  sounds  of  glee,  as  they  snatched  their  ])rize.  .   .   . 

The  woin(>n  are  t)etter  treated  than  the  men,  eleven  women 
in  one  car.  near  tlie  guards'  car.   .  .  . 

Tliis  morning  we  were  told  by  the  guards  that  tliree  men 
had  (lied  (hiring  the  night.  As  we  walked  up  the  string  of 
cars,  we  wcrt'  hailed  by  the  inmates  of  one  and  the  guards 
informed  that  tliere  were  dead  within.     We  insisted  on  the 


922   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

door  being  opened.  Lying  across  the  threshold  was  the  body 
of  a  dead  boy,  not  over  eighteen  or  nineteen  years  old,  no 
coat,  merely  a  thin  shirt  in  such  rags  that  his  chest  and  arms 
were  exposed,  and  for  trousers  a  piece  of  jute  sacking  pinned 
around  him,  nothing  more  in  this  bitter  Siberian  cold.  .  .  . 

Of  the  twenty-one  hundred,  on  November  21  only  thirteen 
hundred  and  twentv-four  were  alive ;  the  other  eight  hundred 
had  died  of  typhus,  dysentery,  blood  poisoning  and  starvation. 
The  officers  of  the  Inter-Allied  Typhus  Train  held  up  the 
prisoners'  train  as  long  as  they  could,  bathed  and  gave  medical 
and  surgical  treatment  to  as  many  as  possible  and  furnished 
food  and  clothing,  but  the  train  was  finally  shunted  along  on 
its  way  eastward. 

In  March,  1919,  the  officers  of  the  Inter- Allied  Typhus 
Train  met  another  such  train,  this  one  of  thirty-two  box  cars 
filled  with  Red  Guard  prisoners.     Captain  Bukeley  wrote: 

Some  of  these  men  have  been  prisoners  for  months,  but  the 
greater  part  of  them  were  captured  on  the  Perm  Front  some 
six  weeks  ago.  The  box  cars  are  indescribably  filthy,  as  well 
they  may  be,  not  having  been  cleaned  in  any  manner  for  six 
weeks.  On  the  two  tiers  of  wooden  planks,  without  mat- 
tresses or  blankets,  wrapped  in  tlieir  greasy,  lice-covered  furs, 
lie  tliese  poor  wretelies,  d3'ing  of  typhus,  dysentery,  pneu- 
monia, without  drugs  or  medicine.  .  .  . 

You  can  pass  within  twenty-five  yards  on  the  little  sleigh- 
tracked  road  with  its  tumble-down  shacks  and  the  train  ap- 
pears to  be  an  ordinary  striiig  of  empty  box  ears;  there  is  no 
sign  of  life  or  movement,  all  doors  are  closed,  as  though  the 
Russians  had  left  it  lliere  and  forgotten  its  existence.  .  .  . 

As  far  as  I  can  gather,  the  men  are  fairly  well  fed  with 
bread,  meat  and  water  for  their  tea ;  the  food  is  brought  to 
within  a  short  distance  of  the  end  of  the  train.  Here  you  can 
watch  a  man,  in  throes  of  fever,  with  chattering  teeth  and 
limbs  half  naked  through  his  rags,  staggering  on  between  the 
cars  with  some  kind  of  a  container  in  his  hand.  perhai)s  a 
rusty  jam  can,  to  get  some  of  the  food  left  at  the  end  (jf  the 
train.  Kvery  few  stejjs  he  stoj)?  and  leans  against  a  box  car 
until  he  can  gather  en<jugh  strength  to  crawl  on  a  few  more 
yards. 

Two  sights  of  this  train  particularly  affected  me.  One  was 
that  of  a  man  who  bad  left  his  box  car  in  search  of  food  and 
on  coming  back  found  that  the  door  of  the  car  had  been  swung 
to,  owing  to  the  cold  :  there  he  st'jod  leaniiiir  airainst  the  car 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    923 

and  beating  feebly  on  the  door  with  his  hands,  trying  to 
attract  the  attention  of  those  inside.  He  was  too  weak  to  open 
it  himself  and  his  cries,  mere  throatish  muttcrings  for  help, 
could  not  be  heard  ten  yards  off. 

The  other  sight  was  of  a  man  waiting  for  his  turn  to  get 
into  our  bath-cars.  His  comrades  had  gone  inside  and,  as  the 
car  was  then  full,  he  had  to  wait  for  the  next  contingent; 
there  he  sat  on  the  steps  of  the  bath-car,  the  tears  of  weakness 
and  disappointment  coursing  down  his  cheeks  because  he 
feared  that  he  was  too  late  and  would  get  no  bath  or  under- 
clothes. Brok  [the  Russian  sanitar~\  and  I  promised  that  he 
would  not  lose  out  and  gave  him  a  few  cigarettes  to  help  him 
forget  the  waiting.  .  .  . 

To  return  to  the  American  Red  Cross  mirses  who  had  started 
westward  in  October,  1018,  under  ]\Iiss  Farmer's  leadership: 
These  nurses  went  as  far  as  Tumen,  a  small  border-town  under 
the  Ural  Mountains  on  the  West-Siberian  frontier.  There  the 
American  Red  Cross  representative,  Dr.  Lewis,  took  over  a 
large  school  building  and  the  nurses  and  sanitars  converted  it 
into  a  hospital  of  two  hundred  beds  for  the  Czech  soldiers. 
"We  all  like  the  Czech  soldiers  very  much/'  wrote  Miss  Farmer 
to  Miss  Delano,  "and  we  hope  that  they  can  soon  go  back  to 
their  families  again.  Some  have  not  received  any  word  from 
their  families  for  over  a  year." 

The  question  of  equipment  for  the  Tumen  Hospital — and 
for  that  matter  all  hospitals — was  one  which  caused  the  execu- 
tives of  the  American  Red  Cross  in  Siberia  much  weariness 
and  vexation  of  spirit.     Mrs.  St.  John  wrote : 

All  hospital  equipment,  drugs  and  supplies  for  the  Tumen 
Hospital  .  .  .  had  to  be  purchased  in  China  and  Japan  and 
shipped  to  Vladivostok,  forced  through  the  congestion  of  the 
harbor  and  the  disorganized  customs  and  landed  in  our  ware- 
houses. One  by  one  freight  cars  were  ferreted  out  in  railroad 
yards,  on  sidings,  in  roundhouses  and  machine  shops  and  the 
supplies  loaded  in  them.  After  a  sufficient  number  of  ears 
had  been  collected  and  loaded,  endless  wire  pulling  was  re- 
quired to  get  an  engine  to  pull  the  train.  Then  began  the 
long  journey  of  five  tliousand  miles  over  a  dilajudated  road, 
ex]K)sed  niucli  of  the  way  to  attacks  by  the  Bolsheviki  and 
dependent  all  along  the  line  to  the  whims  of  station  com- 
numders.  Our  ])(>rsonn('l  was  taken  forwaril  as  l)cst  as  and 
whenever  we  could,  both  supply  and  })ersonnel  trains  being 


924    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

always  sent  out  under  the  protection  of  an  American  military 
guard. 

The  nursing  unit  included  five  American  nurses,  two  of 
whom  were  enrolled  in  the  American  Red  Cross,  Miss  Farmer 
and  Nettie  Grace  McBridc.  During  the  second  week  in  De- 
cember Miss  McBride  came  down  with  typhus,  and  on  De- 
cember 23,  she  died.  "Six  American  soldiers,"  wrote  Miss 
Farmer  to  Miss  Delano,  "carried  her  body  to  its  last  resting- 
place,  in  a  small  Russian  cemetery  where  the  Czech  soldiers 
who  had  died  in  our  hospital,  are  buried.  It  is  a  beautiful 
place,  like  a  small  woods.  She  was  buried  in  her  Red  Cross 
uniform,  with  the  American  flag  across  the  casket." 

Several  of  the  American  nurses  at  Tumen  returned  in  Janu- 
ary%  1919,  to  their  mission  posts  in  China,  and  General  Powell, 
of  the  British  Expeditionary  Forces  in  Siberia,  assigned  five 
British  nurses  to  the  American  Red  Cross  Hospital  at  Tumen. 
Miss  MacGregor,  of  the  British  Red  Cross,  a  veteran  who  had 
served  both  in  France  and  ^Mesopotamia,  was  in  charge  of  them 
and  of  several  Russian  Sisters. 

The  American  Red  Cross  hospital  at  Tumen  was  maintained 
until  July,  1919.  On  April  28,  Miss  Farmer  wrote  Miss 
Delano : 

We  expect  to  increase  our  hospital  shortly  to  410  beds. 
Just  now  we  have  a  Kiissian  unit  working  with  us.  We  still 
have  some  Czech  patients  but  the  majority  now  are  Eussians, 
— mere  boys.  1  still  like  them  as  much  as  I  did  in  Kief  and, 
I  suppose,  always  will. 

Of  the  Russian  temperament,  Captain  Bukeley,  who  was  at 
this  time  in  the  Ural  Mountain  area  on  the  Inter- Allied  Typhus 
Train,  wrote : 

Eussia  is  essentially  a  singing  country.  On  all  possible 
occasions,  the  Russians  sing:  when  they  are  tired,  to  rest 
them ;  when  they  are  miserable,  to  help  them  forget  their 
troubles ;  when  they  are  hai)})y.  because  they  are  happy.  .  .  . 
Their  folk  songs  are  beautifully  sinij)le.  often  with  a  minor 
melody  rumiing  through  the  refrain.  The  boys  and  girls  each 
have  their  own  folk  songs  and  it  is  delightful  to  listen  to 
them.  The  girls,  now  that  spring  has  come,  wander  through 
the  villa<;e  with  their  arms  intertwined  and  sin<i^  of  flowers 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     925 

and  spring  and  love;  and  the  boys  gather  around  one  or  two 
of  their  companions  who  play  the  balalaika,  a  wooden  stringed 
instrument.  .  .  . 


To  return  again  to  the  American  Red  Cross  nurses  who  were 
being  held  in  Harbin  in  October,  1918:  A  second  unit  under 
Gertrude  P.  Carter  was  started  westward  at  this  time  on  a 
sanitary  train  and  went  to  Omsk,  which  was  located  forty-eight 
hours'  eastward  from  Tumen  on  the  Trans-Siberian  Railroad. 
Of  this  city,  Captain  Bukeley  wrote: 

Omsk  is  a  strange  and  ugly  city  situated  some  seven  versts 
away  from  the  main  railroad  station.  Omsk  would  have  a 
normal  ])opulation  of  say  one  hundred  thousand,  but  to-day 
there  are  five  times  that  number.  The  barracks  are  crowded 
with  Czech,  Eussian  and  other  troops  and  there  must  be 
twenty-five  thousand  German- Austrian  prisoners  in  barracks 
and  concentration  camps. 

There  is  no  transportation,  no  importation  of  goods  except 
what  is  smuggled  in  by  passengers  and  provodnyiks.  There 
are  many  beautiful  stores  but  their  stock  would  shame  a  little 
country  store.  .   .  . 

In  the  Irtish  Hiver  lie  all  kinds  of  boats,  icebound  for  tlie 
winter.  The  average  man  has  no  idea  of  these  Siberian 
rivers,  the  Irtish  at  Omsk,  the  Volga  flowing  south,  and  the 
Ob.  the  Yenise,  the  Anuir,  the  Dvina  flowing  through  virgin, 
unexplored  land  to  the  frozen  North.  On  the  other  side  of 
the  bridge  spanning  the  Irtish  at  Omsk  is  a  large  space  kept 
free  and  swept  for  ;-kating  and  in  the  afternoons  you  see 
wonderful  exhibitions  of  the  sport.  Nobody  seems  to  worry 
about  ])overty  or  the  fact  that  a  typhus  epidemic  is  raging; 
the  skating  rink  is  crowded.  In  the  one  restaurant  I  visited, 
a  large  orchestra  was  playing. 

Then  from  the  city  you  drive  back  to  the  station  over 
fields  and  bare  wastes  covered  with  snow  which  a  biting  wind 
drives  into  your  eyes.  At  the  station  you  walk  along  the 
tracks  to  wliere  your  train  is  lying  in  the  yards,  surrounded 
by  trains  of  box  cars,  all  very  dirty,  with  all  kinds  of  rcfus(> 
lying  about  and  with  refugees  wandering  around  and  looking' 
very  cold,  dirty  and  buiigry  .  .  .  the  women  usually  ■'vitli  an 
old  shawl  tied  around  their  bead  aiul  shoulders,  the  men  in 
filthy  shee])skin  overcoats  and  the  children  in  rags,  little,  wan, 
skinny,  ferret-featured  creatures,  always  peering  around  for 
siuuetbinir  tbat  some  one  has  thrown  awav.   .  .  . 


926  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  American  Red  Cross  established  a  hospital  at  Omsk  and 
maintained  it  for  some  months.  On  January  11,  1919,  Miss 
Carter  wrote  Miss  Noyes : 

Our  unit  arrived  in  Omsk  on  November  10.  By  this  time, 
the  Czechs  had  started  their  hospital  in  Ecteunburgh  ,  .  . 
and  all  they  wished  from  us  were  drugs  and  supplies.  .  .  . 
They  did  not  seem  to  need  women  nurses;  in  the  field  they 
use  sanitars  from  the  ranks  of  Austrian  prisoners.  .  .  . 

We  had  some  difficulty  in  finding  a  building  in  Omsk 
suitable  for  a  hospital.  After  eight  weeks,  the  Agricultural 
College  was  turned  over  to  us  to  use  as  a  hospital  for  the 
Czechs,  but  it  was  grudgingly  given.  In  fact,  they  imme- 
diately put  186  Bolsheviki  into  it  for  safe-keeping,  but  by 
December  30  we  had  our  beds  made,  our  scanty  equipment  in 
place  and  were  ready  to  receive  patients,  and  four  French 
patients  arrived  and  ten  days  later,  two  hundred  Eussians.  .  .  . 

Our  hospital  capacity  at  present  is  two  hundred  and  fifty 
patients.  The  building  is  large,  but  is  chiefly  corridors. 
However,  it  is  a  fine  building,  but  is  located  six  miles  from 
the  city  and  about  twelve  miles  from  the  railroad  station.  Of 
course  the  present  unsettled  conditions  account  for  much 
delay,  but  .  .  .  this  is  the  way  things  go  in  Siberia.  .  .  . 

In  addition  to  the  large  hospitals  at  Tumen  and  Omsk,  the 
American  Red  Cross  maintained  smaller  ones  at  N^ovo-lS^iko- 
laevsk,  Omsk,  Petropavlosk  and  Cheliabinsk  for  the  treatment 
of  typhus  cases.  On  account  of  the  limited  number  of  Ameri- 
can nurses,  these  hospitals  were  staffed  by  Russian  nurses,  but 
the  result  was  not  highly  satisfactory.  In  her  report  of  June 
30,  1919,  Mrs.  St.  John  wrote: 

My  experience  with  the  Russian  nurses  has  convinced  me 
that  one  of  the  serious  obstacles  to  their  efficiency  is  their  own 
lack  of  knowledge  of  personal  protection.  ]\rany  go  about  in 
bare  feet,  exposing  themselves  needlessly  to  infection ;  as  a 
result,  the  percentage  of  nurse  infection  is  very  high  and  the 
mortality  proportionate.  In  a  Russian  hospital  which  we 
were  assisting  at  Ekaterinburg,  five  nurses  and  three  doctors 
died  of  typhus  during  the  first  two  months  of  its  operation. 

Thus  an  opportunity  for  far-reaching  service  presented 
itself  to  the  American  Red  Cross  in  the  training  of  a  corps 
of  I^ussian  nurses. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    927 

The  first  exporiment  in  the  field  of  nursing  education  was 
made  at  the  Vhidivostok  Refugee  Hospital.  In  February, 
1!)10,  Miss  Hood  returned  to  her  mission  post  in  China  and 
Janet  Dewar  succeeded  her  as  chief  nurse.  Miss  Devvar  was  a 
California  nurse  who  had  since  1909  served  as  superintendent 
of  the  Kanikeolani  Children's  Hospital  at  Honolulu,  Hawaii. 

On  April  1,  1919,  a  simple  course  of  nursing  was  established 
by  ^liss  Dewar  and  twelve  Russian  girls,  all  of  them  nineteen 
years  old  and  over  and  gTaduates  of  high  school,  were  regis- 
tered as  pupils.  In  a  report  addressed  April  30,  1919,  to  ]Major 
Emerson,  then  acting  medical  director  of  the  commission, 
]\Iiss  Dewar  wrote: 

The  curriculum  includes  weekly  three  classes  of  two  hours 
each  on  both  the  tiieory  and  practice  of  nursing,  also  five 
lectures  weekly  from  members  of  the  medical  staff  of  the 
hospital.  The  hours  of  work  in  the  wards  are  from  7  :30  a.m. 
to  7  :30  P.M.,  with  the  usual  time  off  duty,  and  the  work  is 
done  under  the  direct  supervision  of  the  American  nurses. 
Tlie  students  are  clas^sed  as  nurses'  aides  and  receive  $30.00 
monthly  in  addition  to  maintenance.  We  do  not  aim  to  give 
complete  training  such  as  is  given  in  a  good  hospital  in  the 
►States,  but  we  do  aim  to  give  these  girls  thorough  ground- 
work in  the  tlieory  and  practice  of  nursing. 

We  have  found  these  students  more  satisfactory  help  than 
the  Russian  luirses  who  have  had  more  or  less  experience  at 
the  front.  They  are  intelligent  and  loyal  when  once  their 
confidence  has  been  gained.  They  are  not  to  be  driven  but  are 
easily  coiitrolltMl  by  kindness.  They  are  willing  to  do  the 
liard  menial  work  of  nursing  but  they  seem  to  lack  physical 
reserve  strength.  .  .  . 

The  course  was  given  up  on  June  20,  the  date  when  ^liss  Dewar 
returned  to  her  former  position  in  Honolulu. 

Tlu>  political  situation  in  Siberia  in  the  spring  of  1919 
favored  the  dcvelopnient  of  an  extensive  American  relief  pro- 
gram. In  Fcbruarv,  1919,  it  will  be  remembered,  the  Allies 
d(>cid(>d  to  assume  responsibility  for  the  rehabilitation  and  di- 
rection of  the  Trans-Siberian  Railway.  In  his  reply  addressed 
July  25,  1!»19,  to  the  Senate  resolution  mentioned  above, 
I*resid(Mit  Wils(ui  wrote: 

Tn  February.  1919.  as  a  conclusion  of  negotiations  begim 
early   in   th(>  sinnmer  of  1918,  tlie   riiitiM]   Stales  accepted   a 


928  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

plan  proposed  by  Japan  for  the  supervision  of  the  Siberian 
railways  by  an  international  committee,  under  which  com- 
mittee Mr.  John  F.  Stevens  would  assume  the  operation  of 
the  Kussian  Kailway  Service  Corps.  In  this  connection  it  is 
to  be  recalled  that  Mr.  John  F.  Stevens,  in  response  to  a 
request  of  the  Provisional  Government  of  Russia,  went  to 
Russia  in  the  spring  of  1917.  A  few  months  later  he  was 
made  official  adviser  to  the  Minister  of  Ways  of  Communica- 
tion at  Petrograd  under  the  Provisional  Government. 

At  the  request  of  the  Provisional  Government  and  with  the 
support  of  Mr.  John  F.  Stevens,  there  was  organized  the  so- 
called  Russian  Railway  Service  Corps,  composed  of  American 
engineers.  As  originally  organized,  the  personnel  of  this 
corps  constituted  fourteen  skeleton  division  units  as  known  in 
this  country,  the  idea  being  that  these  skeleton  units  would 
serve  as  practical  advisers  and  assistants  on  fourteen  different 
sections  of  the  Siberian  railway  and  assist  the  Russians  by 
their  knowledge  of  long-havil  problems  as  known  in  this  coun- 
try and  which  are  the  rule  and  not  the  exception  in  Siberia. 

Owing  to  the  Bolshevik  uprising  and  the  general  chaotic 
conditions,  neither  Mr.  Stevens  nor  the  Russian  Railway 
Service  Corps  was  able  to  begin  work  in  Siberia  until  March, 
1918.  They  have  been  able  to  operate  effectively  only  since 
the  railway  plan  was  adopted  in  February,  1919.  The  most 
recent  report  from  Mr.  Stevens  shows  that  on  parts  of  the 
Chinese-Eastern  Trans-Baikal  Railway  he  is  now  running  six 
trains  a  day  each  way,  while  a  little  while  ago  they  were  only 
able  to  run  that  many  trains  per  week. 

In  accepting  the  railway  plan  (in  February,  1919)  it  was 
provided  that  some  protection  should  be  given  by  the  Allied 
forces.  Mr.  Stevens  stated  frankly  that  he  would  not  under- 
take the  arduous  task  before  him  unless  he  could  rely  upon 
support  from  American  troops  in  an  emergency.  Accord- 
ingly, as  provided  in  the  railway  plan,  and  with  the  approval 
of  the  Tnter-Allied  Committee,  the  military  commanders  in 
Siberia  have  established  troops  where  it  is  necessary  to  main- 
tain order  at  difPerent  parts  of  the  line. 

The  American  forces  under  General  Graves  are  understood 
to  be  protecting  parts  of  the  line  near  Vladivostok  and  also  on 
the  section  around  Verkhne-Udinsk.  There  is  also  understood 
to  be  a  small  body  of  American  troops  at  Harbin.  The  exact 
location  from  time  to  time  of  American  troops  is,  however, 
subject  to  cbange  by  the  direction  of  General  Graves. 

The  instructions  to  General  Graves  direct  him  not  to  inter- 
fere in  Russian  affairs,  but  to  support  Mr.  Stevens  wherever 
necessary.    The  Siberian  Railway  is  not  only  the  main  artery 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    929 

for  transportation  in  Siberia,  l)ut  it  is  the  only  open  access  to 
European  Kussia  to-day.  The  population  of  Siberia,  whose 
resources  have  been  almost  exhausted  by  the  long  years  of 
war  and  the  chaotic  conditions  which  have  existed  there,  can 
be  protected  from  a  further  period  of  chaos  and  anarchy  only 
by  the  restoration  and  maintenance  of  traffic  on  the  Siberian 
Railway.  .  .  . 

The  Russian  authorities  in  this  country  have  succeeded  in 
shipping  large  quantities  of  Russian  supplies  to  Siberia  and 
the  Secretary  of  War  is  now  contracting  with  great  coopera- 
tive societies  which  operate  throughout  European  and  Asiatic 
Russia  to  ship  further  supplies  to  meet  the  needs  of  the 
civilian  population.  The  Kolchak  Government  is  also  en- 
deavoring to  arrange  for  the  purchase  of  medical  and  other 
Red  Cross  supplies  from  the  War  Department  and  the  Ameri- 
can Red  Cross  itself  is  attempting  the  forms  of  relief  for 
which  it  is  organized.  .  .  .^^ 

Partial  responsibility  for  the  care  of  American  engineers 
and  certain  specified  medical  aid  to  the  Russian  Army  was 
rested  in  the  American  Red  Cross.  Moreover,  there  was  im- 
perative necessity  of  more  adequate  organization  and  additional 
personnel  if  the  maintenance  of  the  hospitals  already  estab- 
lislied  was  to  be  continued.  The  leave  of  absence  which  had 
been  granted  the  original  physicians  and  nurses  of  the  early 
commission  by  their  mission  hospitals  had  expired  and  they 
were  obliged  to  return  to  China,  Korea  and  Japan.  With  their 
departure  ended  the  pioneer  period  of  American  Red  Cross 
service  in  Siberia, — a  period  marked  by  sterling  service  in  the 
face  of  gigantic  needs,  a  chaotic  political  situation  and  general 
lack  of  organization. 

In  jVIarch,  IDII),  while  on  a  train  in  central-western  Siberia, 
Mrs.  St.  John  met  with  an  accident  which  made  necessary  her 
return  to  the  United  States  for  treatment.  At  the  same  time, 
Dr.  Teusler  planned  to  come  to  National  Headquarters  to  lay 
before  the  Executive  Committee  plans  for  the  development 
of  further  American  Red  Cross  activity  in  Siberia. 

In  February,  1010,  the  Siberian  Commission  had  cabled  to 
National  IIead(]uarters,  asking  for  the  assignment  of  one 
hundred  and  thirty  nurses  and  fifty  nurses'  aides  f(n"  service 
in  Siberia.  Other  types  of  personnel  which  were  recjuested 
were  sixty  doctors,  six  dentists  and  a  large  clerical  and  account- 

"  "Russian  Scries  No.  4,"  pp.  ;■)-(!.     State   Department. 


930  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ing  staff.  The  total  number  of  persons  recruited  from  America 
during  1919  exceeded  six  hundred,  of  which  one  hundred  and 
fiftj-six  were  American  Red  Cross  nurses  and  forty-three  were 
nurses'  aides. 

The  first  contingent  of  nurses  and  aides,  with  Grace  Har- 
rington in  charge,  arrived  in  Vladivostok  on  April  24,  1919, 
thirteen  days  before  Mrs.  St.  John  left  for  America.  Miss 
Harrington  was  appointed  acting  chief  nurse  of  the  Siberian 
Commission  and  for  the  first  time  the  status  of  the  JSTursing 
Service  was  defined.  Hitherto,  the  nurses  had  had  no  repre- 
sentation on  the  Finance  (the  governing)  Committee  of  the 
commission ;  they  had  been  assigned  to  service  by  the  doctors 
and  had  had  little  voice  in  the  determination  of  nursing  policies. 
Upon  the  occasion  of  Miss  Harrington's  appointment,  the  gen- 
eral supervision  of  nurses  and  their  assignment  to  duty  was 
delegated  to  a  separate  Department  of  Nursing,  of  which  Miss 
Harrington  was  made  acting  director.  She  was  given  a  place 
on  the  Finance  Committee  and  powers  and  facilities  to  organize 
the  Nursing  Service  along  the  same  general  lines  of  office  detail 
and  administration  prevailing  at  National  Headquarters. 

Miss  Harrington  was  a  graduate  of  St.  Mary's  Hospital, 
Milwaukee,  Wisconsin,  and  had  done  public  health  and  indus- 
trial nursing  in  Seattle,  Washington,  previous  to  her  Red  Cross 
assignment. 

A  second  group  of  nurses  arrived  in  Vladivostok  on  June  5, 
under  the  leadership  of  Ethel  Pinder,  a  young  and  able  nurse 
who  after  graduation  from  the  Atlantic  City  (New  Jersey) 
Hospital  School,  had  had  experience  in  medical  social  service 
at  Bellevue  Hospital  and  in  public  health  nursing  at  Henry 
Street.  Upon  her  arrival  at  Vladivostok,  Miss  Pinder  was  as- 
signed to  duty  as  Miss  Harrington's  assistant ;  she  promptly 
established  the  records  of  duty  and  correspondence  files  for  the 
nurses  of  the  commission,  in  conformity  with  the  system  pre- 
vailing at  National  Headquarters. 

On  June  20,  Anna  L.  Tittman  and  a  unit  of  twenty-five 
nurses  and  seven  aides  arrived  in  Siberia.  IMiss  Tittman  had 
been  selected  by  Miss  Noyes  as  a  nurse  executive  who  would 
be  particularly  valual)le  in  straightening  out  the  organization 
difficulties  in  Siberia.  She  possessed  a  penchant  for  details 
and  with  it  a  keen  and  well-balanced  mind.  She  was  graduated 
in  190r)  from  the  Springfield  (llliiiois)  School  for  Nurses  and 
had  had  post-graduate  work  at  the  Johns  Hopkins  and  Dellevue 


American  Red  Cross  nurses  and  snr,i;('oiis  on  route  to  Vladivostok,  Siberia, 
visit  the  lyeysan  Temple,  Xikko,  Japan. 


Nurses  of  the  Siberian  Commission  po  slioppiiig  at  a  market  of  Manchuria 

Station. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    931 

Hospitals.  She  later  organized  public  school  nursing  in  Spring- 
field and  was  for  sonic  years  secretary  and  treasurer  of  the 
Illinois  Board  of  Nurse  Examiners. 

The  activities  of  the  reorganized  Cominission  for  Siberia  in- 
cluded medical  and  general  relief  in  three  principal  zones:  the 
Eastern  Division  which  included  the  Vladivostok  District  and 
extended  westward  to  ^lanchuria  Station ;  the  far-Western 
Division,  which  included  the  territory  extending  from  the  Ural 
Mountains  to  Krasnoyarsk ;  and  the  Central  Division,  which 
included  the  provinces  of  Irkutsk  and  the  Trans-Baikalia.  The 
account  of  the  American  Red  Cross  nursing  activities  in  these 
three  zones  will  deal  first  with  events  which  transpired  in  the 
Eastern  Division,  then  in  the  far- Western  and  Central  Di- 
visions. 

Vladivostok  was  the  port  of  entry  for  all  American  Red 
Cross  personnel  of  the  commission  and  relief  supplies  in 
Siberia ;  all  files  were  kept  there  and  all  reports  of  its  activities 
cleared  through  the  Vladivostok  office  to  National  Headquar- 
ters. The  nurses  and  aides  of  the  reenforced  commission  were 
housed  in  the  Russian  Barracks,  "an  international  compound," 
wrote  Miss  Finder  to  Miss  Noyes,  "where  Japanese,  Chinese, 
French,  Italian  and  British  soldiers  are  billeted  in  the  sur- 
rounding buildings."  As  the  needs  for  their  services  developed 
in  western  Siberia,  nurses  were  sent  into  the  interior  on  Red 
Cross  trains.  Nurses  and  aides  assigned  to  service  in  Vladi- 
vostok continued  to  live  at  the  Russian  Barracks  or,  if  condi- 
tions permitted,  were  furnished  quarters  in  the  hospitals  to 
which  they  were  assigned. 

The  first  work  of  the  Nursing  Department  in  the  Eastern 
Division  was  the  reorganization  of  nursing  activities  in  all  Red 
Cross  hospitals  in  this  zone.  This  reorganization,  with  its  im- 
provement in  the  quality  of  nursing  care  given  the  patients,  had 
not  been  possible  before  because  of  the  limited  immber  of  nurses 
and  the  shortage  of  supplies. 

Russian  Island  Hospital  was  the  first  institution  to  undergo 
tlie  reorganization.  Mary  ^larcy,  formerly  superintendent  of 
the  House  of  Mercy  Hospital  at  Pittsfield,  ^lassachusetts,  was 
assigiu^d  to  duty  at  Russian  Island  Hospital  as  chief  nurse  and 
a  large  detail  of  American  Red  Cross  nurses  were  stationtHl 
tliere  to  assist  her.  The  capacity  of  the  hospital  was  (H)usi(ler- 
ably  raised  and  its  scope  broadened.  In  a  letter  addressed  on 
()et(ilier   12,    lUlU,  to   Miss  Nov(>s,   Miss   Marev  wrote: 


932    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  the  summer,  Russian  Island  is  a  place  of  great  beauty. 
It  is  about  seventeen  miles  long,  has  many  inlets  and  is  hilly 
and  covered  with  small,  rather  stunted  trees  and  quantities  of 
wild  flowers  (we  counted  forty  varieties  at  one  time).  We 
are  a  thirty  minutes'  boat  ride  across  the  bay  from  Vladi- 
vostok. 

The  hospital  itself  is  situated  on  a  cliff  overlooking  the  bay 
and  consists  of  three  one-story  buildings.  ^Mien  I  first  came 
here  in  July,  there  were  only  Czech  soldiers  here,  but  since  it 
has  been  changed  into  a  general  hospital,  our  patients  repre- 
sent about  ten  nationalities.  Our  staff  is  made  up  of  two 
American  and  two  Russian  doctors,  fourteen  American  nurses, 
two  Czech  aides  and  eighteen  Russian  Sisters.  .  .  . 

"Next  to  the  Russian  Island  Hospital  was  an  American  Red 
Cross  children's  colony.  In  the  summer  of  1918,  a  committee 
of  Petrograd  parents,  organized  under  the  sanction  of  the  De- 
partment of  Education  of  the  Soviet  Government,  had  sent  a 
large  colony  of  Petrograd  children,  with  their  teachers,  to 
western  Siberia  on  account  of  the  food  shortage  in  Russia. 
Starvation  and  disease,  however,  had  overtaken  them  in  Siberia 
and  finally  the  Russian  woman  in  charge  of  the  colony,  Madame 
Vera  Qvanovna  Kutchenakaiga,  appealed  to  representatives  of 
the  American  Red  Cross  then  in  the  Ural  Mountain  regions 
for  aid.  ''She  told  us,"  wrote  Captain  Bukeley,  ''of  the  suffer- 
ing of  these  children  who  had  trekked  their  way  from  European 
Russia,  traveling  many  hundreds  of  miles  on  foot.  .  .  .  Many 
of  them  became  little  frightened  animals  who  ran  away  at  the 
sight  of  human  beings  who  would  have  helped  them,  ran  until 
they  were  free  from  pursuit,  when  they  would  eat  grass  and 
roots  until  exposure  mercifully  let  them  sleep  without  awaken- 
ing." 

Two  hundred  and  seventy-two  children  were  gathered  to- 
gether by  the  American  Red  Cross  early  in  1019  at  Lake  Tur- 
goyal  and  were  started  in  July  upon  their  long  journey  east- 
ward. Others  were  collected  from  adjoining  towns  and  villages  ; 
three  hundred  arrived  in  Vladivostok  in  Augnist  and  s(>ven 
hundred  more  several  weeks  later.  The  entire  colony  of  over 
nine  hundred  was  established  in  barracks  next  to  the  American 
Red  (h'oss  II()S])it!i]  on  Russian  Island.  Two  nurses,  Aliriam 
Lewis  and  ]\Iau(le  K.  Moody,  were  the  first  nurses  assigned  to 
the  colony  to  look  after  the  children's  physical  welfare. 

The  Vladivostok  Refugee  Hospital  underwent  the  same  gen- 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    933 

eral  reorganization  and  expansion  as  did  the  Rnssian  Island 
Hospital.  Mary  H.  Jjethcl,  a  capable  and  energetic  former 
chief  nnrse  in  the  Navy  Nurse  Corps,  was  assigned  to  duty 
there,  first  as  dietitian  and  assistant  chief  nurse,  later  as  chief 
nurse.  A  large  and  active  clinic  \Yas  organized  at  the  Refugee 
Hospital;  Josephine  Albright  was  placed  in  charge  of  public 
health  mirsing  and  medical  social  service  work  in  connection 
with  it. 

Owing  to  the  influx  of  Russian  refugees  into  Vladivostok  in 
the  fall  of  lOlt),  an  inlhix  due  to  victories  of  the  Red  Guard 
in  the  West,  the  commission  took  over  on  November  1  sections 
of  the  Morskoi  (Naval)  Hospital.  Red  Cross  wards  had  a 
capacity  of  220  patients  and  treated  principally  surgical  cases. 
The  nursing  stait"  consist(>d  of  twenty-eight  American  nurses 
and  twenty  Russian  aides.  ]\Iiss  Bethel  was  chief  nurse,  a  re- 
sponsibility added  to  her  duties  at  the  Refugee  Hospital. 

On  November  18,  street  fighting  broke  out  in  Vladivostok 
between  the  upholders  of  the  Kolchak  Government  and  local 
Bolshevik  sympathizers,  and  numerous  civilians  were  wounded. 
An  emergency  hospital  was  established  in  twenty-four  hours' 
time  by  the  commission  in  American  Red  Cross  Barracks  No. 
7.     Miss  Tittman  wrote  Miss  Noyes: 

During  the  revolution  in  Vladivostok,  everyone  at  Barracks 
No.  7  worked  hard  and  long.  Our  Red  Cross  men  showed 
spirit  and  conrage  in  picking  up  and  bringing  in  the  wounded. 
The  variety  of  our  patients  (there  were  5(5  admitted  to  the 
emergency  hospital)  exemplified  the  true  principles  of  I^ed 
Cross  neutrality.  There  was  a  Korean  who  had  been  picked 
up  from  his  sam])an  ;  two  Japanese;  (Jeneral  Gaida's  woman 
cook,  who  had  been  beaten  with  the  butts  of  soldiers'  guns;  a 
Russian  j^riest ;  a  British  officer;  soldiers  of  all  the  factions 
involved  in  the  tight;  railroad  men;  innocent  bystanders;  and 
even  an  American  sailor. 

By  November  li).  practically  all  the  victims  of  the  strcot 
fighting  had  been  transferred  to  other  Red  Cross  and  IJussian 
hospitals  or  to  their  homes.  Most  of  the  military  cases  were 
taken  to  the  Morskoi  Hospital.  .  .  . 

In  November,  1010,  :^rrs.  St.  John  and  Colonel  Tousler  re- 
turntMl  to  Vladivostok.  ]\Irs.  St.  John  rcsum(>d  her  duties  ;is 
chief  nurse  of  the  Sib(>rian  Commission  and  Miss  Tittman  con- 
tinued as  chief  nurse  of  the  Kastern   Division. 


934)  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  addition  to  the  maintenance  of  the  hospitals  described 
above,  the  Nursing  Service  in  Siberia  took  up  again  the  edu- 
cational project  initiated  by  Miss  Dewar  in  April,  1919,  and 
Helen  L.  Bridge  was  made  responsible  for  its  development. 
Miss  Bridge  had  taken  her  B.  S.  degree  at  Teachers'  College, 
had  been  an  instructor  at  the  St.  Luke's  (New  York  City) 
School  for  Nurses  and  had  later  served  as  superintendent  of  the 
Washington  University  School  for  Nurses  at  St.  Louis.  In  a 
report  submitted  to  Miss  Tittman  on  December  17,  1919,  Miss 
Bridge  wrote: 

On  August  4,  1919,  a  four  months'  course  of  study  was 
initiated  for  Russian  women  serving  as  nurses'  aides  in  the 
American  Red  Cross  hospitals  at  Russian  Island  and  Vladi- 
vostok. During  the  course  it  was  planned  to  give  sixty-four 
hours'  instruction  in  elementary  nursing  and  hygiene,  includ- 
ing bandaging;  discussion  of  the  commoner  medical  and 
surgical  emergencies  and  forty-eight  hours'  class  work  in 
English. 

The  object  underlying  the  course  was  to  improve  the 
standard  of  the  nursing  service  in  the  American  Ked  Cross 
hospitals  by  giving  the  pupils  a  systematic  training  which 
could  be  coordinated  with  their  practical  work  in  the  hospital 
Avards.  ...  In  addition,  it  was  felt  that  the  organization  of 
class  work  for  Russian  girls  offered  a  splendid  educational 
opportunity  in  itself;  a  national  characteristic  of  the  Russians 
is  their  passion  for  study. 

Two  classes  were  organized,  one  at  Russian  Island  Hospital 
and  the  other  at  Madivostok.  .  .  .  During  the  past  four 
months,  the  theoretical  instructor  has  taught  four  hours  a 
day  for  three  days  a  week  on  Russian  Island  and  three  hours 
a  day  for  three  days  each  week  in  Vladivostok.  .  .  .  The 
ward  instructors  .  .  .  have  supplemented  the  pupils'  class- 
room instruction  with  bedside  teaching.  As  there  was  no 
nursing  textbook  in  Russian  procurable,  a  digest  of  the  text- 
book of  Home  Hygiene  and  Care  of  the  Sick  was  translated 
and  later  published  in  Russian;  the  translator  also  served  as 
interpreter  during  the  classroom  work. 

For  the  English  instruction,  no  books  were  available  until 
within  a  few  weeks  before  the  conclusion  of  the  course.  Then 
a  sup])ly  of  Beshgeturians'  "Foreigners'  Guide  to  English'* 
was  received  from  ^lanila. 

On  Dcccnilicr  1.  1I»1!»,  seventeen  pupils  were  graduated 
from  tlio  Russian  Island  class  and  eleven  others  from  the 
Vladivostok  class. 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    935 

A  third  class  was  organized  on  November  6  and  was  com- 
posed of  Kussian  girls  of  over  eighteen  years  of  age  from  the 
Petrograd  Children's  Colony.  Fifteen  students  entered  this 
course  and  received  their  practical  instruction  in  American 
Red  Cross  wards  of  the  ^forskoi  Naval  Hospital. 

These  three  elementary  courses  had  been  initiated  as  an  ex- 
periment to  determine  whether  or  not  it  would  be  feasible  for 
the  American  Red  Cross  to  attempt  to  develop  in  Vladivostok 
a  permanent  training  school  for  nurses  under  the  Nightingale 
System.  Miss  Noyes  had  been  anxious  for  the  Department  of 
Nursing  to  establish  one  but  to  ^liss  Tittman  and  Miss  Bridge 
it  had  seemed  wiser  not  to  attempt  it  for  the  following  reasons, 
which  were  contained  in  a  letter  written  December  3,  1919, 
by  Miss  Bridge  to  Colonel  Teusler: 

1.  The  preliminary  education  of  candidates  is  too  uneven  to 
allow  definite  methods  of  instruction  or  the  giving  of 
prescribed  courses. 

2.  There  is  an  inadequate  number  of  candidates  with  satis- 
factory preliminary  education. 

3.  Applicants  come  to  us  not  because  of  a  deep-rooted  interest 
in  nursing  and  a  desire  for  training  but  because  they  are 
forced  to  earn  their  livelihood. 

4.  American  nurses  cannot  teach  without  more  of  a  working 
vocabulary  of  Kussian  tlian  tliey  could  acquire  in  the  time 
spent  here.  It  is  not  wholly  satisfactory  to  teach  through 
interpreters.  The  pupils,  although  eager  and  quick  to 
learn  Englisli,  would  not  be  able  to  use  English  textbooks. 
There  are  no  satisfactory  Kussian  textbooks  available. 


In  addition  to  the  courses  offered  to  Russian  hospital  aides, 
Miss  Bridge  also  organized,  with  the  cooperation  of  the  Kussian 
Red  Cross,  courses  in  Home  Hygiene  and  Care  of  the  Sick  for 
laywomen.  The  first  class  was  started  on  December  10;  Vasliti 
Bartlett  was  the  instructor.  During  the  progress  of  this  course 
a  teaching  center  was  opened  at  No.  10  Peter  the  Great  Street 
and  during  December,  1919,  and  January,  1920,  five  additional 
classes  of  Vladivostok  women  were  instructed  there.  Another 
class  was  started  in  December  which  included  girls  of  the 
Petrograd  Children's  Colony  fifteen  years  of  age  and  ovtn-. 

An  interesting  phase  of  the  (xlucational  program  lind  taken 
place  in  August.     Miss  Uridgc  described  it  in  her  tinal  I'cport: 


93G   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

-  During  the  month  of  August,  the  Department  of  Nursing 
was  requested  to  provide  instruction  to  a  group  of  Korean 
women  in  the  city  of  Vladivostok.  The  Red  Cross  agreed  to 
do  this  if  an  interpreter  could  be  secured.  It  was  necessary 
to  send  to  Korea  for  one  and  she  did  not  arrive  in  Vladivostok 
until  December.  A  further  delay  was  encountered  by  the 
necessity  of  preparing  a  Korean  translation  of  the  textbook  in 
Home  Hygiene  and  Care  of  the  Sick.  After  having  overcome 
these  difficulties,  the  classes  could  not  be  given  owing  to  the 
imminent  withdrawal  of  American  Red  Cross  nurses  from 
Siberia.  It  was  suggested,  however,  that  the  courses  be  given 
anyhow,  the  theoretical  instruction  by  a  Korean  woman  who 
is  a  graduate  of  a  mission  school  for  nurses  in  Seoul,  and 
the  practical  demonstrations  by  a  Russian  nurses'  aide  who 
served  as  interpreter  to  Miss  Bartlett  and  assisted  in  the  con- 
duct of  the  classes  for  laywomen. 

An  effort  was  made  to  extend  the  class  work  and  the  instruc- 
tion of  nurses'  aides  to  western  Siberia  but  the  military  sit- 
uation in  the  summer  of  1919  made  the  development  of  such  a 
project  impossible. 

When  the  American  Red  Cross  closed  its  program  in  Siberia 
in  the  spring  of  1920,  fourteen  classes  had  been  organized,  in- 
cluding the  three  for  nurses'  aides,  and  21G  pupils  had  been 
enrolled.  Of  the  close  of  the  educational  program,  Miss  Bridge 
wrote: 

A  plan  has  been  formulated  to  continue  the  Teaching 
Center  under  the  direction  of  Sister  Selma  Chepposova,  a 
graduate  Eussian  nurse  who  will  be  assisted  by  Valentina 
Alexandrof,  interpreter  to  Miss  Bartlett.  Miss  Farmer,  the 
American  Red  Cross  nurse  in  charge  of  the  Petrograd  Chil- 
dren's Colony,  will  continue  the  classes  among  the  girls  of  the 
Colony. 

As  to  the  textbooks  in  hand,  .  .  .  the  "Foreigners'  Guides 
to  Englij^h''  have  been  turned  over  to  Miss  Farmer  for  use  in 
the  Children's  Colony.  The  Russian  text  of  Home  Hygiene 
and  Care  of  the  Sick  was  received  from  the  printer  early  in 
February.  Some  of  these  will  be  used  by  the  Children's 
Colony  and  the  Teaching  Center  and  others  will  be  turned 
over  to  the  Russian  educational  authorities  and  public  officials. 

Immediately  west  of  Vladivostok  in  the  ]\ranchurian  province 
of  China  lay  the  city  of  Harbin.  Here  in  August  and  Septem- 
ber,  1919,  cholera  was  epidemic.     Five  American  Red  Cross 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    937 

nurses  of  the  Siberian  Commission  were  assigned  in  August  to 
assist  American  Red  Cross  doctors  in  their  efforts  to  check 
the  disease.  The  head  nurse  of  this  detachment  was  Vashti 
Bartlett,  who  needs  no  introduction  here  to  readers  of  this 
history.     On  September  2,  Miss  Bartlett  wrote  Miss  Noyes: 

The  five  of  us  arrived  here  in  Harbin  on  the  morning  of 
August  2C  and  spent  our  first  day  being  taken  on  a  survey 
about  the  city.  Ilarbin  is  divided  into  three  principal  dis- 
tricts; each  district  is  a  distinct  city  in  itself.  One  is  occu- 
pied by  the  Chinese,  another  by  the  Russians  and  a  third  by 
the  Jews. 

Our  first  morning  was  spent  in  the  Chinese  city.  There  we 
met  many  people  wearing  masks.  Lime  is  sprinkled  every- 
where and  we  saw  coffins  in  the  streets  waiting  to  be  hauled 
off.  We  were  told  that  in  the  beginning  of  the  epidemic  the 
bodies  were  thrown  in  any  clump  of  tall  grass,  but  that  has 
been  stopped.  Now  coffins  are  given  to  anyone  who  asks  for 
one ;  the  relief  societies  and  the  American  Red  Cross  here  put 
aside  a  sum  of  money  for  this  express  purpose. 

The  Chinese  City  Hospital  has  a  most  capable  Chinese  doc- 
tor in  charge  of  it.  Dr.  Wu.  Our  American  Red  Cross  doctors 
were  also  working  here;  on  the  following  day,  two  of  our 
nurses  reported  there  to  help  with  the  transfusions.  The 
cause  of  death  from  cholera,  it  seems,  is  due  to  the  fact  that 
so  mucli  of  the  fluids  of  the  body  are  given  off  in  the  almost 
constant  vomiting  and  stools  that  the  blood  cannot  flow  for 
lack  of  fluid.  Thus  transfusions  supply  the  needed  fluid,  and 
under  this  treatment  the  death  rate  is  lessened  fifty  per  cent. 
Indeed,  I  have  seen  men  brought  in  unconscious  and  half  an 
hours  later  1  have  seen  them  walk  out.  One  of  the  chief 
difficulties  in  treating  the  Chinese  is  to  keep  them  long  enough 
for  the  two  or  three  transfusions  needed. 

No  one  who  liad  not  been  liere  can  imagine  the  numbers  of 
flies  wliich  swarm  over  the  patients.  At  your  approach,  a 
black  cloud  of  tbom  will  rise  from  the  patients  who  lie  about 
waiting  their  turn.  As  soon  as  the  American  doctors  and 
nurses  could  get  it  done,  straw  sheds  were  made  and  the  doors 
covered  with  net.  The  Chinese  jirefer  to  sleep  on  the  floor  on 
straw,  which  is  afterwards  burned.  Other  than  this,  wc  really 
did  very  little  but  give  the  transfusions,  because  the  ])atients 
are  soon  able  to  look  after  themselves.  I  don't  know  what  we 
would  have  done,  however,  if  the  disease  bad  not  boon  one 
from  which  its  victims  recovered  quickly  after  treatment,  as 
the  epidemic  was  spreading  from  the  Chinese  City  to  the  other 
sections. 


938  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  the  Russian  section  of  Harbin,  the  situation  was  even 
more  desperate.    Miss  Bartlett  wrote  Miss  N^oyes : 

Our  nurses  are  now  working  in  two  Eussian  hospitals  and  a 
building  of  the  Central  Hospital  has  been  turned  over  to  us. 
This  building  houses  about  a  hundred  patients.  In  a  Russian 
hospital,  things  are  not  done  as  we  do  them.  For  instance,  I 
was  in  a  ward  to-day  with  three  Russian  doctors  and  several 
nurses;  a  patient  was  sick  and  they  let  her  vomit  three  times 
and  made  no  motion  to  get  a  basin  or  to  clean  up  the  floor,  but 
did  after  the  fourth  time.  The  Russian  nurses  go  on  duty  for 
twenty-four  hours  and  then  go  off  again  for  forty-eight  hours. 
Men  and  women  are  put  in  the  same  room  in  beds  next  to  one 
another  and  1  have  yet  to  see  a  screen.  No  attempt  is  made 
to  keep  the  patient  cotered  and  as  likely  as  not  the  orderly 
will  wait  upon  a  woman  patient  and  the  nurse  upon  a  man.  I 
have  seen  them  bring  a  patient  the  length  of  the  building  on  a 
stretcher  without  anything  on  him;  now  they  seem  to  know, 
however,  that  I  insist  upon  a  sheet. 

Patients  used  to  be  brought  in,  placed  on  any  vacant  bed 
and  transfused  right  there  with  friends  and  other  patients 
looking  on.  As  I  have  not  yet  seen  a  rubber  sheet,  the  beds 
were  always  wet  and  bloody.  Xow  we  have  a  room  with  three 
long  tables  in  it  and  the  patients  are  laid  on  them  and  trans- 
fused there.  I  often  lead  them  by  the  hand  back  to  their 
relatives  or  friends.  Things  appear  to  be  going  excel- 
lently. .  .  . 

By  the  end  of  October,  cholera  had  been  stamped  out  in 
Harbin  and  three  of  the  nurses,  among  them  Miss  Bartlett, 
were  recalled  early  in  Xovcmber  to  Vladivostok.  The  other 
two  remained  to  assist  in  caring  for  American  engineers  in  the 
hospital  of  the  Russian  Railway  Service  Corps.  This  hos- 
pital had  been  started  early  in  1919  and  had  then  had  a  nursing 
staff  of  two  American  Red  Cross  nurses,  (Mrs.)  Gertrude  C. 
Brandon  and  Mabel  E.  Doub,  two  British  Red  Cross  nurses 
and  one  British  aide.  In  November,  Miss  Tittman  visited  the 
R.  R.  C.  S.  Hospital,  the  Central  Hospital,  the  City  Hospital, 
the  Chinese  Hospital  and  the  Russian  Red  Cross  Hospital,  all 
of  them  places  in  which  American  nurses  had  been  stationed. 
]\riss  Tittman  wrote  ^liss  Xoyes  on  Xovcmber  15  that  she  was 
"again  impressed  with  the  weak  organization  and  meager  equip- 
ment of  Russian  hos])itals  in  Siberia.  The  Russian  Red  Cross 
Hospiti'.l  gives  a  two  year  course  of  training  to  nurses,''   she 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    939 

added,  "and  I  mado  an  effort  to  secure  data  on  their  course  of 
instmction  but  received  oidy  va^e  comments." 

The  educational  projects  and  the  nursing  service  which  was 
maintained  in  the  hospitals  established  or  aided  l)v  the  com- 
mission in  Vladivostok  and  Harbin,  constituted  the  nursing 
activities  of  the  Eastern  Division.  Extensive  civilian  relief  was 
also  given  in  the  Vladivostok  District  and  throughout  western 
Siberia.  Barracks  were  erected  to  house  the  refugees  and 
meals  were  served  to  them.  Sewing  rooms,  a  weaving  and  a 
tailoring  shop  was  opened.  Boots,  pajamas,  sheepskin  coats, 
shirts,  socks,  sweaters  and  underwear  to  the  number  of  880,000 
articles  were  distributed  bv  February  28,  1919.^** 

The  nursing  activities  of  the  American  Red  Cross  in  the 
western  and  central  provinces  of  Siberia  were  manifold  and 
the  service  itself  difficult  and  fraught  with  many  hardships  and 
considerable  peril.  To  return  to  the  summer  of  1919  and  the 
reorganization  of  the  Nursing  Service:  Upon  Miss  Tittman's 
arrival  at  Vladivostok  late  in  June,  IMiss  Harrington  had  been 
appointed  chief  nurse  of  the  Western  Division  and  in  company 
with  Major  F.  P.  Mangct,  then  acting-commissioner  and  man- 
ager of  the  Western  Division,  had  gone  west  in  June  to  Omsk 
to  supervise  the  establishment  of  an  office  from  which  nursing 
personnel  could  be  distributed  in  western  Siberia.  It  will  be 
remembered  that  at  this  time  the  American  Red  Cross  was 
operating  a  large  hospital  at  Tumen,  of  which  ^Fiss  Farmer  was 
chief  nurse ;  another  at  Omsk,  of  which  Miss  Carter  was  chief 
nurse;  and  typhus  hospitals  at  various  other  towns  and  cities  in 
western  Siberia.  Colonel  Teusler  and  ]\Irs.  St.  John,  it  will 
also  be  remembered,  had  gone  to  the  United  States  and  ]\riss 
Tittman  and  ]\Iaj()r  J.  X.  Strong  were  left  in  charge  in  Vladi- 
vostok during  their  absence. 

Among  the  Red  Cross  personnel  who  went  west  with  ^liss 
Harrington  and  Alajor  ^langet  was  a  merrv-S})irite(l  nurses' 
aide,  Kdith  Barnett.  On  July  3,  she  wrote  from  Omsk  to 
Miss  Binder: 

I  wish  I  could  adequately  describe  iliis  sweet  spot  in  wliidi 
we  are  waiting  for  our  assignments.  The  husiiital  itself  is 
l)eaiitifully  situated  al>()ut  five  miles  from  town  and  we  ai'e  in 

^  For  furlluT  details  of  tlic  oivilinn  relief  proLrriim.  see  "'riie  Work  of 
the  Atneriean  lied  Cross  diiriiifi  the  War:  A  Statement  of  Finances  and 
Aceomplislinients ;"  also  Annual  Reports.  l!)l!t  and  1!)2(>:  Red  Cross 
Librar\'. 


940  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  real  Eussian  log  house  set  in  a  grove  of  birch  trees.  The 
song  birds  awoke  us  this  morning  and  we  lay  on  our  cots  on 
the  summer  sleeping  porch  and  looked  out  through  the  quiver- 
ing birch  leaves  to  the  cobalt  sky — for  the  sky  can  be  bluer  in 
Siberia  than  anywhere  else,  it  seems. 

We  had  a  most  beautiful  trip  on  the  train.  We  came  by 
freight  and  stopped  at  all  the  wood  piles  and  watering  tanks. 
The  scenery  and  wild  flowers  were  indescribably  beautiful. 
On  the  upgrades  some  of  the  men  would  jump  off  the  train 
and  gather  flowers  that  filled  our  compartments  and  dining 
rooms.  We  were  in  a  bower  of  purple  iris,  marigolds,  yellow 
lilies,  peonies,  lilies-of-the-valley,  blue  columbine  and  wild 
roses.  .  .  . 

On  July  9,  Miss  Harrington  with  six  American  Red  Cross 
nurses  and  three  aides  arrived  at  Cheliabinsk  and  found  that 
the  American  Red  Cross  had  taken  over  the  Pereeelenchesky 
Punkt,  or  Government  Immigration  Station,  two  weeks  before, 
but  that  they  were  not  yet  fully  established.  Miss  Harrington 
wrote  Miss  Noyes: 

We  gradually  took  possession  of  the  buildings  as  they  were 
freed  from  vermin,  whitewashed  and  made  sanitary.  Eleven 
of  the  sixteen  buildings  were  soon  in  our  possession  and  our 
wards  filled  with  patients  delighted  with  the  bugless  beds  and 
the  fresh  sheets  and  Red  Cross  pajamas.  We  had  inherited 
three  hundred  surgical  and  seventeen  typhus  cases.  Stephanie 
Pohle  is  chief  nurse. 

A  good -sized  laundry  and  big  bath  were  in  the  process  of 
being  made  sanitary,  also  five  other  buildings  to  be  used  for 
patients.  In  addition,  there  was  a  good-sized  Ambulatoryah 
or  clinic  where  during  a  four  days'  observation  five  hundred 
cases  were  treated.  When  the  hospital  was  first  taken  over, 
there  was  a  large  percentage  of  hand  and  foot  or  self-inflicted 
wounds.  Under  our  regime,  these  cases  were  refused  hospital 
care  but  allowed  treatment  at  the  Amhulatoryah. 

Taking  it  in  all,  the  Punkt  was  an  ideal  location  for  a 
hospital.  IVainloads  of  wounded  from  the  front  could  be 
backed  into  tlie  yards  and  unloaded  with  little  effort;  the 
grounds,  though  neglected,  could  have  been  made  highly  at- 
tractive, and  the  buildings  usable. 

In  a  letter  written  ]Miss  I^oyes  on  July  23,  Miss  Harring- 
ton, then  en  route  to  Omsk,  described  the  fate  of  the  Chelia- 
binsk Hospital : 


NURSING  SERVICE  TO  CIVILIAN  POPULATION     941 

After  we  had  been  at  Cheliabinsk  for  two  days,  we  learned 
that  the  Bolsheviki  were  making  rapid  progress  and  tliat 
different  Russian  regiments  which  had  been  sent  to  the  front 
had  vanished  in  thin  air.  Major  Manget,  acting  commis- 
sioner, decided  to  push  on  to  Miass  to  interview  General 
Suroff  regarding  true  conditions,  so  our  car  was  attached  to  an 
outgoing  train  heavily  guarded  by  Russian  soldiers  and  we 
made  ^Iiass  in  al)()ut  eight  hours.  Thus  Major  Maugct  was 
advised  to  evacuate  eastward  the  Red  Cross  personnel  at 
Cheliabinsk  and  the  Petrograd  Red  Cross  Children's  Colony 
then  at  Lake  Turgoyal,  about  sixteen  versts  from  the  station 
at  Miass.  We  three  women,  one  an  interpreter  and  the  other 
a  publicity  woman,  started  out  for  the  colony  in  the  rain  and 
arrived  there  about  two  o'clock  in  the  morning. 

The  next  morning,  a  beautiful  one,  the  children  gathered 
with  their  treasures  and  .  .  .  finally  all  were  gotten  started 
on  their  way  eastward.  We  finally  reached  Cheliabinsk  and 
were  there  for  a  day,  then  pulled  out  one  train  behind  that 
carrying  the  Children's  Colony. 

The  conditions  here  seem  hopeless  now.  The  latest  news 
from  Cheliabinsk  is  serious  and  Ekaterinburg  is  in  the  hands 
of  the  Bolsheviki.  Nothing  in  the  world  can  prevent  them 
from  swooj)ing  down  on  Omsk  and  where  the  front  will  be  in 
three  weeks  is  a  matter  for  conjecture. 

On  July  26,  Miss  Harrington  wrote  ]\Iiss  j^oyes  from  Omsk 
regarding  the  evacuation  before  the  victorious  Ked  Guard: 

We  arrived  at  Omsk  on  July  24  and  were  astonished  to  find 
that  our  American  ])ersonnel  had  already  been  moved  down 
the  line.  Kkaterinburg  is  also  evacuating,  so  Major  Manget 
after  a  consultation  with  American  Consul  General  Harris 
and  our  Army  otlicials,  felt  that  it  would  be  well  to  get  our 
personnel  out  before  traliic  is  paralyzed  and  our  people  bottled 
up  iiere  indefinitely. 

The  comjjlote  personnel  from  Tumen  will  be  moved  to 
Tomsk  to  open  a  200()-bed  hospital  there.  The  rest  will  go  on 
to  Irkutsk  to  await  further  orders.  .  .  . 

All  our  j)laiis  for  the  four  months'  intensive  training  for 
Russian  aides  have  had  to  be  given  up.  It  is  discouraging 
because  the  liussian  nurses  at  the  front  are  trying  to  use  <uir 
su])plies  and  it  does  seem  as  if  we  ought  to  train  thes(>  young 
women  in  the  proper  way  to  use  them.  Most  of  them  art>  just 
young  rel'ngi'c  girls  who  nnist  luive  enijiloyment  nnil  previous 
to  their  work  with  us  have  had  no  traiuiui;  of  anv  kind. 


942  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  second  train  carrying  our  personnel  starts  eastward  this 
afternoon.  There  will  be  left  only  seven  nurses  in  Omsk  and 
they  will  evacuate  with  other  American  personnel  on  Consul 
General  Harris'  train  when  he  feels  that  the  proper  time  has 
come.  We  are  sad,  indeed,  over  the  sudden  change  of  affairs 
and  we  can  only  hope  that  within  a  short  time  we  will  be  back 
in  Omsk  and  even  in  Cheliabinsk. 

The  success  which  had  met  the  advance  of  the  Red  Guard 
in  the  Cheliabinsk  district  continued  and  on  July  29,  ^lajor 
Strong,  in  charge  of  American  Red  Cross  activities  in  Vladi- 
vostok, wired  Colonel  Teusler,  then  in  Washington : 

Owing  to  Bolshevik  advances,  Cheliabinsk  and  Tumen  have 
already  been  evacuated.  Omsk  is  being  evacuated  and  the 
nursing  staff  has  already  left.  The  supply  trains  going  west 
are  being  returned  east.  Irkutsk  will  have  a  three  hundred 
bed  hospital,  but  further  extensions  or  storage  impossible  on 
account  of  the  overcrowded  conditions  of  the  city.  We  are 
arranging  store  depots  at  Verkhne-Udinsk  and  Harbin  as  the 
most  advisable  western  points  for  warehouse  space. 

The  personnel  will  be  housed  at  Buchaloo  until  the  situation 
clears.  Further  incomers  are  being  stopped  at  Japan,  as  there 
is  no  space  in  Vladivostok. 

Tomsk  w\HS  the  next  large  city  located  east  of  Omsk  on  the 
Trans-Siberian  Railway  and  for  some  weeks  it  became  the  head- 
quarters of  the  American  Red  Cross  in  western  Siberia.  Miss 
Harrington  detailed  nurses  and  aides  to  the  American  Red 
Cross  hospital  w'hich  had  been  established  in  1918  with  the 
cooperation  of  the  Faculty,  in  one  of  the  twenty-nine  buildings 
of  the  Tomsk  University.  No  American  nurses  had  been  as- 
signed to  duty  there  in  1918,  however,  because  they  could  not 
be  spared,  and,  indeed,  their  stay  in  the  handsome  University 
Hospital  during  1919  was  short.  The  city  of  Tomsk  possessed 
the  beauty  traditional  to  Russian  and  Siberian  cities.  The 
streets  were  broad  and  well  kept  and  the  stores  large  and,  pre- 
vious to  1914,  well  stocked  with  luxuries  of  all  kinds.  The 
University,  where  ]\letchnikoff  had  performed  some  of  his  re- 
markable experiments,  had  made  Tomsk  the  center  of  Siberian 
art,  science  and  letters.  It  had  also  been  the  seat  of  the  Kolchak 
Government. 

All  American  Red  Cross  women  personnel  were  evacuated 
from  Tomsk  late  in  August  and  got  out  safely,  all  except  Edith 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    943 

Barnett,  who  had  died  of  typhus  on  August  15  and  had  been 
buried  several  days  later  at  Verkhne-Udinsk. 

During  the  month  of  September,  1919,  only  three  American 
Red  Cross  hospitals  were  maintained  in  the  Western  Division, 
the  first  at  Omsk ;  the  second  at  Novo-Nikolanvsk ;  and  the 
third  at  Tomsk.  American  Red  Cross  physicians  were  still  in 
charge  but  no  American  Red  Cross  nurses  were  on  duty  in  any 
of  them.  The  thousand-bed  hospital  which  had  been  started  in 
1918  in  the  agricultural  school  at  Omsk,  was  staffed  by  Russian 
Sisters,  with  Helen  Domerschikoff  in  charge.  Other  Russian 
Sisters  and  Russian  nurses'  aides  were  on  duty  at  Novo-Niko- 
lansk  and  Tomsk. 

The  city  of  Irkutsk,  some  miles  west  of  Lake  Baikal,  became 
in  September  the  center  of  American  Red  Cross  activity  in  the 
Siberian  interior.  Previous  to  1014,  Irkutsk  had  been  perhaps 
the  largest  commercial  center  in  Siberia  and  with  its  many 
stores,  museum,  the  university  and  a  military  barracks  capable 
of  housing  thirty  thousand  men,  was  still  regarded  in  1919,  in 
spite  of  paralyzed  trade,  as  the  metropolis  of  Siberia. 

L^pon  his  return  to  Vladivostok  from  the  United  States, 
Colonel  Teusler  had  proceeded  west  to  Irkutsk  to  confer  with 
Major  Manget  regarding  the  reorganization  of  the  Western 
Division.  Upon  his  arrival  there  in  the  fall  of  1919,  a  third 
Division  was  created  and  its  headquarters  established  at  Irkutsk. 
Miss  Harrington  was  appointed  acting  chief  nurse. 

At  Irkutsk,  the  commission  established  four  large  hospitals. 
One  of  the  first  of  these  was  described  by  Miss  Harrington  in 
her  September  Report : 

The  American  Ed  Cross  Hospital  on  Xamanskaya  Ulitza, 
with  Christine  Kemp  in  charge  of  it,  is  now  caring  for  2"-23 
patients,  most  of  wiiom  are  wounded  soldiers  brought  down 
from  the  Western  Front.  As  the  shortest  time  in  which  we 
have  received  tiiem  after  they  have  started  from  the  front  is 
four  weeks,  the  condition  of  some  of  them  upon  arrival  is 
appalling.  Even  their  bandages  are  alive  with  vermin  and 
their  garments  in  an  untliinkable  state.  The  surgical  work 
done  here  (and  our  agreement  with  the  Russian  military 
authorities  provides  that  we  take  only  surgical  cases)  consists 
principally  of  re-amputations,  amputations  and  drainage 
surgery  of  all  kinds. 

The  new  Chapel  ward  of  4r)-bed  capacity  is  reserved  solely 
for  convalescent  Czechs  and  is  a  sunny,  cheerful  room,  a  joy 


944   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

to  these  men  who  deserve  the  best.  .  .  .  The  American  ward, 
reserved  for  male  members  of  the  American  Eed  Cross  per- 
sonnel, the  American  engineers  and  the  Y.  M.  C.  A.  and  those 
of  our  Allies,  holds  an  average  of  two  or  three  patients,  all 
grateful  indeed  for  the  homelike  surroundings  and  the  fa- 
miliar medical  and  nursing  methods. 

A  second  American  Red  Cross  hospital  at  Irkutsk  was  Di- 
vision No.  2  of  the  Russian  Military  Hospital.  The  commis- 
sion supplied  here  personnel  and  hospital  supplies  to  carry  on 
the  clinic  where  300  hospital  patients  and  numerous  out-patients 
had  their  wounds  dressed  daily ;  it  also  operated  a  surgical  ward 
of  sixty-two  beds  and  a  medical  ward  of  twenty-six.  Stephanie 
Pohle  was  chief  nurse  and  Harriet  Hunt  in  charge  of  the  clinic. 
But  it  was  up-hill  work;  in  a  report  submitted  on  October  11 
to  the  Finance  Committee  of  the  Central  Division,  Miss  Har- 
rington described  the  conditions  existing  in  the  Russian  Military 
Hospital : 

On  entering  the  hospital  each  morning,  it  is  not  the  greatest 
inspiration  to  be  greeted  by  the  sight  of  dead  bodies;  then 
passing  up  the  stairs  and  through  the  corridors  thick  with 
smoke  and  heavy  with  odors,  to  arrive  at  a  floor  where  300 
patients  are  being  housed.  Ninety  are  in  Red  Cross  wards, 
but  two  himdred  and  ten  others  receive  hit-and-miss  care; 
some  of  these  have  been  lying  for  days  without  change  of 
clothes  on  the  floor  in  the  same  clothes  which  they  had  on 
over  a  month  before  at  the  front.  Infected  with  typhus, 
carrying  vermin  as  they  are,  they  constitute  a  serious  menace 
to  the  Russian  and  American  personnel. 

After  heroic  labors,  ]\Iiss  Pohle  and  her  nurses  rid  the  Rus- 
sian ]\Iilitary  Hospital  of  vermin  and  established  more  sanitary 
conditions. 

The  third  American  Red  Cross  hospital  at  Irkutsk  was 
maintained  for  the  benefit  of  wounded  soldiers  from  the  Czecho- 
slovak Army.  Lillian  Craig  Clark,  an  enrolled  American  Red 
Cross  nurse,  and  throe  Czech  aides  formed  the  nursing  staff. 

The  fourth  hospital  was  located  in  five  barracks  at  Military 
City,  an  encampment  which  lay  some  five  versis  from  Irkutsk. 
Mabel  Clare  Blackmer,  the  former  chief  nurse  of  the  short- 
lived Omsk  Hospital,  was  chief  nurse.  The  Military  City 
Hospital,  as  it  was  called,  was  of  four  hundred  bed  capacity  and 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    945 

cared  for  the  patients  who  were  being  constantly  sent  eastward 
from  the  west  Siberian  provinces  before  the  on-coming  Bolshevik 
armies. 

An  emergency  dressing  car  was  equipped  at  Irkutsk  and  set 
up  in  the  main  railroad  station  where  from  eighty  to  one  hun- 
dred wounded  soldiers  and  civilians  en  route  eastward  had  their 
wounds  re-dressed  each  day,  Katherine  Steelman  and  a  Rus- 
sian nurse  were  later  assigned  to  duty  there. 

Directly  opposite  the  main  station  at  Irkutsk  was  established 
a  large  Red  Cross  dispensary,  of  twelve  rooms,  including  a 
waiting-room,  a  small  operating-room,  a  recovery  room  and  an 
emergency  typhus  infirmary.  Eva  Smythe,  the  nurse  who  had 
organized  Red  Cross  child  welfare  work  at  St.  Etienne,  France, 
was  chief  nurse  and  was  aided  by  four  other  American  Red 
Cross  nurses. 

As  the  Bolsheviki  pressed  eastward  from  Omsk  in  their  fight 
for  the  control  of  the  Trans-Siberian  Railway,  train  after  train 
filled  with  wounded  and  typhus-stricken  Czech  and  Russian 
soldiers  and  refugees  pulled  into  Irkutsk.  On  August  10,  an 
American  engineer  stationed  at  Irkutsk  wrote  one  of  the  nurses 
of  the  Siberian  Commission  : 

As  a  nurse,  you  will  be  interested  in  the  Eussian  sanitary 
trains  which  run  through  this  town  at  the  rate  of  from  three 
to  six  a  day.  P^aeh  train  carried  fully  five  hundred  wounded 
or  sick  soldiers  in  a  few  sanitary  and  many  box  cars.  From 
personal  observation,  I  know  that  five  young  Russian  girls 
took  care  of  this  number  of  sick  and  wounded  on  one  train. 
Many  of  the  men  sufi'er  from  tuberculosis,  typhus  and  chronic 
dysentery.  Through  an  instinct  of  cleanliness,  most  cases  of 
the  latter  disease  try  to  leave  the  cars  at  every  stop  and  are 
then  so  weak  that  they  faint,  falling  under  the  cars,  and  have 
to  be  assisted  aboard  again.  Every  train  takes  off  dead  at 
each  terminal.  The  supplies  are  so  scarce  here  that  not  even 
a  rag  or  a  piece  of  paper  can  be  spared  to  cover  the  faces  of  the 
dead.  It  is  needless  to  tell  you  that  such  a  state  of  affairs 
lias  been  brouglit  about  by  unsanitary  conditions  in  the  camps 
and  the  lack  of  suitable  nourishment  for  the  men. 

The  Russian  sanitary  trains  have  no  actual  funds  with 
which  to  buy  supplies  or  foodstuffs  and  the  officers  have  to 
rely  entirely  on  the  generosity  of  the  public  all  along  the  line. 
The  public  has  nothing  to  give.  We  are  located  in  the  very 
heart  of  the  famine  belt  and  see  hungry  men  and  lots  of  them. 
It's  not  })leasant  to  come  face  to  face  with  this  sort  of  thing, 


946    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

but  it's  tougher  to  see  hungry  women  and  it's  plain  hell  to  see 
hungry  children.  .  .  . 

One  of  the  first  projects  of  the  American  Red  Cross  in 
Siberia  had  been  the  equipment  and  maintenance  of  sanitary 
trains  for  the  Czech  and  Russian  forces.  At  Irkutsk,  an  in- 
teresting experiment  was  made  in  1919  in  the  assignment  of 
American  Red  Cross  nurses  to  one  of  these  trains.  In  her 
September  Report,  Miss  Harrington  wrote: 

American  Eed  Cross  Sanitary  Train  Xo.  1  operates  between 
Omsk  and  Verkhne-Udinsk  and  is  made  up  of  twenty-three 
cars.  Two  of  our  nurses,  Vera  Allen  and  Katherine  Steelman. 
and  ten  Eussian  Sisters  composed  the  nursing  personnel  on  its 
initial  trip.  They  carried  nearly  three  hundred  cases  and  did 
forty  major  operations  en  route.  Some  of  the  patients  were 
unloaded  at  Irkutsk  and  the  others  at  Yerkhne-T'dinsk  and 
the  train  made  the  return  trip  to  Omsk  and  the  front  without 
the  American  nurses. 

The  military  situation,  in  Colonel  Teusler's  estimation,  did 
not  permit  reassignment  of  American  nurses  to  this  precarious 
type  of  service. 

Irkutsk  was  located  on  the  western  shore  and  Yerkhne- 
Udinsk  on  the  eastern  shore  of  Lake  Baikal.  At  Irkutsk  were 
stationed  some  twenty-five  thousand  Czech  soldiers  and  at 
Yerkhne-Udinsk  about  500  versts  away,  were  numerous  com- 
panies of  Japanese  troops  and  the  27th  U.  S.  Infantry,  which 
then  numbered  about  eighteen  hundred  men.  Since  August, 
Irkutsk  had  boon  the  dead-line  for  American  Red  Cross  women 
personnel  and,  indeed,  there  were  iow  of  them  there.  The 
majority  had  l)een  sent  east  through  the  tunnels  of  Lake  Baikal 
to  Yerkhne-Udinsk.  There  was  a  possibility  that  the  Red 
Guard  nriglit  any  day  blow"  up  the  tunnels  and  cut  the  line  of 
communication  between  the  East  and  West.  Of  the  military 
situation  in  the  AVest,  Miss  Harrington  wrote  Miss  Noyes  in  her 
October  Report,  dated,  however,  Xovember  28: 

Since  last  week,  the  Western  Division  has  ceased  to  exist. 
Omsk  has  fallen  and  the  Eed  (luard  has  obtained  a  great  deal 
of  ammunition  and  sujjplies  of  all  kinds.  All  of  our  Eed 
Cross  supply  trains  are  now  on  this  side  of  Xovo-Xikolansk. 
Conditions  here  at   Irkutsk  were  most  serious  last  week  and 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    947 

we  have  evacuated  as  many  of  our  women  as  we  can  possibly 
spare,  in  order  to  ^iet  them  east  of  the  Baikal  tunnels.  Thirty- 
nine  nurses,  aitles  and  clerical  workers  went  east  to  Verkhne- 
Udinsk  on  a  Red  Cross  special  train  and  we  have  retained 
only  enough  here  to  carry  on  our  work  until  the  lUissian 
Sisters  arrive  from  Omsk.  Consul  General  Harris  and  his 
stall'  are  now  at  Irkutsk.  His  presence  here  reassures  us,  for 
he  has  his  finger  on  the  j)ulse  of  the  political  situation  and 
now  that  Colonel  Teusler  has  been  called  back  to  Vladivostok, 
he  can  advise  us. 

Typhus  is  the  great  ])roblem  and  peril  here.  One  of  our 
interpreters  informed  us  that  ^5,000  cases  of  typhus  had  been 
registered  among  the  sohliers  alone  in  Innokentivskaya.  just 
outside  of  Irkutsk.  It  is  generally  known  that  it  was  typhus 
among  the  white  armv  that  gave  the  lieds  their  victory  at 
Omsk. 


With  large  supplies  at  Verkhnc-L^dinsk  and  a  considerable 
niunber  of  nurses  and  surgical  cases,  the  commission  in  August 
established  a  hospital  and  a  dispensary  there.  The  American 
Red  Cross  Hospital  was  located  in  a  one-story  building  which 
had  formerly  housed  a  department  store.  It  was  originally  of 
two  Inuidred  and  fifty  bed  capacity  but  was  later  increased  to 
six  hundred  beds.     (Jrace  ^Iclntyre  was  chief  nurse. 

In  addition  to  Miss  ^Iclntyre's  Hospital,  the  American  Red 
Cross  in  Verkhne-rdinsk  took  over  and  maintained  the  Provost 
Guard  Hospital  and  established  an  emergency  typhus  hospital 
of  KiOO  beds  in  twenty-eight  warehouses.  ^'General  Seminoff," 
wrote  ^liss  ILirrington  in  her  October  Report  to  Miss  Xoyes, 
"wired  that  we  could  have  the  warehouses  provided  that  we 
would  take  infectious  cases.  Typhus  is  everywhere."  Flor- 
ence Farmer  was  chief  ntirse  of  the  Barracks  Hospital  for 
typhus  patients. 

Practically  the  only  nursing  aid  which  the  (\unmissi()n  for 
Siberia  gav(^  to  the  American  Fxpeditionary  Forces  in  Siberia 
was  the  assignment  of  American  Red  Cross  nurses  t<>  aid  in  an 
influenza  epidemic  wliicli  broke  nut  in  the  fall  of  linO  among 
American  tr()o])s  at  Verkhne-rdinsk.  The  American  Armies 
in  Siberia  had  their  own  hospital  facilities.  Kiglit  nurses  of  the 
commission  were  loaned  to  the  American  Military  I-!stablish- 
ment  for  duty  at  the  V.  S.  Army  Field  Hospital  at  Verkhnc- 
Fdinsk.  During  th(>  week  of  Xovemlx^-  KI,  twelve  otlu^-s  un- 
der  the   leaderslii})  of   Sallie   -I.    Bryant   were   assigned   to   Be- 


948  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rosvka,  the  winter  quarters  of  the  27th  IT.  S.,  and  served  there 
in  U.  S.  Army  Evacuation  Hospital  No.  17,  of  which  Major 
Robert  E.  Parrish,  Medical  Corps,  was  then  in  command  and 
Katherine  C  Hannan,  chief  nurse.  Of  the  work  of  Miss 
Bryant's  detachment  of  nurses,  Miss  Harrington  wrote  Miss 
Noyes  on  December  16: 

At  Berosvka,  just  outside  of  Verkhne-ITdinsk,  the  nurses 
found  two  hundred  very  sick  boys  and  managed  in  less  than 
twenty-four  hours  to  transform  the  hospital.  Young  inexperi- 
enced corpsmen  had  been  in  charge.  The  boys  seemed  to 
regard  the  arrival  of  the  Eed  Cross  nurses  as  a  gift  from 
Heaven,  and  under  their  care  the  epidemic  w^as  soon  checked; 
not,  however,  before  twenty-eight  of  our  men  had  died.  These 
new  men  are  very  young !  One  little  fellow  of  fourteen  cried 
so  hard  for  his  mother  before  his  death. 


Throughout  the  fall  of  1919,  the  Red  Armies  had  been  gain- 
ing in  the  West  and  were  pushing  eastward  toward  Vladi- 
vostok. The  American  Armies  were  withdrawn  from  Irkutsk 
in  December  and  with  them  went  all  American  Red  Cross  per- 
sonnel. Miss  Harrington  in  her  Report  to  the  Finance  Com- 
mittee for  the  week  ending  December  30,  1919,  wrote: 

On  December  23,  the  Executive  Committee  informed  the 
heads  of  all  departments  that  they  were  to  make  preparations 
for  the  complete  evacuation  of  their  personnel.  No  definite 
time  was  set,  but  it  was  understood  that  we  were  to  be  pre- 
pared to  leave  within  twenty-four  hours.  A  communication 
was  immediately  sent  to  the  American  Red  Cross  Hospital  on 
Xamanskaya  IJlitza  and  the  Station  where  our  personnel 
were  on  duty  on  the  Emergency  Dressing  Car  and  Dispensary. 

Tbe  Divisional  Manager  stated  in  a  communication  dated 
December  24  that  Russian  Sisters  who  so  desired  would  be 
taken  on  itcd  (-ross  evacuation  trains  as  far  east  as  Yerkhne- 
T^dinsk  or  Chita  if  they  could  prove  that  they  had  friends  or 
relatives  in  cither  place,  but  that  they  must  be  off  the  trains, 
with  all  l)aggage,  two  hours  after  arrival  at  either  station. 

Christmas  Day  found  us  all  monu^ntarily  ex])ecting  the 
storm  to  break  but  endeavoring  to  maintain  a  holiday  spirit 
becoming  to  foreigners  in  this  land  which  has  suffered  beyond 
description.  As  you  entered  the  brilliantly-ligbted  cba])cl 
wards  of  tbe  Irkutsk  IIos])ital  and  saw  the  trees,  the  gifts  for 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    949 

everyone,  the  festooned  walls,  the  three  Czech  aides  who  were 
Santa  (Clauses,  it  was  hard  to  realize  that  outside  in  the  city 
proper  there  was  neither  electric  ligiit  nor  water,  and  that  it 
was  doomed  to  fall.  .  .  . 

On  December  2G  evacuation  began  at  9 :00  A.M.  All 
American  Red  Cross  nursing  activities  at  Division  No.  1  of  the 
Russian  Military  Hospital,  at  the  Czecho-Slovanska  Hospital 
and  the  Czecho-Surgical  Hospital  were  brought  to  a  close. 

Baggage  other  than  hand  bags  had  already  been  sent  to  the 
trains  in  order  that  our  departure  might  cause  as  little  com- 
ment as  possible  among  the  Russian  pooi)le,  who  were  nearing 
the  "panicky"  stage  anyhow.  As  the  day  drew  to  a  close,  only 
sixteen  of  our  personnel  had  time  to  cross  the  pontoon  bridge 
over  the  Angara,  because  of  darkness,  the  rapid  current  and 
the  huge  cakes  of  ice  brought  down  from  the  Baikal.  .  .  . 

December  27 :  Tiie  rest  of  the  nursing  personnel  were 
evacuated  to-day.  As  the  last  boatload  of  Red  Crossers  pulled 
out  from  the  western  shore  of  the  Angara,  the  battle  around 
the  telegraph  station  in  Irkutsk,  just  back  of  our  former 
personnel  house,  began.  .  .  . 

For  seven  days,  however,  the  American  Red  Cross  evacuation 
trains  waited  in  the  Irkutsk  Railroad  Yards  for  final  word  from 
Consul  General  Harris  to  evacuate  eastward.  '^The  atmosphere 
was  tense  and  rumors  wild,"  wrote  j\liss  Harrington  in  her 
Weekly  Report  ending  January  7,  1920,  "the  yard  workmen 
and  railway  employees  had  all  been  armed.  Red  Cross  women 
personnel  were  recpiired  to  stay  near  their  own  track  and  coupe, 
for  at  the  least  provocation  a  volley  of  bullets  would  come  and 
might  prove  fatal  to  those  innocently  taking  an  airing.  The 
nurses  busied  themselves,"  added  ^liss  Harring-fon,  "in  sewing 
curtains  for  their  coupes." 

On  January  ■),  the  Americans  evacuated  Irkutsk,  Consul 
General  Harris'  train  went  first,  preceded  by  a  (^zecli  eschelon, 
or  arni(^re(l  train.  Xext  cam(>  tiie  trains  carrying  American 
personnel.  Kach  train  left  the  yards  at  twenty-minute  intervals 
and  was  preceded  and  followed  by  a  Czech  eschelon. 

The  nurses  did  not  stay  long  at  Verkhne-Udinsk,  ^liss  Har- 
rington wrote : 

Hero  wp  met  ^Frs.  St.  Jolni.  wlio  had  coine  up  on  Colonel 
Teusler's  car  and  had  already  arraiiged  for  the  evacuation  of 
a  large  number  of  the  Anicricaii   Iicd  Cross  personnel   there. 
.  .  .   Plans   were   immediately   made   to  evacuate   the   others. 


950   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

They  left  on  January  6,  the  nurses  under  the  leadership  of 
Florence  Farmer.    The  others  came  later,  .  .  . 

On  January  7,  Mrs.  St.  John  wrote  Miss  l^oyes  from 
Verkhne-Udinsk,  just  before  the  departure  of  the  last  train: 

The  complete  dissolution  of  any  stable  form  of  government 
in  Siberia  has  made  it  impossible  for  us  to  carry  on  success- 
fully any  Eed  Cross  work  other  than  the  distribution  of  warm 
clothing  and  relief  supplies;  with  the  growing  military  activi- 
ties east  of  Baikal  and  the  withdrawal  of  American  troops 
from  this  section,  it  is  impossible  to  keep  our  nurses  or  other 
women  personnel  east  of  Manchuria  Station.  This  practically 
concentrates  our  work  in  Vladivostok,  so  far  as  the  nurses  are 
concerned.  Because  of  this,  I  am  instructing  all  the  nurses 
from  the  west  to  prepare  for  early  transportation  home  and 
have  written  Miss  Tittman  to  ask  that  passage  be  secured  for 
all  excepting  those  needed  for  replacements  in  Vladivostok. 

You  will  be  interested  to  know  that  apparently  the  Social 
Democrat  movement  in  Irkutsk  has  been  largely  fostered  by 
the  Czechs  and  almost  surely  they  are  in  more  or  less  sym- 
pathetic contact  with  the  somewhat  modified  Bolshevism  of 
western  Siberia.  Here  in  Verkhne-Udinsk  we  are  surrounded 
by  Bolsheviki  and  this  is  true  all  the  way  east  to  the  Amur 
Basin. 

With  such  conditions,  the  opposition  ofi^ered  by  the  Cossacks 
cannot  be  efl^ective  much  longer  and  probably  by  the  time  this 
letter  reaches  you  either  Social  Democracy  or  Bolshevism  will 
rule  Siberia  to  the  environs  of  Vladivostok.  You  can  easily 
see  that  for  at  least  the  next  few  months  it  would  be  impossible 
for  the  l?ed  Cross  to  operate  here  successfully. 

The  people  will  see  us  leave  with  real  regret,  but  we  will 
withdraw  at  a  time  when  the  Russians  will  have  the  least 
reason  to  criticize  us  for  this  action,  and  I  am  glad,  if  the 
work  has  to  be  discontinued  in  Siberia,  that  the  break  has 
come  now. 

The  next  terminal  eastward  from  Verkhne-Udinsk  was  Chita 
and  here  the  American  lied  Cross  evacuation  trains  were  held 
long  enough  for  the  personnel  to  distribute  the  supplies  which 
had  been  brought  into  the  city  from  the  west  on  Train  ]^o.  27. 

Margaret  L.  ^latthew,  then  acting  director  of  the  Depart- 
ment of  Civilian  Relief  in  the  Central  Division,  was  in  charge 
of  the  work,  with  ^Irs.  St.  John  and  Miss  Bridge  as  her  as- 
sistants.    Madame  Semenoff  placed  at  the  disposal  of  the  Red 


NURSING  SERVICE  TO  CIVILIAN  POPULATION    951 

Cross  an  old  cafo,  with  shelves  along  the  walls  and  counters 
running  around  the  room ;  behind  the  cafe  was  a  large  courtyard 
which  was  well  adapted  for  warehouse  purposes  and  which 
could  be  easily  guarded.  The  distribution  began  on  January 
IG  and  lasted  until  the  2.3rd.  "The  entire  American  Red  Cross 
staff,"  wrote  Miss  JNIatthew,  "volunteered  to  help  in  the  dis- 
tribution,— doctors,  nurses,  clerical  workers  and  even  the  Rail- 
way engineers  and  the  American  Guard."  The  militia  was 
called  in  to  police  the  crowds  but  even  they  could  not  control 
them.  "The  street  became  a  seething  mass  of  humanity,"  wrote 
]Miss  ]\ratthew,  "and  they  crowded  so  as  to  endanger  the  glass 
windows  of  the  cafe.  It  was  then  decided  to  allow  the  military 
to  give  out  every  day  in  each  district  headquarters  fifty  tickets 
for  each  of  the  six  districts  of  the  town,  thus  making  three 
hundred  tickets  in  all.  This  department  gave  out  in  the  seven 
days  39,313  garments  to  11,355  persons." 

A  carload  of  goods  was  distributed  to  the  Railroad  employees 
at  Chita  and  a  considerable  amount  of  general  supplies  fur- 
nished to  German,  Austrian  and  Hungarian  prisoners  then 
interned  at  three  camps  nearby.  Private  lists  mimbering  253 
needy  families,  which  were  sent  in  for  Madame  Semenoff's  ap- 
proval, were  also  filled.  "Madame  Semenoff,"  wrote  ]\Iiss  St. 
John  to  Miss  Noyes,  "is  utterly  fearless  in  visiting  the  typhus 
hospitals  and  prisons  and  when  she  finds  orphaned  and  destitute 
children,  she  ad()])ts  them  until  they  are  claimed.  She  has  a 
home  for  orphaned  children  opposite  her  own  and  when  I  visited 
it,  I  found  it  clean,  well  ordered  and  the  children  happy  and, 
of  course,  devoted  to  her." 

On  January  23,  the  trains  pulled  out  of  Chita,  and  thus  was 
closed  the  work  of  the  American  Red  Cross  in  the  Western  and 
C^entral  Divisions  of  Siberia.  The  personnel  had  started  out 
rich  in  supplies,  plans  and  enthusiasm,  but  had  been  able  to 
accomplish  little  in  comparison  with  the  true  needs  of  the 
country.  Thr  nurses  had  had  scant  opportunity  to  do  the  work 
for  which  they  had  gone  out,  but  they  had  met  the  changing 
situations  with  etjuanimity.  "You  would  have  been  proud  of 
them,"  wrote  Miss  Harrington  to  ]\liss  Xoyes,  "if  you  had  seen 
their  spirit  and  che(>rfnl  willin^^l(■ss  to  work  throuuh  the  up- 
heaval, when  the  revolutionary  forceps  were  steadily  pushing  us 
eastward  in  wave  after  wave  of  evacuation  among  the  non- 
descript mixture  of  convict,  typhus  and  the  so-called  sanitary 
trains  and  the  hordes  of  refncees." 


952  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

By  the  first  of  April,  1920,  practically  all  American  Red 
Cross  personnel  had  left  Vladivostok,  which  was  then  under 
frank  Bolshevik  rule.  Of  the  closing  of  the  program  Mrs.  St. 
John  wrote  Miss  ISToyes  on  March  4: 

Two  weeks  before  the  Morskoi  (Naval)  Hospital  was  turned 
over  to  the  Eussians,  the  American  nurses  were  withdrawn 
and  it  was  then  staffed  entirely  by  Russian  nurses  and  aides 
trained  by  us.  I  inspected  the  hospital  during  this  period 
and  found  it  well  kept  and  reflecting  in  a  satisfactory  manner 
the  training  received  under  Miss  Bethel's  able  administration. 
This  hospital  has  been  thoroughly  equipped  and  is  much  im- 
proved since  the  Eed  Cross  took  it  over  in  Xovember,  1919. 

The  American  nurses  in  the  Russian  Island  Hospital  were 
withdrawn  February  1  and  the  Russian  nurses  and  aides  are 
carrying  on  the  work.  .  .  . 

Miss  Farmer  has  been  appointed  assistant  to  Dr.  Coulter, 
chief  of  the  Petrograd  Children's  Colony.  She  will  probably 
be  the  only  American  Red  Cross  nurse  from  the  commission 
who  will  remain  in  Siberia.  ...  I  think  the  transfer  of  these 
children  back  to  their  homes  in  Moscow  and  Petrograd  one  of 
the  important  questions  with  which  the  commission  has  to 
deal.  Plans  are  ready  to  be  developed  to  give  them  safe  trans- 
portation provided  conditions  in  central  Russia  make  their 
return  advisable.  [This  transfer  was  accomplished  in  the 
summer  and  autumn  of  1920  under  the  auspices  of  the  Ameri- 
can Junior  Red  Cross.] 

^liss  Harrington  and  her  unit  arrived  from  Harbin  on 
February  (i  on  Consul  General  Harris'  train  and  the  majority 
of  the  nurses  went  immediately  to  the  U.  S.  transport,  which 
took  them  home.  Miss  Tittman  left  on  February  28,  but  will 
remain  in  China  and  Japan  for  a  few  weeks.  I  will  see  her  in 
Tokyo  and  ask  her  to  bring  you  the  final  records  and  efficiency 
reports;  slie  will  go  immediately  to  AV'ashington.  I  expect  to 
leave  Vladivostok  in  about  four  days. 

The  continuation  under  Russian  auspices  of  the  Teaching 
Center  and  educational  phases  of  the  nursing  service  pro- 
gram has  already  been  described. 

Thus  was  closed  American  Red  Cross  nursing  service  in 
Siberia,  a  gallant  attempt,  all)eit  somewhat  chaotic  and  short- 
lived, to  implant  in  a  land  not  yet  ready  to  receive  and  nurture 
them,  the  standards  and  traditions  of  modern  American  nurs- 
ing service. 


CHAPTER  X 

AT   NATIONAL   HEADQUARTERS 

Auxiliary  Kursiiig  Service — The  Summer  Months  of  1918 — 
The  Influenza  epidemic — The  Armistice  is  Signed 

UNDEK  the  main  facts  of  history  lie  the  human  relation- 
ships of  the  participants  and  these  relationships  may 
be  called  the  backiZToiind  against  which  the  actual  events 
stand  out  like  the  principal  motifs  in  the  design  of  a  Persian 
rug.  This  background,  when  viewed  in  a  changeable  and  un- 
certain light,  often  appears  blurred  and  even  distorted  to  differ- 
ent observers  and  each  observer  sees  the  details  according  to  his 
own  position  and  his  own  methods  of  observation.  Yet  the  back- 
ground as  a  whole  forms  a  vital  part  of  the  pattern  and  must  be 
taken  into  consideration  if  the  pattern  is  to  be  described. 
Hence  this  chapter  of  this  history  will  deal  largely  with  these 
hunuui  relationships  and  their  bearing  upon  the  nursing  situa- 
tion of  the  European  War.  Yet  it  must  be  remembered  that 
the  true  pattern  of  American  war  nursing,  as  developed  and 
seen  in  the  minds  of  American  nursing  leaders,  was  often 
blurred  and  distorted  by  war  psychology. 

''War  is  a  savage  state  of  society  and  it  strikes  at  many  things 
we  have  cherished,"  wrote  an  American  lied  Cross  nurse  serving 
in  Fraiu-e.  ''I  really  have  faith  in  the  ultimate  outcome,  though 
I  think  that  we  must  l)e  ready  to  go  through  a  black  period  at 
first."  VoY  the  Nursing  S(>rvic(^,  this  black  period  l)egan  to 
loom  up  early  in  1!)18  and  continued  until  the  signing  of  the 
Armistice. 

Three  ju-oblcms  confronted  ^liss  Delano  and  ]\Iiss  Xoyes 
during  this  imjxirtant  time:  the  needs  of  the  nurses  themselves; 
the  needs  of  the  Aiilitary  Establishmcmt ;  and  ultimately,  the 
needs  of  the  civilian  p()])ulation, 

Tlie  lUM'ds  of  the  nurses  themselves  were  the  least  perplexing. 
Existing  regulations  of  th(>  War  and  Xavy  Departments  and 
the  Ived  Cross  nave  to  the  Nursing  Service  the  power  to  mobilize 
American  Hod  Cross  nurses  into  tlu^  Army  and  N'avy  and  the 

953 


954   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

War  Council  appropriated  the  funds  necessary  to  equip  them; 
after  this  had  been  accomplished,  the  responsibility  of  the  Red 
Cross  ceased.  For  nurses  in  foreign  service  directly  under  the 
Red  Cross,  Miss  Delano  and  Miss  Xoyes  were  concerned  with 
organization  difficulties  previously  described. 

The  second  and  the  genuinely  distressing  problem  was  the 
military  nursing  needs  and  in  certain  aspects  of  this  question 
Miss  Delano  stood  alone,  facing  on  the  one  hand  the  professional 
group  of  which  she  herself  was  a  member  and  on  the  other,  the 
untrained  women  of  America  who  clamored  for  opportunity, 
through  the  American  Red  Cross,  for  war  nursing  service. 

As  the  war  progressed,  the  nursing  needs  of  the  Military 
Establishment  and  the  available  supply  of  graduate  nurses  grew 
more  apparent  to  Army,  Navy  and  Red  Cross  officials.  The 
numbers  of  men  in  the  Military  Establishment  were  increasing 
to  gigantic  figures ;  the  activities  of  the  enemy  and  the  resulting 
numbers  of  casualties  to  the  Allies,  were  also  increasing  to  an 
alarming  degree,  especially  after  the  German  offensive  of 
March  21.  During  the  spring  of  1918,  public,  professional  and 
military  opinion  upon  the  nursing  situation  crystallized  into 
two  groups:  those  who  felt  that  the  Military  Establishment 
should  include  only  professional  nurses,  and  those  who  felt 
that  the  ^Military  Establishment  should  include  professional 
nurses  and  assistants  or  aides  working  under  professional  di- 
rection. On  February  9,  1918,  General  Gorgas  wrote  to  the 
Director  General  of  ^Military  Relief  of  the  American  Red  Cross 
that  "in  my  opinion  it  is  highly  advisable  that  measures  be  taken 
by  the  American  Red  Cross  to  carry  out  the  plans  already 
formulated  by  them  to  provide  a  large  number  of  nurses'  aides 
who  may  be  used  to  supplement  the  nursing  force  in  military 
hospitals  should  need  arise.  .  .  .  The  aides  Avill  be  classed  as 
civilian  employees  of  the  ]\Icdical  Department  at  large  and  will 
be  given  a  salary  of  $30  per  month,  with  quarters,  subsistence, 
the  laundering  of  their  uniforms  while  on  duty  in  hospitals  and 
the  necessary  traveling  expenses  when  traveling  under  orders." 

On  ]\londay  morning,  February  18,  ^liss  Goodrich  assumed 
her  duties  in  the  Surgeon  General's  office.  Late  that  week,  she 
heard  about  the  plan  for  utilization  of  Red  Cross  aides  in  mili- 
tary hospitals  and  she  immediately  took  up  the  matt(>r  with 
Colonel  Winford  Smith,  then  chief  of  the  Hospital  Division 
on  the  Surgeon  General's  office,  with  the  result  that  Colonel 
Smith  asked  the  Red  Cross  to  withhold  the  announcement  re- 


AT  NATIONAL  HEADQUARTERS  955 

gardiiig  aides  until  !Miss  Goodrich  and  her  assistant,  Elizabeth 
Burgess,  had  had  "time  to  study  the  situation  in  base  hospitals 
and  could  make  recommendations."  ^ 

On  February  20,  1918,  Colonel  Smith  wrote  to  Miss  Delano: 

Eeferring  to  the  request  recently  sent  to  you  from  this 
oflfice  requesting  that  steps  be  taken  to  inaugurate  short 
courses  for  tlie  training  of  nurses'  aides  or  attendants,  I  am 
directed  by  the  ►Surgeon  General  to  request  that  for  the  present 
no  steps  he  taken  to  put  tliis  plan  in  actual  operation  in  tlio 
hospitals;  in  other  words,  it  is  desired  to  withhold  announce- 
ments and  circulars  for  a  brief  time  until  a  report  has  been 
made  as  to  the  possibility  and  desirability  of  modifying  this 
plan,  or  of  accomplishing  the  same  purpose  in  a  different 
manner.  It  is  expected  that  this  report  will  be  available 
within  the  next  two  weeks. 

This  is  not  to  be  considered  as  a  definite  abandonment  of 
the  polity  as  indicated  by  the  previous  request,  but  is  merely  a 
delay  in  its  execution  until  additional  data  are  available. 

Out  of  the  study  and  recommendations  of  ]\riss  Goodrich 
grew  the  plan  for  the  Army  School  of  Nursing  and  the  question 
of  utilizing  the  fifteen  hundred  aides  already  trained  as  per- 
sormel  of  the  base  hospital  plan,  and  others  to  be  trained  by  the 
Red  Cross,  was  again  "tabled,"  in  spite  of  ]\Iiss  Delano's  efforts. 

The  proposed  plan  for  the  Army  School  evoked  many  differ- 
ences of  opinion  within  the  medical  and  nursing  professions. 
Discussion  on  this  subj(H't  came  to  a  head  in  the  Twenty-fourth 
Annual  (/ouvcntion  of  tlie  Xational  League  of  iSTursing  Educa- 
tion, which  met  at  Cleveland,  May  7-11,  1918. 

Three  groups  were  represented  at  this  convention :  the  nurs- 
ing group,  jealous  for  the  maintenance  of  hard-won  professional 
standards ;  the  advocates  for  the  supplementary  volunteer  nurs- 
ing service;  and  the  v<dunteers  themselves,  anxious  to  share  in 
war  nursing.  The  rank  and  file  as  well  as  the  leaders  of  nursing 
represented  tlie  first  group.  Dr.  S.  S.  Gokhvater,  superint(>n- 
dent  of  ]\rt.  Sinai  Hospital  and  chairman  of  the  Connnittee  on 
Hospitals  of  the  G(Mieral  ^ledical  Board  of  the  Council  of 
Xational  Dcfens(\  was  spokesman  of  the  second  group.  In 
sunnning  up  the  convention,  ^[is&  Palmer  wrot(>  in  tli(>  editorial 
columns   (June,   lOlS)   of  the  American  Journal  of  Xurshig: 

'  Sec  Twcntv-fourlh  -.Annual  Report  of  tlic  League  of  Nursing  Education, 
1918.  '  ■ 


956   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  two  papers  which  were  of  greatest  importance  were 
those  presented  by  Colonel  Winford  Smith  in  which  he  sub- 
mitted plans  for  an  Army  School  of  Nursing,  and  by  Dr. 
Goldwater,  entitled  "A  Nursing  Crisis,"  in  which  he  advo- 
cated the  employment  of  nurses'  aides  as  they  have  been 
trained  for  the  past  three  or  four  years  through  the  education 
committees  of  the  Eed  Cross.  .  .  . 


As  the  organization  of  the  Army  School  of  Niirsing  has 
already  been  set  forth  in  a  previous  chapter,  Colonel  Smith's 
paper  will  not  be  given  herewith.  Dr.  Goldwater  told  of  the 
Surgeon  General's  plans  for  three  hundred  thousand  hospital 
beds,  stated  that  during  the  past  year,  the  Army  and  Navy, 
with  the  help  of  the  Red  Cross  and  the  active  support  of  hos- 
pitals and  nursing  organizations,  had  been  able  to  secure  only 
one-fifth  of  the  number  of  nurses  needed  and  made  the  state- 
ment that  "the  country  cannot  spare  the  number  of  graduate 
nurses  that  the  Army  requires,  nor  can  the  training  schools 
produce  new  graduates  in  sufficient  numbers  to  satisfy  the  needs 
of  the  military  and  civilian  population."  ^ 

After  detailed  discussion  of  the  possibility  of  securing  an 
adequate  supply  of  graduate  nurses  from  those  already  trained ; 
of  increasing  the  supply  of  student  nurses  in  schools ;  of 
utilizing  "practical  nurses"  in  the  Army ;  and  of  the  establish- 
ment of  the  Army  School  of  Nursing,  Dr.  Goldwater  made  the 
following  recommendation : 

I  come  finally  to  what  appears  to  me  to  be  the  safest  ajid 
best  way  out, — in  fact,  the  only  way  out,  namely,  the  training 
of  a  large  number  of  non-professional,  voluntary,  war  nursing 
aides,  enlisted  for  the  period  of  the  war  only  and  composed  of 
a  class  which  will  not  take  up  nursing  professionally  under 
any  circumstances,  but  which  is  willing  to  give  gratuitous 
hospital  service  during  the  emergency.  .  .  .  Tlie  women  I 
have  in  mind  belong  wholly  or  almost  wholly  to  the  leisure 
class.  They  are  now  contributing  nothing  to  the  elhciency  of 
the  nation  or  to  the  success  of  the  war;  yet  they  are  strong, 
healthy,  patriotic  and  willing.  Tliey  are  the  onhj  laJior 
reserrest  tliaf  the  ronntrj/  possesses  and  theij  can  he  hronght 
into  the  riurstiir/  field  villi  out  lessening  the  available  supply 
of  workers  for  ani/  essential  industry.  .  .  .^ 

^Twfiitvfoiirtb   Annual   Report.  N.  L.  N.  E..  pp.   L32-T.3.3. 

'  IhUJ..  j>p.   i:?8-i:!!'. 


AT  NATIONAL  HEADQUARTERS  957 

On  tliG  following  day  ^fiss  Delano  addressed  the  convention 
on  ''the  lied  Cross  Aide  Versns  the  Short-term  Course"  and  her 
words  are  significant  to  every  student  of  military  nursiug  ser- 
vice, both  professional  and  volunteer.  She  said  that  the  idea 
of  Red  Cross  service  had  developed  out  of  war  experience ;  that 
the  "aim  of  Red  Cross  societies  was  primarily  to  cocJrdinate 
and  develop  the  volunteer  service  of  the  world;"  that  the  Ameri- 
can Red  Cross  had  chosen  to  develop  a  professional  nursing 
service  thinking  that  this  service  would  afford  the  most  efficient 
nursing  care  to  the  American  ^lilitary  Establishment;  and 
that  the  development  of  this  professional  nursing  service  had 
been  entrusted  in  1009  to  the  American  nursing  profession. 

The  American  Red  Cross  Nursing  Service  thus  stood  alone 
among  the  nursing  sei'\aces  of  national  Red  Cross  societies 
and  this  professional  foundation  evoked,  it  may  be  frankly  ad- 
mitted, considerable  criticism.     Miss  Delano  continued: 

I  confess  that  this  attitude  of  the  American  Red  Cross  was 
viewed  with  more  or  less  suspicion  by  many  of  the  countries 
signatory  to  the  Geneva  Treaty.    It  was  an  innovation.  .  .  . 

About  five  years  ago  [1912]  there  was  held  in  the  city  of 
Wasliington  an  international  conference  of  the  Red  Cross 
organizations  of  tlie  world.  I  had  the  lionor  to  be  a  delegate 
to  that  convention.  Xursing  questions  were  discussed  more 
or  less  throughout  tlie  entire  convention,  because  the  supply- 
ing of  the  service  of  nurses  in  time  of  war  was  always  recog- 
nized as  the  clnef  function  of  the  Red  Cross.  .  .  .  The  fact 
tliat  we  built  the  service  up  entirely  on  professional  service, 
which  is  of  necessity  expensive  and  wliicli  is  restricted  in 
certain  ways  as  it  deprives  the  women  of  tlie  country  of  the 
service  which  they  have  considered  from  time  immemorial 
their  riglit,  this  plan  of  ours  was  viewed  with  more  or  less 
sus})i(ion.  especially  by  tlie  women  of  France,  who  believed 
that  their  ]ilan  was  far  superior  to  ours.  ...  In  this  inter- 
national ((inference  the  American  Red  Cross. — not  the  nurs- 
ing depart nicnt  but  the  American  Red  Cross  of  the  Cnited 
States, — ask(Ml  itself  whether  it  had  done  all  that  it  should  do 
to  provide  for  the  needs  of  war.  .  .  . 

Here  followed  in  ^liss  Delano's  words  a  description  of  the 
project  which  has  been  briefly  alluch^d  to  previously,  with 
referenc(>  to  ^liss  Marion  Oliver's  work  in  organizing  groups  of 
lay  workers,  resembling  the  British  system  of  Voluntary  Aid 
Detachments.     ^liss  Delano  continued: 


958    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

An  oflficer  of  the  Medical  Corps  of  the  Army  then  assigned 
to  Red  Cross  service  was  sent  to  Europe  during  the  summer 
following  the  International  Convention  to  study  the  nursing 
service  of  the  European  countries,  especially  England.  He 
came  back  in  the  late  summer  to  recommend  to  the  Executive 
Committee  of  the  American  Red  Cross  that  an  organization  of 
women  should  be  built  up  in  this  country  along  the  same  lines 
as  the  Voluntary  Aid  Detachments  in  England.  The  course 
was  planned  out,  a  circular  concerning  this  work  was  printed 
and  the  whole  plan  was  laid  out,  to  be  put  into  operation  in 
this  country. 

I  felt  tliat  our  nursing  standards  were  absolutely  threat- 
ened, that  our  Nursing  Service  would  be  of  no  avail  with 
these  groups  of  women  unrelated  to  us,  organized  by  physi- 
cians, taught  by  physicians,  serving  under  their  guidance, 
their  own  leaders  .  .  .  that  our  Xursing  Service  was  seriously 
threatened  and  that  our  nursing  standards  might  all  go  by 
the  board.  .  .  . 

Miss  Delano  then  explained  how  she  had  called  the  National 
Committee  together  (on  November  14,  1912,  in  New  York 
City)  and  had  laid  the  situation  before  them.  Miss  Maxwell, 
Mrs.  Tice,  Miss  Nevins,  ]\Iiss  Nutting,  Miss  Goodrich,  Miss 
Nichols,  Miss  Mclsaac,  Miss  Palmer  and  Miss  Wald  had  been 
present.*     ]\Iiss  Delano  recounted  the  results  of  that  meeting: 

The  whole  question  of  the  organization  of  the  Voluntary 
Aid  Detacliment  was  discussed  at  length  and  I  stood  then 
positively  opposed  to  it.  1  told  the  Red  Cross  that  if  this  plan 
were  put  through  that  I  should  at  once  sever  my  connection 
with  the  Red  Cross ;  that  I  believed  that  every  member  of  the 
National  Committee  and  every  meml)er  of  the  State  and 
Local  Committees  would  go  out  with  me.  That,  to  the  Red 
Cross  at  tliat  time,  was  an  unanswerable  argument  and  it  was, 
I  assure  you.  ...  a  difficult  thing  to  convince  tliem  that  this 
plan  should  be  set  aside  and  they  should  turn  it  over  bodily  to 
us  to  develop.  AVe  took  from  them  that  day  the  responsibility 
for  the  development  of  the  auxiliary  nursing  service  of  the 
American  Red  Cross. 

I  consider  that  practically  a  pledge,  a  promise,  and  for  five 
years  we  have  developed  that  auxiliary  service.  We  have 
built  up  every  step  of  the  way.  detail  after  detail.     We  never 

*  For  furtlier  derails,  soo  ^linutes  of  the  Xational  Committee  on  Red 
Cross  Nursing  Service;  also  the  American  Journril  of  yursing,  December, 
}912, 


AT  NATIONAL  HEADQUARTERS  959 

had  one  single  interference  or  one  word  of  suggestion  from 
the  Ked  Cross  regarding  the  work.  Absolutely  no  pressure 
has  been  brought  to  bear  upon  us  to  modify  or  to  change  or  to 
alter  one  iota  or  one  tittle  of  the  plan.  It  has  been  our  plan. 
It  was  indeed  the  plan  of  the  Red  Cross  and  in  every  step 
that  I  took  in  the  development  of  the  service  I  was  guided 
absolutely  by  the  Xational  Committee,  representing  first  the 
American  Nurses'  Association  and  second  equal  representation 
from  the  three  national  organizations  of  nurses.  Even  the 
name  .  .  .  A^olunteer  Xurses'  Aide,  was  selected  by  the  Com- 
mittee after  careful  discussion  .  .  .  but  more  than  that,  the 
women  of  this  country  accepted  our  leadership.'^ 

Miss  Delano  then  explained  how  the  course  of  instruction 
in  Home  Hygiene  and  Cure  of  the  Sick  had  been  used  as  a  basis 
of  selection  for  the  groups  of  laywomen  and  how  the  hospital 
training  of  nurses'  aides  for  the  base  hospital  units,  had  been 
the  next  step.  At  every  move,  the  plans  for  the  development  of 
the  service  were  discussed  with  leaders  of  the  nursing  profes- 
sion then  serving  as  members  of  the  National  Committee  on 
Red  Cross  Nursing  Service.     Miss  Delano  said  further: 

I  hold  no  brief  for  nurses'  aides  as  such,  but  I  do  hold  a 
brief  for  your  obligations  and  giving  your  word  and  then 
standing  by  it.  For  I  am  absolutely  in  sympathy  with  any 
plan  that  will  help  meet  the  needs  of  the  country  to-day.  The 
Eed  Cross  stands  ready  to  cooperate,  in  any  way  possible,  in 
any  plan  which  the  Surgeon  General  adopts  to  meet  the  needs 
of  the  military  hospitals  to-day.  .  .  .  But  I  do  not  believe  that 
any  plan  suggested  now  would  relieve  us  of  the  obligation 
w^hich  we  definitely  assumed  five  years  ago  and  I  believe  that 
the  nursing  profession  will  stand  reproached  by  the  ])eople  of 
America  if  they  repudiate  the  responsibilities  which  they 
fought  to  secure. 

I  have  expressed  myself  as  entirely  willing  to  put  all  the 
resources  of  the  Eed  Cross. — and  the  resources  of  the  Eed 
Cross  to-day  are  not  insignificant. —  ...  at  the  disposal  of 
the  Army,  to  cooperate  in  any  plan  that  the  Surgeon  Oeneral 
brings  forward.  We  shall  go  forward  with  just  as  much  zeal 
and  help  in  securing  a  staff  for  training  schools  if  this  should 
be  thought  necessary  to  be  done,  as  we  were  in  trying  to 
provide  aides  for  this  service.  .  .  .  Tt  is  not  at  all  a  question 
for  us  of  one  thing  as  against  the  other.     We  are  willing  to 

'  Twontv-fmirtli  Annual  Ilcport  of  the  Loapiu?  of  Xursiiip  Education,  pp. 

i()2-it;;i. 


960  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

help  in  any  way  we  can,  in  any  way  we  possibly  can.  But  I 
shall  never,  so  long  as  I  stand  at  the  head  of  the  Red  Cross 
Nursing  Service,  repudiate  the  solemn  obligation  we  have 
assumed.® 

Miss  Delano  then  stated  her  opinion  of  the  proposed  Army 
School  of  Nursing: 

Personally,  I  do  not  believe  that  the  establishment  of  a 
training  service  will  meet  the  needs.  I  do  not  believe  it  can  be 
put  into  operation  quickly  and  promptly  enough  to  meet  the 
need  when  our  troops,  who  are  now  in  service,  are  brought 
back  to  this  country.  I  do  not  say  by  that  that  I  disapprove 
of  the  idea  of  a  training  service  or  of  trying  it.  I  think  it  is 
worth  while  to  try  anything  that  will  meet  the  emergency 
when  it  comes,  because  it  is  surely  coming. 

If  it  be  schools,  in  carefully  selected  places,  I  say  let's  try 
and  get  students  for  them.  I  feel  that  it  is  for  the  Nurses' 
Association  and  those  who  are  more  familiar  with  the  influence 
of  training  schools  to-day  to  decide  whether  this  question  of 
the  Army  training  schools  is  going  to  be  a  greater  menace 
than  the  selection  of  the  nurses'  aides  for  training.  I  do  not 
pass  on  that.  It  is  a  technical  question.  .  .  .  But  I  do  feel 
that  there  is  a  place  in  the  small  hospital  for  hands  and  for 
feet  more  or  less  trained.  .  .  .'^ 

Although  Miss  Delano  was  primarily  a  nurse  and  regarded 
herself  as  the  representative  in  the  Red  Cross  of  the  American 
Nurses'  Association,  she  presented  at  this  meeting  in  part  the 
continental  point  of  view  and  thus  sponsored  the  cause  of  the 
laywoman.  ''To  help  win  the  war  and  to  give  adequate  care 
to  the  sick  and  wounded,"  wrote  ]\Iiss  Palmer  in  the  Journal, 
"was  her  religion  from  the  day  that  war  was  declared.  Xext 
to  that  came  her  aspiration  to  have  the  rank  and  file  of  tlie 
American  Nurs(>s'  Association  satisfied  with  her  work  as  their 
representative  in  the  Tied  Cross.   .   .   ." 

Miss  Delano's  next  words  expressed,  in  part,  this  intense 
and  earnest  patriotism  which  lighted  her  whole  Red  Cross 
service : 

What  T  want  to-day  is  for  the  nurses  of  the  country  to 
forget  everytliing  except  the  importance  of  the  need  at  this 

"  Twpntv-foiirtli   Annual  Eeport,  N.  L.  X.  E.,  p.  105. 
'  Ihid.,  p.  IGG. 


AT  NATIONAL  HEADQUARTERS  961 

time.  If  we  can  meet  it  one  way,  let's  move  heaven  and  earth 
to  meet  it  that  way.  If  that  is  not  enough,  let  us  be  broad- 
minded  and  meet  it  any  way  we  can. 

Miss  Delano  then  discussed  the  possibility  of  securing  enough 
graduate  nurses;  the  possibility  of  securing  transportation  over- 
seas for  these  nurses ;  the  wisdom  and  necessity  of  holding  these 
nurses  in  military  base  hospitals  in  France,  where  they  might 
perhaps  be  idle  for  months  in  order  that  when  an  unexpected 
drive  occurred  and  the  wounded  w^ere  sent  back  to  the  bases, 
they  might  be  on  hand  and  prepared  to  nurse  the  men.  She 
next  brought  up  the  utilization  of  soldier-orderlies  in  hospitals. 
She  said: 

No  one  speaks  of  the  able-bodied  men  in  the  hospitals. 
Nobody  tells  you  that  to-day  there  are  115,000  able-bodied, 
strong  men  in  the  Army  hospitals  alone,  doing  work  for 
which  they  are  not  in  any  way  fitted  or  trained  or  prepared, — 
115,000  able-bodied  men  doing  very  hard  work  in  military 
hospitals,  running  and  waiting  on  patients  more  or  less  effi- 
ciently. We  are  talking  about  10,000  nurses  whom  we  have  in 
the  Army  hospitals  but  we  forget  that  for  the  10,000  women 
we  have  115,000  able-bodied  men.  The  Surgeon  General  in 
my  office  the  otlier  day  spoke  about  that  very  question.  He 
said  he  was  anxious  for  the  number  of  able-bodied  men  serving 
in  military  hospitals  instead  of  out  learning  to  fight.  And 
these  men  arc  the  pick  of  the  nation,  all  young,  able-bodied, 
strong,  ambitious  men,  like  a  lot  of  running  horses  tied  down 
to  drawing  carts.     It  is  not  right. 

Those  men,  I  Ijelieve,  should  bo  re])laced  l)y  women.  .  .  . 
Now,  1  say,  let  us  provide  the  super\ision  of  the  finest  women 
we  can  find,  and  let  us  supjjlemcnt  that  force  with  women 
trained  or  in  ])rocess  of  being  trained,  so  tluit  these  115,000 
men.  or  at  least  a  large  proportion  of  them,  can  be  sent  out 
to  training  and  commissions.  Doesn't  that  sound  reason- 
able? ... 

For  1  cannot  believe  that  we  should  use  at  this  time  the 
services  of  our  graduate  nurses  to  sit  dowii  and  feed  our  help- 
less men  in  the  war;  I  believe  that  women  of  common  sense  or 
judgment,  a  student  or  aide  or  whatever  she  is,  could  do  those 
services  acce])tal)ly  and  that  a  vcrv  grave  responsiljility  will 
rest  upon  us  if  ultimately  we  prevent  from  drawing  into  the 
hospitals  a  sufficient  number  of  women,  trained  students  or 
aides,  to  meet  the  military  needs.** 

*  Twonty-fourtli  Animal  Ucport,  X.  L.  N.  E.,  ])p.  IfiT-KiO. 


962   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Delano  closed  her  address  with  a  plea  for  the  lay  aides : 

As  far  as  the  Red  Cross  is  concerned,  we  have  nothing  to 
recommend.  We  stand  ready  to  cooperate  with  any  plan 
brought  forward  by  the  Surgeon  General.  The  only  point 
that  I  think  important,  and  1  will  make,  is  that  we  are  not 
fair  to  the  women  of  this  country  if  we  say  absolutely  after 
five  years  of  building  up  a  service  for  them  and  they  are  not 
yet  accepted  to-day, — if  we  say,  "we  will  have  none  of  you." 

I  think  we  have  prejudiced  our  profession  in  the  minds  of 
the  public  by  this  attitude  more  than  by  anything  that  has 
ever  happened.  I  have  heard  things  that  might  never  come 
to  the  ears  of  others  and  I  know  that  there  is  underneath,  in 
the  spirit  of  the  women  of  this  country,  a  feeling  that  they 
have  been  dealt  with  most  unfairly;  and  I  assure  you  that  I 
will  not  take  part  in  anything  that  eliminates  absolutely  the 
women  of  this  country  whose  loved  ones  are  serving  in 
France.^ 

Miss  Delano  left  the  platform  and  immediately  the  president 
of  the  National  League  of  Nursing  Education  called  upon  Miss 
Goodrich  to  present  her  "Plan  for  the  Army  School  of  Nurs- 
ing." Miss  Goodrich  spoke  with  her  usual  brilliant  powers. 
The  chairman  then  called  for  discussion  and  a  spirited  re- 
buttal took  place.  Finally  Miss  Niitting  threw  her  influence 
as  a  well-loved  and  trusted  leader  toward  the  acceptance  of  Miss 
Goodrich's  plan. 

The  nursing  profession  may  well  be  said  to  have  stood,  on 
this  May  morning,  at  the  cross-roads.  Miss  Goodrich  beckoned 
at  one  fork  for  them  to  follow  her,  Miss  Delano  at  the  other. 
The  tension  of  the  meeting  had  grown  very  high.  After  further 
discussion,  the  chairman  put  the  question  to  a  vote.  Miss 
Powell  moved  "that  the  Army  School  of  Nursing  as  planned 
by  Miss  Goodrich  be  endorsed  by  the  three  organizations,"  the 
motion  was  amended  to  read  "as  planned  by  the  committee" 
and  was  passed.  This  endorsement  of  the  Army  School  by  the 
three  national  organizations  of  nursing  Avas  sent  to  Washington, 
the  Secretary  of  War  approved  the  plan  on  ]May  24,  1918,  and 
the  development  of  the  School  was  immediately  begun.-® 

»  Twenty-fourth  Annual  Report,  X.  L.  X.  E.,  p.  lOfl. 

'"On  May  10,  1018,  a  nieetint;  of  tlie  Xational  Committee  on  Red  Cross 
Xursin^r  Service  was  lield  in  Cleveland  and  tlii.s  whole  question  was  again 
discussed.  The  Minutes  of  the  meijtijip  record  that  Miss  Xutting  moved 
"tliat  the  jueinbers  of  tlie  Xational   Committee  give  their  support  to  the 


AT  NATIONAL  HEADQUARTERS  963 

On  June  8,  1918,  Miss  Delano  wrote  to  Miss  Palmerj  editor 
of  the  Journal: 

The  discussions  concerning  the  Army  School  for  Nurses' 
Aides  seems  to  liave  developed  into  very  much  of  a  feud  .  .  . 
with  Colonel  Smith,  Miss  (Joodrich  and  followers  represent- 
ing one  side  and  Dr.  (Jolthvater  and  his  foUowers,  largely  the 
American  Hospital  Association,  on  the  other  side.  I  am  kept 
husy  trying  to  steer  my  craft  hctween  the  hreakers,  helieviiig 
as  1  do  that  hoth  si(U's  are  right  and  hoth  sides  are  wrong. 
With  your  understan(iing  mind,  you  will  know  what  1  mean. 

1  I)elieve  the  school  idea  a  good  thing  to  try  out  and  one 
more  way  to  lielp  meet  the  need  and  if  carried  out  along 
])retty  definite  lines  and  with  definite  affdiations  with  civilian 
schools,  ought  not  to  disrupt  the  training  schools  of  the 
country. 

On  the  other  hand,  I  helieve  we  are  entirely  justified  in 
using  women  who  are  past  the  age  for  admissi(jn  to  this 
school  for  minor  ])ositions  in  military  hospitals,  such  as  the 
care  of  linen  rooms,  serving  diets,  feeding  of  patients  and  a 
thousand  and  one  details  whicli  our  graduate  nurses  have  no 
time  to  do.  .  .  . 

On  July  22,  1918,  General  Gorgas  wrote  to  Mr.  Davison: 

Understanding  that  General  Noble  told  you  when  at  Camp 
^leade  the  otlu'r  day  something  of  our  recently  established 
Army  School  of  Nursing,  1  am  enclosing  a  report  of  the 
conunittce  ajipointed  to  prepare  the  plan  of  the  school,  which 
may  interest  you.  A\"ith  comparatively  little  publicity,  a  very 
great  interest  lias  been  aroused  and  we  have  not  only  received 
over  1(),()(H)  letters  of  inquiry  from  would-be  candidates,  but 
have  actually  on  file  over  1000  completed  applications  a  large 
majt^rity  of  which  meet  our  requirenuMits  for  admission. 

^lay  1  say  that  we  are  indebted  for  this  enrollment  in  no 
small  measure  to  the  various  Ked  Cross  Divisions  and  Cha})- 
ters  throughout  the  country  that  have  constantly  recruited 
for  us.  It  is  my  belief  that  this  hearty  res])onse  to  the  appeal 
of  the  school,  together  with  the  recruiting  drive  for  a  student 
reserve  body  of  "jrj.ooo  which,  as  you  know,  tlu'  Woman's 
Committee  of  Xational  Defense  with  the  endorseiiuMit  of  the 
IJed  Cross  and  this  otlice  is  undertaking,  to  jirovide  an  in- 
creased munber  of  students  for  the  civil  bos]utals,  as  well  as 

])r()iii>s(<(l  Army  Sduicil  in  military  hospitals  ami  that  tlicN'  bend  all  t>fTorts 
to  hriiiLT  it  into  cxistctK  c.  Icavinjr  the  (lucstioii  of  aides  in  abfViince 
until  this  is  scttli'd."     This  motion  was  seconded  and  carried. 


964   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  military,  will  meet  our  arising  needs  and  that  we  need  not 
further  consider  the  preparation  of  aides  through  shorter  and 
more  superficial  courses.  It  is  obvious  that  should  the  supply 
of  graduate  nurses  prove  inadequate  for  the  overseas  service, 
this  student  group  will  render  the  most  satisfactory  service 
and  will  be  the  next  to  go. 

I  understand  that  you  are  preparing  aides  to  supplement  the 
work  of  the  public  health  nurses  in  France  and  Italy.  In 
order  not  to  deflect  desirable  students  from  the  more  con- 
structive and  comprehensive  preparation  provided  through 
the  Army  School  of  ISTursing,  and  also  to  avoid  any  mis- 
understanding and  disappointment  on  the  part  of  the  young 
women  taking  these  courses,  may  I  ask  you  to  direct  those  in 
charge  of  this  branch  of  work,  especially  those  who  are  con- 
cerned with  the  publicity,  to  make  it  clear  to  these  students 
that  these  courses  will  not  lead  to  a  nursing  service  in  the 
Army. 


By  November,  1918,  the  Army  School  had  1099  students  on 
duty  in  twenty-five  military  hospitals  in  the  United  States,  567 
more  waiting  assignment  and  a  total  of  10,689  applications 
filed. 

The  rejection  of  her  proposal  for  the  utilization  of  Red  Cross 
aides,  as  contained  in  the  endorsement  of  the  Army  School  by 
the  American  Nurses'  Association  at  the  Cleveland  meeting, 
may  bo  said  to  have  marked  the  crisis  of  Miss  Delano's  pro- 
fessional career.  For  the  first  time,  the  rank  and  file  of  nurses 
had  not  followed  her.  Unquestionably,  pressure  had  been 
brought  to  bear  on  the  Red  Cross  from  infiuential  groups  out- 
side of  the  organization.  j\Iiss  Delano's  words  show  that  she 
felt  that  the  nursing  profession,  in  its  continued  rejection  of 
lay  assistance,  was  not  true  to  the  trust  which  the  National  Com- 
mittee had  assumed.  In  this  meeting,  Miss  Delano  had  carried 
her  cause  into  the  open,  had  defended  and  lost  it. 

On  the  other  hand,  the  strong  professional  group  may  have 
thought  they  saw  in  ]\Iiss  Delano's  championship  of  the  lay- 
worker  a  desertion  of  the  fundamental  principles  of  the  nursing 
profession,  a  bending  before  the  winds  of  Red  Cross  opinion. 
The  principle  of  the  sentimentalist  versus  the  trained  worker, 
as  old  as  American  war  nursing,  had  raised  its  bead  again  and 
nurses  may  have;  thought  they  saw  in  ]\Iiss  Delano  a  recently 
won  but  powerful  ally  of  the  traditional  influence  of  th(^  con- 
tinental Red  Cross  societies,  so  inhibiting  to  efficient  nursing 


AT  NATIONAL  HEADQUARTERS  965 

service.  Miss  Nutting  and  Miss  Goodrich  had  spent  their 
lives  in  trying  to  better  the  standards  of  nursing  education; 
their  words  spoken  at  the  May  meeting  show  that  they  did  not 
possess  sufficient  knowh'dge  of  the  military  and  nursing  situa- 
tion overseas  to  recognize  the  seriousness  of  the  existing  short- 
age of  nurses,  a  shortage  which  was  then  estimated  at  1121 
nurses.  This  was  the  time  when  the  statement  was  made  in  the 
Chief  Surgeon's  office  that  "a  breakdown  in  medical  service  was 
threatened"  and  on  May  3  a  cable  had  been  sent  to  the  War 
Department  asking  for  the  immediate  dispatch  of  555  nurses, 
but  even  with  these  reC-nforcements,  it  is  hard  to  conceive  how 
the  War  Department  could  have  thought  that  a  nursing  service 
overseas  of  some  twenty-five  hundred  nurses  would  be  able 
to  care  for  the  casualties  of  the  then  clearly  anticipated  offen- 
sives of  May,  June  and  July. 

Because  of  the  Surgeon  General's  call  for  fifty  thousand 
nurses  by  June  1,  1011),  Miss  Delano  felt  that  it  was  highly 
unsafe  to  trust  to  a  slow,  constructive  up-building  of  an  edu- 
cational system  like  the  Army  School ;  she  felt  that  it  was  even 
then  a  time  for  emergency  action.  On  the  other  hand,  Miss 
Nutting  and  Miss  Goodrich  did  not  think  the  military  crisis  as 
imminent  as  it  really  was  and  in  view  of  their  long  struggle  for 
nursing  advancement  and  standards,  it  can  readily  be  under- 
stood how  they  should  have  continued  to  lay  the  greatest  em- 
phasis upon  phases  of  nursing  education. 

As  for  ]\Iiss  Delano,  the  Cleveland  meeting  marked  her  last 
public  appearance  before  the  nursing  profession  and  in  the 
memories  of  thousands  of  nurses  her  image  as  she  appeared 
that  day  was  indelibly  stamped.  For  t\w  remaining  eleven 
months  of  her  life,  ^liss  Delano  kept  her  own  councils.  How- 
ever, it  was  not  during  these  last  months  that  she  was  first  called 
politic.  She  had  always  been  a  silent  woman,  talking  little  to 
her  sister  nurses  regarding  her  hopes  and  plans.  Among  them, 
however,  a  strong  fraternal  spirit  of  inter-relianct^  and  confi- 
dence had  developed;  pioneers  all  of  them  and  intensely  eager, 
they  had  shared  their  hopes  and  the  stories  of  their  struggles 
with  each  other,  but  Miss  Delano  had  never  taken  them  fully 
into  her  confidence.  Because  they  did  not  know  her  well,  per- 
haps because  they  were  not  given  the  chiince  to  know  her  well, 
they  distrusted  her  to  som(>  extent.  However,  it  is  undoubtedly 
true  that  the  nursing  and  general  pulilic  did  not  sei^n  to  appre- 
ciate, in  the  spring  and  ^ununer  of  1!>1S,  the  real  and  impera- 


966    HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tive  need  for  immediate  reenforcement  of  the  nursing  service  as 
Miss  Delano  appeared  to  know  or  at  least  to  sense  it.  The 
War  Department  could  not  make  public  the  true  sanitary  situa- 
tion in  France  in  May  and  June  of  1918.  Miss  Delano,  how- 
ever, had  been  for  ten  years  a  student  of  sanitary  theory  and 
practice  and  with  that  uncanny  gift  called  vision,  she  was  able 
to  look  ahead  and  visualize  the  conditions  which  later  existed 
in  military  hospitals  in  the  zone  of  the  base  and  the  advance, 
conditions  already  described  in  preceding  chapters.  Many  of 
her  listeners  that  ^May  morning  in  Cleveland  must  have  felt 
that  she  was  taking  an  unduly  pessimistic  view  of  the  situation. 
Yet  on  that  May  morning  she  was  like  a  prophet  crying  in  the 
wilderness — with  voice  not  heeded. 

To  the  student  of  history  the  whole  controversy  well  illus- 
trates the  irony  and  even  the  tragedy  of  war.  On  the  days 
when  the  nursing  profession  was  preparing  to  argue  these 
theories  at  the  Cleveland  meeting,  the  Germans  had  struck 
their  second  great  blow  on  the  Western  Front,  this  time  in  the 
Armentieres  sector ;  they  had  advanced  seventeen  miles  up  the 
Lys  valley,  had  finally  been  repulsed  and  during  the  first  three 
weeks  of  May  were  massing  their  forces  for  their  third 
major  ofi^ensive,  an  offensive  during  which  the  fate  of  Paris 
and  the  Allied  cause  hung  in  the  balance.  Knowledge  of  the 
extreme  military  crisis,  however,  was  then  not  fully  known  or 
made  public,  and  indeed  neither  student  nurses  nor  Red  Cross 
aides  nor  all  the  graduates  then  in  civilian  hospitals  in  the 
United  States  could  have  relieved  the  nursing  shortage  existing 
late  in  May  and  early  in  June  in  France — for  there  were  no 
ships  available  to  carry  them  overseas.  Throughout  the  last 
year  of  the  European  War  and  especially  during  the  summer 
of  1918,  many  hundreds  of  nurses  were  kept  marking  time  at 
Ellis  Island,  because  precedence  in  transportation  was  neces- 
sarily given  to  combat  troops  and  supplies. 

^'We'll  do  it  another  way !"  IMiss  Delano  declared  after  the 
Cleveland  meeting  had  adjourned.  Following  the  acceptance 
of  the  Army  Scliool  as  a  substitute  for  her  plan  of  utilizing 
Red  Cross  aides  to  supplement  professional  military  nursing 
service,  tlic  recruiting  of  a  sufficient  number  of  graduate  nurses 
to  meet  the  militnrv  needs  seemed  to  ^liss  Delano  the  only  way 
out.  This  was  tlie  first  duty  of  the  Red  Cross  J^Tursing  Service 
and  INIiss  Delano  knew  tbat  the  executives  at  National  Head- 
quarters would  put  no  obstacles  in  the  way  of  her  purposes  and 


AT  NATIONAL  HEADQUARTERS  967 

plans.  She  knew  that  she  possessed  the  complete  confidence  of 
the  War  Council,  for  once  ]\Ir.  Davison  had  said :  "Do  as  you 
think  best,  Miss  Delano.  Keep  us  informed  of  your  general 
plans  and  of  the  money  you  need,  but  go  ahead  yourself.  Even 
if  you  make  mistakes,  you  know  more  about  Ked  Cross  nursing 
than  any  other  woman  or  man  we  could  get  to  handle  it." 

Miss  Delano  and  her  assoqiates  returned  to  Washington  and 
to  Division  headquarters  and  during  the  torrid  summer  months 
flung  themselves  into  the  recruiting  of  graduate  nurses.  8he 
and  ]\Iiss  Noyes  built  up  an  office  force  at  National  Head- 
quarters of  over  one  hundred  persons.  The  Division  staffs  wore 
enlarged  and  the  entire  Ked  Cross  ^Nursing  Service,  with  its 
State  and  Local  Committees,  bent  its  energies  almost  solely  to 
securing  graduate  nurses. 

The  total  number  of  nurses  needed  was  divided  into  thirteen 
parts  and  a  quota,  based  upon  the  nursing  resources  of  each 
locality,  was  given  to  each  Division  Director  of  Nursing  and 
she  was  charged  with  the  responsibility  of  securing  her  quota. 
The  following  statistical  table  is  of  interest: 


Assignments 

First 

Assignments 

Allotment 

Allotment 

to  August  1 

Still  Due 

Atlantic 

5708 

2000 

3108 

45% 

Central 

,-5940 

2311 

1629 

58% 

Gulf 

8fi4 

324 

540 

37% 

Lake 

2748 

1205 

1543 

43% 

^Mountain 

2G4 

221 

43 

83% 

New  England 

3318 

13G0 

1958 

41 7o 

Nortliern 

11G5 

598 

567 

50% 

Xortliwestern 

641 

386 

255 

60% 

Pacific 

1030 

899 

187 

87  7o 

Pennsylvania 

2154 

1302 

852 

60% 

Potomac 

1300 

764 

602 

56% 

Soutliern 

1371 

382 

989 

28  7o 

Soutlnvostern 

2425 

995 

1430 

41 7o 

The  effects  of  the  ^'nurses'  drive"  have  been  given  in  a  previ- 
ous chapter.  For  the  five  months  beginning  July  1  and  ending 
December  1,  11,118  luirscs  were  enrolled,  an  average  of  2220 
nurses  a  month.  Tn  one  month  alone  of  that  historic  summer, 
the  American  Red  Cross  secured  and  assigned  to  the  ^lilitary 
Establishment  over  twice   as  manv  graduate  nurses   as  there 


968   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

were  students  supplied  by  the  Army  School  during  the  entire 
period  of  hostilities. 

In  July,  1918,  the  Comptroller  of  the  United  States  Treasury 
rendered  to  the  Secretary  of  War  a  decision  of  injustice  to 
Army  nurses.  Information  as  to  this  ruling  and  its  possible 
effect  upon  the  nursing  situation  was  contained  in  the  follow- 
ing letter  of  protest  written  on  August  31  by  Miss  Noyes,  as 
president  of  the  American  I^urses'  Association,  to  the  Honor- 
able W.  W.  Warwick,  comptroller  of  the  U.  S.  Treasury : 

On  July  16,  you  rendered  a  decision  to  the  Secretary  of 
War  to  the  effect  that  members  of  the  Army  ISTurse  Corps  who 
may  be  taken  as  prisoners  of  war  are  not  entitled  to  pay 
during  captivity. 

I  feel  sure  that  you  were  not  familiar  with  the  history  of 
the  organization  of  the  Army  Xurse  Corps  and  its  legal 
relation  to  the  Army,  when  you  rendered  this  decision.  As 
president  of  the  American  Nurses'  Association,  which  is  affili- 
ated with  the  Eed  Cross  and  assumed  with  it  the  responsibil- 
ity of  organizing  the  graduate  nurses  of  this  country  as  a 
reserve  of  the  regular  Army  Xurse  Corps,  I  was  filled  with 
dismay  when  I  read  your  decision. 

Keudered  at  a  time  when  the  Government  was  appealing  for 
a  thousand  nurses  a  week  for  service  with  the  Army,  your 
decision  could  not  help  but  be  destructive  to  their  enrolhnent. 
It  is  therefore  a  vital  IdIow  at  the  welfare  of  our  soldiers. 

Approximately  fifteen  thousand  nurses  are  in  service  with 
the  Army  and  Xavy.  These  nurses  who  have  already  entered 
the  service  and  those  al)0ut  to  enroll  should  liave  every  assur- 
ance that  the  government  is  ready  to  jirotect  them  in  their 
hazardous  work  and  safeguard  them  in  their  statutory  rights. 
Will  you  not  be  willing  to  give  them  this  assurance? 

On  S(^ptembor  27  a  decision  was  rendered  by  the  Comptroller 
of  the  Treasury  which  reversed  the  ruling  of  July  16.  It  was 
addressed  to  the  Secretary  of  War  and  contained  the  following 
paragraphs : 

In  view  of  unusual  conditions  that  have  arisen,  I  am  of  the 
opinion  tliat  from  the  time  any  member  of  the  Army  Xurse 
Corps  is  a  prisoner  of  war  held  ])y  the  enemy,  without  fault 
on  her  ]iart  as  to  her  capture,  her  absence  from  duty  should 
be  excused  as  unavoidable  and  she  be  treated  as  in  a  full  pay 
status. 


AT  NATIONAL  HEADQUARTERS  969 

The  decision  of  July  KJ,  1918,  is  niodided  accordingly. 
As  to  field  clerks  and  members  of  the  Army  Xurse  Corps 
reported  "missing,"  my  decision  is  similar  to  that  given  in 
the  cases  of  oflicers  and  enlisted  men  reported  "missing" 
(25  Comp.  Dec,  3(5)  and  is  as  follows:  No  definite  general 
rule  that  shall  cover  pay  of  field  clerks  and  members  of  the 
Army  Xurse  Corps  reported  "missing"  in  action  or  otiierwise 
missing  shall  be  formulated.  "Their  pay  should  be  withheld 
until  their  status  can  be  definitely  ascertained.  In  case  no 
information  estal)lishiiig  their  status  can  be  obtained,  indi- 
vidual cases  must  be  considered  on  their  merit  and  determined 
upon  such  evidence  as  may  be  obtainable."  ^^ 

Another  trying  condition  which  Miss  Noyes  met  was  the 
refusal  of  wealthy  chronic  patients,  some  of  whom  were  in 
health  good  enough  to  permit  them  to  go  to  their  olTices  every 
day,  to  give  up  their  private  nurses.  Another  minor  difficulty 
was  encountered  in  the  protests  of  doctors  who  refused  to  re- 
lease for  military  service  office  nurses  whcmi  they  wished  to 
retain  to  hold  their  practice  together  while  they  themselves 
went  into  the  Army.  Protests  also  came  from  owners  of  small 
private  hospitals,  who  refused  to  give  up  their  graduate  special 
luirses.  In  this  respect,  however,  many  small  private  hospitals 
were  patriotic  enough  to  close  their  doors  entirely  for  the  period 
of  the  war. 

On  August  1  the  Surgeon  General  issued  his  historic  call 
for  a  "thousand  nurs(^s  a  week  for  a  period  of  eight  weeks." 
The  strain  at  National  Headquarters  grew  intense,  ^[oreover, 
Washington  was  overcrowded  and  was  suffering  from  record- 
breaking  heat.  In  a  letter  addressed  September  .5  to  Miss 
De  Long  in  Italy,  Miss  Noyes  wrote: 

The  work  at  National  Headquarters  has  never  been  so  diffi- 
cult and  is  now  overwhelming  us.  The  demand  for  one 
thousand  nurses  a  week  by  the  Surgeon  Ceneral  has  made  it 
necessary  for  everyone  to  buckle  down  to  work  from  one  (Mid 
of  the  Ignited  States  to  the  other  in  order  to  rout  out  every 
possible  nurse  from  her  hiding  jilace. 

We  have  done  a  tremendous  piece  of  work,  ^'esterday  we 
sent  the  papers  of  '['24  nurses  io  tiie  War  DeiJartnieut.  tlie 
day  before  l.'V2.  and  ibey  average  i^t!  per  dav.  There  will  be 
no  nurses  left  in  civil  life  if  we  ke(>p  on  at  this  rate.   .   .  . 

"  Decisions  of  the  Comptroller,  U.  S.  Treasury,  Arniv  Field  Clerks, 
A.   G.  ().,  221.51;    p.   6. 


970   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

There  seems  to  be  an  impression  abroad  that  the  war  may 
end  in  1919. 

At  this  critical  moment  an  unfortunate  newspaper  article 
had  a  definitely  inhibiting  effect  on  recruiting.  A  personal 
interview  with  the  chairman  of  the  Committee  on  Nursing  of 
the  Council  of  National  Defense  was  so  written  as  to  sound 
official  and  unduly  optimistic.  Lest  the  impression  given  by 
this  article  should  deter  nurses  from  entering  military  service, 
the  Acting  Surgeon  General  of  the  Army  issued  a  public  state- 
ment of  the  actual  nursing  conditions  and  also  stated  it  in  a 
letter  written  September  7  to  ]\rajor  Franklin  Martin,  then 
chairman  of  the  Medical  Board,  Council  of  National  Defense : 

At  least  25,000  graduate  nurses  will  be  needed  by  January 
or  as  soon  as  they  can  possibly  be  obtained.  There  are  at  pres- 
ent somewhat  over  1G,000  graduate  nurses  on  duty  at  home 
and  abroad.  This  number  by  no  means  meets  the  need  of  the 
present  situation,  owing  to  the  fact  that  large  numbers  of 
troops  are  being  sent  overseas  weekly.  The  Ked  Cross  reports 
that  over  9000  additional  graduate  nurses  must  be  enrolled 
before  January  1  to  meet  this  need.  In  the  Atlantic  Division 
alone,  which  includes  New  York  City,  2452  additional  nurses 
must  be  enrolled  to  complete  their  quota.  It  will  be  impos- 
sible for  the  Army  School  of  Nursing  to  be  of  any  great  assist- 
ance in  solving  the  nursing  problem  of  military  hospitals 
during  the  present  year.  Only  221  students  have  as  yet  been 
assigned  to  seven  (7)  cantonment  hospitals  and  105  additional 
are  under  orders  to  proceed,  but  they  cannot  be  relied  upon  to 
take  the  place  of  graduate  nurses,  as  they  are  expected  to 
serve  a  four  months'  probation  with  only  a  limited  number  of 
hours  in  the  wards  of  the  hospital  during  this  probationary 
period. 

It  is  rocjuested  tliat  such  action  as  may  be  necessary  be 
taken  to  correct  this  statement,  in  order  that  the  public  and 
the  nurses  may  be  informed  of  the  true  situation  and  that  the 
work  of  recruiting  nurses  shall  not  be  interfered  with.  .  .  . 

This  incident  was  also  of  some  importance  in  that  it  illustrated 
the  danger  of  misunderstanding  which  may  arise  when  two 
national  committe(>s  such  as  the  Committee  on  Nursing  of  the 
Council  of  National  Defense  and  the  National  Committee  on 
Red  Cross  Nursing  Scuwice  were  both  operating  in  the  field. 
In  the  fall  of  101 S  tlic  n\irsing  needs  of  the  civilian  popula- 


AT  NATIONAL  HEADQUARTERS  971 

tion  engulfed  the  American  Red  Cross.  Late  in  August,  Span- 
ish influenza  broke  out  among  the  men  of  the  Navy  Receiving 
Ship  in  Boston  Harbor  and  swept  across  the  United  States 
during  September  and  October.  The  first  call  for  Red  Cross 
assistance  came  on  September  14  from  the  United  States  Public 
Health  Service,  for  nursing  personnel  for  the  Quarantine  Sta- 
tion, Boston  Harbor.  Almost  simultaneously,  calls  began  to 
come  in  from  all  parts  of  New  England  and  from  Washington, 
D.  C.  Within  a  few  weeks  the  infection  had  become  pandemic 
in  the  eastern  cantonments  and  spread  from  the  soldiers  to  the 
civilian  population  and  thence  westward.  One  thousand 
nurses,  it  will  be  remembered,  had  been  withdrawn  from  the 
cantonment  nursing  stafts  and  had  arrived  in  August  in 
France.  True,  the  American  Red  Cross  had  sent  the 
papers  of  2700  additional  nurses  to  the  Surgeon  General's 
office  in  August  alone,  but  it  took  some  time  to  assimilate  these 
nurses  into  the  Military  Establishment.  On  September  7  the 
Army  School  had  only  221  students  on  duty  in  seven  canton- 
ment hospitals,  according  to  the  Acting  Surgeon  General's  let- 
ter of  September  7  addressed  to  Dr.  Martin.  These  students 
were  "green  probationers"  and  it  was  estimated  that  it  would 
take  four  months  of  training  before  their  services  would  be  of 
material  value.  The  truly  desperate  condition  which  existed 
in  the  cantonment  and  Naval  hospitals  during  that  memorable 
September  and  October  of  1918  has  already  been  described. 
Colonel  Ayres  wrote  : 

More  than  40,000  died  of  pneumonia.  Of  these,  probably 
25,000  resulted  from  the  influenza-pneumonia  pandemic 
which  swept  through  every  camp  and  cantonment  in  this 
country  and  caused  thousands  of  deaths  in  the  Expeditionary 
Forces.  Up  to  September  14,  1918,  only  9840  deaths  from 
disease  had  occurred  in  the  Army  and  the  death  rate  for  the 
period  of  the  war  up  to  that  time  was  only  5  per  year  for  each 
1000  men. 

During  the  eiglit  weeks  from  September  14  to  the  8tli  of 
November,  31(),089  cases  of  influenza  and  53.449  of  pneu- 
monia were  reported  among  troops  in  tliis  country.  The  ex- 
plosive character  of  the  epidemic  is  shown  in  diagram  50 : 
[83.G9r  of  the  total  deaths  were  from  ])neumonia|.  It 
reached  its  high  ])oint  the  secoiid  week  in  October,  when  four 
out  of  every  1000  troo})s  under  arms  in  this  country 
died.  .  .  .1-  " 
"  "Tlie   War   with   Cerniany,"   pp.    r2r)-12G. 


972  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  situation  among  the  civilian  population  was  equally 
critical  and  responsibility  for  aid  was  vested  in  the  United 
States  Public  Health  Service  and  the  American  Red  Cross. 
At  National  Headquarters  a  meeting  was  called  at  which  were 
present  representatives  of  the  Surgeon  Generals  of  the  Army, 
the  Navy  and  the  Public  Health  Service  and  of  the  Red  Cross 
and  a  preliminary  plan  for  affording  nursing  relief  was  formu- 
lated. ]\Iiss  Delano  was  then  in  Atlantic  City  attending  a 
meeting  of  the  American  Hospital  Association,  so  Miss  Noyes 
drew  up  the  plans  for  the  mobilization  of  nursing  resources 
and  throughout  the  pandemic  carried  all  national  details  re- 
garding nursing  relief. 

National  Headquarters  was  of  course  the  center  to  which  the 
nursing  needs  of  the  entire  country  came.  National  morale 
was  already  under  a  heavy  war  strain  and  the  confessed  lack 
of  medical  knowledge  regarding  the  nature  of  the  disease 
fanned  the  flames  of  public  alarm.  Many  hundreds  of  nurses 
in  civilian  and  military  service  themselves  came  down  with  the 
disease  and  the  calls  for  nurses  increased  proportionately.  By 
long  distance  telephone,  by  telegraph  and  personal  interviews 
with  Miss  Noyes,  State  health  officials.  Army  officers,  heads 
of  civilian  hospitals  and  particularly  men  in  charge  of  indus- 
tries, importuned  National  Headquarters:  ''If  you  cannot  send 
us  nurses,"  they  affirmed,  "our  men  will  all  come  down  with 
the  flu  and  production  will  stop." 

On  September  24  ]\[iss  Noyes  wired  the  Division  Directors 
of  Nursing  to  mobilize  all  Home  Defense  nurses  for  emer- 
gency duty  to  meet  tlie  situation.  The  assignment  to  influenza 
w^ork  of  nurses  who  were  being  mobilized  for  military  service 
was  to  be  avoided  as  long  as  possible.  No  Division  was  per- 
mitted to  recruit  nurses  from  other  Divisions  without  confer- 
ring with  National  Headciuarters.  Nurses  not  enrolled  in  the 
Red  Cross  Nursing  Service,  attendants,  practical  nurses  and 
laywomen  volunteers  who  had  taken  the  Red  Cross  course  in 
Home  Hygiene  and  Care  of  the  Sick,  were  to  be  assigned  to 
duty  under  the  direction  of  enrolled  Red  Cross  nurses.  All 
Local  Committees  on  Red  Cross  Nursing  Service  were  to  be 
called  upon  innnediately  for  recruiting  nursing  personnel.  In 
every  Division  Department  of  Nursing,  additional  clerical  as- 
sistance was  to  be  secured  and  masks  made  in  the  Chapters  for 
use  in  Army  cantonment  hospitals.  Complete  records  of  all 
assignments  ^vere  also  to  be  kept. 


AT  NATIONAL  HEADQUARTERS  973 

The  need  for  nurses  daily  grew  more  imperative.  On  Sep- 
tember 27  Miss  !Noyes  telegraphed  to  all  Division  Directors  of 
Nursing: 

We  should  like  you  to  orfranize  in  your  Division  one  or  more 
mobile  units  of  ten  to  iifteen  nursing  })ersonnel  to  be  sent  to 
other  localities  if  necessary.  IMace  competent  Home  Defense 
nurse  in  char<(e  and  autiiorize  her  to  secure  assistants,  under- 
graduates, attendants,  or  nurses'  aides  and  prepare  them  for 
instant  service. 

Several  days  later  the  general  manager  appointed  a  National 
Committee  on  InHuenza,  which  was  composed  of  the  directors 
of  the  departments  at  National  Headquarters,  with  W.  Frank 
Persons,  then  Director  General  of  Civilian  Kelicf,  as  chair- 
man. On  October  1,  Kupert  Blue,  Surgeon  General  of  the 
U.  S.  Public  Health  Service,  vested  in  the  lied  Cross  the  fol- 
lowing responsibility : 

In  order  that  all  available  resources  may  be  utilized  to  the 
best  advantage  in  combating  the  present  epidemic  of  influ- 
enza, 1  have  the  honor  to  make  the  following  recommendation 
in  regard  to  the  ])articipation  of  your  organization  in  this 
campaign : 

1.  That  the  Hed  Cross  assume  charge  of  supplying  all  the 
needed  nursing  })ers()nnel  and  pay  the  salary  and  other  ex- 
penses connected  with  the  detail  of  such  personnel  for  work 
during  the  present  e})idomic. 

2.  That  the  l?ed  Cross  furnish  emergency  supplies,  when 
it  is  found  that  local  authorities  are  unable  to  furnish  such 
supplies  with  the  promptness  required  by  existing  circum- 
stances. 

On  the  same  day,  the  War  Council  appropriated  $575,000 
for  influenza  relief  and  the  entire  Hed  Cross  organization,  in 
Washington  and  in  the  field,  set  to  work  to  combat  this  most 
virulent  of  any  pandemic  which  had  hitherto  attacked  the 
country. 

The  coc'iperatiou  between  tlic  Federal  Pul)lic  Health  Service 
and  the  American  lied  Cross  was  outlined  in  the  following 
Plan,  issued  October  o : 

1,    That  the  lied  Cross  should  assume  charge  of  supplying 
needetl  personnel  and  will  ])ay  salaries  and  other  expenses 


974  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

connected  with  detail  of  such  personnel  for  work  during 
the  present  epidemic. 

2.  That  the  Eed  Cross  will  furnish  emergency  hospital  sup- 
plies when  local  authorities  are  unable  to  furnish  such 
supplies  with  the  promptness  required  by  existing  circum- 
stances. 

3.  The  United  States  Public  Health  Service  wdll  gather 
facts  about  the  spread  of  this  disease  and  the  adequacy  of 
existing  resources  and  will  determine  when  and  where  to 
send  additional  nursing  personnel  and  emergency  hospital 
supplies  and  to  what  person  the  nursing  personnel  shall 
report  and  such  supplies  be  delivered. 

4.  The   Public  Health   Service  will   decide  when   any  such 
•  nursing  personnel   and   supplies   have   served   the   emer- 
gent purpose  and  may  be  transferred  to  some  other  place 
for  further  duty. 

5.  The  Nursing  Department  of  the  Red  Cross  will  have  full 
charge  of  enrolling  and  assigning  all  nursing  personnel  as 
requested  by  the  Surgeon  General  and  will  also  determine 
their  salaries  and  other  compensation.  In  this  connection 
it  is  important  to  add  that  the  widespread  call  for  nurses 
and  the  obligations  of  the  Nursing  Service  to  supply  nurses 
also  for  the  Army  and  Navy  render  it  imperatively  neces- 
sary that  the  Nursing  Department  shall,  through  its  own 
officers  and  committees  under  the  direction  of  the  head  of 
the  Department,  be  and  remain  in  full  charge  of  this  part 
of  the  program. 

6.  The  United  States  Public  Health  Service  will  conduct  all 
necessary  dealings  with  the  state  and  the  local  boards  of 
health  concerning  all  the  above  matters  and  the  Divisional 
offices  of  the  Red  Cross  will  act  in  providing  nursing  per- 
sonnel and  in  furnishing  supplies  only  upon  the  request  of 
the  Federal  Public  Health  Service. 

7.  The  United  States  Public  Health  Service  will  mobilize  all 
needed  doctors. 

8.  The  United  States  Public  Health  Service  will  from  time 
to  time  ask  the  Red  Cross  through  the  usual  channels  to 
distribute  official  statements  issued  by  the  former  concern- 
ing means  of  prevention  and  methods  of  care  of  this 
disease. 

9.  All  general  publicity  concerning  the  part  of  the  Red  Cross 
in  this  program  raid  all  general  directions  concerning  the 
use  of  the  Red  Cross  resources  except  the  enrollment  and 
assignment  of  nursing  personnel  will  be  issued  by  tlie 
chairman  of  tiie  Red  Cross  National  Committee  on 
Influenza. 


AT  NATIONAL  HEADQUARTERS  975 

Development  of  this  general  plan  for  further  mobilization 
of  the  Red  Cross  for  emergency  relief  was  authorized  during 
the  next  few  days.  Each  Red  Cross  Chapter  was  instructed  to 
organize  immediately  a  Chapter  Committee  on  Influenza,  con- 
sisting preferably  of  the  chairman  of  the  Chapter,  a  leading 
physician,  a  representative  of  the  Local  Committee  on  Red 
Cross  Nursing  Service  where  one  existed,  the  chairman  of  the 
Chapter  Committee  on  Nursing  Activities,  the  chairman  of 
the  Home  Service  Section,  and  such  additional  members  as 
were  deemed  necessary.  This  committee  was  instructed  to 
work  in  close  cooperation  with  the  local  public  health  officer, 
making  a  survey  of  available  nursing  personnel  and  hospital 
supplies  within  its  jurisdiction.  Only  at  request  of  the  local 
health  officer  and  in  consultation  with  the  Division  office,  how- 
ever, were  these  nurses  and  supplies  to  be  mobilized  to  meet 
local  needs. 

A  Division  Committee  on  Influenza  was  also  appointed, 
made  up  of  the  Division  ^lanager,  the  Division  Directors  of 
Civilian  and  ]\Iilitary  Relief,  Nursing,  Supplies,  Accounts  and 
Chapter  Production.  After  issuing  this  general  plan  for  mobil- 
ization of  all  Red  Cross  resources,  the  National  Committee  on 
Influenza  left  its  further  developments,  excepting- where  ques- 
tions of  policy  arose,  to  the  judgment  of  the  Division  and  Local 
committees.  The  educational  campaign  was  developed  largely 
by  the  L'nited  States  Public  Health  Service. 

The  medical  and  nursing  relief  afforded  by  the  Red  Cross 
to  the  civilian  population  in  large  cities,  industrial  centers, 
small  towns,  and  rural  and  isolated  communities  was  probably 
as  extensive  as  has  ever  been  offered  by  any  Red  Cross  society 
in  any  country  and  is  therefore  of  interest. 

The  efforts  of  the  Red  Cross  in  the  larger  cities  in  the 
United  States  is  well  illustrated  in  the  work  done  in  Washing- 
ton, I).  C.  In  cooperation  with  the  United  States  Public 
Health  Service,  the  Local  Chapter  equipped  and  maintained 
an  influenza  hospital  on  F  Street.  When  it  became  evident 
that  this  hospital  would  be  inadequate  to  care  for  the  increas- 
ing number  of  patients,  a  second  hospital  was  opened  by  the 
U.  S.  Public  Health  Service  at  Eighteenth  and  Virginia  Ave- 
nues. Lucy  ^linnigcrode  rendered  conspicuous  service  in  or- 
ganizing the  F  Street  hospital  and  Rachel  Independence  Al- 
baugh,  whose  name  will  appear  numerous  times  in  post-^^rmis- 
tice  sections  of  this  history,  handled  details  of  equipment. 


976   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  U.  S.  Public  Health  Service  divided  the  city  into  head- 
quarters and  four  main  divisions,  each  of  which  was  then  sub- 
divided into  districts.  Each  district  had  a  headquarters  to 
which  all  calls  for  influenza  relief  work  should  come.  A  cen- 
tral recruiting  station  for  nurses  was  opened  by  the  Red  Cross 
Chapter  at  Fourteenth  and  F  Streets,  for  the  purpose  of  secur- 
ing additional  nursing  personnel.  In  this  the  cooperation  of 
the  school  teachers  proved  of  great  value.  As  the  schools 
throughout  the  country  were  closed  during  the  most  virulent 
periods  of  the  epidemic,  many  of  the  teachers  volunteered  as 
assistants  to  the  nurses  and  rendered  efficient  service.  The 
work  of  lay  volunteers,  especially  that  rendered  by  women  who 
had  had  Red  Cross  class  instruction,  was  of  great  value. 

An  enrolled  nurse  who  had  once  taught  classes  in  Home  Hy- 
giene but  who  had  had  to  give  up  active  service  on  account  of 
ill  health,  rallied  to  duty  again  during  the  pandemic.  She 
wrote : 

Owing  to  my  semi-mvalidism,  I  was  not  officially  under  the 
local  organization,  but  my  former  students  had  enrolled  with 
me  and  I  called  on  them.  We  did  what  we  could  where  we 
ourselves  knew  the  need  to  be  great  and  we  were  able  to  carry 
several  hundred  homes  through  to  safety  with  only  one  death. 
Many  refused  relief,  but  we  systematized  our  work  so  that  the 
inexperience  of  the  volunteer  aides  would  not  work  hardship 
either  on  patient  or  aide.  I  sat  at  my  phone  day  and  night, 
backing  tlieir  orders  with  advice  and  instruction.  It  was  the 
sweetest  thing  in  the  world  to  hear  their  responses  come  back 
when  I  called  on  them,  "Why,  yes,  of  course  I  will  do  what  I 
can  to  help." 

To  return  to  the  District  of  Columbia,  the  District  Chapter 
Canteen  Service  organized  a  kitchen  in  each  of  the  four  divi- 
sions, where  food  was  prepared  for  those  who  could  not  secure 
it  in  other  ways,  because  of  the  illness  of  members  of  their 
families  or  because  of  the  crowded  conditions  existing  on  ac- 
count of  the  housing  problems.  From  this  kitchen  in  each 
division  a  hot  lunch  was  daily  served  to  doctors  and  nurses  to 
save  their  time.  The  District  Chapter  ]\lotor  Corps  put  its 
ambulances  and  other  cars  with  their  drivers  to  valuable  use 
in  carrying  patients  to  the  hospital  and  in  transporting  the 
nurses  about  the  city. 

The  organization   which  was  developed   in   industrial   towns 


AT  NATIONAL  HEADQUARTERS  977 

is  well  illustrated  by  the  work  at  Wilkes  Barre,  Pennsylvania. 
Mrs.  Gertrude  Williamson,  the  Ked  Cross  nurse  in  charge  of 
the  emergency  hospital,  wrote: 

For  two  days,  volunteers  mostly  from  Red  Cross  classes  in 
Home  Hygiene  and  Care  of  the  Sick,  worked  like  beavers,  cut- 
ting draw-sheets,  making  up  the  Army  cots,  scrubbing  hat- 
racks  to  serve  as  linen  shelves  and  cleaning  camp  chairs  to  be 
used  as  bedside  tables.  The  Armory  was  scrubbed  from  roof 
to  basement  and  four  wards  were  partitioned  off  with  beaver- 
board  and  lavatories  and  sinks  were  installed  in  the  only 
available  rooms. 

The  I^ed  Cross  Canteen  Service  took  entire  charge  of  the 
basement  kitchen  and,  with  a  few  paid  employees,  but  mostly 
volunteers,  served  all  the  food  to  the  nurses,  the  physicians, 
the  orderlies  and  the  members  of  the  National  Guard  who 
w^ere  always  on  duty,  besides  sending  out  food,  broths  mostly, 
to  over  150  families  daily,  who  because  of  the  "flu"  had  no 
one  well  enough  to  prepare  their  meals. 


In  small  towns,  where  there  were  rarely  any  hospital  facili- 
ties of  any  kind,  the  emergency  was  met  in  an  equally  efficient 
way.  In  Watkins,  Xew  York,  the  Ked  Men  offered  the  use  of 
their  hall  to  the  Local  Ked  Cross  Chapter  as  an  emergency 
hospital.  This  offer  was  immediately  accepted.  The  problem 
of  equipment  presented  a  grave  difficulty  but  each  housewife 
sent  whatever  she  could  spare — a  cot,  a  pair  of  sheets,  a  blanket. 
In  the  same  way,  the  kitchen  was  supplied  and  the  principal  of 
the  High  School,  released  for  the  period  of  the  contagion,  took 
complete  charge  of  the  preparation  of  the  diets. 

In  rural  communities,  where  no  hospital  facilities  existed, 
the  Local  Chapters  established  temporary  ones  in  schoolhouses 
or  churches.  Miss  Barber,  Director  of  Nursing  of  the  North- 
ern Division,  wrote : 

The  houses  are  often  half  a  mile  or  more  apart  from  each 
other,  so  we  used  tlie  rural  and  village  schoolhouses  for 
emergency  hospitals,  wiring  them  with  electricity  in  many 
cases  just  for  tliis  iiurposc.  We  also  sec-ured  mobile  kitchens, 
which  had  previously  been  used  in  the  harvest  fields,  and 
attached  them  to  the  schoolhouses  for  canteen  service.  The 
result  was  highly  satisfactory. 

To  the  most  isolated  countrv  districts,  we  assiirned  nurses' 


978  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

aides  who  remained  in  the  houses  of  their  patients  as  long  as 
the  need  for  nursing  care  existed. 

A  nurse  assigned  to  influenza  relief  work  in  Denio,  Oregon, 
wrote: 

Our  patients  are  mostly  families  of  sheep  herders ;  they  live 
in  miserable  cabins  scattered  in  most  inaccessible  places,  a 
house  to  a  hill  and  each  hill  from  twelve  to  fifteen  miles  apart. 
There  is  no  food,  no  bedding  and  absolutely  no  conception  of 
the  first  principles  of  hygiene  and  sanitation  or  of  nursing 
care. 

I  have  taken  over  the  hotel  as  a  hospital' and  the  Big  Boss, 
who  employs  the  sheep  herders,  is  having  all  who  are  not  too 
ill  to  be  moved,  brought  in  here.  The  men  are  willing,  some 
are  intelligent,  but  most  are  sick,  and  if  it  were  not  for  the 
grit  and  brains  of  the  nurses  who  have  been  working  here 
before  and  for  the  women  of  the  community,  God  help  us ! 

I  am  writing  by  fits  and  starts,  as  1  can  snatch  a  minute  off 
to  jot  down  our  needs,  hoping  that  the  situation  may  be  clear 
to  you  and  that  you  will  be  able  to  get  us  some  supplies  before 
we  get  snowed  in  for  the  winter.  Our  greatest  need  (next  to 
fruit  and  malted  milk)  is  feeding  cups  and  drinking  tubes, 
which  we  can't  get  at  Winnimucca,  our  nearest  town.  We 
also  need  lots  of  gauze  or  cheesecloth  and  cotton  for  pneumo- 
nia jackets ;  also  rubber  sheeting  and  quantities  of  old  rags,  to 
be  used  and  burned,  also  gallons  of  formaldehyde,  if  we  are  to 
stamp  out  the  disease;  everything  is  thrown  on  the  ground  and 
will  thaw  out  next  spring  and  release  all  these  germs  again,  if 
we  do  not  take  precautions  against  it. 

Annie  L.  Colon,  a  Red  Cross  public  health  nurse  on  duty  in 
Luce  County,  northern  Michigan,  wrote : 

Some  of  our  patients  lived  miles  back  in  the  woods  in  the 
logging  camps  where  not  even  a  road  could  reach  them.  We 
would  go  after  our  patients  in  hand  cars,  mounted  on  the 
logging  trains,  and  so  saved  many  lives.  We  had  gasoline 
engines  on  tlie  most  modern  type  of  hand  cars  and  we  hitched 
a  flat  car  to  each  one,  usually  with  wire,  put  a  board  floor  on 
it,  laid  mattresses  over  that  and  with  a  canvas  cover  to  break 
the  wind  we  carried  our  patients  fifteen  or  more  miles  to  a 
decent  bed  and  a  chance  to  live. 

With  this  equipment,  we  rode  usually  at  night  through  the 
deep  woods  and  over  the  rough  roadbeds  to  the  camps.    Many 


AT  NATIONAL  HEADQUARTERS  979 

times  we  would  find  thirty  or  forty  eases,  sometimes  ten 
people  all  with  fever  over  104  degrees,  huddled  together  on 
two  or  three  beds  in  a  tiny  cabin,  too  sick  to  remove  their 
clothes. 

Assignments  of  Red  Cross  nursing  personnel  (including  en- 
rolled nurses,  Home  Defense  nurses,  pupil  nurses,  practical 
nurses  and  laywomen  who  had  taken  the  Red  Cross  course  in 
Home  Hygiene  and  Care  of  the  Sick),  which  covered  only 
the  first  wave  of  influenza  that  swept  across  the  country  from 
September  14,  1918,  to  November  7,  1918,  totalled  15,000 
women. 

On  November  2,  1918,  the  United  States  Public  Health^ 
Service  reported  that  115,000  persons  had  died  from  influenza 
and  pneumonia.  The  battle  deaths  of  the  American  Expedi- 
tionary Forces  were  48,900,  less  than  half  the  influenza  deaths, 
and  the  pandemic  was  not  yet  under  control.  The  contagion 
continued  to  spread  and  Red  Cross  relief  was  carried  on  until 
late  in  the  spring  of  1919.  In  round  figures,  the  number  of 
civilian  deaths  from  infiuenza  and  pneumonia  totaled  150,000 
persons. 

During  the  influenza  epidemic,  I^ational  Headquarters  had 
opportunity  to  test  the  efiiciency,  as  an  emergency  relief  agency, 
of  Red  Cross  national,  division  and  local  organization  to  an 
extent  unequalod  even  by  the  opportunities  for  service  coinci- 
dent to  the  European  War.  Moreover,  JSTational  Headquarters 
learned  beyond  doubt  that  this  organization  could — and  did — 
function  cfliciently. 

The  influenza  epidemic  impressed  upon  the  general  public 
realization  of  two  vital  needs.  The  first  of  these  was  the  need 
for  organized  public  health  nursing  activities  in  every  com- 
munity. "The  only  good  which  could  possibly  come  out  of  an 
epidemic  which  has  carried  off  a  great  number  of  our  best  as 
well  as  our  poorest  citizens,"  wrote  Katherine  La  Prade,  chair- 
man of  the  Xursing  Committee  of  the  Victoria  (Texas)  Red 
Cross  Chapter,  "is  the  proof  to  the  public  of  the  need  and  value 
of  organized  public  health  nursing  service  and  also  the  absolute 
necessity  for  a  county  hospital  in  every  rural  community," 

A  second  need  was  that  of  health  education.  In  many  places 
a  fear  of  the  influenza  prevailed  which  was  akin  to  the  terror 
of  the  Middle  Ag(>s  regarding  the  Black  Plague,  Amy  Potts, 
Red  Cross  public  health  nurse  in  ^[onmouth  County,  New 
Jersey,  wrote : 


980  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

One  poor  woman  had  nursed  her  husband  and  her  three 
boys  through  serious  cases  of  the  flu  and  then  came  down  with 
it  herself.  All  she  begged  was  to  be  left  alone, — she  was  so 
"tired."  Her  husband  got  up  and  tried  to  do  his  best.  Not 
one  of  the  neighbors  would  come  in  to  help,  I  stayed  there  all 
night  and  in  the  morning  telephoned  to  the  woman's  sister. 
The  sister  came  and  tapped  on  the  window,  but  refused  to 
talk  to  me  until  she  had  gotten  a  safe  distance  away.  Finally 
I  managed  to  pull  her  into  the  house  and  convinced  her  that 
she  had  to  stay.  When  she  heard  that  her  sister's  recovery 
was  doubtful,  she  was  ashamed,  but  we  could  do  nothing  for 
the  woman  after  midnight,  except  send  for  the  priest. 

The  influenza  epidemic  and  the  resulting  call  for  nurses 
came  at  a  time  when  the  entire  Red  Cross  Nursing  Service 
staff  was  already  overburdened  with  the  needs  of  the  Military 
Establishment.  At  National  Headquarters,  Miss  Delano  and 
Miss  Noyes  had  long  since  begun  to  show  the  effects  of  the 
responsibility  and  work  they  had  been  carrying.  These  were 
trying  days,  also,  for  Miss  Kerr  and  Miss  Deans,  for  the  pa- 
tience of  these  two — perhaps  Miss  Delano's  closest  friends  at 
National  Headquarters — was  often  tried  by  their  harassed  and 
exhausted  lady-in-chief. 

As  August  and  September  had  passed  wdth  crowded,  oppres- 
sively hot  days  and  breathless  nights,  the  contrast  of  tempera- 
ment between  Miss  Delano  and  Miss  Noyes  had  daily  grown 
more  apparent.  Dark  circles  deepened  under  Miss  Delano's 
eyes,  her  usual  kindliness  of  manner  gave  way  now  and  then, 
deep  lines  appeared  about  her  resolute  mouth.  But  at  no  time 
in  her  entire  Red  Cross  service  was  she  less  confident,  less 
splendid  in  her  sure  and  brilliant  strength. 

If  ^liss  Delano  carried  the  major  responsibility  for  the  poli- 
cies and  ways  and  means  of  procedure,  ]\Iiss  Noyes  carried 
the  actual  responsibility  for  and  details  of  recruiting  and  as- 
signing nurses  to  military  and  influenza  service.  As  her  bur- 
dens increased,  ]\Iiss  Noyes  grew  more  silent,  more  poised,  in 
appearance  more  cool.  Her  unshakable  control,  the  result  of 
temperament  and  circumstances,  seemed  to  render  her  impervi- 
ous to  vexatious  detail.  Looking  neither  to  the  right  or  left, 
seemingly  indifferent  at  times  even  to  ]\riss  Delano's  extreme 
urgings  for  liaste,  she  forged  ahead  on  the  given  task  that  was 
hers. 

Karly  in  the  autumn  of  1018,  General  Gorgas  went  overseas 


AT  NATIONAL  HEADQUARTERS  981 

and  Merritte  W.  Ireland,  Chief  Surgeon  of  the  American  Ex- 
peditionary Forces,  was  recalled  to  the  United  States  and  was 
appointed  as  Surgeon  General.  General  Ireland  was  probably 
more  familiar  with  the  actual  nursing  shortage  existing  in  the 
Medical  Department  in  France  than  any  other  man  and  one  of 
his  first  moves  was  to  call  upon  the  American  Red  Cross  to 
recruit  fifteen  hundred  nurses'  aides  for  immediate  service 
overseas.  This  request  involved  the  initiation  of  an  extensive 
drive  for  aides  and  plans  were  developed  for  securing  them 
through  cooperation  with  the  Daughters  of  the  American  Revo- 
lution, the  Association  of  Collegiate  Alumna,  the  Professional 
Section  of  the  Women's  Employment  Service  of  the  Depart- 
ment of  Labor  and  other  organizations  which  were  in  touch 
with  women  who  would  qualify  as  candidates. 

The  call  for  aides  seemed  like  the  '4ast  straw."  However, 
the  beginning  of  the  end  was  in  sight.  On  November  6,  a 
United  States  Army  hospital  train  on  which  three  reserve 
nurses  were  serving  stopped  at  the  station  at  Sommielle, 
France.     One  of  these  nurses  was  Anne  P.  Hill;  she  wrote: 

An  officer  in  charge  of  the  scliedule  of  trains  passing 
through  Sommielle  told  one  of  our  officers  that  a  special 
train  was  then  on  its  way  toward  Verdun  and  that  this  train 
was  carrying  the  principal  Allied  war  generals  to  meet  a  dele- 
gation from  Germany. 

The  news  spread  like  wild-fire  through  the  train  and  greatly 
excited  patients  and  nurses  alike.  xVt  four  o'clock  on  the 
afternoon  of  November  8,  a  special  train  drew  up  to  ours  on 
the  next  track  and  on  it  were  those  same  war  generals  return- 
ing from  negotiating  an  armistice  with  the  Germans.  All  the 
country-side,  too,  seemed  to  sense  that  the  end  of  the  war  was 
in  sight.  .  .  . 

The  first  word  that  an  armistice  had  been  signed  and  that 
firing  had  ceased,  came  to  Washin<>ton  and  to  Red  Cross  Head- 
quarters at  eleven  o'clock  on  the  morning  of  Xovember  10, 
but  was  a  false  report.  A  conference  was  being  held  in  ]\Iis3 
Delano's  office  when  Annie^  the  small  messenger  girl,  burst  in, 
clapping  her  hands  and  crying:  "Peace  has  been  signed,  ^liss 
Delano,  peace  has  been  signed  !"'  The  nurses  and  office  force 
rushed  out  to  confirm  the  report,  for  newspaper  boys  were 
calling  the  extras.  ^liss  Delano  and  ]\Iiss  Xoves  stood  looking 
at  each  other  in  the  deserted,  sunshine-fiooded  room. 


982   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

An  hour  later  Washington  had  gone  mad  with  joy.  Govern- 
ment clerks,  soldiers,  young  stenographers,  business  men,  offi- 
cers, had  rushed  out  from  the  government  buildings  and  swept 
in  a  screaming,  waving  hysterical  mass  to  the  closed  and 
guarded  gates  of  the  Executive  Office  of  the  White  House. 
Until  late  in  the  night,  the  celebration  continued. 

On  that  same  night  in  an  Army  tent  of  Evacuation  Hospital 
No.  8,  which  was  located  at  Souilly,  near  Verdun,  France,  a 
group  of  tired  American  Army  nurses  gathered  about  the  stove 
in  complete  discouragement.  They  knew  that  the  firing  had 
not  ceased,  because  they  could  still  hear  the  sound  of  the  guns. 
Among  them  was  a  Navy  nurse  on  detached  duty,  Mary  Elder- 
kins.    She  wrote : 

Eumors  of  peace  had  kept  drifting  in,  but  we  really  had 
little  faith  in  them.  The  false  armistice  report  made  but  a 
slight  impression,  as  we  could  still  hear  the  fighting  going  on. 

The  night  of  November  10  we  were  sitting  in  my  tent 
around  the  stove  in  utter  dejection.  We  regretted  that  the 
hopes  of  those  in  America  and  of  the  rest  of  the  world  were 
being  raised  only  to  be  disappointed,  so  sure  were  most  of  us 
that  there  would  be  no  armistice.  At  3  A.M.,  November  11, 
we  were  awakened  by  the  most  terrific  barrage  we  had  had  in 
weeks.  Someone  cynically  remarked,  "That  sounds  like 
peace !'' 

At  9  A.M.  the  message  came  that  the  Armistice  had  been 
signed.  At  eleven  al]  ears  were  strained  to  see  if  the  firing 
would  cease.     It  did  ! 

We  operated  all  day  long  and  received  wounded  men  as  late 
as  eleven  that  night,  but  the  usual  ceremony  of  putting  up  tlie 
black  curtains  at  five  o'clock  was  omitted  and  for  the  first 
time  we  looked  out  on  a  camp  ablaze  with  light. 


CHAPTER  XI 


DEMOBILIZATION 


Miss  Delano's  Death — The  Close  of  the  Military  Program 
Overseas — Bureau  of  Information  for  Nurses — Nurse 
Corps,  U.  S.  Public  Health  Service — Caswilties  Among 
Nurses — Memorials  to  Nurses — Red  Cross  Aides — Educa- 
tional Projects — Militarij  Rank  for  Army  Nurses 

A  WEEK  after  the  sig^iing  of  the  Armistice,  Miss  Delano 
had  presented  to  the  War  Council  a  plan  for  the  de- 
velopment of  public  health  nursing  and  class  instruction 
throughout  the  United  States  and  had  won  its  approval.  Full 
accounts  of  these  projects  may  be  found  in  subsequent  pages. 
This  chapter  will  relate  the  closing  of  the  military  program, 
the  return  of  nurses  from  military  to  civilian  fields,  post- 
Armistice  activities  and  the  final  termination  of  American  Red 
Cross  war  emergency  relief  in  Europe. 

The  shutting-down  of  the  military  nursing  needs  was  im- 
mediate. Three  days  after  the  Armistice  had  been  signed,  the 
Superintendent  of  the  Army  I^urse  Corps  had  notified  all 
nurses  awaiting  assiiiiiment  that  ''unless  such  steps  had  been 
taken  by  them  toward  entering  the  service  as  to  make  it  in- 
convenient and  a  financial  loss  if  they  did  not  do  so,  they  would 
not  be  given  service  in  the  immediate  future."  ^  The  lowering 
of  the  standards  for  service  in  the  Army  Xurse  Corps  on  ac- 
count of  the  urgent  need  for  nurses,  was  immediately  rescinded 
and  all  nurses  whose  applications  showed  that  they  did  not 
meet  the  former  peace-time  requirements,  were  informed  that 
they  were  not  eligible  for  appointment.  Four  hundred  of  the 
nurses  then  awaiting  transportation  (n'ers(>as  at  the  ^lobiliza- 
tion  Station  in  New  York — and  there  were  on  November  15 
some  fourteen  hundred  of  them — were  sent  to  France  as  soon 
as  transportation  could  be  secured  to  relieve  the  shortage  exist- 
ing there. 

On  Xoveniber  If)  Miss  Thompson  wrote  ^liss  Delano: 

*  See  Weekly   Report    eiulinir  Xoveniber    15.    IHIS.   of  the   Superintendent, 
Army  Nurse  Corps,  to  the  Surgeon  General,  U.  S.  A. 

•<)83 


984  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Since  the  signing  of  the  Armistice  within  the  past  week,  the 
need  for  the  assignment  to  active  duty  of  more  nurses  has 
ceased,  at  least  for  the  time  being,  as  it  is  thought  there  is  a 
sufficient  number  for  the  present  need.  This  office  has  re- 
ceived instructions  to  assign  no  more  nurses  to  active  duty  and 
to  notify  the  Eed  Cross  to  that  effect.  It  is  thought  wise, 
however,  that  the  recruiting  of  nurses  be  continued  in  the 
event  of  a  possible  future  need. 

In  all  probability,  nurses'  aides  will  not  be  called,  either  for 
duty  in  this  country  or  abroad,  but  there  seems  to  be  no 
reason  why  the  Eed  Cross  should  not  continue  with  the  train- 
ing of  these  aides  in  cooperation  with  the  civil  hospitals,  but 
it  should  not  be  with  a  definite  understanding  that  they  are 
to  be  called  into  service  as  soon  as  they  have  completed  their 
training. 

On  November  23  Surgeon  General  Ireland  wrote  Miss  De- 
lano: 

The  war  being  virtually  over,  I  desire  to  take  this  occasion 
to  express  my  appreciation  and  that  of  the  Medical  Depart- 
ment of  the  Army  of  the  splendid  service  which  you  and 
your  organization  have  rendered  the  government  in  supplying 
practically  eighteen  thousand  nurses  to  the  Army  Xurse  Corps 
alone. 

The  group  of  women  now  serving  in  the  Corps  is,  I  believe, 
one  of  the  largest  organized  groups  of  professional  women  in 
the  world,  and  it  is  largely  due  to  your  efforts  and  that  of  the 
nurses  of  your  organization  that  this  has  been  made  possible. 
The  service  of  the  nurses  have  been  efficient  in  the  highest 
degree  and  their  work  both  in  this  country  and  abroad  has 
been  very  highly  recommended. 

I  desire  also  to  express  through  you,  to  the  directors  of  the 
different  Divisions  of  tlie  American  Eed  Cross  and  their  assist- 
ants, my  appreciation  of  the  remarkable  service  which  they 
rendered  the  government  during  the  influenza  epidemic  in 
supplying  the  military  hospitals  with  hundreds  of  nurses  and 
nurses'  aides  for  tenrporary  duty  at  a  time  of  acute  need. 

A  statistical  summary  of  the  nurses  in  military  service 
showed  that  the  Army  Xurse  Corps  had  on  duty  on  Xovem- 
ber  15,  1918,  approximately  21, .'^44  nurses.  Of  this  number, 
some  nine  thousand  were  serving  with  the  American  Expedi- 
tionary Forces  in  (iroat  Britain  and  France;  fourteen  hundred 
others  were  in  Xew  York  City  awaiting  transportation  over- 
seas; the  remaining  eleven  thousand  were  on  duty  in  military 


DEMOBILIZATION  985 

hospitals  in  the  United  States.  The  papers  of  five  hundred 
more  were  in  the  Surgeon  General's  office,  these  nurses  await- 
ing at  home  their  travel  orders. 

Of  this  total  maximum  strength  of  the  Army  Nurse  Corps 
of  21,480  nurses,  17,931  were  reserve  nurses — nurses  recruited 
and  assigned  to  the  Military  Establishment  by  the  American 
Red  Cross  Nursing  Service.  Thus  more  than  four-fifths  of  the 
members  of  the  Army  Nurse  Corps  were  American  Red  Cross 
nurses. 

Of  these  17,931  reserve  nurses  some  4400  had  joined  the 
Army  Nurse  Corps  as  members  of  base  hospitals ;  some  400  as 
members  of  base  hospital  units,  some  11,500  as  members  of 
emergency  detachments,  about  1400  as  members  of  training 
school  units  and  approximately  200  as  members  of  special  units. 

During  the  nineteen  months  in  which  the  United  States  par- 
ticipated in  the  European  War,  the  American  Expeditionary 
Forces  suftered  280,330  battle  casualties,  of  which  48,909 
were  of  men  killed  in  action.  In  the  American  Army  56,991 
men  died  from  disease  and  6522  from  accidents.  Thus  the 
total  number  of  lives  lost  in  the  Army,  including  the  Marines 
attached  to  it,  from  April  5,  1917,  to  May  1,  1919,  were  112,- 
432.  Five  out  of  every  six  men  who  were  sent  to  hospitals  were 
cured  and  returned  to  duty. 

In  the  toll  of  battle  deaths  of  the  European  War,  the  United 
States  stands  third  from  the  Ixjttom  of  the  list  of  belligerents, 
as  the  following  table  will  show: 


Russia 

1,700,000 

Germany 

l,fiOO,000 

France 

1,385,300 

Great  Britain 

900,000 

Austria 

800,000 

Italy 

330,000 

Turkey 

250.000 

Serbia  and  ^fonten^ 

egro 

125,000 

Belgium 

102,000 

l?()uniania 

100,000 

Bulgaria 

100.000 

United  States 

48.900 

(JiH'ece 

7,000 

I'ortugal 

2,000 

Total 

7,450,200  2 

-  "Tlie   War   with    ritTinaiiv,"    p. 

119. 

986  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

While  the  European  War  was  undoubtedly  the  bloodiest  in 
the  history  of  warfare,  the  disease  rate  among  the  American 
forces  was  remarkably  low.  Nineteen  out  of  every  thousand 
men  of  the  Expeditionary  Forces  died  of  disease.  During  the 
Mexican  War,  110  per  year  of  every  thousand  men  had  died 
of  disease ;  during  the  Civil  War,  65  out  of  every  thousand 
men,  and  during  the  Spanish-American  War,  26  out  of  every 
thousand  men.  The  causes  of  this  remarkably  low  disease 
death  rate  among  the  American  forces  in  the  European  War 
was  due  to  ( 1 )  a  highly  trained  medical  and  nursing  personnel ; 
(2)  compulsory  vaccination  of  the  entire  Army  against  typhoid 
fever;  (3)  thorough  camp  sanitation  and  control  of  drinking 
water;  (4)  adequate  provision  for  hospital  facilities.^ 

On  November  11,  1918,  the  total  strength  of  the  Navy 
Nurse  Corps  was  approximately  1500  nurses.  The  maximum 
number  of  nurses  actually  serving  in  the  Navy  was  reached  on 
October  19,  1918,  when  1460  nurses  were  on  duty.  Forty- 
three  others  had  signified  their  willingness  to  undertake  navy 
nursing  service,  had  executed  their  oath  of  office  and  were 
awaiting  travel  orders  but  later  resigned  on  account  of  the 
lessening  of  the  needs  for  nurses  due  to  the  signing  of  the 
Armistice.  Of  these  1503  regular  and  reserve  members  of 
the  Navy  Nurse  Corps,  1058  had  been  recruited  and  assigned 
to  the  Corps  by  the  American  Red  Cross  Nursing  Service.  Thus 
more  than  two-thirds  of  the  members  of  the  Navy  Nurse  Corps 
were  American  Rod  Cross  nurses. 

The  total  number  of  deaths  in  the  Navy  between  April  5, 
1917,  and  :\Iay  1,  1919,  was  10,068  men.  Thus  the  cost  of 
life  to  the  American  jMilitary  Establishments  during  the  Euro- 
pean War  was  122,500  men.'* 

The  American  Red  Cross  Nursing  Service  assigned  18,989 
of  its  enrolled  nurses  to  the  ]\lilitarv  Establishments  and  in 
addition  assigned  284  to  the  hospitals  and  cantonment  zones 
of  the  United  States  Public  Health  Service  and  604  others  to 
foreign  service  under  American  Red  Cross  commissions  to  the 
Allies.  Thus  the  total  number  of  American  Red  Cross  nurses 
in  military  service  during  the  European  War  was  19,877.  The 
total  number  of  American  graduate  nurses  who  served  in  the 
European  War  was  23,868. 

"'Tlio  War  with   Gormanv,"  p.   125. 
*Ibid.,  p.   123, 


DEMOBILIZATION  987 

Sinco  1012  Miss  Delano  had  not  left  tho  United  States,  as 
she  had  felt  that  her  place  was  at  National  Headquarters.  She 
had  long  desired,  however,  to  see  the  conditions  under  which 
nurses  were  working  in  Europe ;  the  War  Council  also  wished 
her  to  go  overseas.  On  December  15,  1918,  Miss  Noyes  was 
appointed  acting  director  of  the  Department  of  Nursing,  and 
Miss  Delano  left  Headquarters  and  Washington  to  make  a  trip 
of  inspection  in  France. 

In  France  the  signing  of  the  Armistice  had  arrested  the 
flow  of  fresh  casualties  into  American  Army  and  Red  Cross 
hospitals,  but  influenza  patients  and  the  numbers  of  men 
wounded  in  the  Argonne,  St.  Mihiel  and  Verdun  offensives 
crowded  the  wards  to  such  an  extent  that  the  "peak  days"  for 
the  hospital  centers  occurred  late  in  November. 

The  pressure  of  work  quickly  lightened,  however,  in  the 
zone  of  the  advance.  After  the  casualties  of  the  pre-Armistice 
drives  had  been  evacuated  to  the  zone  of  the  base,  no  more 
patients  came  in  and  the  nurses  had  ample  time  to  look  about 
at  the  paraphernalia  of  war.  Priscilla  J.  Hughes,  chief  nurse 
of  Evacuation  Hospital  No.  2,  wrote : 

Five  days  after  the  Armistice,  we  went  up  to  the  trenches 
and  across  Xo-]\Ian's  Land,  climbed  in  and  out  of  the  shell 
holes  and  through  the  terrible  barbed-wire  entanglements  into 
the  German  trenches.  It  was  quite  apparent  that  the  Boche 
had  at  least  thouglit  he  had  come  to  stay.  The  dugouts  were 
like  summer  bungalows ;  some  had  beds  and  others  had  bunks 
with  chicken  wire  for  sj)rings  and  really  soft  mattresses.  The 
walls  were  covered  with  a  blue  li'ore  material  resembling 
burlap,  and  bookcases  and  cupboards  had  been  built.  The 
windows  were  of  glass  and  opened  on  hinges. 

We  saw  one  of  their  "pill-boxes,'"  made  of  concrete  and 
iron.  A  small  narrow  gauge  railroad  ran  right  up  to  the 
doors  of  the  huts.  Outside  were  little  rustic  walks  and  steps 
and  bridges.  In  one  of  the  dugouts  we  found  coffee  in  steins 
and  broad  still  on  the  table,  bread  which  quite  answered  the 
description  we  had  beard  that  it  was  made  of  sawdust  and 
chicken  featliers.  It  certainly  looked  it!  They  also  had 
carpenter  shops  fitted  out  with  all  kinds  of  tools. 

By  November  1 T)  the  first  released  war  prisoners  began  to 
straggle  back  to  the  French  and  American  lines  and  many  of 
them  were  brought  to  American  hospitals.     Miss  Hughes  wrote: 


988  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

On  Xovember  15,  some  of  our  corpsmen  were  down  in  the 
village  and  they  ran  across  two  Tommies  who  had  just  wan- 
dered into  Baccarat  on  their  way  back  from  a  German  prison 
somewhere  in  Alsace.  Our  men  practically  carried  those 
boys  to  the  hospital,  gave  them  good  showers,  dressed  them  up 
in  U.  S.  A.  0.  D.  and  sat  them  down  before  the  first  good 
meal  which  they  had  had  since  they  had  been  taken  prisoners 
last  ^farch. 

Each  day  the  boys  would  come  back  to  the  hospital  with 
more  Tommies  in  tow  and  by  means  known  only  to  the 
doughboy,  had  them  admitted.  To  the  credit  of  our  C.  0. 
and  the  officers  and  the  joy  of  the  nurses,  nothing  was  said 
until  finally  the  French  sent  us  word  we  were  not  to  interfere 
with  the  British  prisoners  and  that  they  were  to  go  to  the 
French  barracks.  Then  our  boys  fixed  up  cans  of  IT.  S.  A. 
coffee,  sandwiches  and  all  the  cigarettes,  tobacco  and  chocolate 
they  could  lay  their  hands  on,  carried  them  down  to  the 
French  barracks  and  bribed  the  guards  with  some  of  the  food 
to  let  them  pass  the  rest  through  the  railings  to  the  British 
boys. 

These  Tommies  were  simply  in  rags.  They  told  us  that  the 
Germans  .  .  .  had  practically  starved  them,  which  was  quite 
evident.  Three  hundred  and  thirty  of  them  had  been  set  at 
liberty  from  this  particular  prison  and  guards  had  gone  with 
them  for  about  thirty  kilometers,  then  left  them  to  find  their 
way  back  as  best  they  could.  Over  thirty  of  them  had  died  by 
the  road.  How  some  of  them  ever  managed  to  walk,  espe- 
cially across  Xo-Man"s  Land,  is  a  wonder,  they  were  so  sick 
and  weak. 


On  T^ovember  30  the  German  High  Command  telegraphed 
Paris  headquarters  of  the  American  Red  Cross  that  authority 
had  been  granted  "for  the  American  Red  Cross  to  send  at  once 
to  Treves,  food,  clothing  and  necessary  supplies,  with  a  mini- 
mum of  personnel,  to  handle  the  distribution  of  same  to  the 
Allies'  wounded  in  the  Military  Hospital  at  Treves."  Six 
mobile  units,  each  consisting  of  two  doctors,  four  American 
Red  Cross  nurses,  one  camion  of  food  supplies,  one  camionette 
of  medical  and  cleaning  supplies  and  a  touring  car  and  ambu- 
lance for  transferring  the  personnel  and  their  baggage,  were 
organized  and  started  on  their  way,  "The  plan,"  wrote  Colonel 
Burlingame,  "was  to  mobilize  these  six  units  near  the  border  to 
precede  the  Army  as  soon  as  permission  was  granted.  They 
were  to  move  into  Gernian  hospitals  and  carrv  on  until  such 


DEMOBILIZATION  989 

time  as  the  Medical  Corps  was  allowed  to  advance  and  take 
over  the  patients."  ^ 

These  six  units  left  Paris  at  dawn  of  December  1,  and  during 
their  trip  into  Germany  had  an  extraordinary  opportunity  to 
view  conditions  in  the  devastated  regions.  One  of  the  units 
was  compos(>d  of  Dr.  (J.  K.  Wiseman,  Dr.  Baldwin  and  Rachel 
Torrance,  Eleanor  Beatrice  Brown,  ^lary  Irene  Kelly  and 
Henrietta  Altmau.     Dr.  Wiseman  wrote : 


Sunday,  December  1 :  Up  at  dawn.  At  eleven-thirty  wp 
left  the  Hue  do  IJivoli  for  Germany.  The  old  applewoman  at. 
the  Porte  gives  me  two  apples  and  "God  bless  the  Croix  Rouge 
Americmne!"  Over  the  muddy  roads  to  ^leaux ;  then  the 
rolling  country-side,  beautiful  in  the  glinting  autumn  sun- 
light. The  big  trucks  break  down.  We  lunch  at  ^leaux  and 
the  nurses  talk  of  Chateau-Thierry  and  the  Champagne  and 
Evacuation  Xo.  ?>.  The  gun  lieutenant  with  the  Xaval  guns 
hails  us:  "Hello,  Americans!"  The  cold  hotel,  the  cathedral 
against  the  gray  sky,  the  dim  old  square  with  the  movie  filled 
with  French  poUiis,  the  American  military  police  on  guajd 
the  endless  sound  of  horns  of  passing  motors  and  Army  trans- 
ports— ^leaux. 

^londay :  Vaux  and  the  graves  of  the  ^Marines  on  Hill  204, 
wet  in  the  mist,  the  colors  on  the  wooden  crosses.  The  sand- 
bags in  the  torn  and  bloody  woods,  Chateau-Thierry  and  the 
smashed  bridge  across  the  Marne,  in  the  valley  overlooked  by 
the  heights  the  Germans  held  as  the  engineers  built  the  pon- 
toon we  cross  on  now,  a  pontoon  built  then  under  shell  and 
machine  gun  and  airj)lane  fire,  with  a  ('rashing  city  behind 
them.  In  the  twilight  and  darkness  T  walk  along  the  river 
M'ith  a  nurse  wlio  liad  once  served  in  the  Plotel  de  Dieu  Hospi- 
tal across  tlie  river.  Tiie  questions  of  the  wounded  to  each 
other  come  back  to  her  and  reconstruct  the  fight:  "ITello, 
Buddy!  Did  they  get  you  along  the  danm  railroad?''  "You 
got  yours  in  tbat  hellish  river  bed?'"  The  sliock  nurse  tells 
of  the  clieerfulness  of  the  wounded  in  the  Argonne.  .   .  . 

T  l)uy  sausage  and  l)eg  bread  from  an  Army  mess  for  din- 
ner and  on  we  go.  the  white  li,iihts  of  the  cars  throwing  into 
ghostly  relief  the  stark  ruins  of  I)ormans.  wliere  the  Germans 
crosscMl  and  were  thrown  hack.  The  shell-pierced  chateau 
walls,  the  cut  trees,  ihe  re<iular  piercing  hits  by  the  artillery 
on  the  stniH^  f(Mices  :  over  the  river  the  hills  loom  in  the  dark- 
ness, silent  now. 


'"Military  History  of  tlic  American   Red  Cross  in   France."  p.   ] 


no. 


990  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

We  reach  ruined  Epemay  and  filthy  cots  in  a  French 
convent. 

The  raw  French  winter  was  closing  in  and  the  units  went 
forward  under  chilling  mist  and  rain.  Dr.  Wiseman  con- 
tinued : 

Tuesday :  Smashed  Epernay,  where  we  breakfasted  in  a 
dark  stone  cellar  room  with  French  privates.  Rain !  Rain ! 
Rain !  Along  the  rolling  hills,  then  past  endless  French 
cavalry  and  convoy  columns  into  busy  Chalons,  with  its  Ger- 
man prison  camp.  The  Boche  give  us  gasoline  and  we  roll 
slowly  by  the  bombed  houses  in  the  square,  where  twilight  is 
settling  down  like  mist.  Darkness,  and  we  start  for  St. 
Menehould  behind  the  Rheims  Front.  The  rush  of  motors  in 
the  dark,  muddy  streets,  the  crowds  of  poiltis,  the  Americans, 
the  returning  refugees !  We  camp  in  the  trucks,  overlooking 
the  lights  of  Chalons.  On  the  wet  breeze  the  sweet  tones  of 
the  cathedral  chimes  steal  up  out  of  the  misty  valley  to  the 
Champagne  plains. 

Wednesday :  Dawn  and  the  crows  in  the  cold  trees.  Past 
great  shanties  of  the  rear  area  camps;  tremendous  hangars, 
black  and  brown ;  old  emplacements  beside  the  road — all  in  the 
early  morning  mist  banks.  Breakfast  in  an  old  stone  house 
across  the  creek  where  the  Red  Cross  canteen  serves  in  the 
muddy  rooms.  The  blazing  fire,  the  Victrola,  the  tired  dough- 
boys sleeping  on  the  cots  or  writing  home.  All  day  in  the 
rain  we  fix  the  trucks  in  the  narrow  muddy  street  while  the 
armies  pass.  .  .  . 

Thursday :  At  noon  we  climb  the  rolling  hills  again.  On 
either  side  of  the  road,  the  long  barbed  wire  vineyards  point 
like  spear  heads  at  the  dark  road  ahead.  Dusk  comes  early 
and  we  see  more  and  more  American  instead  of  French  trucks. 
We  climb  the  hill  through  ruined  Clermont  with  its  fantastic 
asseml)lagc  of  American  mechanical  .genii — caterpillars,  trac- 
tors, Fords,  giant  trucks  and  motors  lining  the  road  through 
the  shattered  houses  and  crowding  every  inch  of  the  muddy 
field  beside  the  orchard  where  the  gasoline  station  is  found. 
No  more  gas  until  the  Third  Army  is  reached  in  Germany 
now.    We  load  up  and  start  for  Verdun. 

The  Verdun  road,  a  subway  of  lamplight  tunneling  the 
valleys  on  the  straight  camouflaged  roads !  The  lights  of  a 
camp  flash  by  and  the  strains  of  an  American  band  reach  us. 
Green  flares  show  our  trucks  the  ])roteote;l  roadway,  pitcli- 
black  again  in  an  instant,  a  roadway  flanked  by  the  great  hill- 


DEMOBILIZATION  991 

sides,  the  blinking  camps,  the  black  mist  and  mud.  We  come 
out  on  the  level  road  around  Verdun  by  the  hospital,  once 
Evacuation  No.  3. 

Two  o'clock  now  and  we  run  along  beside  the  re-won  rail- 
road where  an  American  engine  puffs  heavily.  We  go  through 
the  great  high  ancient  gate  into  ruined  Verdun;  past  the 
enormous,  bastioned,  monstrous  walls,  the  ghostly  shattered 
stone  houses,  the  iianging  blinds  and  torn  floors,  the  barri- 
cades, the  fire  in  the  ruined  corner  house  on  the  Kue  l^tain 
where  we  ask  three  watching  doughboys  the  way. 

The  convoy  refiles  through  the  Porte  St.  Paul  and  clatters 
out  towards  No-Man's  Land.  Still  the  enormous  hills,  the 
headlights  on  the  shell-torn  fields,  the  fog.  The  convoy 
forges  ahead  and  we  are  left  alone  on  the  Road  of  Ghosts. 
At  last  we  fix  our  tires  and  push  on,  now  at  dawn  we  see 
the  riddled  muddy  fields,  glimpsed  through  endless  camouflage 
stretched  from  one  blasted  tree  to  another.  The  concrete 
towers  and  the  cable  defense  against  the  allied  tanks  stretch 
along  the  barbed-wire-filled  meadows,  the  zigzag  trenches  and 
pulverized  farmhouses.  At  last  we  reach  destroyed  Etain, 
with  its  German  signs.  A  negro  regiment  is  encamped  here 
and  the  bugle  call  in  the  misty  desolation  speaks  breakfast  to 
our  hungry  crowd.  The  nigger  jazz  band  serenades  us  as  we 
pass  out  through  the  ruins.  It  is  another  day  and  we  have 
forgotten  to  sleep. 

The  convoy  had  now  penetrated  behind  the  former  German 
lines  into  the  territory  of  great  strategic  importance,  where 
tlie  Americans  had  seized  the  ]\retz  railway  and  had  thus 
broken  the  Gernum  line  of  communication.  Dr.  Wiseman's 
report  continued : 

Friday :  Again  we  saw  the  endless  barbed  wire  entangle- 
ments, the  cleared  plains  etched  with  trenches  now  empty  and 
cleared  by  the  desperate  battle  in  the  forest  of  tlie  Argonne  to 
the  nortlnvest ;  now  we  saw  lines  of  negro  troopers  on  the 
muddy  roads;  a  salvage  engineer  train  on  the  Metz  railroad 
with  American  locomotives;  a  bombed  station;  the  (Jerman 
road  signs  and  orders;  the  barrels  of  rum  and  the  darkies' 
ready  cups;  the  vast  jnles  of  flares  and  band  grenades  and 
enemy  materials;  the  re-named  streets,  the  Kron  I'rinz 
Strasse;  the  silent  town  now  deserted  ;  on  the  hills  old  gra\<'s 
of  1!)1-].  1  examine  one,  guarded  by  tiny  fir  trees  and  tlowtTs  : 
"Hicr  Licnt  cin  /h'uts-rhcr  Soldaf."  Hevond  is  the  prison 
cam]),  with  its  rough,  heavy  barbed  wire  walls;  by  the  kitchen, 


992  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  potato  peelings  are  still  fresh  in  the  barrels;  litters  of 
filthy  clothes  still  lie  on  the  two-tiered  plank  bunks.  Haste 
had  visited  here.- 

Before  us  at  last  stretched  the  road  to  Esch  and  Luxem- 
bourg. The  long  hills  are  passed  in  the  starlight  and  we 
reach  Esch  with  its  flaring  mills,  its  factories  roaring  with 
energy  and  life.  Little  girls,  with  odd  accents  and  infinite 
charm,  crowd  our  camionette.  Then  we  ride  past  the  great 
beautiful  residences  of  Luxembourg  into  the  lighted,  crowded 
town  and  park,  finally  in  the  statued  square.  About  us  gather 
curious  crowds,  friendly  faces,  and  we  hear  the  German 
tongue.  In  the  Clesse  Hotel  we  sleep  for  the  first  time  since 
Wednesday,  to  dream  of  the  road  of  black  towering  trucks 
with  locomotive  headlights,  crushing  our  little  Ford 
camionette  on  the  heaps  of  stones  by  the  roadside.  .  .  . 

On  Saturday  morning  the  convoys  started  out  on  the  last 
leg  of  their  six  days'  journey.     Dr.  Wiseman  wrote: 

Through  incredible,  romantic,  castled  Luxembourg  we  go, 
across  the  great  bridge  over  the  Moselle,  a  bridge  now  crowded 
with  the  grim,  matter-of-fact  divisions  of  the  American  Army. 
An  endless  chain  of  huge,  mud-splashed  trucks,  of  easy-riding 
cavalry  squadrons ;  of  trains  of  mules  drawing  canvas-covered 
wagons ;  mess  outfits,  kitchens ;  ammunition ;  tired  infantry- 
men in  brown  steel  trench  hats — all  moving  steadily  across  the 
stone  bridge  and  up  into  the  giant,  green  and  black  forest 
with  its  maroon  carpet  of  autumn  leaves  covering  the  tower- 
ing hills.  Below  and  beyond,  we  saw  the  green  of  winter 
wheat ;  the  neat  dainty  houses ;  and  far  down  the  valley  of 
the  ^loselle,  the  endless,  slow-moving  convoys  of  canvas 
wagons  marking  each  river  road  on  both  banks.  Along  the 
roadside  the  faces  of  old  men  stare  at  us  through  the  windows 
and  doorways  as  we  cross  into  Germany. 

Children,  first,  thousands  of  children,  wearing  Fritzie's  red- 
banded  cap,  ofi'ering  Iron  Crosses  for  sale,  saluting,  asking  for 
chocolate,  cigarettes !  Through  the  outskirts  of  Treves  we 
drive  until  we  strike  Cesar's  old  arch  and  the  Hotel  Porta 
Xegra.  1  buy  dijmer  for  the  nurses  and  we  get  a-plenty  ! 
And  for  seven  marks  apiece !  I  meet  some  friends  and  in  the 
hotel  bar  below  we  drink  weiss  Wein. 

Outside  gapes  the  servile  populace.  Like  the  doughboy, 
we  all  find  dilliculty  in  changing  from  the  French  to  the 
German  language.  Still  we  meet  no  hostility.  The  douglil)oy 
smiles  readily:  tlie  children  are  ridiculous;  the  old  people  are 
friendly;  cbargcs  are  low.    The  doughboy  likes  (iermanyl 


DEMOBILIZATION  993 

I  go  to  bed,  aware  of  an  appalling  anti-climax.  My  mind 
still  pictures  tired,  frugal,  denying  France. 

At  Treves  the  six  mobile  units  were  not  sent  forward  as  had 
been  originally  planned,  but  were  fitted  in  for  service  wherever 
need  existed.  Units  Nos.  1,  3  and  4  were  assigned  to  duty  at 
U.  S.  Evacuation  Hospital  Xo.  3  at  Treves;  Unit  No.  5  was 
sent  to  Montmedy  to  take  over  a  civilian  hospital  where  men  of 
the  Fifth  Division  were  ill  with  influenza,  pneumonia  and  dys- 
entery; Unit  Xo.  G  went  to  Stenay  to  care  for  forty  American 
men  left  behind  with  a  detachment  from  an  Army  field  hospital ; 
Unit  No.  2  was  sent  to  Vitron.  These  units  stayed  in  Germany 
until  late  in  January,  1919,  when  they  were  recalled  to  Paris. 

In  the  meantime  the  Army  of  Occupation  was  pushing  on 
from  Treves  and  with  it  went  Evacuation  Hospital  iSTo.  2.  In 
this  column  were  many  regular  and  reserve  Army  nurses. 
Miss  Hughes,  the  chief  nurse,  wrote : 

From  Treves  began  the  most  wonderful  and  historic  part 
of  our  journey  through  the  beautiful  valley  of  the  Moselle. 
To  those  who  do  not  know  it:  Imagine  a  valley  with  a  broad 
silver  river  winding  in  and  out  among  picturesque  hills 
grouped  on  either  side  in  many  shapes  and  heights  but  with 
wonderful  symmetry,  hills  covered  with  grape  vines  arranged 
with  the  most  metliodical  exactness,  not  a  single  one  out  of 
line.  Here  and  there  were  tiny  patches  of  gardens  in  greens 
and  reds  and  browns,  which  reminded  one  of  a  picture  puzzle 
carefully  placed  together.  Some  of  the  hills  seemed  almost 
perpendicular  and  one  Avould  think  that  the  peasants  must 
have  been  suspended  by  tbcir  eyel)rows  to  plant  and  care  for 
the  vines.  Here  and  there  towering  high  above  the  hills  were 
the  ruins  of  old  Roman  fortifications  and  medieval  castles  and 
at  their  feet  nestled  cosily  quaint  little  villages,  with  never  a 
sign  of  the  havoc  and  desolation  only  a  few  kilometers  away. 

The  railroads  and  bridges  were  all  guarded  by  our  own 
American  soldiers;  vrith  fixed  bayonets,  tbey  stood  at  inter- 
vals along  the  rigbt  of  way.  As  we  passed  through  the 
Kaiser's  Tunnel,  we  distinguished  the  flash  of  bayonets  as 
we  s])ed  along  in  the  dark. 

Tlien  out  we  came  into  a  part  of  the  valley  where  our  train 
ran  along  in  tbo  center  and  we  had  a  full  view  of  the  valley. 
There  on  cither  side  marched  our  troops  into  (Jermany.  the 
Stars  and  Stripes  and  the  hVgimental  Colors  flying  at  the 
head  of  the  cohnnus.  the  sun  shining  on  the  enthusiastic  faces 
of  our  hovs  and  tlashin<x  on  the  brass  instruments  of  the  bands. 


994  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  the  center  went  our  train,  with  "Our  Flag"  on  the  pilot  of 
the  engine  and  a  German  engineer  at  the  wheel.  Surely  we 
women  of  America  had  been  given  many  privileges,  but  I  do 
not  think,  in  the  history  of  women,  that  there  has  been  a 
precedent  to  this  experience  given  the  nurses  of  Evacuation 
Hospital  No.  2. 

On  Wednesday  afternoon,  December  11,  1918,  the  train 
carrying  Evacuation  Hospital  Ko.  2  pulled  into  Coblenz,  but 
as  the  Army  had  not  yet  come  in,  it  was  switched  back  to  Guile, 
a  village  on  the  city's  edge,  to  wait  until  the  arrival  of  the 
Army.     Miss  Hughes  wrote  of  their  reception  at  Guile : 

The  children  of  the  village  came  down  to  the  train  and  our 
boys  were  soon  wearing  Iron  Crosses  which  they  had  traded 
for  hard  tack  and  "corned  willy."  The  children  said  that  the 
Prussian  soldiers  marched  into  their  homes  and  took  anything 
they  wanted.  They  also  told  us  that  there  had  been  riots  in 
Coblenz  three  days  before. 

Meanwhile  the  troops  had  caught  up  with  us  and  on 
Friday  morning,  December  13,  went  marching  by  into  the 
city.  We  climbed  up  on  the  banks  and  stood  at  attention  as 
the  advance  guard  swung  past.  And  on  Saturday  our  train 
moved  on  into  the  Coblenz  Station  and  we  were  ordered  to  a 
hotel  before  going  on  to  Ems  to  establish  our  hospital.  We 
left  the  station  and  started  for  the  street  car  and  how  the 
fraus  and  frauleins  stared  at  us  and  everybody  stopped  in  the 
streets  to  turn  and  gaze  after  us. 

All  day  long  Sunday,  Monday,  Tuesday  and  Wednesday  the 
American  Armies  continued  to  stream  into  Coblenz.  Miss 
Hughes  wrote : 

Men,  horses,  mules,  field  kitchens,  ammunition  caissons, 
trucks,  ambulances,  motor-cycles !  The  children  swarmed  like 
flies.  If  the  Germans  had  had  any  doubt  as  to  the  numbers 
of  Americans  who  had  crossed  the  ocean,  they  certainly 
seemed  to  have  their  eyes  opened  during  those  days.  They 
stood  and  stared  and  stared  at  the  seemingly  endless  Ameri- 
can Army  with  a  bewildered,  stolid  expression. 

During  these  days  Evacuation  Hospitals  ISTos.  9,  14,  4  and  6 
came  into  Coblenz,  and  buildings  were  assigned  to  them  all. 
Xo,  2  was  given  an  old  German  barracks,  of  which  Miss 
Hughes  wrote : 


DEMOBILIZATION  995 

It  had  been  left  in  an  almost  impossible  condition  and  was 
inhabited  by  everytliin<(  from  cooties  to  dead  horses'  heads; 
the  Boc'he  had  apparently  been  living  on  horse  meat.  Helmets 
and  bayonets,  some  like  saws  with  teeth  half  an  inch  long, 
littered  the  place.  We  used  the  bayonets  to  poke  up  the  fires. 
In  the  attics  were  piled  smashed  furniture  of  all  types,  and 
an  extensive  library  full  of  books  ami  charts  and  maps  of 
France,  England,  America,  and  Palestine;  apparently  they 
had  been  teacliing  the  soldiers  all  about  the  world  which  they 
had  expected  to  occupy.  .  .  . 

Here  we  are  now,  located  on  a  beautiful  little  island  right 
on  the  Khine  witii  the  famous  fortress  of  Ehrenbreitstein  just 
across  the  river  from  the  hospital  and  the  Stars  and  Stripes 
flying  atop  and  almost  reaching  the  sun ! 

During  the  days  when  the  American  and  Allied  Armies  were 
coming  into  Coblenz,  Miss  Delano  was  preparing  to  leave 
Washington  for  her  inspection  trip  overseas.  On  December  15 
she  left  National  Headquarters  and  went  to  New  York  to  await 
transportation  to  France.  She  dreaded  the  arduous  trip  ahead 
of  her  and  seemed  to  be  filled  with  foreboding  and  a  depression 
foreign  to  her  usual  equanimity.     She  was  very  tired. 

j\[iss  Noyes  accompanied  her  to  New  York.  Miss  Deans 
was  already  there  on  special  duty  with  the  Atlantic  Division 
and  she  and  Miss  Delano  stayed  at  the  same  hotel.  The  Sur- 
geon General  had  secured  sailing  for  Miss  Delano  on  the 
LeviatJian  for  December  24,  but  delay  resulted.  Finally  ar- 
rangements were  made  that  she  should  sail  on  the  George 
Washington,  which  was  due  to  leave  New  York  on  Decem- 
ber '31.  On  the  night  before  she  sailed,  she  and  Miss  Deans 
were  dining  at  a  large  hotel  and  an  Army  ofhcer  wearing  the 
ribbons  of  several  foreign  decorations  came  over  to  their  table, 
talked  with  !Miss  Delano  and  passed  on.  Miss  Deans  looked  at 
^liss  Delano's  outdoor  uniform  and  asked  her  why  she  was 
not  wearing  some  of  her  own  decorations.  Miss  Delano 
laughed : 

"What  do  those  ribbons  mean  to  me  ?  All  I  want  is  the  love 
of  the  nurses." 

Miss  Delano  went  aboard  the  George  Washington  at  two 
o'clock  in  the  afternoon  of  December  31  and  the  transport 
sailed  the  next  morning.  General  Jefferson  Randolph  Kean, 
a  great  friend  of  hers,  was  on  board,  and  ^Hss  Delano's  diary 
recounts  the  pleasant  passage: 


996  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  was  given  a  comfortable  room  to  myself  on  the  upper 
deck;  it  had  a  dressing-room  adjoining  it.  General  Kean 
found  that  he  had  a  room-mate.  General  Ennis,  whom  he 
knew  slightly.  At  the  same  table  with  us  was  a  Miss  Poe, 
on  her  way  to  Rome  for  some  work  connected  with  military 
intelligence.    We  had  discovered  many  mutual  friends. 

On  January  10  the  George  Washington  docked  at  Brest. 
Admiral  Wilson  had  been  advised  of  her  arrival  and  sent  a 
JSTavy  launch  to  take  Miss  Delano  and  the  two  Navy  nurses 
assigned  to  the  George  Washington  ashore.  They  went  directly 
to  Navy  Base  Hospital  No.  1.  Of  Miss  Delano's  reception, 
Miss  Van  Ingen  wrote : 

I  was  finishing  some  paper  work  when  a  message  came  from 
the  C.  O's  office  that  Miss  Delano  had  arrived.  Taken  very 
much  by  surprise  and  thinking  that  the  Red  Cross  had  secured 
rooms  for  her  at  the  hotel,  I  decided  to  go  order  some  flowers 
sent  as  a  welcome  from  our  hospital.  Before  I  could  reach  the 
street,  she  was  at  our  door.  We  made  her  as  comfortable  as 
we  could.  The  weather  was  especially  bad  at  that  time,  sleet, 
snow,  rain,  and  the  penetrating  cold  that  seems  to  belong  just 
to  Brest.  .  .  . 

In  her  diary  Miss  Delano  wrote  of  her  first  day  at  Brest : 

Dr.  Brinsmead,  the  medical  director  of  the  Brooklyn  Unit, 
said  he  would  take  me  wherever  I  wished  to  go  in  his  car.  It 
was  arranged  that  Miss  Yan  Ingen  should  accompany  us  and 
that  we  should  leave  at  once  for  the  army  base  hospitals  near 
Brest. 

We  went  first  to  Army  Base  Hospital  No.  Go  at  Kerhuon, 
which  is  known  as  the  Kerhuon  Hospital  Center  and  has  con- 
nected with  it  Army  Base  Hospital  No.  105  which  operates 
in  part  as  a  separate  hospital  but  is  under  the  general  direc- 
tion of  the  hospital  center.  Bree  S.  Kelly  is  chief  nurse  of 
the  center,  and  ^laud  Parsons,  of  Base  No.  105.  The  hospital 
is  built  on  the  barrack  system  and  at  the  time  of  my  visit  all 
the  wards  were  connected  by  board  walks,  which  are  shipped 
in  sections  and  set  up  as  needed.  Before  these  board  walks 
were  placed,  there  was  the  necessity  for  the  nurses  to  wear 
rubber  boots  when  on  duty  as  the  mud  at  this  time  of  the  year 
is  more  than  ankle  deep. 

At  present  tliere  are  240  nurses  in  the  two  hospitals.  I 
visitc'l  iicnrlv  all  ibc  wards  nurses'  quarters  and  the  quarters 


DEMOBILIZATION  997 

for  sick  nurses.  The  nurses  seem  to  be  given  excellent  care 
and  so  far  as  I  could  judge  were  well  contented  and  satisfied. 

The  hospital  has  a  total  of  IJOOO  patients  and  bed  capacity 
for  even  more.  The  lied  (-ross  had  built  a  comfortal)le  rec- 
reation house  with  a  young  dietitian  in  charge.  .  .  .  The 
nurses  were  called  together  here  and  I  spoke  to  them  and  told 
them  of  our  appreciation  of  the  splendid  work  they  are  doing. 
We  then  went  to  a  little  sitting  room  off  the  general  recreation 
room  and  had  tea.  .  .  . 

Miss  Kelly  assured  me  that  the  nurses'  mess  was  conducted 
by  the  commissary  department  rather  than  as  a  separate  mess, 
but  this  plan  seemed  to  work  quite  satisfactorily.  I  visited  the 
kitchen  and  found  that  they  were  to  have  for  dessert  that  night 
real  American  pie  which  looked  excellent. 

On  Saturday  morning,  January  11,  Miss  Delano  started 
rounds  at  Navy  Base  Hospital  No.  1  at  Brest.  In  her  diary 
she  wrote: 

The  dormitories  open  on  verandas  where  the  patients  can 
be  moved  in  pleasant  weather.  All  French  people  injured  by 
Americans  are  cared  for  in  this  hospital,  also  the  Army  and 
the  Marines.  I  saw  one  Frenchman  who  had  been  run  over 
by  an  Army  truck  and  who  had  unfortunately  lost  both  legs. 
Two  or  three  French  women  were  also  ill  and  were  occupying 
the  same  infirmary  as  the  sick  nurses. 

There  is  a  great  lack  of  quarters  here.  .  .  .  The  water 
supply  is  most  inadequate,  practically  no  running  water  dur- 
ing the  day.  .  .  .  There  is  very  little  heat  in  the  nurses'  dor- 
mitories and  none  in  the  room  where  T  slept.  The  nurses 
seem  accustomed  to  the  difficulties  and  do  not  complain.  .  .  . 

On  the  same  morning  Miss  Delano  went  out  to  Camp  Ponta- 
nazen.     She  wrote : 

^liss  Jones,  cliief  nurse,  was  at  Xice  on  her  vacation, 
so  Miss  Helm  met  me  and  we  made  fairly  complete  rounds  of 
the  wards.  They  have  144  nurses  living  in  wluit  are  known 
as  inside  aiul  outside  quarters.  The  inside  portion  of  the  hos- 
pital is  located  in  the  old  French  barracks  and  tlie  nurses 
assigned  to  duty  inside  live  in  a  convent,  a  most  attractive  old 
building,  with  a  garden,  which  is  attached  to  the  barracks 
hospital.  The  outside  quarters  were  built  on  the  barracks  plan 
by  our  Army  and  each  nurse  is  given  a  separate  cubicle  witli 
convenient  shelves  and  a  good  bed.  .  .  ,  The  dormitories  are 


998   HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

comfortably  heated  by  a  large  stone  at  each  end  with  space 
for  sitting  room  aronnd  each  stone.  Seats  were  built  in  and 
comfortably  cushioned. 

As  many  as  eighty  thousand  troops  have  been  in  this  camp 
at  one  time  with  a  water  supply  for  only  twenty  thousand. 
To  meet  this  emergency,  large  quantities  of  wine  casks  were 
purchased  and  Avater  was  hauled  to  the  camp.  Inadequate 
preparation  seems  to  have  been  made  for  the  care  of  the  troops 
at  Brest,  but  in  spite  of  the  difficulties,  about  a  million  men 
have  come  into  France  through  the  port  of  Brest  and  probably 
a  large  proportion  of  the  army  will  be  re-embarked  from  this 
port.  .  .  . 

The  mud  was  overpowering  and  only  a  few  board  walks 
have  been  built.  In  some  parts  of  the  camp,  it  was  almost 
impossible  to  get  through  even  in  the  automobile,  so  one 
wonders  how  the  nurses  have  been  able  to  get  from  ward  to 
ward.  In  almost  all  the  wards,  I  saw  the  nurses  actually 
caring  for  the  patients. 

The  spirit  of  the  nurses  was  excellent.  In  one  ward,  T  met 
Miss  Lord,  one  of  the  older  Eed  Cross  nurses.  She  has  had 
a  great  deal  of  training  school  and  hospital  experience.  She 
told  me  that  never  in  her  life  had  she  found  more  satisfying 
work  and  that  she  was  very  happy  to  have  been  able  to  be  in 
charge  of  a  ward  and  able  to  take  care  of  the  soldiers  herself. 

At  noon  that  day  Miss  Delano  spoke  to  the  nurses  of  Navy 
Base  Hospital  No.  1.    Miss  Van  Ingen  wrote : 

She  told  them  how  her  heart  had  been  with  each  one,  how 
she  wished  she  might  have  shared  all  their  discomforts,  that 
she  welcomed  the  bad  weather  she  Avas  encountering  as  it  gave 
her  a  better  idea  of  what  those  in  France  had  had  to  endure. 
It  was  a  talk  such  a?  one  comrade  would  have  had  with  an- 
other, not  a  hint  at  criticism  or  supervision,  just  encourage- 
ment and  approbation.  .  .  . 

Saturday  afternoon  ^liss  Delano  left  Brest  for  Paris.  The 
Roosevelt  party  liad  chartered  a  special  car  and  IMrs.  Tvoosevelt 
asked  ^liss  Delano  to  join  them.  In  Paris  ]\Iiss  Delano  w-as 
taken  to  the  Hotel  Wagram.  IMonday  morning  she  Avent  down 
to  Paris  headquarters  and  found  that  IMiss  Hall,  who  had 
succeeded  JNIiss  Stimson  as  chief  nurse  of  the  American  Bed 
Cross  in  France,  was  absent  at  Tours.  IMiss  Delano  was  given 
an  oifice  and  a  stenographer  and  spent  most  of  the  day  dictating 


DEMOBILIZATION  999 

letters,  making  out  reports  on  the  hospitals  at  Brest,  and 
writing  her  diary.  "I  met  many  nurses  both  on  the  street  and 
at  the  office  whom  I  knew,"  she  wrote. 

During  the  next  two  days  Miss  Delano  made  plans  for  ex- 
tensive trips  to  the  various  auxiliary  hospitals  in  France.  On 
January  13  Walter  D.  McCaw,  Chief  Surgeon,  A.  E.  F.,  wrote 
the  following  letter  of  introduction : 

To :  Commanding  officers  of  all  hospitals,  A.  E.  F. 
Subject :  Inspection  of  nursing  service  by  Miss  Delano. 

1.  Miss  Delano,  chief  of  the  nursing  division,  American 
Eed  Cross,  who  has  organized  the  nursing  reserve  of  the 
U,  S.  Army,  has  come  to  France  with  the  approval  of  the 
Surgeon  General,  U.  S.  A.,  to  visit  and  inspect  the  nursing 
detachments  of  the  hospitals  of  the  Army. 

2.  It  is  believed  that  her  visit  will  not  only  result  in  ob- 
taining information  which  will  be  of  value  to  the  Medical 
Service,  but  will  also  be  of  much  benefit  to  the  morale  and 
esprit  de  corps  of  the  nursing  service. 

3.  The  ]\Iedical  Department  of  the  Army  is  under  deep 
obligations  to  Miss  Delano  for  her  patriotic  and  arduous  serv- 
ice in  organizing  the  nursing  reserve.  It  is  requested  that 
commanding  officers  give  Miss  Delano  all  possible  facilities 
and  assistance  in  the  performance  of  her  mission,  and  issue 
such  instructions  as  will  be  necessary  to  secure  this  object. 

On  January  15  Miss  Delano  went  to  American  Red  Cross 
Military  Hospital  Xo.  2,  and  on  the  following  day  to  iSTo.  1, 
the  former  American  Ambulance.  On  the  next  day  she  went 
with  Miss  Hall  to  inspect  United  States  Army  Base  Hospital 
No.  57,  which  was  maintained  by  the  Memphis  (Tennessee) 
Unit.  Miss  Delano  was  delighted  with  the  establishment.  She 
wrote : 

I  was  greatly  pleased  over  Margaret  E.  Thompson,  tlie 
chief  nurse,  and  the  general  condition  of  the  hospital.  The 
wards  were  orderly  and  clean;  this  is  the  first  hospital  I  have 
seen  where  all  the  beds  had  white  covers.  She  had  utilized 
sheets  which  had  been  re-issued  to  her  from  some  of  the  hos- 
pitals which  have  been  closed.  Here  I  found  for  the  first  time 
an  atteni])t  to  oil  the  ward  floors.  My  general  impressions  of 
this  hospital  were  excellent:  the  discipline  among  tlie  men 
was  gootl,  the  patients  became  quiet  on  our  entry  into  the 
wards  and  the  corps  men  were  quite  willing  to  respond  to 
!Miss  Thompson's  order  of  attention. 


1000  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

From  there  we  went  to  American  Eed  Cross  Military  Hospi- 
tal No.  3,  Mrs.  Whitelaw  Keid's  hospital  for  officers,  which  is 
located  in  her  former  Club  for  Girls.  The  building  is  prob- 
ably better  suited  for  a  convalescent  home  than  for  seriously 
ill  patients. 

We  returned  to  the  office  about  two  o'clock  and  went  at  once 
with  Miss  Ashe 

Here  Miss  Delano's  diary  broke  off.  It  was  never  finished. 
However,  on  January  18  she  wrote  Miss  Noyes  a  long  and  con- 
fidential letter  about  various  administrative  questions.  Three 
days  later  Miss  Hall  wrote  Miss  Noyes: 

In  case  you  may  hear  of  it  from  some  outside  source,  I  am 
writing  you  that  Miss  Delano  is  at  the  moment  sick  in  hospi- 
tal. I  know  that  she  has  no  idea  of  letting  you  know  and  I 
think  she  is  not  sufficiently  ill  to  send  a  cable  and  so  perhaps 
stir  you  up  on  the  subject.  On  Saturday  afternoon,  she  said 
she  had  a  slight  sore  throat  and  was  feeling  it  in  her  ear; 
later  in  the  evening  she  had  very  severe  pain  and  at  eight 
o'clock  the  ear  drum  ruptured.  We  called  an  ear  specialist 
from  American  Ked  Cross  Military  Hospital  Xo.  1  to  see  her 
and  she  was  taken  at  once  to  Xo.  101,  where  Miss  Jones  is 
giving  her  most  splendid  care.  We  are  all  disturbed  and 
anxious,  for  after  all  it  is  a  little  difficult  to  come  into  this 
French  climate  in  the  middle  of  winter,  particularly  after  one 
has  been  through  so  many  months  of  strenuous  life  as  Miss 
Delano  has. 

Miss  Delano  was  soon  up  and  out  again — too  soon,  many 
thought. 

She  went  on  with  her  trips  of  inspection.  On  February  14 
she  visited  Base  Hospital  Xo.  27  at  Angers  and  her  report  is 
of  interest.  She  had  had  an  outline  stenciled,  and  when  she 
visited  a  hospital  she  wrote  in,  in  longhand,  her  comments. 

From  Angers  Miss  Delano  went  southward.  A  nurse  wrote 
that  she  had  seen  her  standing  on  a  windy  station  platform  near 
St.  Xazaire,  her  muffler  lield  up  to  protect  her  face  and  ear  from 
the  penetrating  cold.  But  she  did  not  make  any  more  inspec- 
tion visits  as  she  was  soon  again  troubled  by  severe  pain.  She 
was  taken  to  Savcnay  Hospital  Center,  twenty  miles  from 
St.  Xazaire,  successfully  underwent  a  mastoid  operation  on 
February  21  and  a  second  one  on  February  24. 

Savenay  Hospital  Center  was  in  the  spring  of  1919  a  bar- 
rack city ;  in  eight  base  hospitals  ten  thousand  American  sick 


DEMOBILIZATION  1001 

and  wounded  were  being  cared  for.  Miss  Delano  had  a  small, 
bare,  pine-boarded  room  on  the  ground  floor  of  the  nurses'  bar- 
racks, adjoining  the  nurses'  sitting  room.  For  the  operations 
which  she  underwent  at  Savenay  this  sitting  room  was  con- 
verted into  a  perfectly  equipped  operation  theatre.  In  this, 
the  scene  of  her  last  effort,  her  fight  for  life  was  characteristi- 
cally determined.  "It  was  thought  at  all  the  operations  that 
her  case  was  practically  hopeless,"  wrote  Colonel  Coulter,  the 
commanding  officer  of  Savenay  Hospital  (Jenter,  to  General 
Ireland,  "but  she  rallied  each  time  and  her  life  was  not  de- 
spaired of  until  the  last  operation.  .  .  ." 
On  March  4  Miss  Hall  wrote  Miss  Noyes : 

While  Savenay  is  perfectly  bare  and  cheerless  in  many 
ways,  Miss  Delano  is  in  a  place  wliere  she  can  have  every  pos- 
sible medical,  surgical,  and  nursing  care.  Colonel  Coulter  was 
in  the  Surgeon  (Jeneral's  office  and  has  put  every  resource 
in  the  center  at  her  disposal.  .  .  .  She  has  tliree  special 
nurses,  all  of  whom  she  likes,  and  they  are  giving  lier  splen- 
did care.  The  otHcers  of  the  Ked  Cross  are  much  distressed 
and  have  placed  all  the  facilities  of  the  Eed  Cross  through  the 
zone  officers  at  her  disposal.  .  .  .  The  nurses  all  over  France 
are  much  distressed  about  her  illness  and  there  have  been 
countless  inquiries  for  her  and  quantities  of  flowers  have  been 
sent  to  her. 

During  the  first  three  weeks  of  March  Miss  Delano's  health 
mended  steadily.  She  celebrated  her  birthday  on  ^larch  12 
and  asked  to  have  a  cake  made.  "She  invited  a  number  of  her 
friends  to  come  have  tea  in  lier  room,"  wrote  ^liss  Hall  to  ]\Iiss 
Noyes,  "and  during  the  tea  she  told  them  it  was  her  birthday 
and  that  she  was  having  a  party.  She  seemed  to  enjoy  herself 
very  much.  On  ^londay,  !^Iarch  17,  she  went  for  a  short  motor 
ride  in  a  large  closed  car  and  seemed  to  enjoy  that  a  great  d(>al." 

On  ^farch  l]l  ^liss  Hall  again  wrote  to  ^liss  Xoyes  regarding 
Miss  Delano: 

Colonel  Coulter  started  on  Saturday,  ]\Iarch  21,  in  a  motor 
to  find  the  l)est  man  avaihil)le  for  l)rain  surgery.  At  Xantcs.  he 
found  Captain  Tranter,  a  young  man  who  lias  had  Dr.  Ciish- 
ing's  neurological  service  at  the  Brigham  Hospital  and  who 
has  since  specialized  in  brain  surgery,  a  very  able  and  carclul 
man.  He,  with  Captain  Orr.  operated  on  Sunday,  Mar(  h  '2-k 
.  .  .  Two  days  following  the  operation,  the  temperature  was 
normal  and  her  mind  quite  clear.  .   .  . 


1002  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  talked  with  her  Saturday  morning,  March  29,  for  about 
twenty  minutes,  when  she  had  quieted  down  from  her  dress- 
ing. She  told  me  to  tell  you  that  it  would  be  at  least  another 
month  before  she  is  able  to  start  for  home.  She  further  said 
that  she  felt  she  would  not  be  able  to  do  any  work  during  the 
coming  summer;  that  at  the  present  time  she  is  not  able  to 
dictate  any  letters ;  that  she  reads  only  a  few,  or  has  them  read 
to  her  because  it  tires  her  to  concentrate  her  mind  on  these 
matters.  She  selects  the  personal  letters  and  lets  the  others 
go.  She  also  said  that  in  any  questions  that  need  deciding, 
you  must  go  ahead  and  not  depend  on  her  for  suggestions 
and  advice  because  it  will  be  a  long  time  before  she  is  able 
to  be  a  help  and  she  feels  that  there  are  many  things  which 
must  not  wait. 

When  I  saw  her  on  March  21,  I  felt  much  depressed  about 
her  and  found  her  four  physicians  also  very  much  discouraged. 
At  that  time,  I  thought  she  would  not  live  to  return  to 
America.  However,  on  INIarch  29,  the  whole  picture  has 
changed  and  I  believe  she  will  rally  and  be  able  to  go  home, 
perhaps  not  in  a  month  but  surely  m  a  reasonable  time,  con- 
sidering the  three  operations  and  all  she  has  passed  through. 

I  do  not  know  what  you  will  decide  over  there  to  do  about 
having  Miss  Kerr  or  some  close  personal  friend  come  over. 
Over  here,  we  feel,  have  felt,  that  we  wanted  to  leave  nothing 
undone  tliat  would  in  any  way  add  to  her  comfort  or  happiness 
during  this  period  of  illness.  !Miss  Delano  does  not  know  that 
we  have  asked  to  have  some  one  come  over,  but  I  feel  sure  she 
would  be  delighted  to  see  some  one  who  stands  in  the  relation 
of  family  to  her,  for  after  all  she  is  among  most  unattractive 
surrouiidings,  although  as  I  have  said  before,  she  is  having 
everything  that  can  possibly  be  done  for  her  from  the  surgical, 
medical  and  nursing  standpoint.  There  are  now  five  nurses 
assisting  in  her  care;  three  of  them  are  the  original  three,  on 
an  eight-hour  schedule  of  duty.  .  .  . 

Anna  Kerr,  Miss  Delano's  closest  friend,  arrived  in  Savenay 
on  Saturday  afternoon,  April  12.  ]\Iiss  Delano  joyfully  recog- 
nized her  and  talked  with  her  for  a  few  minutes  before  taking 
the  anesthetic  for  the  fourth  operation.  She  recovered  from 
the  ether  three  hours  later,  again  talked  with  Miss  Kerr  for  a 
few  minutes,  and  asked: 

"Who  is  doing  your  work  in  Washington  while  you  are 
away  ^" 

Miss  Kerr's  answer  satisfied  her,  but  in  a  moment  she 
aroused  herself,  and  with  a  flash  of  her  old  energy  exclaimed: 


DEMOBILIZATION  1003 

"But  what  about  my  work?     I  must  get  back  to  my  work." 
She  did   not   speak  again.      All  day   Sunday,   ^Monday  and 
Tuesday  she  seemed  to  rest  (juietly;  about  eight  o'clock  Tues- 
day evening,  April  15,  she  died. 

To  Savenay  during  the  following  days  went  the  thoughts 
of  the  nursing  and  Kcd  (Voss  worlds.  The  funeral  was  mili- 
tary in  character.     A  nurse  spectator  wrote : 

On  Friday  morning  at  eight-thirty,  the  casket,  borne  by 
eight  enlii-ted  men  and  guarded  by  six  nurses,  was  taken  to 
the  K'ed  Cross  auditorium.  It  was  covered  by  a  large  Ameri- 
can flag  and  was  placed  directly  before  tlie  stage.  Behind  and 
around  were  })lace(l  .  .  .  flowers  in  profusion,  from  tlic 
American  Eed  Cross  at  Paris,  the  nurses  of  the  various  units 
and  many  groups  at  home. 

By  nine  o'clock,  the  nurses  began  coming  and  .  .  .  the 
service  started  promptly  at  half-past  nine.  Chaplain  Gilbert 
0.  Miller,  of  the  3O0th  Kngineers,  read  the  Episcopal  burial 
service.  .  .  .  After  the  address,  the  casket  was  carried  l)y 
soldiers  to  a  flag-draped  caisson.  A  company  of  soldiers  linijig 
the  road  presented  arms  as  the  body  was  borne  to  the  gun- 
carriage.  The  procession  then  formed:  the  band  of  the  30yth 
Engineers,  the  military  escort,  the  caisson  with  the  ten  pall- 
bearers, the  four  honorary  pall-bearers,  the  nurses  representing 
the  American  b'ed  Ooss  and  the  Army  Xurse  Corps,  both  in 
France  and  America,  and  Army  nurses  from  nine  base 
hospitals.  .  .  . 

The  line  of  march  was  up  the  road,  through  the  grounds 
past  the  main  hospital  building  and  over  a  small  incline  to 
the  mortuary.  The  band  played  Chopin's  ]\Iarch  and  as  the 
long  line  ])assed  slowly  by,  every  man  in  khaki — and  there 
were  hundreds  of  them — stood  at  attention  ;  small  Freni-h  boys 
in  tlieir  black  school  pinafores  doffed  their  caps  and  stood  at 
the  salute;  a  French  officer  saluted  and  a  poihi  put  down  his 
heavy  bundle  before  b.e  did  likewise. 

The  flag  before  the  main  hospital  building  was  at  half-mast. 
Beneath  it  in  the  gateways  and  windows  were  crowds  of 
wounded  sokliers  and  convalescent  patients.  As  we  wound 
out  of  the  gate  and  turned  up  the  hill  between  high  stone 
walls,  we  passed  a  typical  Frencli  scene,  a  row  of  small  stone 
houses  with  thatched  roofs,  before  which  stood  two  old  Breton 
peasants,  in  white  head-dresses,  and  some  boys  and  girls. 

Kard  as  it  was  to  lose  ^[iss  Delano  in  tliis  way.  it  seemed 
fitting  that  the  nurses  whom  she  had  organized,  tlie  soldiers 
for  whom  tliev  were  enrollei].  and  the  iieople  whom  Imtii  had 


1004  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

crossed  the  ocean  to  help,  should  have  surrounded  her  at  the 
last.« 

Even  the  enemy  for  whom  Miss  Delano  had  labored  in  the 
days  before  the  United  States  entered  the  European  War  was 
present.     The  account  of  the  funeral  continued : 

As  the  procession  wound  up  the  hill,  it  passed  groups  of 
German  prisoners,  who  saluted.  When  it  reached  the  mor- 
tuary, the  guard  presented  arms  and  the  band  played  "Nearer 
My  God  to  Thee,"  as  the  nurses  filed  up  to  form  a  crescent- 
shaped  group,  just  beyond  the  main  building.  As  the  casket 
was  carried  inside,  the  chaplain  read  part  of  the  Committal 
Service  and  the  brief  rites  were  over.  Soldiers  will  guard  the 
house  until  word  is  received  to  send  the  body  home  for  final 
burial  in  Arlington.  ,  .  . 

The  whole  service  was  singularly  beautiful.  The  sun  shone 
and  the  blue  sky,  the  soft  green  of  the  trees  and  the  brown, 
freshly  turned  earth  of  the  plowed  fields,  seemed  a  part  of  our 
last  tribute.  .  .  .  The  rows  and  rows  of  one-story  barracks 
and  the  canvas  tents  of  the  huge  cantonments  lie  in  the  midst 
of  peasant  cottages  and  small  farms.  There  are  hills  in  the 
distance  but  for  the  most  part,  the  landscape  rolls  with  here 
and  there  trim  gardens,  walled-in  fruit  orchards  or  a  short, 
lazily  revolving  Brittany  wind-mill.  The  strictly  American 
camp,  lying  in  the  midst  of  this  peaceful  French  countryside, 
emphasized  to  us  again  the  reason  why  we  had  the  French 
Tricolor  and  the  American  Stars  and  Stripes  side  by  side  in 
our  Ked  Cross  auditorium.'' 

On  May  2  Miss  Delano's  body  was  temporarily  interred  in 
the  American  military  cemetery  at  Savenay.  Four  or  five 
nurses,  three  Army  officers  and  two  Army  chaplains  stood  by 
as  ''taps"  were  sounded  over  this  the  grave  of  an  American 
war  nurse.  The  white  wooden  cross  which  stood  for  many 
months  at  the  head  differed  in  no  wise  from  the  three  hundred 
odd  crosses  which  marked  the  other  graves  in  this  one  section 
of  Savenay  military  cemetery. 

"The  dead,"  wrote  ]\raeterlinck,  "are  dead  only  when  we 
stop  thinking  about  them."  The  American  Red  Cross  appointed 
May  7,  1!J1!),  as  a  national  memorial  day  for  Jane  Dehmo  and 
at  National  Headquarters  in  Washington  and  at  Division  head- 

'  "Last  Honours,"  Edna  Foley,  The  American  Journal  of  Xursinff,  Vol. 
19,  pp.  G89-092. 
'  Ibid. 


DEMOBILIZATION  1005 

quarters  throughout  the  United  States,  nurses  and  civilians 
gathered  in  thousands  to  pay  tribute  to  the  nurse  who,  in  the 
words  of  the  editor  of  the  Journal,  "was,  at  the  time  of  her 
death,  the  most  eonspieuous  woman  of  the  war."  Of  the  many 
words  ^  spoken  on  these  occasions,  perhaps  none  better  tit,  in 
their  simplicity  and  strength,  her  character  and  work  than  do 
those  of  an  Army  surgeon : 

To  the  cause  of  the  sound  education  of  the  nurse  and  the 
extension  of  her  s})here  of  activity  in  relation  not  only  to 
hospitals  and  to  private  practice  but  to  the  broader  fields  of 
public  hygiene  and  sanitary  instruction,  Miss  Delano  gave 
much  of  her  life. 

She  lived  to  see  nursing  generally  recognized  as  an  indis- 
pensable complement  to  the  practice  of  medicine,  as  it  must 
one  day  be  recognized  as  an  integral  ])art  of  the  art  of 
therapy;  she  lived  to  see  the  trained  nurse  universally  re- 
garded aiul  employed  as  a  vital  agent  in  measures  of  public 
sanitation  throughout  the  civilized  world. 

To  the  affiliation  and  coordination  of  the  important  nursing 
agencies  of  the  country,  to  the  end  that  under  the  American 
Red  Cross  there  might  be  established  a  force  oi  nurses  prop- 
erly selected  and  organized,  adequate  not  oidy  for  the  de- 
mands of  peace,  but  for  the  emergencies  of  war,  she  gave  the 
latter  years  of  her  life.     It  was  work  well  done. 

She  lived  to  see  the  standards  of  nursing  for  which  she 
stood  recognized  by  the  Government.  She  lived  to  see  the 
nursing  agencies  of  America  united  and  cooperating  with  the 
Army  and  the  Red  Cross.  She  lived  to  know  that  the  Red 
Cross  was  ready,  and  to  realize  tliat  it  had  given  to  the  Army 
a  contingent  second  to  none  in  the  service,  in  character,  in 
morale,  in  organization  and  in  etliciency.  She  lived  to  see 
that  the  American  Army  nurse  had  stood  the  test.  She  gave 
her  life  freely  and  unreservedly  to  a  noble  service.  She  ac- 
complished that  which  she  undertook.  She  died  at  the  height 
of  her  powers,  at  work.  She  was  a  line  figure,  the  figure  of  an 
American  nurse. ^ 

Seventeen  months  after  her  death  in  Brittany,  commitnuMit 
services  were  held  at  Arlington  Xational   Cemetery   for  Jane 

'Trihutt's  paid  to  Miss  Dt'lano's  iiu'iiKirv  by  i'resiiii'nt  WiNmi.  (Jfiicral 
Pershiiiir  and  other  iiifiiihers  of  tlio  V .  S.  Cox cniiiiciit -.  by  ollicials  oi  tlie 
Ainoricaii  and  other  Wvd  Cross  societies;  and  Ii\  h'ach'is  of  tlie  iiiedical 
and  nursin<jr  professions  are  on   file  at   National   ileachpiarters. 

"  ■'Xursin!,'  and  tlic  Art.  of  Medicine,"  W.  S.  Thayer,  ihe  Amiricmi 
Journal  of  Sursing.   \ol.   -JO,   pp.    ini-l!l2. 


1006  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Delano  and  at  last  her  body  rested  among  the  nation's  soldier 
dead  on  a  wooded  hillside  slope  overlooking  the  white,  cypress- 
shaded  amphitheater,  the  gleaming  stretch  of  the  Potomac  be- 
yond and  in  the  distance  Washington,  the  city  in  which  had 
been  enacted  the  crowning  events  of  her  high  and  lonely 
destiny. 

To  the  student  of  history,  no  phase  of  study  is  more  engaging 
or  more  productive  of  speculation  than  the  rise  of  leaders  to 
fit  the  changing  needs  of  the  changing  times.  For  each  specific 
need,  circumstances  (for  want  of  a  better  word)  appear  to 
bring  forward  men  and  women  temperamentally  attuned  to  each 
specific  need,  and  for  the  moment  the  new  leader  rides  on  the 
crest  of  the  wave.  Then  the  need  changes,  the  wave  recedes, 
the  old  leader  sinks  back  into  the  turbulent  seas  of  human 
effort  and  a  new  wave,  bearing  on  its  crest  a  new  leader,  comes 
crashing  in  upon  the  shores  of  time. 

In  1016  Miss  Xoyes  had  been  Miss  Delano's  own  choice  as 
a  co-worker,  and  upon  her  poised  and  unobtrusive  strength 
Miss  Delano  had  relied  to  her  last  conscious  moments  of  life. 
Thus,  in  the  period  of  demobilization  and  reconstruction,  it 
was  a  natural  consequence  that  Miss  Xoyes  should  follow  Miss 
Delano.  Miss  Xoyes  was  as  admirably  fitted  for  leadership  in 
the  new  era  as  ^liss  Delano  had  been  in  the  old.  War  is  a 
spectacular  cataclysm,  incredibly  dramatic,  and  Miss  Delano, 
in  her  life  and  death  and  personality,  had  matched  it.  De- 
mobilization with  its  unrest  and  reconstruction,  with  its  uncer- 
tainty and  indecision,  called  for  sanity  and  an  unerring  sense 
of  proportion,  by  means  of  which  the  displaced  social  order 
might  be  neatly  rearranged  again  into  the  normal  conditions 
of  peace.  In  temperament  and  methods  of  work  ^liss  Xoyes 
matched  the  newer  need.  On  August  8,  1919,  the  general 
manager  at  Xational  Headquarters  announced  her  appoint- 
ment as  director  of  the  Department  of  Xursing:  since  the 
previous  December  she  had  been  serving  as  acting  director. 
At  its  first  meeting  after  the  Armistice,  a  meeting  held  De- 
cember 9,  1919,  the  Xational  Committee  on  Red  Cross  Xursing 
Service  unanimously  nominated  ^liss  Xoyes  as  its  chairman 
and  the  Executive  Committee  on  January  2,  1920,  ratified  the 
nomination. 

In  the  midwinter  of  1918-1919  Xational  Headquarters  en- 
deavored to  check  its  war  machinery  and  through  a  policy  o^ 


DEMOBILIZATION  1007 

contraction  and  economy  to  assume  peace-time  dimensions.  On 
February  15,  1911),  an  adjourned  session  of  tiie  annual  meeting 
of  the  American  Red  Cross  was  held  at  National  Headquarters 
and  the  officers  and  committees  which  were  to  carry  on  the 
activities  of  the  organization  were  elected.  The  members  of 
the  War  Council  had  announced  their  intention  to  resign  on 
March  1,  so  the  responsibility  for  the  leadership  of  the  Ameri- 
can Jxed  Cross  would,  on  that  date,  revert  to  the  Central  Com- 
mittee. 

Dr.  IJvingston  Farrand  had  been  appointed  by  President 
Wilson  as  the  new  chairman.  Dr.  Farrand  was  graduated 
from  Princeton  University  in  1888,  had  there  taken  his 
master's  degree,  had  been  graduated  from  the  College  of  Physi- 
cians and  Surgeons  of  Columbia  University  and  had  studied 
at  Cambridge  and  Berlin.  He  was  for  nine  years  executive 
secretary  of  the  National  Association  for  the  Study  and  Pre- 
vention of  Tuberculosis  and  had  served  in  France  during  the 
war  as  director  of  the  llockefeller  Commission  for  the  Preven- 
tion of  Tuberculosis  in  France.  This  organization  was  later 
merged  into  the  International  Health  Board.  From  1914  until 
1917  he  had  been  president  of  the  University  of  Colorado. 
His  point  of  view  thus  embraced  that  of  the  administrator,  the 
social  service  worker  and  the  educator. 

The  Central  Committee  had  as  its  new  vice-chairman,  Wil- 
loughby  Walling,  of  Chicago.  Robert  Lansing  represented  the 
Department  of  State,  John  Skelton  Williams  the  L^.  S.  Treas- 
ury, General  Ireland  and  Admiral  Braisted  the  War  and  Xavy 
])epartments,  Alexander  King  the  Department  of  Justice.  The 
new  members  elected  by  the  Board  of  Incorporators  were  ^Irs. 
Frank  V.  Hammar  and  Charles  E.  Scott,  former  general  man- 
ager at  National  Headquarters. 

The  newly-appointed  Executive  Committee,  of  which  Dr. 
Farrand  was  chairnian  ex-officio,  was  made  up  of  those  who 
represented  botli  the  old  and  new  orders.  Four  members  had 
served  on  the  War  Council ;  they  were  ]\Ir.  Davison,  ^fr.  Wads- 
worth,  ^fr.  Bliss  and  ]\lr.  Scott.  The  new  members  of  the 
Committee  were  General  Ireland,  Admiral  Braisted  and  Secre- 
tary of  the  Tnt(>rior  Lane. 

To  fill  vacancies  caused  by  death,  three  women  were  elected 
memb(M'S  of  the  Board  of  Incorporators.  They  were  ^^Tr:^.  Leon- 
ard Wood,  ^Irs.  Joseph  (^udnhy  and  Mrs.  August  Bolnioiit. 
]\Irs.  Belmont  had  served  as  an  assistant  to  the  War  Ctumcil 


1008  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  in  her  the  IS^ursing  Service  found  a  powerful  and  sympa- 
thetic ally. 

On  the  eve  of  demobilization  the  American  Red  Cross  had 
an  adult  and  junior  membership  of  over  thirty  millions.  ''Al- 
most immediately  following  the  Armistice,"  stated  the  Annual 
Report  of  the  Society  for  the  year  1919,  "thoughtful  American 
Red  Cross  leaders  began  to  study  the  problem  of  utilizing  the 
great  Red  Cross  machinery  developed  by  the  war  and  the  rich 
Red  Cross  experience  acquired  in  the  war,  for  peace-time  needs, 
primarily  in  the  United  States;  secondly  for  the  welfare  of 
humanity  at  large."  ^^  Out  of  this  study  grew  the  League  of 
Red  Cross  Societies  and  in  the  United  States,  the  Red  Cross 
peace  progTam  in  the  interests  of  public  health,  a  field  in  which 
Dr.  Uarrand  was  an  acknowledged  leader.  The  development 
of  rural  nursing  and  class  instruction  to  women  formed  perhaps 
the  most  important  and  lasting  phase  of  this  program  and  ac- 
counts of  these  projects  may  be  found  in  subsequent  chapters. 

As  to  the  American  Red  Cross  foreign  program  of  emergency 
relief,  the  personnel  of  the  Commission  for  France  had  their 
fingers,  during  1918  and  1919,  on  the  pulse  of  European  public 
opinion.     On  December  17,  1918,  Miss  Hall  wrote  Miss  Xoyes: 

I  wish  I  could  make  you  miderstand  how  little  the  French 
either  want  or  need  us  at  the  present  time.  In  spite  of  the 
cordiality  of  their  welcome  to  President  Wilson,  it  is  made 
apparent  to  us  that  they  will  be  glad  to  have  us  leave  their 
country.  It  is  not  that  they  do  not  appreciate  what  we  have 
tried  to  do  for  them ;  but  if  you  could  see  this  country,  as  it 
is  overrun  even  to  the  remotest  corners  with  Americans  who 
are  buying  out  the  food,  usurping  the  places  on  street-cars, 
trains  and  theaters  everywhere  in  France,  you  would  appre- 
ciate their  desire  to  have  their  country  to  themselves.  I  think 
that  all  members  of  the  Hed  Cross  organization  have  more  and 
more  the  feeling  that  the  sooner  we  can  wind  up  affairs — 
doing  this  in  the  spirit  in  which  we  began  work — the  better 
it  will  be.  Tlie  work  of  the  Children's  Bureau  and  the  Bureau 
of  Tu])erculosis  will  be  brought  to  a  conclusion  by  the  first 
of  April.  Tlie  Commissioner  tells  me  that  the  work  in  Italy 
is  being  closed  as  rapidly  as  that  in  France. 

It  would  appear  tliat  at  the  present  time,  the  Army  is  not 

returning  large  numbers  of  its  nurses  home,  so  it  is,  therefore, 

able  to  take  care  of  its  own  troops  without  the  aid  of  the  Red 

Cross  to  any  extent.     This  means  that  our  military  program 

"Annual   Report,    li)l!),   p.   13. 


DEMOBILIZATION  1009 

is  very  rapidly  being  l)rought  to  a  conclusion.  Groups  of 
nurses  raii<j:in<^  from  thirty  to  fifty  are  hein^  released  every 
week  and  1  am  sendin<r  a  fjood  many  home.  There  is  no  doubt 
but  tliat  at  the  present  time  you  need  nurses  more  at  home 
than  we  do  here.  We  have  forty-nine  nurses  in  Germany; 
they  were  sent  up  to  care  for  American  prisoners  but  will 
probably  be  returned  to  us  in  about  six  weeks. 

During  the  winter  and  spring  of  1918  and  1919  the  Com- 
mission for  France  maintained  eleven  convalescent  homes  for 
members  of  the  American  Expeditionary  Forces.  A  list  of 
these  institutions  may  be  found  in  the  Appendix. 

The  exodus  of  the  American  Armies  from  France  during 
the  first  five  months  of  1919  was  as  rapid  as  had  been  their 
advent  and  the  '^transportation  miracle"  of  May,  June  and 
July,  1918,  was  repeated  in  March,  April  and  May  of  1919. 
In  the  ofhcial  summary  of  the  War  Department  Colonel  Ayres 
wrote : 

As  soon  as  the  Armistice  was  signed, preparations  were  made 
for  returning  the  troops  to  tlie  United  States  in  the  shortest 
possible  time.  This  was  rendered  difficult  by  tlie  fact  that  for 
the  eastward  movement,  we  had  relied  largely  on  the  British, 
who  carried  ap})roximately  half  of  the  troops.  After  the  sign- 
ing of  the  Armistice,  the  British  needed  these  ships  for  the 
return  of  their  own  colonial  troops  to  Canada,  Australia  and 
South  Afrit-a.  This  situation  was  met  by  the  Army  Transport 
Service,  which  immediately  began  the  conversion  of  one  large 
cargo  ship  into  troo])-carrying  vessels.  By  means  of  these 
converted  cargo  ships,  by  the  assignment  of  German  liners  and 
also  by  the  great  aid  rendered  by  the  Xavy,  which  put  at  the 
Army's  disposal  cruisers  and  battleships,  the  Army  is  being 
brought  back  home  even  more  rapidly  than  it  was  taken  to 
France.^  ^ 

During  February  181, THl  men  sailed  for  the  United  States; 
during  JMarch,  212,899 ;  during  April,  290, .'577,  and  during 
May,  .'}.'38.838.  which,  with  the  numbers  of  sailors  and  ninriiies 
also  return(>d  that  same  month,  brought  the  month's  total  to 
well  over  one-third  of  a  million  mcii.^- 

As   the  movement   of  American    soldiers  from   the   Western 

Front  to  the   ports  of  embarkation  began   the   American   Ked 

"  "'llio   War  with   (iennanv."'   pp.   47-4S. 
"Ibid.,  pp.  37-;W. 


1010  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Cross  ill  France  established  a  chain  of  infirmaries  and  dis- 
pensaries which  were  located  along  the  line  of  communication 
and  at  the  docks. ^^  In  connection  with  this  work  Miss  Fitz- 
gerald's name  reappears,  for  to  her  was  delegated  the  super- 
vision of  American  Red  Cross  nurses  assigned  to  this  phase  of 
demobilization  service.     She  wrote : 

Another  activity  for  which  I  have  been  made  responsible 
has  been  the  supervision  of  the  American  Red  Cross  infirma- 
ries. .  .  .  The  following  extracts  from  a  report  will  give  an 
idea  of  these  activities : 

At  Xantes,  the  infirmary  seems  to  more  than  justify  its 
existence.  There  are  anywhere  from  20  to  25  dispensary  cases 
daily.  In  the  infirmary  of  eight  beds,  patients  can  be  placed 
until  the  ambulances  are  secured  to  take  them  to  the  hospital. 
If  the  beds  are  not  used  for  this  purpose,  officers  are  allowed 
to  sleep  there  at  night,  being  charged  a  small  fee  to  cover 
the  laundrying  of  the  bed  linen.  While  I  was  there,  an  offi- 
cer came  in  who  had  evidently  Just  left  the  hospital.  He  was 
chilly  and  very  miserable.  He  was  at  once  told  to  lie  down 
on  the  bed  nearest  the  stove  and  was  covered  with  blankets. 
Probably  a  couple  of  hours  of  rest  would  be  sufficient  to  enable 
him  to  continue  his  journey.  A  corpsman  is  on  duty  at  this 
infirmary  every  night,  so  that  any  accident  case  is  cared  for 
at  any  time  during  the  twenty-four  hours.  The  nurse  in 
charge  of  the  infirmary  also  looks  after  the  dormitory  where 
about  seventy  enlisted  men  may  sleep  either  by  day  or  night. 
Perhaps  twenty-five  exhausted  men  were  sleeping  there  as  1 
went  through. 

The  Red  Cross  infirmary  at  Dijon,  which  was  located  in 
one  of  the  main  railroad  stations,  was  a  busy  place  during  the 
early  months  of  1919.     Miss  Fitzgerald  wrote  of  it: 

This  particular  station  has  practically  been  given  over  for 
the  use  of  Americans.  The  American  special  train  from  Toul 
to  Chaumont  stops  here,  so  a  largo  number  of  our  men  are 
always  to  be  found  either  just  arriving  or  just  departing  from 
Dijon.  The  slightly  injured  find  their  way  to  the  Ped  Cross 
infirmary  and  there  receive  First  Aid  care.  Besides  these 
men,  the  district  surgeon's  office  sends  to  this  infirmary  for 
observation,  all  tlie  men  who  are  not  fit  to  be  on  duty,  but 
who  are  not  ill  enough  to  be  admitted  to  a  base  hospital. 
Often  a  couple  of  days  in  l)ed  will  enable  these  men  to  go 

"For  a   list   of  these  infirmaries   and   dispensaries,   see   tlie   Appendix. 


DEMOBILIZATION  1011 

back  to  duty  without  beinf^  transferred  to  the  hospital  at  all. 
The  nurses  in  charge  of  the  infirmaries  are  all  most  enthusi- 
astic about  their  work.  They  get  very  near  to  the  men  and 
are  able  to  help  them  in  many  smail  ways. 

At  the  dock  infirmaries  the  nurses  found  perhaps  the  hap- 
piest work  which  they  experienced  during  the  European  War. 
"Here,"  wrote  ^liss  Fitzgerald,  ''they  come  in  contact  with 
men,  some  of  them  still  ill,  others  convalescent,  but  all  of  them 
radiant  at  the  thought  of  going  home." 

Brest,  St.  Xazaire  and  Bordeaux  were  the  three  principal 
ports  of  embarkation.  Miss  Fitzgerald  wrote  of  the  infirmary 
at  Brest : 

Its  position  could  not  be  improved  upon.  It  is  on  the  dock 
from  which  the  tugs  leave  to  carry  the  patients  to  the  trans- 
ports lying  at  anchor  outside  the  breakwater.  The  Army  has 
put  up  a  new  shed  about  four  times  as  large  as  the  one  hous- 
ing the  original  infirmary  which  is  still  used  to  take  care  of  the 
overflow.  They  have  erected  a  new  building  also  for  the 
canteen  departniQiiit;  it  is  next  door  to  the  infirmary  and  hot 
drinks  can  now  be  served  much  more  easily. 

I  saM'  the  loading  of  one  boat.  Several  hundred,  sick  and 
wounded,  passed  through  the  infirmary  in  good  order  and 
without  confusion.  They  are  classed  in  groups  such  as 
''tul)ercular,"  "wounded,"  "casuals'  and  other  types.  The 
port  authorities  have  their  officers  present  checking  them  up 
and  the  system  works  well  and  quickly. 

Ambulances  and  ambulance  trains  unload  the  men  riglit  on 
the  dock.  If  the  weather  is  bad  or  there  is  much  delay  in 
loading  the  tug,  all  stretcher  cases  are  ke})t  in  the  infirmary 
hut,  are  given  warm  drinks  and  are  made  comfortable  in  every 
possible  way.  If  the  weather  is  rough,  the  ])aticnts  are  here 
transferred  to  the  "snow-shoe  stretcher."  which  is  better  suited 
for  embarkation  purposes.  Extra  Ijlankets  are  provided  for 
the  patients  during  their  trip  in  the  tugs  to  the  transports 
and  one  or  two  nurses  accompany  each  l)oatload. 

The  patients  are  then  settled  comfortably  on  the  ship,  the 
extra  blankets  are  removed  to  be  kept  for  future  use,  the 
[)atients  are  given  what  they  need  in  tlie  wav  of  comforts  and 
the  l\ed  Cross  nurses  and  other  workers  finally  leave  tliem. 
Several  times,  on  account  of  rough  weather  or  late  hours,  the 
patieids  liave  not  been  allowed  to  come  aboard  the  steamer 
and  have  had  to  he  "jrought  l)a{k  by  tug  to  the  dock.  In  suc-h 
cases,  they  have  been  ke})t  in  the  h'ed  Cross  hut  until  arrange- 


1012  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ments  could  be  made  for  their  return  to  hospitals  in  the  neigh- 
borhood.   Meals  are  served  them  by  the  Ked  Cross  Canteen. 

Navy  Base  Hospital  No.  5  had  received  most  of  the  "Class 
D"  men  who  were  returned  to  the  United  States  during  the 
early  mouths  of  1018,  but  in  April  of  that  year  Kehuron  Center 
was  developed  and  later  Camp  Pontason.  During  1919  the 
"Class  D"  men  were  evacuated  almost  entirely  through  the 
hospitals  of  these  camps  to  the  docks. 

South  of  Brest  was  St.  Nazaire,  and  here  the  American  Red 
Cross  established  another  large  infirmary.  A  special  dock  was 
given  over  entirely  for  the  sick  and  wounded.  Near  it  was 
an  enormous  shed  which  had  been  divided  into  two  unequal 
sections.  The  larger  section  was  turned  over  to  the  Y.  M. 
C.  A.,  which  looked  after  the  welfare  of  well  troops.  The 
smaller  section  was  assigned  to  the  American  Red  Cross.  Here 
Red  Cross  canteen  workers  set  up  counters,  installed  a  dough- 
nut-baker and  provided  facilities  for  feeding  large  numbers  of 
men.  At  the  farther  end  several  cots  were  set  up  and  here  the 
Red  Cross  nurses  held  sway.  Miss  Fitzgerald  wrote:  "I  was 
much  struck  by  the  activities  which  were  going  on  at  Embarka- 
tion Camp  No.  7,  at  St.  Nazaire,  where  over  three  thousand 
men  are  daily  bathed,  deloused  and  entertained  in  Red  Cross 
huts.  .  .  ." 

South  of  St.  Nazaire  was  the  busy  port  of  Bordeaux.  Here 
the  Red  Cross  dock  infirmary  was  located  in  a  large  ware- 
house. Four  nurses,  Amarita  Heath,  Ida  K.  Neville,  Emma 
Wilson  and  Ella  Robinson,  were  assigned  to  duty  there;  Evelyn 
Walker  was  chief  nurse  of  the  Bordeaux  zone  and  had.  general 
supervision  of  the  work.     Miss  Robinson  wrote: 

We  took  care  of  about  30,000  sick  and  wounded  men  on  the 
docks  at  Bordeaux  l;et\veen  December  and  ]\Iay.  Early  in 
1911),  we  had  the  severely  wounded  men.  To  tliese  we  gave 
every  possible  attention  we  could,  adjusting  their  helpless 
bodies  or  limbs  to  a  more  comfortable  position  on  the  stretch- 
ers, reinforcing  a  dressing,  assisting  them  to  eat,  for  many 
of  theni  were  jaw  or  arm  fractures  and  were  not  able  to  raise 
themselves  to  swallow. 

To  each  man  on  the  stretchers,  we  gave  pajamas,  handker- 
chiefs, a  waslicloth.  toothpaste  aiul  brusli,  cigarettes,  gum  and 
cookies  and  a\ e  tried  to  fulfill  any  request  he  might  make  such 
as  forwarding  a  cablcirram  or  mailin<;'  a  letter  or  card. 


DEMOBILIZATION  1013 

To  the  walking  eases,  we  gave  small  packages  containing 
handkerciiiet's,  cigarettes  and  cookies.  In  themselves  these 
gifts  seemed  trifling  and  we  sometimes  questioned  wiiether  it 
was  worth  while,  hut  they  were  gladly  accepted  and  many 
times  the  hoys  would  say  as  they  took  them,  "Here's  the  Ked 
Cross  to  the  end  !*'  The  men  were  wonderfully  appreciative 
and  I  think  we  received  more  than  we  gave. 

Emma  Wilson  wrote  that  ^'they  are  too  happy  to  need  much, 
these  boys  who  are  going  home,  but  they  are  always  ready  to 
shout  for  the  Ked  Cross." 

A  nurse  always  stood  at  the  gang-plank  to  see  the  wounded 
and  sick  safely  aboard.  ''Thus  the  last  thing  they  see  as  they 
are  carried  upon  the  boats,"  wrote  Miss  Fitzgerald,  "is  the 
American  Red  Cross  nurse." 

The  first  units  of  the  American  Medical  Department  to  re- 
turn home  were  the  original  six  American  Red  Cross  base  hos- 
pitals, which  as  units  of  the  American  Army  had  been  serving 
with  the  British  Expeditionary  Forces.  The  Presbyterian 
Unit,  Xo.  2,  sailed  on  January  25  and  on  March  13  the  Peter 
Bent  Brigham  Unit,  No.  5,  embarked  for  home.  The  other 
four  followed  in  quick  succession ;  the  Lakeside  L^nit,  Xo.  4, 
sailed  on  ]\Iarch  22;  the  Pennsylvania  Unit,  Xo.  10,  on 
April  2 ;  the  St.  Louis  Unit,  Xo.  21,  on  April  13,  and  the 
Xorthwestern  Unit,  Xo.  12,  three  days  later.^^  One  by  one 
during  the  spring  of  1919  the  personnel  of  American  base  hos- 
])itals  and  other  sanitary  columns  in  France  were  returned 
through  the  port  of  Xew  York  to  Army  camps  and  cantonments 
in  the  l.^nited  States  and  subsequently  were  mustered  out  of 
the  Army. 

The  home-coming  nurses  were  not  met  with  the  popular  ac- 
claim with  which  the  home-coming  troops  were  hailed.  They 
were  not  greeted  at  the  docks  with  waving  flags,  were  not  asked 
to  nuirch  in  the  parades.  In  the  editorial  columns  of  the 
Journal  Miss  Palmer  wrote: 

We  recently  spent  some  time  in  Xew  York,  where  the  ar- 
rival of  transports  bringing  our  troops  from  l-'rance  was  a 
daily  occurrence  which  was  made  much  of  hv  the  ])ress.  .  .  . 
Practically  all  these  incoming  trans])orts  had  nurses  aboard. 
Occasionally  a  newspaper  mentioned  when  summing  up  tbe 

'""History  of  Xursinir  Activities,  A.  K.  V..  on  tlic  Wt'stcrii   Front   (liiriii<^ 
tlit>  Will-   I'i'iiotl."  .1.   (".   Slinison.   p.  4;    Suig(>on   (icnt'rars  Otlicc,   I'.   S.  A. 


1014  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

personnel  of  officers  and  men,  "five  or  twenty  or  fifty  women 
nurses"  but  none  of  them  by  name.  .  .  . 

A  few  days  ago,  we  saw  a  group  of  our  nurses  come  off  a 
big  transport,  carrying  their  heavy  suitcases,  wraps  and  bags, 
go  down  the  gang  plank  that  looked  to  be  at  an  angle  of 
forty-five  degrees,  and  walk  the  whole  length  of  the  Hoboken 
pier,  between  rows  of  soldiers  lined  up  on  either  side.  There 
was  not  the  slightest  attention  paid  to  them  by  any  of  the 
official  groups  who  were  there  to  welcome  the  men  or  by  the 
public  in  general. 

Almost  eleven  thousand  American  nurses  were  in  Europe 
during  the  early  months  of  1919 ;  ten  thousand  were  serving  in 
the  American  Expeditionary  Forces  and  some  seven  hundred 
others  directly  under  the  American  Red  Cross.  In  the  military 
hospitals,  in  camps  and  cantonments  in  the  United  States, 
eleven  thousand  others  were  on  duty.  The  return  of  these 
twenty-three  thousand  nurses  to  civilian  life  offered  difficulties 
of  adjustment  of  a  nature  wdiich  the  Red  Cross,  which  had 
called  them  into  military  service,  was  well  able  to  anticipate  and 
understand.  And,  too,  since  the  Nursing  Service  had  mobil- 
ized the  great  proportion  of  these  nurses  into  military  service, 
Miss  I^oyes  and  Miss  Delano  felt  a  responsibility  for  facilitat- 
ing their  return  to  the  types  of  nursing  which  had  previously 
most  interested  them. 

On  December  10,  1918,  Miss  Noyes,  as  president  of  the 
American  Nurses'  Association,  had  written  to  Miss  Delano : 

In  view  of  the  fact  that  large  numbers  of  nurses  are  about 
to  be  released  from  service  in  the  cantonment  hospitals  of 
this  country  and  returned  from  duty  overseas,  it  seems  im- 
portant that  a  bureau  of  information  should  be  established 
in  New  York  City,  as  the  majority  of  the  nurses  will  be  re- 
turned through  this  port. 

The  purpose  of  this  bureau  will  be  to  serve  as  a  sort  of 
clearing-iiouse  through  which  the  nurses  may  be  directed 
toward  opportunities  for  service  now  existing  and  also  advised 
as  to  their  future.  Such  a  bureau  would,  1  feel  sure,  be  of 
inestimable  value  to  the  Public  Health  Nursing  Bureau  of  the 
American  Ked  Cross  in  recruiting  nurses  for  the  service.  It 
will  be  equally  valuable  to  the  Visiting  Nurse  Associations 
and  other  forms  of  public  health  service,  hospitals,  training 
schools  and  other  institutions  which  now  appear  to  be  in 
great  need  of  nursing  personnel. 


DEMOBILIZATION  1015 

As  president  of  the  American  Nurses'  Association,  it  was 
first  my  idea  that  this  work  sliould  l)c  done  under  the  auspices 
of  the  tliree  national  nurses'  organizations,  as  it  seemed  to 
be  a  professional  problem.  .  .  .  'J'he  fact  that  the  Ked  Cross 
has  assigned  the  majority  of  these  nurses  to  the  Army  and 
Navy  and  is  in  a  measure  obligated  to  continue  its  interest 
in  them  and  render  such  assistance  to  them  as  seems  possible, 
made  your  suggestion  that  the  Eed  Cross  assume  the  imme- 
diate control  of  such  a  bureau,  most  opportune  and  desirable. 
It  would  further  appear  that  such  an  agency  would  be  of 
great  value  in  helping  secure  nurses  for  the  public  health 
service  of  the  lied  Cross. 

On  IVIonday,  December  2,  I  presented  the  plan  informally 
at  a  joint  meeting  of  the  Boards  of  Directors  of  the  three  na- 
tional organizations  of  nurses.  They  were  deeply  interested 
and  all  expressed  their  general  approval  and  appreciation  of 
the  tentative  plan  and  their  willingness  to  present  it  to  their 
respective  I^oards  of  ])irectors. 

It  was  understood  that  the  plan  presented  was  about  as 
follows  (no  notes  being  taken)  : 

1.  That  the  Ked  Cross  was  prepared  to  open  a  bureau  of 
information  in  New  York  City  for  nurses  released  from  war 
service  and  that  the  three  national  nursing  organizations  were 
invited  to  place  representatives  in  this  office  to  assist  and 
advise  upon  matters  affecting  the  branches  of  service  repre- 
sented by  the  three  associations. 

2.  It  was  understood  that  the  Red  Cross  assume  the  ex- 
pense of  rental,  equipment,  clerical  assistance  and  manage- 
ment. 

3.  It  was  also  understood  that  the  Ked  Cross  would  in  all 
probability  assume  the  management  and  expense  during  the 
period  of  demobilization.  If  upon  the  completion  of  this 
period,  tiie  Ked  (.ross  decided  to  withdraw,  tliat  the  three 
national  organizations  continue  the  l^ureau  under  their  aus- 
pices if  such  an  oflice  seems  necessary. 

4.  That  a  small  Advisory  Council  rejiresentative  of  the 
three  organizations  be  asked  to  serve  in  a  purely  advisory 
capacity  until  such  time  as  the  Ked  Cross  should  withdraw; 
then  this  Advisory  Council  might  form  the  nucleus  of  a 
Board  of  Diroctors. 

On  IVcembor  10  ^fiss  Delano  secured  Kod  Cross  approval 
for  the  dcvolopnicnt  of  this  plan  and  the  fiirthcr  details  of 
organizatiini  were  turned  over  to  ^liss  Xoves. 

On  l)('c(>inl)('r  1.'5  ]\liss  Delano  wrote  to  the  presidcuits  of 
the  three  national  nursing  associations.     She  outlined  the  geu- 


1016  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

eral  purposes  and  organization  of  the  Bureau  of  Information 
and  then  continued : 

...  It  seems  desirable  to  have  the  cooperation  of  the  three 
national  organizations  of  nurses,  giving  them  the  opportu- 
nity to  place  in  the  Bureau  a  representative  who  could  ad- 
vise the  returning  nurses  in  regard  to  available  opportunities. 
.  .  .  The  Red  Cross  will  be  responsible  for  all  expenses,  ex- 
cept the  salaries  of  the  representatives  selected  by  the  national 
organizations. 

It  will  of  course  be  necessary  to  secure  all  possible  informa- 
tion from  training  schools,  hospitals,  public  health  nursing 
organizations  and  other  nursing  activities  in  regard  to  avail- 
able positions  and  it  is  desirable  that  wide  publicity  be  given 
to  the  establishment  of  such  a  bureau,  so  that  the  organiza- 
tions will  naturally  turn  there  for  advice. 

May  I  request,  therefore,  that  you  place  the  matter  before 
your  Board  of  Directors,  asking  for  their  cooperation  and 
giving  them  opportunity  to  place  a  representative  in  the 
office. 

It  would  also  seem  desirable  to  have  a  small  advisory  com- 
mittee which  could  assist  in  the  development  of  the  work. 
I  would,  therefore,  suggest  that  in  addition  to  the  President 
of  your  organization,  two  additional  members  be  selected  to 
serve  on  the  committee. 

The  Joint  National  Committee  of  the  Bureau  of  Information 
was  appointed  early  in  January,  1919,  and  was  composed  of 
Miss  Nutting,  Miss  Francis  and  ]\Iiss  Noyes  as  representatives 
of  the  American  Nurses'  Association ;  ^fiss  Goodrich,  JMiss 
Clayton  and  Miss  Hilliard  as  representatives  of  the  National 
League  of  Nursing  Education,  and  ]\Iiss  Wald,  ]\Iiss  Beard 
and  ]\[iss  Crandall  as  representatives  of  the  National  Organiza- 
tion of  Public  Health  Nursing.  Florence  Johnson  was  the 
office  manager  of  the  Bureau.  She  served  also  as  a  member  of 
the  Committee.  ]\riss  Noyes  was  chairman.  During  the  fol- 
lowing months  the  Joint  National  Advisory  Committee  stood 
sponsor  for  the  development  of  the  Bureau  of  Information  for 
Nurses. 

Florence  Johnson  was  office  manager,  as  it  has  been  stated 
before,  and  she  brought  to  this  as  to  her  other  tasks  in  connec- 
tion with  the  mobilization  and  demobilization  of  nurses,  the 
poise  and  rich  personal  charm  which  characterized  her  pre- 
Armistice  and  post-Armistice  service.     !Miss  Johnson  had  had 


DEMOBILIZATION  1017 

opportunity  to  go  overseas,  first  ■^astassistant  to  Miss  Stimson 
and  later  as  chief  nurse  of  the  American  lied  (Voss  in  Europe, 
but  she  elected  to  remain  in  Now  York.  When  the  homing 
transports  came  in  she  met  the  nurses  at  the  docks  with  the  same 
warm  enthusiasm  with  which  she  had  bade  them  Godspeed 
for  France  eighteen  months  before.  "She  still  lives  on  the 
docks,"  wrote  a  personal  friend  to  Miss  Noyes  in  the  spring  of 
1919,  "and  every  night  she  comes  home  'a  dead  dog.'  Can't 
you  use  your  influence  to  make  her  go  a  bit  slower  or  at  least  to 
take  part  of  Sunday  ?" 

As  the  development  of  the  Bureau  progressed  two  divisions 
were  created,  one  the  Division  of  Institutional  and  Student 
Assignment  and  the  other  the  Division  of  Public  Health 
Xursing. 

Kachel  Independence  Albaugh  was  chief  of  the  first-named 
division.  She  was  a  Maryland  woman  and  had  received  her 
nurses'  training  at  the  Homeopathic  Hospital  at  Baltimore. 
Executive  experience  in  various  Maryland  institutions  followed 
and  later  she  was  superintendent  of  the  Grace  Hospital  at  Xew 
Haven,  Connecticut.  For  the  next  fourteen  years  she  served 
as  secretary  of  the  Connecticut  State  Board  of  Xurse  Examiners 
and  from  1915  to  1919  as  Inspector  of  Training  Schools.  In 
these  capacities  she  conducted  the  valuable  Connecticut  State 
survey  of  nursing  activities  which  was  a  precursor  of  the  Bed 
Cross  nursing  surveys.  Previous  to  her  lied  Cross  appoint- 
ment she  had  been  one  of  Miss  Goodrich's  staff  in  the  Army 
School  of  Xursing. 

To  jMiss  Albaugh  was  delegated  all  detail  in  connection  w'ith 
the  placement  of  nurses  in  hospitals,  schools  of  nursing,  sana- 
toria and  other  institutional  positions.  The  Bureau  of  Informa- 
tion had  on  January  1  taken  over  the  work  of  student  enroll- 
ment from  the  Connnittee  on  Nursing  of  the  Council  of  Na- 
tional Defense  and  also  of  the  Army  School,  so  the  placement 
of  these  students  in  civilian  hospitals  also  fell  to  ^liss  Albaugh. 

Yssabella  Gertrude  Waters  volunteered  her  services  for 
four  months  as  chief  of  the  Division  of  Public  Health  Nursing. 
Possessed  of  independent  means  and  many  advantages  of  birth 
and  education,  she  had,  like  other  women  of  her  generation, 
found  in  nursing  an  outlet  to  her  desire  for  altruistic  service 
ami  was  throughout  her  long  career  a  volunteer.  Tu  ISHT  she 
was  graduatcnl  from  the  -lohns  Hopkins  School  and  soon  aft<'r- 
wards  went  to  Heiirv  Street  to  assist  Miss  Wald.      Duriiii:-  the 


1018  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Spanish-American  War  she  did  military  nnrsing  in  the  United 
States  and  Cuba.  In  1899  she  returned  to  Henry  Street  and 
remained  there  for  thirteen  years.  In  1912  she  undertook 
statistical  work  for  the  National  Organization  for  Public 
Health  Xursing.  Her  volume  on  Visiting  Nursing  in  the 
United  States  ^^  ranks  as  a  leading  source-book  on  the  subject. 
Patrician  in  appearance  and  winning  in  personality,  she 
brought  to  the  Bureau  of  Information  keen  intelligence  and  a 
knowledge  of  public  health  organizations  and  resources  per- 
haps unsurpassed  by  any  woman  in  the  United  States. 

After  four  months'  organization  work  Miss  Waters  resigned 
and  Jane  Elizabeth  Hitchcock  followed  her  as  chief  of  the 
Division  of  Public  Health  jS^ursing.  Miss  Hitchcock  had  at- 
tended Mount  Holyoke  College  for  two  years  and  had  taken 
special  work  for  three  years  at  Cornell  University.  She  was 
graduated  in  1891  from  the  New  York  Hospital  and  was  for 
two  years  a  head  nurse  of  the  Newton  (Massachusetts)  Hos- 
pital. She  then  went  to  Henry  Street  Settlement  and  for 
twelve  years  before  her  appointment  to  the  Bureau  of  Informa- 
tion was  superintendent  of  the  Henry  Street  staff  of  visiting 
nurses. 

During  the  early  period  of  1919  the  day's  work  at  the 
Bureau  of  Information  consisted  largely  in  interviewing  nurses 
returning  from  France ;  often  Miss  Hitchcock  and  Miss  Al- 
baugh  talked  to  thirty  or  more  nurses  each,  listed  their  previous 
experiences  and  future  interests  and  catalogued  the  cards  for 
future  reference. 

Like  the  soldiers,  the  nurses  were  coming  back  physically 
and  nervously  exhausted  and  their  one  desire  was  to  go  home 
and  rest.  This  attitude  and  the' growing  dissatisfaction  to  re- 
turn to  the  comparatively  narrow  fields  of  private  duty  nursing 
was  expressed  by  Laura  Hartwell : 

The  state  of  mind  of  some  ex-members  of  the  American 
Expeditionary  Forces  resembles  somewhat  the  forlorn  deso- 
lation of  a  homeless  eat.  While  this  is  true  of  both  men  and 
women,  it  applies  especially  to  tlie  returned  overseas  nurse, 
not  so  much  to  those  who  return  to  the  arms  of  admiring 
families  to  be  petted  and  spoiled  and  urged  to  take  a  long 
rest,  but  to  those  who  live  in  a  trunk,  as  it  were,  and  who 
make  their  homes  wlierever  their  hat  happens  to  be.  .  .  . 

"  Publislicd  in  1900  under  the  auspices  of  tlie  Russell  Saye  Foundation, 
bv  the  Cliarities  I'ublication  Committee,  New  York  Citv. 


DEMOBILIZATION  1019 

But  at  any  rate,  they  were  at  homo.  And  the  first  private 
duty  case,  when  one  returned  to  the  wliite  uniform,  l)rought  a 
certain  satisfaction,  hut  soon  one's  thou<^hts  turned  wistfully 
hack  to  the  days  when  slithering  around  in  the  mud,  wearing 
ruhher  hoots,  was  the  usual  method  of  going  on  duty. 

As  the  days  passed  and  the  patient  became  convalescent, 
the  longing  for  a  wider  sphere  became  more  acute.  .  .  .  The 
present  somehow  does  not  seem  to  fit  with  the  past  and  the 
future  of  useful  and  remunerative  work  seems  very  distant. 
This  attitude  is,  of  course,  to  a  great  extent  the  reflection  of 
the  world's  unrest,  hut  the  people  who  stayed  at  home  have 
advanced  along  different  lines  from  those  who  went  overseas 
and  they  cannot  see  why  the  daily  round  cannot  easily  be 
taken  up  again. 

And  then  how  one  misses  the  comradeship  of  the  life  over 
there,  wdiere  the  English  language  was  sufficient  introduction, 
the  comradeship  which  by  force  of  contrast  makes  the  bustling 
life  at  home  where  each  one  is  intent  on  his  or  her  own  busi- 
ness, seem  cold  and  unfriendly.  .  .  ^''' 

To  nurses  suffering  from  this  natural  psychological  reaction, 
the  Bureau  of  Information  offered  a  channel  of  reentry  into 
civilian  life.  By  September,  1919,  it  had  proven  unequivocally 
its  value.  In  the  Division  of  Institutional  Assig:nment  the 
names  of  2333  nurses  had  been  registered  for  placement.  On 
the  other  hand,  hospitals  and  schools  of  nursing  had  registered 
1710  vacancies  in  positions  ranging  from  superintendents  of 
hospitals,  superintendents  of  schools  of  nursing,  night  super- 
visors, instructors,  charge  nurses,  anesthetists,  laboratorv  and 
X-ray  technicians,  dietitians  and  general  ward  and  pupil 
nurses.  The  total  number  of  gi-aduate  nurses  placed  in  posi- 
tions by  ^Fiss  Albaugh's  division  numbered  805 ;  this  figure, 
however,  includes  only  the  placements  regarding  which  ]\Iiss 
Albaugh  had  definite  knowledge  that  the  nurse  had  accepted 
the  position  to  which  she  had  been  referred.  Great  difficulty 
was  experienced  to  get  the  nurses  to  report  back  to  the  Bureau 
after  they  had  accepted  a  position. 

The  second  major  activity  of  !Miss  Albaugh's  division  was 
student  assignnKmt.  Of  477  applications  received  from  young 
wouKMi  formerly  enrolled  in  the  Army  School  and  desiring 
})hu'('m('nt  in  civilian  hospitals,  398  were  referred  to  accredited 
schools  of  nursing.  In  this  connection  ^liss  Albaugh  gave 
valuable   information  to  ]\Iiss  Wheeler  in  her  revision  of  the 

^"^  American  Journal  of  Xursiiuj.  \'ol.  20.  jip.  2n4-2!>5. 


1020  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

list  of  accredited  training  schools,  as  published  by  the  Ameri- 
can ^Nurses'  Association  and  assisted  with  much  of  the  clerical 
details  of  compilation. 

The  activities  of  the  Division  of  Public  Health  Nursing 
consisted  in  collecting  and  disseminating  information  regard- 
ing the  general  field  of  public  health  nursing ;  in  collecting  and 
disseminating  information  regarding  public  health  nursing  edu- 
cation, especially  with  reference  to  post-graduate  scholarships ; 
and  in  referring  qualified  public  health  nurses  to  agencies  desir 
ing  their  services.  From  February  10  to  September  15,  1919, 
three  hundred  and  sixty-six  different  public  health  nursing 
organizations  applied  to  this  division  for  assistance  in  securing 
nurses.  "Many  of  the  requests,"  wrote  Miss  Hitchcock,  "come 
in  wholesale.  iSTorth  Carolina  wants  twenty-one  nurses  for 
town  and  country  work;  the  Tuberculosis  Association,  of 
Springfield,  Illinois,  wants  fifty;  the  State  department  of 
health  in  a  middle-western  state  puts  in  a  modest  request  for 
one  hundred  and  fifty  public  health  nurses." 

During  the  first  seven  months  of  its  existence  this  division 
had  registered  the  names  of  1274  public  health  nurses  or  nurses 
interested  in  taking  up  this  specialized  phase  of  the  profession 
and  had  referred  1255  of  them  to  organizations  desiring  their 
services. 

Miss  Hitchcock  gathered  some  interesting  data  regarding 
the  preliminary  education  of  nurses  enrolled  in  her  division. 
Eleven  per  cent  had  had  only  a  grammar  school  education, 
20  per  cent  had  had  college,  normal  or  private  school  educa- 
tion, Gd  per  cent  had  had  high  school  training.  As  to  their 
preparatory  work  in  public  health  nursing,  117  had  had  public 
health  nursing  courses  while  attending  a  general  school  of  nurs- 
ing; 75  had  had  post-graduate  courses  in  public  health  nursing; 
524  had  had  practical  experience.  The  requirements  of  this 
division  for  registry  were  the  same  as  those  of  the  Kcd  Cross 
Bureau  of  Public  Health  Nursing;  Service. 

As  the  end  of  the  demobilization  period  approached  and  the 
Red  Cross  prepared  to  close  the  Bureau  of  Information,  the 
opportunity  for  launching  a  long-cherished  project  seemed  ripe. 
"Almost  from  the  beginning  of  our  organization  life,"  declared 
the  editorial  colunms  of  the  Journal,  "the  need  for  central 
head(|uarters  has  been  talked  of,  first  by  one  gi'oup  of  members 
and  then  by  another,  but  there  has  never  seemed  to  be  a  time 
when  aU  the  conditions  were  favorable," 


DEMOBILIZATION  1021 

In  October,  1019,  Miss  Noyes  made  the  first  move  toward 
the  transfer  of  the  Bureau  of  Information  for  Nurses  from 
the  Ked  Cross  to  the  three  organizations  of  nursing.  At  a 
meeting  of  the  joint  boards  of  directors  of  the  three  national 
organizations,  ^liss  Noyes,  as  presi(k'nt  of  the  American  Nurses' 
Association,  was  authorized  to  appoint  a  committee  to  consider 
ways  and  means  by  which  the  Ked  Cross  Bureau  of  Informa- 
tion could  he  transferred  from  the  Department  of  Nursing  to 
die  three  national  organizations  and  used  as  the  nucleus  for 
central  headquarters  for  the  nursing  associations.  Miss  Nutting 
was  the  chairman  and  Elsie  M.  Lawler,  Mary  S.  Gardner, 
Katherine  Tucker,  Minnie  H.  Ahrens  and  Miss  Noyes  (ex- 
otHcio)  were  the  members  of  this  committee.  They  set  to 
work  and  drew  up  a  plan  which  was  presented  to  the  Board  of 
Directors  of  the  American  Nurses'  Association  at  a  meeting 
held  on  January  15  to  IG,  1920,  in  New  York  City.  The 
report  of  this  Committee  on  Transfer  and  of  the  new  plan  was, 
in  part,  as  follows: 

The  Bureau  of  Information  for  Nurses  was  established  by 
the  Eed  Cross  in  February,  1919,  largely  for  the  purpose  of 
assisting  nurses  who  have  been  in  Army  or  Ked  Cross  service. 
In  this,  it  has  l)een  of  notable  service.  .  .  .  The  time  ap- 
proaches when  the  Red  Cross  will  no  longer  feel  justified  in 
continuing  it.  It  would  seem  inadvisable  to  continue  it  in  its 
present  form.  It  would,  however,  take  its  place  in  a  larger 
plan — the  establishment  of  national  nursing  headquarters  as 
a  center  for  the  work  of  our  national  associations.  .  .  .  The 
committee  believes  that  the  conditions  are  favorable  for  the 
establishment  of  such  headquarters  and  that  steps  should  now 
be  taken  toward  that  end. 

The  definite  work  to  be  carried  on  in  such  a  center  would 
be  limited  at  first  to  that  most  urgently  needed.  Tlicre 
should  be :  ( 1 )  offices  for  the  secretaries  of  each  of  the  three 
national  organizations;  {'I)  a  bureau  of  a])pointment  and 
advice;  (;>)  a  division  of  publicity;  (4)  an  office  for  the 
American  Jouviud  of  Xursing;  (5)  a  library  and  reading 
rooms;  ((>)  the  combined  clerical  forces  of  all  these  depart- 
ments. 

The  e.\])ense  of  maintaining  such  a  headquarters  will  un- 
doul)tedly  be  rather  large,  and  in  order  to  meet  it  much  study 
of  all  our  resources  will  l)e  needed.  It  is  our  opinion  that 
the  needed  iiicnnie  can  be  secure(l  and  in  pursuanci^  of  this 
belief.  th(^  coinniitte"  submits  the   fdllowinLT  resolutions: 


1022  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A.  That  the  three  national  associations  of  nurses  take  over 
from  the  Ked  Cross  the  activities  of  the  Bureau  of  Advice 
and  Information. 

B.  That  this  transfer  be  made  as  soon  as  suitable  head- 
quarters can  be  obtained  (if  possible,  be  the  building  now 
housing  the  Xational  Organization  for  Public  Health  Xurs- 
ing)  and  the  necessary  financial  and  other  arrangements 
made  to  conduct  the  work. 

C.  That  the  Bureau  be  taken  over  as  a  branch  of  a  national 
nursing  headquarters  to  be  established  in  New  York  City, 
looking  forward  to  decentralization  at  the  earliest  possible 
date. 

D.  That  national  headquarters  include  the  three  nursing 
organizations  with  the  cooperation  of  the  Department  of 
Xursing  of  the  American  Red  Cross. 

Three  ways  are  presented  for  the  administration  of  the 
headquarters:  (1)  pooling  the  resources  and  personnel  and 
vesting  responsibility  in  a  committee  with  proportionate  rep- 
resentation; (2)  A  federation  of  the  bodies  concerned  with  a 
central  committee  which  shall  be  advisory;  (3)  A  combina- 
tion of  these  two  plans  by  which  certain  interests  and  ex- 
penses shall  be  shared,  others  handled  by  each  association, 
under  the  direction  of  a  committee  which  shall  act  as  a  board 
of  trustees.    This  is  the  plan  recommended.  .  .  .^" 

The  plan  was  immediately  hailed  with  enthusiasm  by  the 
majority  of  nurses.  It  would  effect  gi'eat  saving  of  time  and 
money,  as  under  the  old  order  duplication  in  the  work  of  the 
three  organizations  had  been  unavoidable.  As  Xew  York  was 
the  nursing  and  hospital  center  of  the  United  States,  it  seemed 
the  logical  city  for  a  headquarters. 

The  American  Xurses'  Association  met  at  Atlanta,  Georgia, 
April  12-17,  1920,  for  its  Twenty-Second  Convention,  and  the 
new  plan  for  central  headquarters  was  presented  on  April  15. 
Miss  Cutting,  as  chairman  of  the  Committee  on  Transfer,  read 
the  report.  The  names  of  ]\Iiss  Goodrich  and  Miss  Clayton 
were  added  to  the  Committee  on  Transfer,  which  was  later 
authorized  to  continue  as  the  Committee  on  Xational  Xursing 
Headquarters.  After  some  discussion  ]Miss  ^lacMillan,  of 
Chicago,  moved  that  ''the  Association  accept  the  report  of  the 
Committee  on  Xational  Headquarters  and  authorize  the  organi- 
zation of  the  headquarters."     The  motion  was  carried. 

"For  further  details,  see  tlie  Anicrican  Jounial  of  Xursing,  Vol.  20,  pp. 
503-505. 


DEMOBILIZATION  J1023 

By  Aupjiist,  1920,  the  details  of  transfer  had  been  completed 
and  the  Central  Headquarters  established  in  New  York  City. 
Miss  Albaugh  was  appointed  office  director  representing  the 
American  Nurses'  Association  and  the  National  League  of 
Nursing  Education.  The  Ked  Cross  financed  the  project  dur- 
ing its  hrst  year.  At  the  joint  convention  of  the  three  national 
organizations  of  nursing,  which  was  held  in  Seattle  between 
June  20  and  July  1,  11)22,  Miss  Noyes  retired  from  office  as 
president  of  the  American  Nurses'  Association  with  the  satis- 
faction of  knowing  that  the  National  Nursing  Headquarters 
would  be  maintained ;  the  revision  of  dues  which  provided  for 
an  increase  from  fifteen  to  fifty  cents  per  capita  for  member- 
ship in  the  American  Nurses'  Association,  accomplished  at  this 
meeting,  made  adequate  financial  provision. 

The  establishment  of  a  central  headquarters  marked  the  reali- 
zation of  a  need  long  felt  by  nursing  leaders ;  it  ranked  as  one 
of  the  signal  accomplishments  of  the  nursing  profession  during 
the  life  of  the  Association. 

A  second  major  development  of  the  demobilization  period 
was  the  organization  of  a  third  government  nurse  corps,  that 
of  the  Ignited  States  Public  Health  Service.  In  this  develop- 
ment the  Ked  Cross  Nursing  Service  played  an  important  part 
by  giving  its  interest  and  support  to  the  program  of  the  Public 
Health  Service  for  the  proper  establishment  of  a  corps  of 
({ualified  nurses  and  rendered  valuable  assistance  in  recruiting 
these  nurst's  for  tiic  new  corps. 

The  bruited  States  Public  Health  Service  had  been  estab- 
lished in  the  year  1798  as  the  ^farine  Hospital  Service.  Lender 
a  reorganization  act  of  July  1,  1902,  this  service  was  enlarged 
and  its  name  changed  to  that  of  the  Public  Health  and  Marine 
Hospital  S(>rvice.  Again  in  1912  different  divisions  which 
were  still  in  operation  in  1919  were  established,  and  its  name 
again  changed  to  that  of  the  United  States  Public  Health 
Service. 

Tm'o  of  the  nine  divisions  of  the  Public  Health  Service  were 
the  Bureau  of  Scientific  Jlesearch  and  the  Bureau  of  ^Marine 
Hospitals  and  Relief.  American  Jied  Cross  nurses  especially 
interested  in  the  care  of  trachoma,  pellagra  and  other  diseases 
had  been  assigned  during  1918  to  the  special  hospitals  con- 
ducted by  the  Iinreau  of  Scientific  Ivesearch.  Other  lied  Cross 
nurses  lind  been  assiuned  to  general  institutional  nursing  in  the 


1024  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospitals  maintained  by  the  Bureau  of  Marine  Hospitals  and 
Relief.  Among  these  was  the  large  base  hospital  at  Nitro, 
West  Virginia,  which  maintained  an  average  nursing  staff  of 
some  ninety  Red  Cross  nurses. 

The  Bureau  of  Marine  Hospitals  and  Relief  was  charged 
particularly  with  responsibility  for  furnishing  hospital  care 
to  civilian  sailors,  bpth  native  and  foreign.  During  the  fiscal 
year  ending  June  30,  1918,  this  bureau  operated  20  such 
marine  hospitals  and  maintained  119  other  relief  stations 
where  hospital  and  out-patient  relief  was  furnished  to  71,806 
patients.^^ 

Red  Cross  public  health  nurses  were  assigned  to  the  sanitary 
zones  maintained  by  the  Public  Health  Service  around  Army 
cantonments.  The  type  of  duty  these  nurses  rendered  has  al- 
ready been  described. 

Previous  to  the  post-Armistice  period  Miss  Noyes  had  se- 
lected nurses  for  these  various  types  of  service  and  had  her- 
self sent  the  nurses'  papers  directly  to  Dr.  Rupert  Blue,  then 
Surgeon  General  of  the  Public  Health  Service.  This  arrange- 
ment was  not  satisfactory,  however,  because  there  was  no 
executive  nurse  in  the  Public  Health  Service  to  W'hom  these 
nurses  might  turn  for  advice  and  aid. 

"With  the  signing  of  the  armistice  and  the  cessation  of  hos- 
tilities," wrote  General  Blue  in  the  Annual  Report  of  the  U.  S. 
Public  Health  Service  for  the  year  1919,  ''arose  the  problem 
of  taking  care  of  the  injured  sailor  and  soldier  after  discharge 
from  the  military  forces."  The  Bureau  of  Marine  Hospitals 
and  Relief  was  selected  as  the  most  promising  machinery  al- 
ready in  existence,  and  plans  for  an  increase  of  one  hundred 
per  cent  in  the  capacity  of  the  marine  hospitals  and  the  estab- 
lishment and  maintenance  of  additional  hospitals  were  formu- 
lated. 

One  of  the  major  phases  of  this  expansion  was  the  provision 
of  an  adequate  force  to  staif  these  hospitals.  General  Blue 
appealed  to  the  Red  Cross  Nursing  Service  in  December,  1918, 
for  additional  nurses.  An  early  step  in  developing  the  nursing 
force  lay  in  the  appointment  of  an  executive  nurse  to  develop 
and  supervise  the  work  and  here  the  Red  Cross  provided  salary 
and  traveling  expenses  until  the  permanent  appointment  of  a 
superintendent   of  nurses   to   develop    this   service   was   made; 

''Anniuil  Report.  1918.  of  tlie  Siiruvon  Cmcral  of  tlie  Piil>lic'  Tlcalth 
Service   of   tlie   I'nited    States.   ]>.   2'MJ;    Government   J-'iinting   Office,    1918. 


DEMOBILIZATION  1025 

Lucy  Minnif^crode  was  chosen  to  undertake  a  tour  of  inspection 
of  the  marine  hospitals.  On  January  10,  1919,  Miss  Noyes 
exphiined  to  the  general  manager  at  National  nead(iuarters 
her  recommendation  that  Miss  Minnigerode's  salary  be  carried 
on  the  Xursing  Service  budget ; 

Some  weeks  ago,  Surgeon  General  Bhie  asked  the  Depart- 
ment of  Nursing  to  appoint  a  nurse  as  inspector  of  the  ma- 
rine hospitals.  In  view  of  the  fact  that  we  have  been  pro- 
viding nurses  for  tliese  institutions,  we  felt  very  anxious  to 
do  this,  in  order  that  we  might  secure  uniformity  and  im- 
prove the  standard  of  nursing  eare  of  the  sick  in  these  hospi- 
tals. I  think  ]\Iiss  Delano  spoke  to  you  about  this  before  she 
left. 

We  engaged  Miss  ]\Iinnigerode  who  had  previously  been  in 
charge  at  National  Headquarters  of  tiie  preparation  of  nurs- 
ing personnel  for  special  overseas  duty,  for  this  purpose.  .  .  . 

During  January,  1919,  Miss  Minnigerode  visited  the  marine 
hospitals  at  Baltimore,  Savannah,  Xew  Orleans,  ^lobile,  ]\Iem- 
phis  and  Wilmington,  North  Carolina.  She  found  that  with 
the  exception  of  the  hospital  at  the  Emigration  Station  at 
Ellis  Island  and  the  special  hospitals  such  as  the  Pellagra 
Hospital  at  Spartanburg,  Xorth  Carolina,  few  nurses  had  been 
employed  in  the  past  in  these  institutions.  There  were  no  ade- 
quate nurses'  quarters  and  the  nursing  care  of  the  patients  was 
given  entirely  by  orderlies. 

Miss  Minnigerode  returned  in  February  to  Washington,  was 
given  a  desk  in  the  ofhce  of  the  Surgeon  General,  U.  S.  I'ublic 
Health  Service,  and  there  she  began  to  study  the  problems  at- 
tendant upon  the  development  of  a  nurse  corps. 

On  March  3,  1919,  Public  Act  320  was  passed  by  Congress, 
which  authorized  the  Secretary  of  the  Treasury  to  ''provide 
immediate  additional  hospital  and  sanatorium  facilities  for 
the  viwo  and  treatment  of  discharged  sick  and  disabled  soldiers, 
sailors  and  marines.  Army  and  Xavy  Xurses  (male  and  fe- 
male), patients  of  the  War  Risk  Insurance  Bureau,  and  the 
following  persons  only:  nuu'chant  marine  seamen,  seamen  on 
boats  of  the  Mississippi  liiv(>r  (\unmission.  oihc(>rs  and  enlisted 
men  of  the  United  States  Coast  Guard,  oilicers  and  employees 
of  the  Pul)lic  Health  Service,  certain  keepers  and  assistant 
keepers  of  the  United  States  Lighthouse  Service.  ..."  and 
other  specially  named  groups.     "It  will  be  seen,"  wrote  General 


1026  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Blue  in  his  Annual  Report  for  1919,  "that  Congress  thus  desig- 
nated the  Public  Health  Service  as  the  medical  agency  of  the 
Government  through  which  beneficiaries  of  the  War  Risk  In- 
surance were  to  be  given  the  necessary  hospital  and  sanatoria 
treatment.  This  legislative  action  is  in  line  with  the  adminis- 
trative practice  of  the  Public  Health  Service  in  endeavoring  to 
have  utilized  by  other  Government  Departments  and  Bureaus 
the  sanitary  and  medical  machinery  which  it  has  perfected." 

In  a  letter  written  on  March  14,  1918,  General  Blue  an- 
nounced to  Miss  Noyes  that  Miss  Minnigerode  had  been  se- 
lected as  superintendent  of  the  United  States  Public  Health 
nursing  service.  In  this  position  she  immediately  began  to 
build  up  an  office  and  field  force.  Obstacles  attendant  upon  such 
pioneering  were  naturally  encountered  in  the  following  months, 
but  with  the  fearlessness  and  outspoken  resolution  which  char- 
acterized her  methods  of  work  and  with  the  firm  support  of 
the  Surgeon  General  and  the  Red  Cross,  Miss  Minnigerode 
cut  her  way  through  prejudice  and  conservatism  and  established 
a  nursing  service  which  employed  the  largest  number  of  nurses 
utilized  by  the  Government  during  the  demobilization  period. 

Hospital  facilities  to  be  used  for  the  care  of  personnel  enu- 
merated in  Public  Act  326  were  to  be  provided  through  the  ex- 
pansion of  the  marine  hospitals ;  through  the  maintenance  by 
the  Public  Health  Service  of  several  former  Army  base  hos- 
pitals, and  through  the  establishment  of  new  hospitals.  The 
United  States  was  divided  into  fourteen  districts  and  offices  for 
the  examination  and  assignment  to  hospitals  of  beneficiaries 
of  the  War  Risk  Insurance  Bureau  were  established  in  each 
district. 

Early  in  1919  arrangements  were  cff'ected  by  which  the 
]*^ursing  Service  at  National  Headciuarters  undertook  to  assign 
nurses  to  Miss  ]\linnigerode's  division.  This  arrangement  was 
outlined  in  the  official  bulletin  issued  in  April,  1919,  by  the 
Public  Health  Service : 


The  XursG  Corps  of  the  U.  S.  Public  Health  Service  con- 
sists of  a  superintendent  of  nurses,  chief  nurses,  nurses  and 
reserve  nurses. 

Assignment  to  duty  as  chief  nurse  is  made  by  the  Surgeon 
General  upon  recommendation  of  the  superintendent  and  after 
the  candidate  has  furnished  satisfactory  evidence  that  she 
meets  the  requirements  of  such  service. 


DEMOBILIZATION  1027 

The  position  of  chief  nurse  in  a  hospital  of  the  U.  S.  Public 
Health  Service,  so  far  as  conditions  permit,  is  equivalent  to 
that  of  su])erintendent  of  nurses  in  a  civilian  hospital.  Slie 
will  have  <iencral  sui)ervision  under  the  medical  officer  in 
char<je,  of  all  the  nursing  service  in  tlie  hospital  and  is  ex- 
pected to  instruct  the  nurses  assi<rned  to  that  hospital  in  the 
duties  peculiar  to  the  Marine  Hospital  Service. 

Nurses 

Application  for  the  appointment  of  nurse  in  the  Xurse 
Corps  of  the  T'.  S.  Public  Health  Service  should  be  made  to 
the  Surgeon  General  U.  S.  Public  Health  Service,  who  will 
direct  that  the  necessary  information  be  sent  to  her.  For 
the  present  and  until  the  Xurse  Corps  is  established,  the 
Nursing  l)ei)artment  of  the  American  Ped  Cross  has  been 
requested  to  assign  the  nurses  to  these  hospitals,  and  the  ap- 
plicants must  therefore  meet  the  requirements  for  enrollment 
in  the  Ped  Cross.  The  Ped  Cross  assigns  the  nurses  for  a 
period  of  six  months,  after  which  time  the  appointment  may 
be  made  permanent.  .  .  . 

Appointments 

Applicants  who  meet  the  requirements  of  this  service  will 
be  placed  on  the  eligible  list  for  appointment  as  their  services 
may  be  required.  .  .  . 

The  first  six  months  after  appointment  shall  be  considered 
as  probationary  ])eriod,  to  observe  the  fitness  of  the  nurse  for 
this  service  and  her  adaptability  to  coiulitions  in  marine  hos- 
pitals. If  during  the  six  months,  a  nurse  has  given  satisfac- 
tory service  and  has  met  the  requirements  of  the  ^Nfarine 
Hospital  Service,  she  may  then  beci  me  a  permanent  member 
of  the  Xurse  Corps,  if  she  so  desires.  She  must  then,  how- 
ever, conform  to  the  regulations  of  the  Civil  Service 
Commission.  .  .  . 

Prior  to  July  1,  1010,  luirsos  in  the  Public  noalth  Service 
received  $70  a  month  for  the  first  two  years  of  service,  with 
proportionate  increases  for  longer  terms  of  service.  After 
July  1,  1010,  the  salary  was  increased  to  $80  a  month.  Chief 
nurses  received  a  base  pay  of  $00  a  month,  which  was  hiter 
increased  to  $1(»0.  Quarters,  subsistence  and  laundering  of 
uniforms  were  furnished  and  the  nurses  received  thirty  days' 
annual  leave  and  thirty  days'  sick  leave,  if  necessary,  within 
a  given  vear. 


1028  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  uniform  to  be  worn  in  the  wards  was  a  white  cotton, 
one-piece  dress,  with  wliite  shoes  and  stockings.  Nurses  as- 
signed to  the  Public  Health  Nurse  Corps  who  were  members 
of  the  Ked  Cross  Nursing  Service  were  permitted  to  wear  the 
Red  Cross  indoor  uniform  and  the  Red  Cross  cape.  However, 
if  they  were  accepted  as  permanent  members  of  the  corps, 
they  were  expected  to  secure  the  regulation  uniform  of  the 
corps.  Later  an  outdoor  uniform,  which  was  forest  green  in 
color  and  which  consisted  of  oxford  coat  and  skirt,  was  author- 
ized. The  insignia  of  the  Public  Health  Service  was  a  bronze 
design  consisting  of  the  coiled  serpent  of  ^sculapius  with  a 
bronze  anchor  superimposed  upon  it. 

Perhaps  because  the  work  in  the  marine  and  other  hospitals 
of  the  Public  Health  Service  dealt  w'ith  the  ex-servace  men, 
or  because  the  arrangement  effected  by  the  Red  Cross  offered 
temporary  employment  until  the  nurses  could  make  up  their 
minds  regarding  the  type  of  permanent  civilian  work  they 
wished  to  enter,  the  Pul3lic  Health  Service  was  for  a  time  very 
popular  with  the  demobilized  nurses.  By  July  1,  1922,  the 
American  Red  Cross  Nursing  Service  had  directly  assigned 
C28  of  its  nurses  to  the  Public  Health  Nurse  Corps  and  had 
recommended  for  appointment  the  names  of  approximately  fif- 
teen hundred  others.  During  February,  1920,  the  Nursing 
Service  at  National  Headquarters  sent  the  papers  of  an  average 
of  twenty  nurses  a  day  to  Miss  Minnigerodc's  division. 

By  the  end  of  the  fiscal  year  1920  the  Nurse  Corps  of  the 
Public  Health  Service  had  a  strength  of  1100  nurses.  Miss 
]\[innigcrode  had  as  her  assistant  Clare  Gaffney,  a  graduate  of 
the  ]\raryland  General  Hospital  School,  of  Baltimore.  Miss 
Gaffney  had  served  in  Sanitary  Zone  No.  9  for  twenty-two 
months,  and  in  November,  1919,  had  been  assigned  to  Wash- 
ington as  assistant  superintendent.  ]\liss  Minnigerode's  staff 
also  included  a  second  assistant,  ]Mary  Ruth  Swan,  who  was 
detailed  partially  to  the  Washington  headquarters  and  par- 
tially to  field  supervision.  Meta  C.  Brooke  and  ]\rabel  K. 
Adams  were  also  assistants  to  ^[iss  ]\[innigcrode  and  were  as- 
signed to  duty  largely  in  tlie  field.  "Cortperative  relationships 
had  also  been  established,"  stated  the  Annual  Report  of  the 
Public  Health  Service  for  the  year  1920,  "with  the  Federal 
Board  for  Vocational  Education  witli  regard  to  a  small  nursing 
force  which  had  been  found  necessary  for  the  prosecution  of 
medical  care  for  trainees  of  that  Board.''      These  nurses  did 


DEMOBILIZATION  1029 

general  medical  and  social  service  ''follow-up"  work.  They 
were  under  the  supervision  of  Airs.  Katherine  C.  Hough,  who 
was  on  duty  in  the  office  of  the  Chief  Medical  Officer  of  the 
Federal  Board. 

The  Annual  Report  of  the  Public  Health  Service  for  the 
year  1920  continued: 

.  .  .  The  greatest  problem  with  which  the  nursing  section 
has  been  confronted  is  the  inability  to  secure  an  adequate 
number  of  well-trained  nurses  suitable  for  the  work.  ...  In 
addition  to  this  the  rapid  organization  of  a  female  nursing 
corps  has  thrown  new  burdens  on  the  Pulilic  Health  Service 
in  the  matter  of  securing  adequate  quarters  and  perfecting  an 
organization  for  the  discipline  of  so  large  a  corps.  These 
problems  are  being  met  gradually  but  the  question  of  quar- 
ters still  remains  a  difficult  one.  .  .  . 

In  the  discipline  of  the  nursing  corps  there  has  been  found 
to  exist  a  certain  spirit  of  unrest  which  is  by  no  means  con- 
fined to  any  one  group  of  persons^  and  this  has  resulted  in  a 
very  large  turnover,  which  it  is  hoped  may  be  avoided  during 
the  coming  year  because  it  does  much  to  militate  against 
tlie  ef1icien(y  of  the  Corps  and  renders  more  difficult  the  es- 
tablishment of  a  higii  morale.  .  .  . 

During  the  period  between  June  30,  1920,  and  July  1,  1921, 

the  co(")p(U"ation  with  the  American  Red  Cross  continued  in- 
directly, but  th(>  nurses  were  referred  to  the  Public  Health 
Service  Xurse  Corps  with  recommendation  for  appointment 
rather  than  assigned  directly,  as  had  been  the  procedure  under 
the  initial  agreement.  Of  the  1350  nurses  apointed  during  this 
fiscal  year,  only  200  were  recommended  through  the  Red  Cross; 
the  other  lOSl  were  r(>cruited  through  Miss  Alinnigerode's 
office.  However,  the  publicity  given  to  the  needs  of  the  Public 
Health  Xurse  Corps  by  the  Red  Cross  and  the  efforts  of  Red 
Cross  Division  Dii-ectors  of  Xursing  wei'e  instrumental  in  se- 
curing tlies(>  nurses.  During  this  period  the  further  develop- 
ment of  the  Xnrsc  Corps  progr(>ssed,  educational  projects  were 
launched  and  a  far  more  satisfactory  esprit  dc  corps  was  built 
up  among  the  nurses.  One-fourth  of  the  inirses  who  resigned 
from  causes  otlier  tlian  ill-iiealth  and  nuirriage,  asked  i'or  re- 
instatement. 

By   ()rd(>r  of   the    Secn^tary  of  the   Treasury,   on    Aju'il   19, 
192i,    all   the   activities  of  the    Public   Health   Service   which 


1030  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

related  to  the  beneficiaries  of  the  Bureau  of  War  Risk  Insur- 
ance, except  those  activities  rehiting  to  the  operation  of  hospitals 
and  dispensaries,  were  transferred  from  the  Public  Health 
Service  to  the  Bureau  of  War  Risk  Insurance.  The  Sweet  Bill, 
which  was  approved  bv  Congress  on  August  9,  1921,  legalized 
this  order  and  created  the  Veterans'  Bureau.  By  an  Executive 
Order  of  May  1,  1922,  all  hospitals  caring  for  ex-service  men 
and  women  were  transferred  on  that  date  from  the  Public 
Health  Service  to  the  Veterans'  Bureau  and  on  July  1  all  dis- 
pensaries, with  the  result  that  some  thousand  nurses  of  the 
Public  Health  Xurse  Corps  were  automatically  shifted  from 
Miss  Minnigerode's  division  to  that  of  the  superintendent  of 
the  Nurse  Corps,  Veterans'  Bureau.  The  Nurse  Corps  of  the 
Public  Health  Service  continued,  however,  to  be  maintained 
to  staff  the  hospitals  and  dispensaries  of  the  former  Bureau  of 
Marine  Hospitals  and  Relief  and  Reconstruction  aides  and 
dietitians  were  placed  in  Miss  Minnigerode's  division  when  the 
hospitals  were  transferred.  On  July  1,  1922,  this  division  had 
a  total  strength  of  -150  nurses,  dietitians  and  aides. 

The  Nurse  Corps  of  the  Veterans'  Bureau  numbered  in  the 
summer  of  1922  some  fourteen  hundred  nurses — those  of  the 
former  Public  Health  hospitals,  those  of  new  hospitals  of  the 
Veterans'  Bureau  and  those  of  the  Federal  Board  of  Vocational 
Re-education.  ]\rarv  Agnes  Ilickey  was  the  newly  appointed 
superintendent.  Mrs.  Hickey  was  born  in  Ireland  and  was 
graduated  in  1900  from  St.  ]\[ary's  Hospital,  Brooklyn,  New 
York.  She  had  extensive  experience  as  a  nurse  instructor  and 
as  a  school  nurse.  She  went  overseas  in  1918  for  service  with 
the  Red  Cross  Children's  Bureau  but  in  the  military  shortage 
was  assigned  to  the  Service  tie  Sante  to  nurse  American 
wounded  in  French  hospitals.  She  was  transferred  to  the 
Army  Nurse  Corps  late  in  1918,  returned  to  this  country  dur- 
ing the  following  year  and  in  August  entered  the  Public  Health 
Nurse  Corps,  where  she  later  served  as  Miss  Minnigerode's 
assistant. 

At  the  present  date  of  writing  the  organization  of  the  Nurse 
Corps,  Veterans'  Bureau,  has  not  l)een  entirely  perfected. 
However,  tlie  first  indication  that  the  Veterans'  Bureau  would 
look  to  tlie  Red  Cross  Nursing  Service  as  its  reserve,  as  had 
the  Piil)lic  Health  S(>rvice,  was  contained  in  a  letter  addressed 
to  ]\liss  Johnson  on  July  5,  1922,  by  Colonel  Robert  U.  Pat- 
terson, assistant  director  of  the  Veterans'  Bureau  and  formerly 


DEMOBILIZATION  1031 

chief  of  the  Red  Cross  Bureau  of  ]\redical  Service  in  1914. 
Colonel  Patterson  said  in  part  that  ''the  Bureau  desires  to  call 
your  attention  to  the  existing  shortage  of  nurses  for  duty  in 
the  U.  S.  Veterans'  hospitals  and  to  rc(iuest  that  you  do  what- 
ever you  are  able  toward  recruiting  nurses  for  this  service.  .  .  . 
To  be  eligible  for  appointment  to  this  service,"  he  added, 
"nurses  must  be  citizens  of  the  United  States,  graduates  of 
recognized  training  schools  for  nurses,  registered  and  able  to 
qualify  under  the  regulations  of  the  Civil  Service  Commission. 
The  salaries  of  nurses  include  quarters,  subsistence  and  laun- 
dry, and  are  as  follows:  staff  nurses,  $960  per  annum;  head 
nurses,  $1020;  assistant  chief  nurses  and  acting  chief  nurses 
in  hospitals  of  less  than  200  beds,  $1200,  and  chief  nurses  in 
hospitals  of  200  beds  or  more,  $1584  per  annum.  Vacancies  in 
the  higher  grades  are  tilled  by  promotion  from  a  lower  rank, 
rather  than  by  new  appointments." 

During  the  European  War  the  casualty  rate  among  Ameri- 
can nurses  in  military  service  seemed  high.  The  principal 
cause  was  disease.  Xo  nurses  were  killed  in  action.  Four 
were  wounded  in  enemy  air  raids.  In  view  of  the  fact  that 
nurses  belong  to  the  sanitary  service  and  that  the  sanitary 
service  is  a  non-combatant  branch  of  the  ^lilitary  Establish- 
ment, a  branch  protected  in  previous  modern  wars  by  interna- 
tional agTcement  and  commonly  accepted  principles  of  hu- 
manitarianism,  this  figiire  is  unique  in  the  history  of  American 
war  nursing.  The  American  nurses  wounded  in  line  of  duty 
were  Beatrice  ^Fary  ]\lacl)onald,  a  nurse  member  of  Base  Hos- 
pital Xo.  2,  who  was  wounded  Augiist  17,  1917,  while  on  de- 
tached duty  at  Casualty  Clearing  Station  Xo.  (51,  British 
Expeditionary  Forces;  Eva  flcan  Parmelee,  of  Base  Hospital 
Xo.  5,  who  was  wounded  September  4,  1917,  while  on  duty  at 
her  base,  Xo.  11  General  Hospital,  British  Expeditionary 
Forces,  Dannes  Camiers,  France ;  Isabelle  Stambaugh,  of  Base 
Hospital  Xo.  11,  who  was  wounded  ^larch  2;3,  1918,  while  on 
detached  duty  at  Xo.  42  Stationary  Hospital,  British  Expedi- 
tionary Forces,  Amiens,  and  Jane  fletl'erv,  an  American  Bed 
Cross  child  welfare  nurse  assigned  to  military  service^,  who 
was  wounded  on  July  15,  1918,  at  American  Bed  Cross  Hos- 
pital Xo.  107,  Jouy-sur-.Morin,  France. 

Of  the  2;}, 000  American  inirses  in  military  service  fn)m 
April  (!,  1917,  to  Xovcmbcr  11,  1919  (this  figure^  docs  not  in- 
clude those  assiancd   to   inthienza   relict"  nor  those  wt)rkinir  at 


1032  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Red  Cross  Chapter,  Division  or  National  Headquarters  or 
serving  npon  Red  Cross  enrollment  committees),  over  three 
hundred  died  from  diseases  contracted  in  line  of  duty,  and  449 
others  suffered  total  or  partial  disability — a  total  of  some  Y49 
nurses.  Thus  three  out  of  every  hundred  nurses  either  died  or 
suffered  temporary  or  permanent  disability  from  war  nursing 
service. 

The  number  of  Army  nurses  who  died  during  the  participa- 
tion of  the  United  States  in  the  European  War  was  2C8 ;  of 
this  number  218  were  reserve  members  and  50  were  regular 
members.  The  number  of  Navy  nurses  who  died  during  the 
same  period  was  28 ;  of  this  number  24  were  American  Red 
Cross  nurses,  one  was  a  reserve  nurse  but  not  assigned  through 
the  Red  Cross  and  three  were  regular  members.  Thus  the 
number  of  American  Red  Cross  nurses  who  died  in  line  of 
duty  with  the  Army  and  Navy  was  242.  Forty  other  Red 
Cross  nurses  died  in  other  types  of  war  nursing,  so  the  total  of 
American  Red  Cross  nurses  who  died  in  line  of  duty  in  the 
European  War  was  282. 

Four  American  Red  Cross  nurses  died  in  line  of  duty  with 
American  Red  Cross  commissions  or  allied  relief  organizations 
overseas.  The  first  of  these  was  Nina  Louise  Seymour,  who 
died  from  pneumonia  on  October  10,  1918,  at  American  Red 
Cross  Hospital  No.  114,  at  Poule,  France;  the  second  was 
Nettie  Grace  IMcBride,  who  succumbed  to  typhus  fever  on  De- 
cember 23,  1918,  at  an  American  Red  Cross  hospital  at  Tumen, 
Siberia.  Jane  Delano  was  the  next  nurse  to  die  under  the  Red 
Cross  flag,  and  on  ]\[ay  17,  1919,  Edith  ^fay  Winchester  died 
from  typhus  at  Erivan,  Armenia,  while  on  duty  with  the  Ar- 
menian and  Syrian  Relief  Committee.  Three  others  of  the 
282  nurses  were  killed  by  accidents;  one  when  the  airplane  in 
wliich  she  had  been  taken  for  a  flight  crashed,  and  the  other  two 
in  the  accident  on  the  S.  S.  Monfjolia.  A  full  list  of  the  Red 
Cross  nurses  who  died  in  military  service  may  be  found  in  the 
Appendix. 

Of  the  449  nurses  partially  or  permanently  disabled,  some 
twenty-five   per  cent   suffered   from  tuberculosis.^'-^     The  high 

"Tliis  fitrure  was  taken  from  information  fiirnisliod  by  American  Ked 
Cross  nurses  wlio  filled  out  tlie  quest ionmiires  issued  by  Division  Depart- 
ments of  Nursing  to  all  ex-service  American  Red  Cross 'nurses.  According 
to  a  compilation  ])repared  in  the  statistical  division  of  tiie  Surgeon  Gen- 
eral's office,  the  pei'centage  of  tuberculosis  among  nurses  admitted  as  pa- 
tients in   Army  hospitals  was  much   lower. 


DEMOBILIZATION  1033 

rate  of  tuberculosis  came,  it  is  thought,  from  general  lowered 
vitality  due  to  the  lack  of  proper  heating  facilities  and  the 
long  hours  of  duty.  On  questionnaires  later  sent  out  by  the 
Red  Cross,  disabled  nurses  stated  that  they  had  first  suffered 
from  heavy  colds  but  had  not  stopped  to  report  them  and  take 
the  needed  rest  because  they  appreciated  that  their  inactivity 
would  place  the  burden  of  their  work  on  the  shoulders  of  their 
already  overburdened  sister  nurses.  While  the  Red  Cross  made 
every  effort  to  secure  a  thorough  physical  examination  before 
the  nurse  was  admitted  to  the  Red  Cross  and  military  services, 
this  was  not  always  possible ;  some  of  the  examining  physicians 
were  thorough  but  some  were  lax.  Upon  reexamination  after 
they  had  seen  service  in  the  Army,  there  were  nurses  who  were 
found  physically  unfit  and  discharged.  Yet  even  with  every 
effort  on  the  part  of  the  Army  to  sift  out  these  nurses,  it  is  quite 
possible  that  many  nurses  whose  vitality  was  not  sufficient  were 
retained  in  Army  service  because  of  the  acute  shortage  of  nurses 
and  the  brief  time  within  which  the  Army  and  the  Red  Cross 
was  called  upon  to  mobilize. 

Public  Act  32G,  which,  it  will  be  remembered,  was  the  Con- 
gressional authorization  for  the  hospital  care  and  treatment  of 
beneficiaries  of  the  Bureau  of  War  Risk  Insurance,  had  espe- 
cially named  Army  and  iSTavy  nurses  as  eligible  for  its  benefits. 
American  Red  Cross  nurses  on  duty  with  the  Army  or  the  Xavy 
in  this  country  or  overseas  were  cared  for  in  special  infirmaries 
maintained  for  sick  nurses  by  the  base  hospitiil  to  which  they 
were  attached.  As  reserve  members  of  the  Army  and  Xavy 
Xurse  Corps,  they  were  eligible  to  all  benefits  of  Federal  care, 
compensation  and  reeducation.  During  1918  Army  nurses 
convalescent  in  this  country  were  sent  to  recuperate  at  Sea- 
bright,  the  country  estate  of  ]\Ir.  and  Mrs.  Jacob  Scliiff,  which 
the  Xew  York  philanthropist  and  his  wife  had  turned  over  to 
the  Army.  Scabright  was  located  at  Redbank,  Xew  Jersey, 
and  "was  not  merely  a  house  but  just  a  big,  beautiful  sunshiny 
liome,  with  everything  in  it  that  the  family  had  loved  and  en- 
joyed," wrote  ^1.  E.  Ilines,  an  Army  nurse.  "It  offers  every 
comfort  one  could  imagine,"  she  continued.  "It  is  more  like 
a  fairy  tale  than  real  life,  for  it  is  actually  true  that  we  felt 
the  atmosphere  of  the  liominess,  the  hospitality,  the  peace  and 
rest  as  soon  as  we  entered  .  .  .  and  although  we  were  sent  by 
the  Government,  and  some  came  reluctantly  and  almost  in 
tears  because  tliev  didn't  know  or  couldn't  conceive  what  kind 


1034  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  a  place  it  was,  we  left  more  reluctantly,  because  nowhere  is 
there  another  place  like  it."  -"  Seabright  was  maintained  en- 
tirely by  the  generosity  of  its  owners,  although  the  Army  Nurse 
Corps  had  supervisory  authority  over  the  nurses  sent  there. 
The  length  of  stay  ranged  from  two  weeks  to  three  months, 
depending  on  the  needs  of  each  patient,  and  the  nurses  were 
entertained  at  no  cost  whatsoever  to  themselves.  Mr.  and  Mrs. 
Schilf  also  gave  much  of  their  time  and  interest  to  the  nurses. 
Seabright  was  closed  during  the  last  days  of  October,  as  the 
heating  facilities  were  inadequate  for  the  winter  months. 

Early  in  January,  1919,  a  rest  house  for  nurses  was  opened 
at  Riverdale,  New  York,  the  former  homestead  of  Grace  Dodge, 
the  New  York  woman  philanthropist  who  did  much  for  the 
establishment  of  the  Young  Women's  Christian  Association 
and  the  Central  Club  for  Nurses  in  New  York  City.  Mr.  and 
Mrs.  Cleveland  Dodge  offered  the  use  of  the  Riverdale  estate 
to  the  Army  Nurse  Corps  and  continued  its  maintenance  until 
the  spring  of  1920.  The  interior  of  the  house  was  charming 
and  the  grounds  sloped  down  to  the  Hudson  River. 

The  manner  in  which  sick  Army  nurses  were  cared  for  over- 
seas was  described  by  Miss  Stimson  in  her  ^'History  of  the 
Nursing  Activities,  American  Expeditionary  Forces,  during 
the  War  Period  on  the  Western  Front :" 

Sick  nurses  have  been  oared  for  in  various  ways.  In  some 
hospitals,  such  nurses  were  kept  in  quarters.  This  method 
is  unsatisfactory  and  should  be  followed  only  when  no  other 
provision  is  available.  Some  hospitals  have  made  a  special 
])art  of  the  nurses'  quarters  into  an  infirmary  and  have  as- 
signed nurses  to  duty  there  as  though  on  regular  duty  in  the 
hospital  wards.  This  plan  is  second  best.  The  most  satis- 
factory scheme  is  to  liave  a  ward  or  part  of  a  ward  of  special 
rooms  in  the  hospital  proper  set  apart  as  a  nurses'  infirmary, 
to  wliieh  all  nurses  luiable  to  go  on  duty  for  any  physical 
reason  whatsoever  are  sent  at  once  and  where  they  receive 
regular  care  as  patients. 

In  some  centers,  it  has  been  found  advisable  to  have  a 
center  infirmary  in  one  of  the  hospitals,  to  which  all  the  sick 
juirses  of  all  tlic  hospitals  of  the  center  are  sent.  While  this 
plan  of  concentration  made  for  economy  of  supplies  and  nurs- 
ing stalT.  it  has  not  worked  out  satisfactorily  in  every  in- 
stance, owing  to  the  prejudice  which  existed  in  the  minds  of 

-"American  Journal  of  Xitrsiiig,  Vol.   IS,  p.   172. 


DEMOBILIZATION  1035 

most  sick  nurses  to  being  cared  for  in  a  hospital  not  their 
own  and  by  nurses  and  due-tors  who  were  strangers  to  them. 

Miss  Stinison  described  the  method  by  which  sick  and  dis- 
abled Army  nurses  were  returned  to  the  United  States  irom. 
foreign  service : 

The  evacuation  of  sick  nurses,  after  the  usual  classification 
by  a  medical  board,  was  tlirough  Base  Hospital  Ko.  8  at 
Savenay  up  to  February,  lUl'J,  when  Base  Hospital  ^o.  113 
was  made  the  place  of  collection  for  patient  nurses. 

The  following  paragraph  in  a  letter  dated  ]\Iarch  3,  1919, 
from  the  Superintendent  of  the  Army  Nurse  Corps  to  the 
Director  of  Nursing,  A.  E.  ¥.,  stated  the  plan  for  tlie  dispo- 
sition of  sick  nurses  upon  their  arrival  in  the  United  States: 
"Those  who  arrive  in  the  United  States  as  patients  may  go 
home  if  tliey  themselves  desire  to  do  so,  provided  they  make 
an  official  request  for  relief  from  service,  stating  at  the  same 
time  that  they  desire  to  forego  further  treatment  a-fc  govern- 
ment expense.  The  ^ledical  Department  is  most  desirous  of 
giving  all  nurses  every  opportunity  to  regain  so  far  as  possi- 
ble their  normal  health,  so  unless  the  nurses  themselves  de- 
sire to  go  home,  they  will  in  all  cases  be  furnished  with  proper 
care  as  long  as  it  is  needed. 

When  acutely  sick  and  disabled  nurses  arrived  in  i^ew  York 
they  were,  if  they  so  desired,  sent  directly  to  Army  base  hos- 
pitals in  this  country  for  further  care.  Yet  among  the  many 
home-coming  nurses  were  women  whose  sickness  and  disability 
had  not  yet  become  acute  enough  for  them  to  have  requested 
hospitalization.  They  returned  to  Xew  York,  got  their  dis- 
charge from  the  Army  and  plunged  into  civilian  nursing  again, 
only  to  find  that  their  health  had  been  undermined  and  that 
they  were  unable  to  work.  The  nurses  suffering  from  tubercu- 
losis offered  examples  of  this  type  of  incipient  disability.  They 
were,  however,  still  eligible  for  Federal  aid,  but  there  was  no 
provision  for  tlu'ir  treatnuuit  and  care  during  the  period  when 
they  were  establishing  their  claims  or  during  convalescence, 
after  they  had  been  discharged  from  hospitals  of  the  Uublio 
Healtli  Service.  For  nurses  sick  or  disabled  in  lied  Cross  for- 
eign service,  there  was  no  provision  whatsoever. 

The  four  women  whose  position  best  enabled  them  to  befriend 
and  aid  sick  and  disabled  luu'ses  were  Florence  Johnson  and 
Christine    Xuno,    at    Atlantic    Division    Headquarters;    Miss 


1036  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Noyes,  at  N^ational  Headquarters,  and  Miss  Minnigerode,  in 
the  Public  Health  Service.  Miss  Johnson  and  Miss  ISTuno  met 
the  sick  nurses  on  the  docks  and  their  interest  and  sturdy  labors 
did  not  cease  until  each  nurse  had  claimed  and  received  the  care 
and  compensation  provided  by  Federal  law  for  Army  and  Navy 
nurses  or  by  National  Headquarters  for  nurses  under  special 
Eed  Cross  service  overseas. 

Christine  Nuno  was  Miss  Johnscn's  assistant.  She  had 
been  graduated  in  1914  from  the  School  of  Nursing  at  St. 
Luke's  Hospital,  New  York  City.  She  was  for  some  months 
chief  nurse  of  the  base  hospital  at  Camp  Meade,  Maryland, 
and  was  then  transferred  to  New  York  and  served  as  chief 
nurse  of  Debarkation  Hospital  No.  5.  In  June,  1919,  she  was 
discharged  from  the  Army  and  went  to  Atlantic  Division  Head- 
quarters to  assist  Miss  Johnson  in  locating  and  caring  for  sick 
nurses,  a  task  for  which  her  unfailingly  happy  disposition  made 
her  admirably  fitted.  Beneath  a  manner  bubbling  over  with 
sheer  exuberance  of  spirits,  she  possessed  a  very  real  and  deep 
sympathy  for  each  and  every  one  of  the  sick  nurses  whom  she 
piloted  through  the  mazes  of  Federal  adjustment.  Her  good 
cheer  seemed  limitless,  her  enthusiasm  could  not  be  cooled  by 
any  amount  of  red  tape  and  delay,  and  in  her  company  the 
sick  nurses  took  heart  and  laughed  with  her. 

Through  the  Red  Cross  Bureau  of  Information  for  Nurses, 
Miss  Johnson  and  Miss  Nuno  came  in  contact  with  many  sick 
and  disabled  nurses  who  were  being  held  in  New  York  pending 
investigation  and  hospitalization  by  the  Public  Health  Service. 
These  nurses  needed  good  accommodations  and  supervisory  aid 
in  presenting  their  claims ;  however,  the  prices  existing  in  New 
York  hotels  were  beyond  their  resources,  especially  since  the 
majority  of  them  had  not  yet  begun  to  receive  compensation 
from  the  Veterans'  Bureau.  The  Atlantic  Division  accordingly 
engaged  accommodations  for  ten  nurses  at  an  excellent  hotel  on 
^[adison  Square,  and  sick  and  disabled  nurses  were  cared  for 
there  without  charge  until  their  claims  were  settled  and  they 
could  leave  New  York.  As  soon  as  the  numbers  of  sick  nurses 
passing  through  New  York  decreased,  these  rooms  were  relin- 
quished. At  the  same  hotel  were  quartered  the  students  of  the 
Army  School  of  Nursing  who  were  taking  th(nr  public  health 
training  at  Henry  Street  Settlement.  The  Surgeon  General  of 
the  Army  had  requested  assistance  from  the  Ked  Cross  to  en- 
able these  students  to  secure  instruction  in  public  health  nurs- 


DEMOBILIZATION  1037 

in^,  and  the  Executive  Committee  on  January  13,  1021,  appro- 
priated a  fund  of  $40,000  for  their  maintenance  while  they 
were  at  Teachers'  College  and  Henry  Street. 

The  hotel  on  ^fadison  Square  provided  comfortable  quarters 
for  sick  nurses  detained  in  Xew  York  City  but  did  not  meet 
the  need  for  a  convalescent  home  where  nurses  might  live  sev- 
eral weeks  in  the  country  at  reasonable  expense  and  in  attract- 
ive surroundings.  On  July  1,  1920,  *'The  Evergreens,"  a 
twelve-acre  country  estate  at  Bay  Shore  overlooking  Great 
South  Bay  on  the  southern  shore  of  Long  Island,  Xew  York, 
was  leased  and  opened  as  a  convalescent  home.  In  the  Annual 
Keport  for  the  year  ending  June  30,  1921,  Miss  iSToyes  wrote 
of  the  Bay  Shore  Convalescent  Home: 

Its  use  was  not  restricted  to  Red  Cross  nurses  alone  and  it 
has  been  patronized  by  the  United  States  Public  Health  Serv- 
ice, the  War  Pisk  and  the  Federal  Boards.  During  the  past 
twelve  months,  294  nurses  have  sojourned  there  and  have  de- 
rived great  benefit  from  the  opportunities  for  relaxation  and 
convalescent  care.  Mabel  Fletcher,  a  Eed  Cross  nurse,  is  the 
hostess.  L'p  to  June  30,  1921,  the  expenses  of  running  the 
house  had  amounted  to  $12,917  but  it  is  felt  that  the  value 
of  this  convalescent  home  to  the  nurses  and  to  the  Red  Cross 
cannot  bo  easily  measured  in  money.  .  .  .  The  majority  of 
the  nurses  not  only  pay  their  way  but  frequently  supplement 
their  board  bills  with  money  donations  of  appreciation.  In 
this  way,  much  of  the  expense  has  been  met. 

Throughout  the  period  of  demobilization,  nurses  were  slow 
to  report  their  disability  to  the  field  representatives  of  the 
Bureau  of  War  Risk  Insurance  and  to  claim  hospitalization 
and  vocational  rec'ducation.  The  following  arrangement,  as 
reported  by  ^liss  ]\[innigerode,  was  finally  effected: 

It  should  be  a  matter  of  common  knowledge,  from  the  wide 
publicity  given  this  Act,  that  nurses  also  are  eligible  for  treat- 
ment under  the  Bureau  of  War  Risk  Insurance.  The  Public 
Healtli  Service  in  cooperation  witli  the  American  Ped  Cross, 
has  agreed  tliat  the  Ped  Cross  Division  Directors  of  Nursing 
may  refer  cases  of  nurses  requiring  treatment  to  the  district 
supervisor  of  the  Public  Health  Service,  who  will  give  in- 
structions as  to  the  procedure  required  to  obtain  treatment 
and  wlio  will  also  uiake»arrangements  for  tlie  hos])italization 
of  inirses  iicedini,''  care. 


1038  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  order  to  facilitate  action,  four  Division  Directors  of 
Nursing  in  different  parts  of  the  country  have  been  appointed 
as  consulting  officers  in  the  Public  Health  Service,  with 
authority  to  confer  with  district  supervisors  concerning  treat- 
ment for  nurses.  These  nurses  are :  Florence  M.  Johnson, 
New  York;  Jane  Van  de  Vrede,  Atlanta;  Lyda  Anderson, 
St.  Louis;  and  Lillian  L.  White,  San  Francisco. 

Nurses  are  also  eligible  under  the  Federal  Board  of  Voca- 
tional Education  and  can  take  any  training  they  desire,  in 
just  the  same  way  as  do  soldiers.  .  .  .  Any  nurse  physically 
unable  to  pursue  her  nursing  work,  as  a  result  of  her  military 
service,  should  be  eligible.  Application  for  this  training 
should  also  be  made  to  the  Red  Cross  Division  Director  of 
Nursing,  who  understands  how  to  reach  the  Federal  Board 
and  how  arrangements  for  vocational  education  should  be 
made.^^ 

Still  the  nurses  continued  to  hold  back  from  claiming  Federal 
aid.  Now  and  then  word  of  an  unusually  unfortunate  case 
would  percolate  to  the  office  of  one  of  the  four  Division  direc- 
tors and  she  would  investigate  the  case,  but  this  system  was 
highly  unsatisfactory.  In  1921  Miss  Johnson  sent  out  a 
questionnaire  to  every  ex-service  nurse  in  the  Atlantic  Division 
and  the  information  received  proved  of  such  value  in  locating 
disabled  nurses  that  Miss  Noyes  authorized  all  the  Division 
directors  to  send  out  similar  questionnaires.  The  following 
is  an  example  of  the  questionnaire  used ;  as  filled  in,  it  is  typi- 
cal of  the  answers  received  from  many  nurses: 

Division  :  Pacific         Questionnaire        Date  :  April  20,  192.2 

1.  Name:  W ,  Lucie  M. 

2.  Address,  Temporary : 

Permanent:  1215  ISth  St.,  Sacramento,  Calif. 

3.  Eed  Cross  Badge  Number:  21Ji2   {Joined  Bed  Cross  in 

1912). 

4.  Date  of  appointment  to  service:  December  21,  1917. 

5.  Date  of  discharge  from  service:  March  21,  191S. 
G.  Service  with  Army :  Yes 

Navy 

Red  Cross :  Yes 

U.  S.  Public  ITcaltli  Service  Sanitary  Zone 
Emergencv,    Infiuenza    Epidemic,    Disaster, 
etc. 
7.  Condition  of  hcaltli  on  diseliargo :  pliysically  e.rhau,sied. 
'^  Amrrirri)!  Journnl  of  Xursing,  Vol.  20,  j).   81)1. 


DEMOBILIZATION  1039 

8.  Condition  of  henlth  at  present  time:  good. 

9.  Approximate  date  of  illness,  if  any  and  where:  October  1, 

1915,  in  New  York  City.  It  was  this  illness  of  nervous 
erhaustion  which  rendered  me  unfit  for  extensive  Army 
service. 

10.  Have  you  notified  the  Veterans'  Bureau  or  the  Ked  Cross 

Nursinf;;  Service :  No. 

11.  Are  you  drawing  compensation  from  the  Veterans'  Bu- 

reau :  No. 
Date  granted. 
Number. 

Hospitalization,  if  any. 
Name  and  address  of  doctor  by  whom  examined. 

12.  Eemarks :  See  above. 

13.  Vocational  training:  Yes,  at  my  own  expense. 
Number. 

Where:  Simmons  College,  Boston,  Mass. 
What  kind:  Public  health  nursing  course. 
Length  of  course:  nine  months. 

14.  Remarks:  Have  never  asked  benefits  far  myself  from  the 

American  Red  Cross. 

15.  Date  granted. 

16.  Present  occupation :  Public  health  nursing  covering  Sac- 

ramento County  binder  direction  of  American  Red 
Cross,  Sacramc7ito  Chapter. 

As  an  example  of  the  further  interest  which  the  Red  Cross 
took  in  the  ex-service  nurse,  when  the  questionnaire  came  into 
Pacific  Division  h('ad(iuarters,  ^[iss  White,  Division  Director 
of  Nursing,  referred  it  to  the  Ked  Cross  Bureau  of  Post-War 
Service,  wliicli  was  a  continuation  of  Red  Cross  Home  Service 
for  ex-service  men,  and  the  director  wrote  the  following  reply 
to  Miss  W : 

]\riss  Lillian  L.  Wb.ite  .  .  .  has  handed  me  your  ques- 
tionnaire of  A])ril  20  for  acknowledgment  and  reply.  We 
note  that  your  present  physical  condition  is  fair,  but  that  you 
were  in  poor  health  at  the  time  of  your  discharge,  probably 
caused  by  an  aggravation  of  an  illness  suflPered  prior  to  en- 
lishment.  In  order  that  your  future  interests  may  be  safe- 
guarded, may  w(^  state  that  the  sub-district  office  of  the 
Veterans'  Bureau,  ^lerchaiits  National  Bank  Building.  Sacra- 
mento— tiiat  branch  of  the  (Jovernment  res])()iisible  for  the 
administration  of  the  War  K'isk  Act — is  autliorizcd  to  oxtoiid 
medical    care,    hospiializatioii,    compensation    ami    vocational 


1040  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

training  to  former  reserve  members  of  the  Army  Nurse  Corps, 
who  may  now  be  incapacitated  with  disabilities  which  are  a 
result  of  military  service.  We  are  offering  this  information, 
should  a  relapse  of  the  illness  you  suffered  prior  to  your  serv- 
ice with  the  Army  N^urse  Corps  occur,  which  might  make  you 
eligible  to  the  benefits  of  the  War  Eisk  Insurance  Act. 

If  you  have  any  unadjusted  claims  against  the  Government 
such  as  liberty  loan  allotment,  adjustment  of  back  pay,  this 
office  is  available  to  serve  you. 

Of  the  449  disabled  nurses,  twenty-two  were  nurses  who  had 
incurred  their  disability  while  in  active  service  under  the 
American  Red  Cross.  To  care  for  them  and  for  other  members 
of  its  overseas  personnel  who  became  ill  in  line  of  duty,  the 
Commission  for  France  established  a  special  hospital,  American 
lied  Cross  Hospital  ISTo.  101,  at  I*^euilly,  near  Paris ;  it  was 
arranged  that  sick  members  of  other  American  welfare  organi- 
zations could  also  be  sent  to  Xo.  101. 

Owing  to  the  exorbitant  prices  which  prevailed  in  France 
in  1918,  need  arose  for  a  convalescent  home  where  nurses  on 
Army,  Navy  and  Red  Cross  service  might  go  to  recuperate 
when  they  no  longer  needed  hospitalization.  The  Kurses'  Bu- 
reau at  Paris  Headquarters  in  July,  1918,  opened  a  convales- 
cent home  at  Le  Croisic,  a  quaint  little  fishing  village  on  the 
Brittany  coast.  The  house  was  located  on  a  stretch  of  sandy 
beach  overlooking  the  ocean  and  had  accommodations  for  one 
hundred  nurses  on  convalescence  or  on  leave.  ''The  good  food, 
the  frcsh^  bracing  air,  the  fine  bathing  and  the  picturesque 
Breton  peasant  life,"  wrote  Miss  Hall,  "combined  to  make  La 
Croisic  an  ideal  resting  place  for  nurses  and  workers  worn 
with  the  strain  of  war  service.  The  rates  of  ten  francs  a  day 
were  most  reasonable  and  brought  the  home  within  the  moans 
of  all." 

In  November,  1918,  the  home  at  Le  Croisic  was  closed  on 
account  of  the  climate,  and  the  Hotel  du  Cap  at  the  Cap  of 
Antibes,  near  Cannes,  in  the  Riviera,  was  opened  January  6, 
1919,  as  a  substitute.  x\ccommodations  were  developed  to 
receive  some  two  hundred  convalescent  Red  Cross  women  per- 
sonnel there.  Five  public  health  nurses  were  sent  down  to  do 
visiting  and  general  nursing.  Kate  C.  Hough  was  the  super- 
vising nurse.  Mrs.  Hough  was  a  graduate  of  the  Xewark  City 
Hospital  School  of  Xursing  and  had  done  private  duty,  hos- 
pital, district  and  industrial  nursing  prior  to  her  assignment 


DEMOBILIZATION  1041 

in  March,  1918,  to  the  Red  Cross  Children's  Bureau.  For 
some  six  weeks  during  the  military  crisis  of  the  summer  of 
1918,  Mrs.  Hough  cared  for  American  wounded  in  French 
hospitals  under  the  special  arrangement  effected  hy  the  Ameri- 
can Ked  Cross  and  the  Service  de  iSante.  With  this  wide  ex- 
perience and  with  native  executive  ability  and  initiative,  she 
developed  at  the  Hotel  du  Cap  at  Cannes  a  convalescent  home 
which  the  nurses  who  visited  her  described  as  ideal.  The 
location  was  one  of  rare  beauty,  the  food  was  excellent  and  the 
atmosphere  which  permeated  the  hotel  one  of  kindly  interest 
and  solicitude. 

Many  of  the  nurses  who  served  overseas  with  the  American 
Red  Cross  were  returned  to  the  United  States  on  Army  trans- 
ports. When  those  who  had  been  taken  sick  or  had  been  dis- 
abled in  Red  Cross  service  arrived  in  New  York  they  were 
temporarily  cared  for  at  the  hotel  on  Madison  Square  or  at 
Bay  Shore  until  settlement  of  their  Red  Cross  insurance  could 
be  effected.  The  provision  made  for  them  by  National  Head- 
quarters was  the  same  as  that  made  for  all  Red  Cross  workers 
in  foreign  service.  As  this  arrangement  was  unique  in  the 
history  of  insurance,  a  brief  account  of  it  will  be  given. 

Previous  to  1917  the  Executive  Committee  had  individually 
considered  every  case  of  sickness,  disability  or  death  of  a  Red 
Cross  worker  and  had  made  specific  recommendations  on  each, 
but  with  the  large  n\imbers  of  Red  Cross  personnel  who  were 
being  sent  overseas  in  1917  it  was  seen  that  a  more  standard- 
ized arrangement  would  have  to  be  effected.  At  a  meeting  held 
September  28,  1917,  the  Executive  Committee  instructed  the 
War  Council  "to  make  an  investigation  of  plans  for  providing 
insurance  for  persons  engaged  in  Red  Cross  work  in  foreign 
countries  .  .  .  and  to  report  to  the  Executive  Committee  for 
action." 

The  War  Council  immediately  appointed  a  National  Advis- 
ory Committee  on  Insurance,  the  members  of  which  were  the 
actuaries  of  the  foremost  insurance  companies  in  the  Tnited 
States.  Arthur  Hunter,  chief  actuary  of  the  Xew  York  Life 
Insurance  Company,  was  the  chairman;  Hendon  Chubb,  ad- 
viser to  the  Bureau  of  War  Risk  Insurance  and  an  authority  on 
marine  insurance,  was  one  of  the  members.  Among  other  mem- 
bers were  R.  Henderson,  actuary  of  the  E(iuital)le  Life:  A.  A. 
Welch,  of  the  Rhoenix  ]\Iutual;  George  Woodward,  of  the  Met- 
ropolitan Life;  Henry  ^loer,  of  the  Home   Life;  WcMulell  M. 


1042  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Strong,  of  the  Mutual  Life;  B.  D.  Flynn,  of  the  Travelers 
Insurance  Company,  and  J.  H.  Woodward,  actuary  of  the 
New  York  State  Industrial  Commission. 

The  Insurance  Committee  immediately  began  to  investigate 
the  possibility  of  having  Red  Cross  overseas  personnel  included 
under  the  War  Risk  insurance  laws  as  Federal  liabilities,  in 
that  the  Red  Cross  was  a  semi-governmental  organization.  Con- 
gress was  approached  on  the  subject  but  it  was  decided  that  if 
the  benefits  of  the  War  Risk  Insurance  and  disability  laws 
were  extended  to  Red  Cross  workers,  they  would  have  to  be 
extended  also  to  the  workers  of  all  welfare  organizations,  a 
procedure  manifestly  impossible.  Moreover,  commercial  com- 
panies refused  to  insure  Red  Cross  personnel  going  into  foreign 
service;  they  felt  the  risk  to  be  too  great  because  Red  Cross 
foreign  service  called  for  the  assignment  of  nurses,  ambulance 
drivers,  outpost  and  line  of  communication  canteen  workers 
to  points  second  only  in  danger  to  that  of  the  front  line.  Hence 
with  the  doors  of  Federal  and  commercial  aid  closed  to  its  over- 
seas personnel,  the  majority  of  whom  were  men  and  women 
of  moderate  means  with  one  or  more  dependents,  the  War 
Council  felt  that  the  Red  Cross  must  devise  its  own  insurance. 

Accordingly,  the  Committee  prepared  several  plans  and  sub- 
mitted them  to  the  War  Council,  which  recommended  to  the 
Executive  Committee  that  the  so-called  "second  plan,"  with 
various  modifications  from  time  to  time,  be  accepted.  The 
Executive  Committee  at  a  meeting  held  on  December  6,  1917, 
approved  the  following  plan,  which  was  without  cost  to  the 
workers : 

The  Eed  Cross  has  procured  life,  health  and  accident  insur- 
ance for  its  workers  abroad.  .  .  .  The  insurance  granted  is 
substantially  as  follows : 

1.  A  policy  of  life  insurance  on  the  term  plan  in  the  sum  of 
$1000  for  each  worker, — payable  in  event  of  death  or  in 
event  of  total  ajid  permanent  disability  from  any  cause, 
payment  for  total  and  permanent  disability  to  be  made  at 
the  end  of  two  years  from  date  of  disability,  and,  in  the 
meantime,  the  worker  receives  the  weekly  indemnity  de- 
scribed in  the  next  paragraph. 

2.  A  policy  of  accident  and  health  insurance  which  provides 
for  the  payment  of  weekly  indemnities  of  $20  per  week 
in  the  case  of  total  disability  resulting  from  bodily  injury 
or  disease,  and,  m  addition,  provides  for  the  payment  of 


DEMOBILIZATION  1043 

$500  in  the  event  of  certain  permanent  injuries  as  men- 
tioned in  tiie  policy. 
Tlie  weekly  indemnity  payments  are  to  commence  four 
weeks  from  the  date  of  disability  and  continue  until  disability 
ceases,  not  exceeding  a  total  period  of  two  years  from  date  of 
disability.  During  the  first  four  weeks  necessary  medical  care 
and  attention  will  be  furnished  by  the  Eed  Cross  without  cost. 

In  a(lo])ting  this  phin  the  Red  Cross  appreciated  that  this 
sum  of  $1000  would  not  be  adequate  to  provide  for  a  bene- 
ficiarv  totally  disabled  in  Red  Cross  foreign  service.  Such  a 
provision  lay  wholly  beyond  the  powers  of  the  society.  How- 
ever, J^ational  Headquarters  felt  that  this  health  and  accident 
insurance  and  this  sum  of  $1000  in  case  of  total  disability  lay 
within  Red  Cross  resources  and  would  prove  of  some  real 
assistance  to  a  disabled  worker  or  to  his  or  her  beneficiarj. 

In  developing  this  plan  the  Red  Cross  set  up  at  National 
Headquarters  in  April,  1918,  a  Bureau  of  Insurance,  of  which 
Robert  C.  Rathboiie,  of  New  York  City,  was  the  director.  He 
was  followed  in  October  of  the  same  year  by  Winficld  A. 
Wilson.  ]\rr.  Wilson  had  been  engaged  previously  in  insurance 
work  in  Washington  and  he  had  charge  of  the  seven  phases  of 
insurance  which  were  used  by  National  Headquarters  to  pro- 
tect the  Red  Cross  in  its  many  activities. 

The  plan  for  life,  health  and  accident  insurance  included 
the  utilization  of  large  commercial  insurance  companies  to 
which  the  Rod  Cross  paid  premiums,  so  that  the  Red  Cross 
might  profit  by  the  field  organization  of  the  large  companies. 
In  the  matter  of  the  payment  of  premiums  the  Red  Cross  en- 
countered the  first  '*snag."  State  and  Federal  law  declared 
that  insurance  premiums  must  be  a  fixed  premium;  tlie  Red 
Cross,  however,  was  loath  to  have  any  profits  accrue  from  con- 
tracts which  they  were  obliged  to  place,  so  the  Advisory  Com- 
mittee appealed  to  the  Insurance  Commission  of  the  State  of 
New  York  (the  hub  of  the  insurance  world)  to  have  an  excep- 
tion made  to  embrace  the  Red  Cross  plan,  which  provided  that 
all  pr(>miums,  minus  actual  losses,  taxation  and  a  small  charge 
for  service,  should  revert  to  the  Red  Cross.  The  Commissioner 
vetoed  the  appeal  but  the  Advisory  (\^mmittee  carried  it  to  the 
Legislature  of  the  Stat(^  of  Xew  York,  where  the  existing  laws 
were  amended,  making  possible  the  Jied  Cross  insurance  on  a 
non-profit  basis, 


1044  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  result  of  this  ruling  was  seen  when  on  December  1, 
1919,  the  Red  Cross  by  vote  of  the  Executive  Committee  de- 
cided to  self-assume  the  life  insurance  and  permanent  disability 
clauses  of  its  insurance.  This  decision  brought  an  accounting 
whereby  the  sum  of  actual  losses,  taxation  and  a  small  charge 
for  service  were  deducted  from  the  total  amount  of  premiums 
paid  from  time  to  time  by  the  Red  Cross  to  the  insurance  com- 
panies, and  the  balance  was  returned  to  the  Red  Cross.  This 
sum  amounted  to  $264,000. 

Several  months  after  the  Red  Cross  had  assumed  this  phase 
of  its  insurance,  the  Executive  Committee,  upon  Mr.  Wilson's 
recommendation,  voted  a  change  in  the  plan  of  payment  of  the 
$1000  due  under  the  total  disability  clause  of  the  life  contract, 
to  the  disabled  worker.  The  original  provision  called  for  pay- 
ment of  the  face  of  the  contract  amounting  to  $1000  if  at  the 
end  of  two  years  the  disability  was  adjudged  to  be  of  a  perma- 
nent and  total  character.  This  clause  was  changed  so  that  at 
the  end  of  the  two-year  period  the  worker  having  received  the 
indemnity  under  the  health  and  accident  policy  paid  only  for 
total  disability,  would,  if  disabled,  be  considered  totally  dis- 
abled within  the  definition  of  the  provision,  whereby  the  $1000 
would  be  paid  in  weekly  installments  of  twenty  dollars  each  in- 
stead of  in  a  lump  sum.  This  change  was  made  because  of  the 
obvious  difficulty  of  determining,  even  by  medical  examina- 
tion, what  constituted  permanent  disability.  The  new  contraci; 
insured  to  the  disabled  worker  a  steady  income  for  practically 
another  year.  After  the  expiration  of  this  fifty  weeks'  allot- 
ment the  case  was  closed.  In  the  case  of  death  of  the  insured, 
the  sum  was  paid  in  a  lump  sum  to  the  beneficiary. 

I^ational  Headquarters  continued,  however,  to  handle  its 
health  and  accident  insurance  through  the  Travellers'  Insur- 
ance Company  that  it  miglit  be  benefited  by  the  assistance  of 
the  field  stafi"  of  that  company  in  preventing  malingering. 

The  provisions  described  above  protected  Army,  Xavy  and 
Red  C^ross  nurses  assigned  to  duty  with  Red  Cross  foreign  com- 
missions. Xo  protection  was,  however,  available  for  Red  Cross 
nurses  who  became  sick  or  disabled  while  temporarily  assigned 
by  the  Red  Cross  to  influenza  relief  in  cantonment  hospitals  or 
in  emergency  hospitals  established  for  the  civilian  sick.  Cases 
of  this  type  wer(»  mniierous  and  finally  in  1920  ]\Iiss  Noyes 
suc('(H'ded  ill  getting  National  lleadciuarters  to  include  them 
among  Red   Cross   responsibilities.      But   they  were   never   in- 


DEMOBILIZATION  10  i5 

eluded  in  the  insurance  plan,  which  was  purely  for  the  benefit 
of  Red  Cross  workers  in  foreign  service  for  the  society. 

Such  were  the  government  and  Red  Cross  provisions  for  sick 
and  disabled  nurses.  Yet  even  in  the  best  regulated  and 
equipped  hospitals  of  the  Public  Health  Service,  or  in  the  lux- 
urious and  sympathetic  environment  at  Bay  Shore,  the  plight 
of  the  disabled  ex-service  nurse  was  as  pitiable  as  that  of  the 
disabled  ex-service  man.  Mental  cases  could  not  be  admitted 
to  Bay  Shore,  and  perhaps  some  of  the  bitterest  agony  of  the 
war  was  endured  by  nurses  in  government  hospitals — imrses 
who  were  trying  to  regain  their  mental  and  nervous  poise; 
like  the  shell-shocked  ex-soldiers,  nothing  seemed  worth  while 
and  they  often  ate  their  hearts  out  in  long  periods  of  extreme 
melancholia. 

i^ot  the  care  given  or  not  given  to  exceptional  cases  but  that 
given  to  the  rank  and  file  will  have  deteraiined  whether  or  not 
the  Government  and  the  Red  Cross  met  their  obligations  to- 
ward the  women  who  sacrificed  health  and  means  of  livelihood 
in  order  that  American  men  might  have  skilled  nursing  care  in 
their  hour  of  need.  Cases  of  neglect  may  have  occurred  just  as 
likely  as  cases  of  '"goldbricking,"  that  term  applied  to  soldiers 
and  nurses  pauperized  by  too  much  help.  That  the  Government 
and  the  Red  Cross  did  its  duty  generously  and  in  kindly  spirit 
to  at  least  one  sick  and  disabled  nurse  and  that  this  aid  was 
truly  appreciated,  is  shown  in  the  following  letter  written  to 
a  Red  Cross  Division  Director  of  Nursing  by  a  disabled  ex- 
service  nurse : 

Your  very  kind  letter  .  .  .  came  on  ^Monday,  and  in  reply 
I  would  like  to  say  that  I  have  been  receiving  full  compensa- 
tion since  my  discharge  from  the  Army.  I  must  say,  too, 
that  nothing  could  exceed  the  kindness  and  consideration  and 
good  care  with  which  1  have  been  treated  since  I  first  took  ill 
in  October.  lULS.  I  was  in  five  different  hos])itals  in  France 
and  tliree  in  the  United  .States  and  in  every  one  of  them  I  was 
treated  with  the  greatest  kindness  and  I  know  I  owe  my  life 
to  the  care  I  received.  I  wish  I  could  make  you  understand 
how  much  I  ai)])reciated  it  all.  ^ly  long  illness,  ])neun]onia, 
follow(>d  hy  einpyeiiiia,  was  made  bearable  and.  between  tlie 
])ainful  ])eri(Mls.  \ery  ph'asant.  I  have  read  and  hi^ard  many 
eoir.plaiiits  frdin  nurses  regarding  their  treatment  in  tlie 
Army,  but  I  hav(>  absolutely  no  complaints  to  make.  Xnthing 
could  exceed  the  courte^v  and  kindness   1   ha\e  recei\i'd   from 


1046  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

every  one  with  whom  I  came  in  contact.  I  am  afraid  my 
nursing  days  are  over,  hut  I  am  glad  to  he  home.  The  climate 
here  is  dry  and  cold  and  seems  to  be  the  only  one  that  agrees 
with  me.  I  have  had  several  abscesses  in  my  lung  since  the 
incision  healed.    Apart  from  that  I  feel  fairly  well. 

Thank  3'ou  so  much  for  your  kind  offer  of  service.  The 
only  thing  I  find  any  need  of  is  reading  matter.  We  are 
twenty  miles  from  a  town  of  any  size  and  you  may  be  sure  I 
make  the  trip  very  seldom.  I  should  be  very  glad  indeed  for 
books  or  magazines. 

One  of  the  projects  of  the  nursing  profession  during  the 
demobilization  period  was  the  establishment  of  a  memorial  to 
American  nurses  who  had  died  in  military  service.  This  was 
not  a  Red  Cross  nursing  project ;  it  was  undertaken  by  nurses 
and  friends  of  nurses.  However,  the  labors  of  Miss  Noyes, 
in  her  position  as  president  of  the  American  Nurses'  Associa- 
tion, and  those  of  Red  Cross  nurses  who  supported  the  me- 
morial, and  also  the  numbers  of  deceased  Red  Cross  nurses 
whose  sacrifice  the  memorial  perpetuated,  make  necessary  brief 
mention  of  the  project  in  this  history. 

In  January,  1919,  Dr.  Anna  Hamilton,  the  founder  of  the 
Nightingale  School  for  Nurses  at  Bordeaux,  France,  visited 
the  United  States  for  the  purpose  of  raising  funds  for  the 
Nightingale  School.  The  Maison  de  Sante  Protestante,  the 
hospital  in  connection  with  which  the  school  was  maintained, 
dated  back  to  18G1  and  had  long  since  outgrown  its  buildings 
and  equipment.  Owing  to  its  location  in  a  closely  built  quarter 
of  the  city,  the  housing  facilities  of  the  hospital  and  school 
could  be  expanded  only  by  removal  to  a  new  site.  In  1914 
Mile.  Elizabeth  Eosc,  of  Bordeaux,  had  presented  to  the  Maison 
de  Sante  through  Dr.  Hamilton,  her  home.  Bagatelle,  an  estate 
of  sixteen  acres,  located  just  outside  the  city,  to  be  used  as  the 
site  for  the  new  hospital.  Funds  for  erecting  the  building 
were,  however,  not  available,  and  the  war  held  up  the  project 
until  the  cessation  of  hostilities. 

When  Dr.  Hamilton  arrived  in  New  York  City  in  January, 
1919,  she  interviewed  many  nursing  leaders;  one  of  these  was 
Miss  Hilliard,  then  superintendent  of  the  Schools  of  Nursing 
at  Bellevue  and  Allied  Hospitals.  ]\riss  Hilliard  later  stated 
to  ^liss  ^faxwell  that  she  believed  that  the  American  Nurses' 
Association  could  raise  funds  to  build  the  school  if  Dr.  Hamil- 
ton could  raise  the  funds  to  build  the  hospital. 


DEMOBILIZATION  1047 

At  a  meeting  of  the  Joint  Boards  of  Directors  of  the  Ameri- 
can Nurses'  Association  and  the  National  Leaf^iie  of  Nursing 
Education,  Miss  Maxwell  proposed  that  the  American  Nurses' 
Association  provide  a  fund  for  a  building  which  would  house 
the  Nightingale  School,  this  building  to  be  a  memorial  to 
American  nurses  who  had  died  in  war  service,  and  especially 
to  the  hundred  American  nurses  who  lay  buried  in  French  soil. 
The  other  members  of  the  Joint  Boards  felt  that  such  a  me- 
morial would  be  in  keeping  with  the  spirit  and  work  of  Flor- 
ence Nightingale,  the  founder  of  professional  luirsing,  who  had 
said :  "Let  every  founder  train  as  many  in  her  spirit  as  she  can » 
then  the  pupils  will  in  their  turn  be  founders  also."  The  Night- 
ingale School  was,  it  will  be  remembered,  the  only  school  in 
France  giving  training  to  nurses  on  the  modern  professional 
basis  known  as  the  '^Nightingale  System." 

The  question  was  then  referred  for  action  to  the  newly  ap- 
pointed Joint  National  Committee  (of  tlie  Bureau  of  Informa- 
tion for  Nurses),  the  committee  which  represented  the  three 
national  organizations  of  nursing  from  which  had  developed 
the  Joint  National  Committee  of  National  Nursing  Head- 
quarters. At  a  meeting  of  this  committee  it  was  voted  that  the 
American  Nurses'  Association  should  undertake  to  raise  by 
December  1,  1919,  a  fund  of  fifty  thousand  dollars  ($50,000) 
to  be  used  in  erecting  and  equipping  a  nurses'  home  and  class- 
rooms for  the  Nightingale  School,  this  sum  to  be  known  as 
''the  ]\lemorial  Fund  to  American  nurses  who  had  died  in  mili- 
tary service  in  the  Kuropcan  War." 

Immediately  through  letters,  personal  solicitation  and  edi- 
torials in  the  Journal,  efforts  were  made  to  raise  the  sum.  The 
Joint  National  Conniiittc^e  was  particularly  charged  with  re- 
sponsibility for  raising  the  amount;  this  committee,  it  will  be 
remembered,  was  composed  of  ^liss  Nutting,  ^Fiss  Noyes  and 
]\liss  Francis,  reprc^senting  the  American  Nurses'  Association; 
!Miss  Clayton,  Miss  Coodrich  and  ^liss  llilliard,  re])resenting 
the  Xational  League  of  Nursing  Education,  and  ^liss  Beard, 
]\Iiss  Wald  and  Miss  Crandall,  of  the  Xational  Organization 
for  Pul)lic  Health  Xursing.  Miss  Xutting,  Miss  A11)augli  and 
^liss  Noyes  prepared  the  lit(n'ature.  ]>y  .lannary,  1921,  the 
fund  had  been  ()versul)scril)ed. 

Early  in  the  spring  of  1!»l'(),  when  the  fund  was  n(>arly  com- 
pleted, a  conuiiittee  to  take  cliarge  of  it,  l>otli  in  this  country 
and  ov(,'rseas,  was  aj)pointed.     ^Irs.  Henry  1\  Davison,  of  New 


1048  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

York,  was  chairman,  and  Mr.  Robert  Bacon  treasurer.  Miss 
Fitzgerald,  who  was  then  in  Geneva,  Switzerland,  Mrs.  Charles 
Tiffany,  Miss  Nutting,  Miss  Maxwell,  Miss  Ruth  Morgan, 
Miss  Noyes,  Mr.  Ethan  Alien  and  Mr.  C.  A.  Coffin  were  mem- 
bers. This  committee  was  later  enlarged  to  include  Miss  Hay, 
then  chief  nurse  of  the  American  Red  Cross  in  Europe,  Mr. 
Nelson  D.  Jay,  of  the  Morgan-Harjes  Company,  Paris,  and 
Dr.  Kendall  Emerson,  of  the  Commission  for  Europe.  As  soon 
as  the  fund  was  transferred  to  the  Morgan-Harjes  Company 
in  Paris  the  large  New  York  committee  went  out  of  existence 
and  disbursement  of  the  fund  was  carried  on  through  the 
smaller  Paris  committee. 

In  September,  1920,  Miss  Noyes  went  to  Europe  to  inspect 
American  Red  Cross  nursing  activities,  and  while  in  France 
visited  Bordeaux  and  conferred  with  the  Trustees  of  the  school 
and  with  Dr.  Hamilton  regarding  the  terms  of  gift.  The  plans 
for  the  school  were  gone  over  and  building  immediately  began. 

The  Charter  and  By-Laws  of  the  Nightingale  School  as 
finally  drawn  up  included  the  following  paragraphs: 

Article  3.     Organization. 

In  1921,  American  nurses,  desiring  to  perpetuate  the  mem- 
ory of  their  fellow-nurses  of  the  American  Army,  Navy  and 
Eed  Cross  who  died  while  in  active  service  during  the  great 
war,  subscribed  a  sum  of  775,000  francs,  known  as  the  Ameri- 
can Nurses'  Memorial  Finid. 

The  Joint  Committee  of  the  three  great  associations  of 
nurses  in  the  United  States  (1.  American  Nurses'  Association, 
president  Clara  Noyes;  2.  National  League  of  Nursing  Educa- 
tion, president  Lillian  Clayton ;  3.  National  Organization  for 
Public  Health  Nursing,  president  Mary  Beard)  decided  to 
devote  this  sum  to  the  construction  of  a  boarding  establish- 
ment for  the  Florence  Nightingale  School,  for  the  sole  pur- 
pose of  facilitating  better  education  for  French  nurses  and  the 
training  of  a  larger  number  of  superior  nurses  for  France. 

An  Advisory  Committee,  created  with  the  approval  of  the 
Administrative  Board,  will  act  as  a  Board  of  Advisors  in  the 
management  of  the  school.  Its  members  will  be  chosen  by  the 
Joint  Committee  of  the  three  great  associations  of  American 
nurses.  This  Advisory  Committee  shall  publish  reports  on 
the  operation  of  the  school.  These  reports  will  allow  the 
nurses  who  collected  the  ^Femorial  Fund  to  follow  the  progress 
of  the  Florence  Nigiitiiifiale  School. 


DEMOBILIZATION  1049 

In  response  to  the  desire  of  tlie  women  who  donated  the 
American  Xurses's  ^lemorial  Fund,  the  school  shall  conform 
more  and  more  to  the  precepts  of  Florence  Nightingale  and 
consequently  will  always  be  directed  by  a  hos})ital  nurse  who 
shall  herself  hold  a  "first-class  diploma"  preferably  from  this 
school. 

Tlie  teaching  of  the  school  shall  be  constantly  improved, 
and  shall  endeavor  to  approximate  more  and  more  closely  the 
program  published  by  the  League  of  Xursing  Education  in  the 
United  States.  .  .  . 

The  members  of  the  Advisory  Committee  of  the  Nightingale 
School  were  ]\Iiss  Janmie,  representing  the  ^Xational  League 
of  Nursing  Education;  Miss  Anne  H.  Strong,  of  the  National 
Organization  for  Public  Health  Nursing,  and  Miss  Noyes,  of 
the  American  Nurses'  Association. 

The  entire  memorial  fund  amounted  to  850,000  francs,  of 
which  775,000  were  expended  for  the  erection  of  the  building 
and  the  remainder  for  equipment  and  furnishings.  In  the 
central  hall  of  the  building  a  bronze  tablet  was  placed,  a  tablet 
bearing  the  inscription : 

To  the  Florence  Nightingale  School 

In  memory 

Of  our  comrades  who  died  in  service 

We 

Tlio  Nurses  of  America 

Dedicate  tiiis  ]\reniorial 

To  the  Higher  Education 

of  Nurses 

For  Ifumauity  and  For  France. 

During  the  late  afternoon  of  June  5,  1021,  the  laying  of 
the  corner-stone  of  the  Florence  Nightingale  School  took  place. 
After  several  addresses,  ]\Iiss  Hay,  acting  as  ^Nfiss  Noyes'  repre- 
sentative, placed  in  the  corner-stone  a  box  containing  the  stat- 
utes of  the  school  and  nanu's  of  th(^  Am(>rican  nurses  who  had 
died  in  service ;  then  the  first  stone  was  laid.  A  year  later, 
on  ]\ray  12,  li)22.  the  on(>  hundred  and  second  annivtu'sary  of 
Miss  Nightingah^'s  birth,  the  Amei'ican  Nurses'  Memorial 
building,  then  completed,  was  dedicated. 

The  ([uestion  of  a  suitable  memorial  to  ]\riss  Delano  was  first 
raised  iniincdiately  after  her  death  and  American  Tied  Cross 
nurses  in  France  subscribed  a  snudl  fund  of  about  six  hundred 


1050  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

dollars  for  the  purpose.  National  Headquarters  authorized 
Miss  Noyes  to  act  as  trustee  of  this  sum  until  a  decision  had 
been  reached  regarding  the  form  which  such  a  memorial  should 
take. 

At  a  meeting  of  the  National  Committee  held  December  9, 

1919,  the  chairman  appointed  a  committee  to  study  and  report 
upon  plans  for  the  memorial.  This  committee  was  made  up 
of  ]\Iiss  Maxwell,  Miss  Kerr,  Miss  Gladwin,  Mrs.  Gretter, 
Miss  Jamme,  Miss  Van  de  Vrede,  and  Miss  Palmer  as 
chairman. 

At  the  meeting  of  the  National  Committee  held  on  April  14, 

1920,  at  Atlanta,  Miss  Gladwin,  in  the  absence  of  Miss  Palmer, 
read  the  report  of  the  Delano  Memorial  Committee.  The  sub- 
ject had  been  discussed  with  Mr.  Powell  ]\1  innigerode,  director 
of  the  Corcoran  Gallery  of  Art  in  Washington,  and  he  had 
suggested  that  a  mural  decoration  symbolizing  Miss  Delano's 
work  be  placed  in  the  interior  of  the  National  Headquarters 
building.  Other  suggestions  had  been  made  that  the  memorial 
take  the  form  of  a  building  to  house  the  Nursing  Service  and 
to  be  erected  on  the  Red  Cross  grounds;  a  scholarship  fund, 
with  a  tablet  at  National  Headquarters  commemorating  Miss 
Delano's  life  and  work ;  a  life-size  figure  in  bronze  representing 
a  Red  Cross  nurse,  to  be  erected  on  the  grounds  of  National 
Headquarters;  a  life-size  statue  of  ]\Iiss  Delano  herself  in 
bronze,  to  be  erected  on  the  grounds  at  National  Headquarters, 
and  a  clubhouse  for  nurses. 

Two  weeks  after  the  Atlanta  meeting,  on  April  27,  death 
removed  from  her  many  activities  the  chairman  of  the  Delano 
^Memorial  Committee,  Sophia  F.  Palmer.  ]\Iiss  Noyes  then 
appointed  Miss  Minnigerode  as  chairman;  she  added  two  more 
members  to  the  connnittee,  .Miss  Boardman  and  ^Ir.  Powell 
Minnigerode,  and  developed  extensive  plans  for  raising  a 
Memorial  Fund. 

At  a   meeting  of  the   National   Committee  held  April   23, 

1921,  ^liss  ]\linnigerode  moved  that  the  Delano  ^lemorial  Com- 
mittee be  enhirged  to  include  the  Division  Directors  of  Nursing 
and  certain  otlun-  nurses  and  members  of  the  laity  in  several 
parts  of  the  United  States;  that  the  members  of  the  National 
Delano  ]Menioi-ial  Committee  be  autliorized  to  form  sub-com- 
mittees in  their  own  localities,  and  tluit  a  general  treasurer  be 
appointed.     The  motion  was  carried. 

The    rcorti-anizcd    Delano    ^Mcmoi'ial    Commiteee    had    as    its 


DEMOBILIZATION  1051 

members  Mrs.  William  Church  Osborn,  IMrs.  Henry  P.  Davi- 
son, Mrs,  An^ist  Belmont,  Mrs.  Frank  X.  Ilammar,  Mrs. 
L.  E.  Gretter,  Miss  Boardman,  Miss  Amy  Alexander,  Mrs. 
John  Lynch,  Miss  Kerr,  Miss  Nevins,  jNIiss  Jamme,  Miss  Glad- 
win, ^liss  Maxwell,  Miss  Stimson,  Miss  Hay,  Miss  Foley,  Miss 
Albaugh,  Miss  Johnson,  and  Miss  ^linnigerode,  chairman. 
At  the  present  date  of  writing,  subscription  to  the  fund  is  in 
process. 

Miss  Delano  herself  had  established  a  fund  under  which 
public  health  nurses  were  to  be  assigned  in  remote  communities 
to  conduct  a  service  in  memory  of  her  father  and  mother.  Of 
the  twenty-two  items  of  Miss  Delano's  will,  nine  of  them  con- 
tained legacies  to  nurses  or  nursing  organizations.  Four  of 
these  items  named  nurse  friends  as  beneficiaries;  the  other  five 
were  in  favor  of  nursing  organizations  as  follows:  the  Alumna) 
Association  of  Bellevue  Training  School  for  Nurses,  the  Alum- 
nx  Association  of  the  Training  School  for  Nurses,  Hospital  of 
the  University  of  Pennsylvania ;  the  New  York  Eye  and  Ear 
Infirmary,  and  the  following  bequest  to  the  American  Red 
Cross : 

Item  XXI :  I  give  and  bequeath  the  sum  of  Twenty-Five 
Thousand  Dollars  ($25,000),  unto  the  American  Red 
Cross  in  trust,  the  principal  of  said  fiuid  to  be  kept  intact 
perpetually  and  the  income  only  arising  therefrom  to  be 
used  for  the  support  of  one  or  more  visiting  nurses,  under 
the  supervision  of  that  organization,  in  loving  memory  of 
my  father  and  mother,  such  nurse  or  nurses  to  be  known 
as  the  "Delano  Red  Cross  Xurse,  or  Xurses."  In  addi- 
tion and  for  the  same  purpose.  I  give  and  bequeath  unto 
the  said  American  Red  Cross  the  entire  right  and  interest 
in  and  to  any  royalties  to  which  I  may  be  entitled  at  the 
time  of  my  death,  unto  any  book  or  books  written  or 
published  by  me.  and  I  direct  that  such  royalties,  as  paid 
to  the  said  Americaii  Red  Cross,  shall  be  added  to  the 
income  from  the  aforesaid  trust  fund  and  used  for  the 
same  purpose  as  hereinbefore  provided  therefor. 

At  a  meeting  of  the  National  Committee  held  on  December  6, 
1021,  a  plan  containing  the  details  of  selection  of  the  Delano 
Ived  (^ross  nurses  and  the  nu^thods  by  which  their  work  was  to 
be  supervised  and  the  fund  administered,  was  submitted  by 
^Liss  Fox  and  approved  by  the  National  Conunittee.     The  first 


1052  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Delano  Red  Cross  nurse  was  Stella  Fuller  and  she  was  assigned 
to  duty  in  Alaska. 

Among  the  unsettled  war  problems  which  claimed  the  atten- 
tion of  nurses  during  the  demobilization  period  was  the  train- 
ing and  utilization  of  Red  Cross  nurses'  aides.  Early  in  1919 
Miss  Boardman,  always  a  staunch  advocate  of  the  volunteer 
aspect  of  Red  Cross  nursing  service,  as  well  as  the  first  friend  of 
the  professional  service,  brought  forward  a  plan  for  utilizing 
Red  Cross  aides  in  connection  with  the  care  of  the  sick  in  com- 
munities where  there  was  an  insufficient  number  of  nurses.  In 
the  plan  it  was  specified  that  the  service  of  these  aides  should  be 
purely  volunteer ;  that  the  aides  themselves  should  be  required 
to  have  taken  the  prescribed  course  of  training  for  Red  Cross 
aides ;  and  that  they  should  work  under  professional  direction 
and  should  wear  a  distinctive  uniform  and  badge. 

At  the  meeting  of  the  National  Committee  on  Red  Cross 
Nursing  Service,  which  was  held  at  National  Headquarters  on 
December  9,  1919,  Miss  Boardman  presented  her  plan;  it  was 
informally  discussed.  At  an  adjourned  meeting  held  the  fol- 
lowing day  Miss  Nevins,  the  chairman  of  a  small  committee 
which  had  been  appointed  to  consider  the  plan,  read  a  recom- 
mendation that  the  "National  Committee  on  Red  Cross  Nursing 
Service  recommend  that  such  Chapters  as  so  desire  may  organ- 
ize those  who  have  taken  the  required  courses  (Home  Hygiene 
and  Care  of  the  Sick,  Food  Selection  and,  if  possible.  First 
Aid)  and  are  ready  to  volunteer  their  services  for  the  sick  .  .  , 
in  cooperation  and  with  the  supervision  of  the  Chapter  Commit- 
tee." Miss  Gladwin  recommended  that  the  plan  be  developed  in 
the  District  of  Columbia  Chapter  as  an  experiment  and  the 
resolution,  with  this  and  other  minor  amendments,  was  passed. 

The  next  mention  of  Miss  Boardman's  plan  appeared  in  the 
Minutes  of  the  National  Committee  of  a  meeting  held  April  16, 
1920,  at  Atlanta,  Georgia.  Again  the  plan  was  discussed,  and 
a  report  of  the  successful  demonstration  in  the  District  of 
Columbia  Chapter  was  read.  j\Iiss  Goodrich,  ]\Iiss  Van  de 
Vredc,  ^liss  Johnson,  Miss  ^laxwcll  and  Miss  Francis  spoke 
of  good  work  done  by  laywomen  with  which  they  were  person- 
ally familiar.  Miss  Noyes  emphasized  the  fact  that  the  point 
of  contact  in  carrying  out  the  plan  would  be  from  the  National 
Committee  to  Division  Directors  of  Nursing  to  Chapter  Com- 
mittees on  Nursing  Activities. 

-Miss  Francis  moved  that  they  approve  the  plan  and  recom- 


DEMOBILIZATION  1053 

mend  that  it  be  extended  to  such  Chapters  as  were  prepared 
to  develop  it,  this  extension  to  be  decided  by  the  Division  Direc- 
tor of  Xnrsini;  in  cooperation  with  the  Division  manager.  The 
motion  was  carried. 

As  the  Nnrsin<^  Service  swung  toward  normality  again,  a 
definite  Red  Cross  peace-time  program  in  the  development  of 
public  health  nursing,  class  instruction  to  women  in  Home 
llygien(>  and  Care  of  the  Sick  and  in  nutrition  was  undertaken. 
Each  of  these  su})jects  will  be  treated  in  subsequent  sections. 
A  final  general  nursing  project  of  considerable  importance 
(hiring  the  demobilization  period  was  of  an  educational  type 
and  included  two  clearly  defined  phases:  the  dissemination  of 
propaganda  regarding  general  and  public  health  nursing  and 
class  instruction,  and  the  dissemination  of  propaganda  regard- 
ing student  nurse  recruiting. 

The  first  of  these  projects,  which  was  as  picturesque  and 
droll  an  undertaking  as  any  in  which  the  Eed  Cross  nurses  had 
hitherto  particii)ated,  first  embraced  the  utilization  of  Chau- 
tauqua platforms  as  a  medium  through  which  to  reach  the 
American  public.  Early  in  April,  1!)17,  the  Kadcliffe  Chautau- 
quas  had  asked  !Miss  Delano  to  assign  a  nurse  to  one  of  their 
circuits  to  speak  on  the  general  Kcd  Cross  military  and  health 
program.  Florence  ^l.  Desley,  a  former  Ked  Cross  Town  and 
Country  nurse,  was  chosen  and  was  the  pioneer  Red  Cross 
troubadour  of  lu^alth.  So  successful  was  she  in  interesting  her 
audiences  in  Ked  Cross  class  instruction  and  general  nursing 
activities  that  ^Ir.  Ivadcliife  a  year  later  asked  Miss  Delano  to 
reassign  ]\Iiss  Besley  and  to  provide  three  other  nurses  for 
similar  work.  Elora  Bradford,  (Mrs.)  ^Margaret  11.  Cooper 
and  Dolly  Twitchell  took  the  road  as  itinerant  nurse-lecturers 
and  instructors. 

Jmmediately  after  the  signing  of  the  Armistice,  public  in- 
terest in  the  I'nited  States  regarding  overseas  service  ran  high. 
National  Ilead(iuarters  was  already  swinging  toward  a  broad 
health  program  and  was  zealous  to  find  ways  in  which  this  pro- 
gram could  be  brought  to  public  attention.  The  Xursing  Serv- 
ice suggested  to  the  Department  of  I'ublicity  that  Ked  Cross 
nurst^  speakers,  nurses  who  had  had  overseas  experience,  should 
ho  assigned  to  the  Chautau(|ua  platforms  and  should  tell  the 
war  and  p(>ace  story  of  th(>  Nursing  Service. 

The  wholly  American  institution  of  Cliautau(iua  was  a  de- 
v(>lopment  of  the   Enivc^rsity  Extension   idea   and   was  a  com- 


1054  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

munity  project  by  which  American  cities  and  especially  towns 
and  villages  too  small  or  remote  to  attract  lecturers  and  enter- 
tainers of  national  prominence  held  a  series  of  lectures  and 
entertainments,  usually  for  a  week's  duration,  which  combined 
educational  and  entertainment  features.  The  method  by  which 
a  community  held  Chautauqua  was  simple :  the  mayor  and 
town  council  voted  to  hold  Chautauqua  Week,  and  signed  a 
contract  with  a  commercial  Chautauqua  company  whereby  the 
company  provided  lecturers  on  civic  and  literary  subjects,  mu- 
sicians and  other  types  of  theatrical  entertainers,  in  return  for 
a  percentage  of  the  gate  receipts.  Chautauqua  Week  was  usu- 
ally held  under  canvas  at  the  local  county  fair  grounds  and  was 
attended  by  young  and  old  alike. 

The  financial  basis  of  the  Chautauqua  campaign  was  a  happy 
one  for  the  Red  Cross.  The  commercial  companies  paid  Na- 
tional Headquarters  a  weekly  salary  rate  for  each  nurse 
speaker  and  provided  maintenance  and  traveling  expenses. 
National  Headquarters  in  turn  reimbursed  the  nurses  and  fur- 
nished posters,  newspaper  plates,  material  for  publication  in 
the  local  press,  and  copies  of  two  pamphlets,  one  promoting  the 
Red  Cross  public  health  program  and  the  other  urging  young 
women  to  take  up  nursing,  for  distribution  to  the  nurses'  audi- 
ence. The  contact  between  the  Chautauqua  companies  was 
made  by  Dr.  Thomas  E.  Green,  then  director  of  the  National 
Red  Cross  Speakers'  Bureau.  Details  of  the  publicity  material 
w^ere  handled  through  the  cooperation  of  the  Nursing  and 
Publicity  departments  and  local  interest  in  the  nurse's  lecture 
was  aroused  by  Red  Cross  Division  and  Chapter  efforts. 

The  nurse  speakers  themselves  had  little  idea,  when  they 
came  to  National  Headquarters  for  a  preliminary  conference 
in  iMay,  1919,  of  the  vicarious  and  nomadic  summer  wliieli 
lay  ahead  of  them,  nor  for  that  matter  had  ]\Iiss  Noyes  and  her 
associates,  else  the  Red  Cross  troubadours  of  health  might  not 
have  taken  the  road  with  such  fervor.  The  majority  of  the 
speakers  had  just  returned  from  one  to  three  years  of  foreign 
service;  many  of  them  had  been  "wp  the  line,"  but  surely  no 
Red  Cross  nurses  were  more  brave  than  the  thirty-one  Chau- 
tauqua speakers  who  started  out  to  try  to  hold  tlicir  own  against 
artists  who  had  spent  their  lives  in  public  speaking  and  enter- 
tainment. And  the  difficulties  of  living  at  the  front  were  oi'tcn 
no  harder  than  those  expc^rienced  by  these  nurses,  who  spoke 
one  day  at  a  given  town,  then  traveled  during  the  night  or  the 


DEMOBILIZATION  1055 

following  morning  to  the  next  town,  there  accepted  what  local 
hotel  accommodations  they  could  find,  spoke  again  in  the  after- 
noon and  traveled  again  at  night. 

The  list  of  Chautauqua  speakers  held  many  names  of  nurses 
who  had  rendered  gallant  war  service.  Mary  K.  Nelson,  of 
fivreux,  was  one  of  the  most  eloquent.  Nurses  preeminently 
successful  as  Chautauqua  speakers  were  Edith  Benn,  Frances 
Maltby,  Edith  Ambrose,  Ida  F.  Butler,  Stella  Fuller,  Eliza- 
beth Hunt,  Josephine  Mulville,  and  Elizabeth  Walsh.  Flor- 
ence Bullard,  tb"  first  nurse  whom  j\Iiss  Russell  had  sent  to 
care  for  American  boys  in  French  hospitals,  had  lived  through 
the  capture  of  Soissons  in  1918  and  her  dramatic  accounts  of 
war  nursing,  followed  by  an  appeal  for  guardianship  of  the 
public  health,  held  audiences  of  from  three  to  five  thousand 
people  tensely  interested  until  she  left  the  platform.  Daisy  P. 
Beyea  was  one  of  the  nurses  of  Evacuation  Hospital  No.  G, 
and  became  so  successful  as  a  "spellbinder"  that  she  continued 
as  a  speaker  after  her  Red  Cross  assignment  was  finished. 
Gertrude  Bowling,  the  young  Hopkins  nurse  whose  accounts 
of  ''shock"  work  at  the  front  have  been  quoted  in  an  earlier 
chapter,  was  another  nurse  who  by  reason  of  her  experiences 
overseas  and  her  great  sincerity  was  able  to  speak  amazingly 
well. 

In  addition  to  the  nurses  already  mentioned,  the  list  of 
Chautau(|ua  nurses  included  Lydia  Breaux,  Jane  T.  Dahlman, 
Anne  Dailev,  ]\label  Fletcher,  Eleanor  Gregg,  jMary  Herring, 
Bree  S.  Kellov,  ^Nfary  jMonroe,  Laura  Phillips,  Laura  Roser, 
and  ^lary  Sedlacek.  To  nurses  drilled  since  their  probation 
days  to  avoid  publicity  and  sensationalism,  the  Chautauqua 
atmosphere  must  have  been  at  least  an  innovation.  Miss  Am- 
brose wrote  ]\1  iss  Noyes : 

You'd  be  quite  entertained  at  the  dramatic  introduction  T 
have.  Our  jirograni  is  worked  out  so  that  my  speech  is 
always  preceded  by  music  and  our  baritone,  quite  a  wonder, 
gets  up  after  tlie  rest  of  the  talent  have  left  the  staiie  and 
sings  a  verse  of  "The  l?ose  of  Xo  Man's  Land."  When  he 
retK'hes  the  lines, 

"]\rid  the  war's  dark  curse 
Stands  tlie  Ked  Cross  nurse," 

the  curtains,  whicli  are  covered  on  one  side  ])y  an  American 
flag  and  on  the  either  hy  a  Hed  Cross  one,  are  drawn  apart  and 


1656  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

there  I  stand,  in  white  uniform,  cap  and  scarlet-lined  cape. 
Then  without  further  parley  after  the  applause  has  died 
down,  I  begin. 

To  some  of  the  nurses  assigned  to  Chautauqua  circuits,  the 
sea  of  upturned  faces  which  confn^nted  them  as  they  stepped 
forward  to  plead  their  cause  was  a  paralyzing  sight,  far  more 
terrifying  than  had  been  nursing  servi(  e  in  an  evacuation  hos- 
pital or  a  bombed  base.    A  nurse  wrote : 

I  used  to  come  wabbling  out  on  the  stage  so  scared  I'd  hang 
onto  the  tent  poles,  until  I  looked  around  my  audience  and 
saw  those  sickly  babies  and  their  tired,  gaunt  mothers;  those 
undernourished  children,  many  of  whom  have  rickets;  those 
hard-working  mountain  fathers.  Then  I  seemed  to  forget 
everything  else  in  the  world — my  stage  fright  and  fatigue, 
that  breathlessly  hot,  crowded  tent,  the  hotel  where  my  bed 
gets  up  and  walks.  All  I  remembered  was  that  I  am  bringing 
to  these  people  a  message  which  may  mean  their  future  happi- 
ness and  freedom. 

The  unexpected  formed  a  potent  factor  with  which  the  nurses 
on  the  road  and  the  executives  at  National  Headquarters  had 
to  be  constantly  prepared  to  meet.  Just  before  their  first 
speech,  three  of  the  nurses  assigned  to  large  and  important  cir- 
cuits suffered  nervous  breakdown  as  a  result  of  their  foreign 
service.  To  keep  faith  with  their  contract  the  Nursing  Service 
had  to  find  and  prepare  substitutes  almost  overnight.  Another 
nurse  kept  several  speaking  appointments,  then  found  the  itin- 
erant life  and  the  uncertain  hotel  accommodations  too  wearing, 
and  resigned.  Another  nurse  suffered  personal  bereavement 
and  was  forced  to  leave  her  circuit.  Two  nurses  found  them- 
selves temperamentally  unfitted  for  the  work.  Substitutes  had 
to  be  found  immediately  for  all  these  speakers. 

The  twenty-five  Chautauqua  circuits  to  which  the  Nursing 
Service  assigned  speakers,  looped  the  United  States.  ]\Iassa- 
chusetts,  Khode  Island,  Connecticut,  New  Jersey,  North  Da- 
kota and  Nevada  were  the  only  states  where  nurses  did  not 
speak.  The  majority  of  the  circuits  took  the  nurses  into  iso- 
lated rural  communities  where  the  barren  soil  yielded  only  a 
meager  return  for  gruelling  labor.  In  these  regions  living  con- 
ditions were  primitive  and  the  people  themselves  of  stoic  and 
somber  temperament;  usually  they  sat  motionless  through  the 


DEMOBILIZATION  1057 

nurse's  lecture  and  when  it  was  ended  left  the  tent  without  re- 
action of  any  kind.  Now  and  then  the  nurse's  words  fell  on 
fruitful  soil.     Miss  Butler  wrote: 

I  give  my  lecture  in  the  afternoon,  always  making  the  plea 
for  the  employment  of  a  community  nurse,  the  great  need  for 
more  public  health  nurses  and  the  need  for  young  women  to 
enter  training  schools.  I  make  as  strong  an  attack  as  I  dare 
on  the  awful  conditions  I  see  with  my  own  eyes  all  through 
this  country, — vile  drainage  and  sanitation ;  hithy  stalls  and 
pig-pens  quite  often  only  a  few  feet  from  a  dug  well.  I  plead 
for  a  revival  of  interest  through  the  Red  Cross  as  a  vital 
memorial  to  the  men  and  women  who  died  in  France. 
Usually  the  small  Red  Cross  Branch  or  Auxiliary  is  the  only 
organization  in  these  communities  outside  a  church  and  a 
school  in  the  Paleozoic  stage  of  education.  But  oh,  it  is  such 
a  forlorn  country !  I  never  dreamed  of  people  in  these  United 
States  of  ours  living  with  so  little  knowledge  of  health  and  of 
decent  and  comfortable  living.  They  fairly  cat  dirt  and  God 
knows  they  drink  it!  But  they  are  touchingly  eager  for  a 
community  nurse, — "some  one  to  show  us  how."  One  woman 
came  to  me  with  tears  streaming  down  her  face.  "I  never 
dreamed,"  she  said,  ''that  consumption  could  be  cured;  what 
you've  said  to-day  is  life  to  me." 

The  day's  work  on  a  Chautauqua  circuit  held  much  of  droll- 
ery as  well  as  of  hardship  and  pathos.  One  afternoon  Miss 
Maltbv  found  her  audience  particularly  difficult ;  the  children 
on  the  front  scat  tittered  and  squirmed  and  pointed.  Finally 
she  stopped  and  said  sternly:  'Mf  the  child  under  the  platform 
will  come  out  I  will  finish  my  lecture."  A  youngster  jumped 
up  and  answered:  ''T'aint  a  child,  nuss,  it's  a  hawg." 

Miss  Butler's  assignment  took  her  to  the  mining  districts 
of  southern  Illinois.  ''I  got  caught  last  night  in  a  little  town," 
she  wrote,  "where  my  experienced  eye  told  me  at  one  glance 
that  here  was  a  hotel  where  I  should  do  little  sleeping.  I  told 
the  manager,  however,  that  I  simply  must  have  clean  sheets ; 
any  one  could  sec  that  the  ones  on  my  bed  had  been  sle])t  on. 

''  ^Sure  they  have,'  he  replied,  'but  the  travelin'  man  in  that 
room  last  night  was  such  a  nice  clean  man  them  sheets  aint 
noways  real  dirty!'" 

One  sleepy  summer  afternoon  ^liss  ^fulville  was  sitting  on 
the  edge  of  an  Iowa  railroad  station  platform  waiting  for  the 
local  accommodation  train  to  wliccze  in  when  a  bairii'aire  man 


1058  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

in  worn-out  khakis  spied  her  and  came  over  to  talk.  The  con- 
versation developed  the  fact  that  both  of  them  had  had  service 
in  France, 

"I  got  mine  in  July  an'  was  shipped  back  to  Bordeaux,"  said 
the  ex-service  man.  "I  come  to  in  a  surgical  ward  of  No.  6 
an'  there  was  a  big  red-headed  nurse  bossin'  that  shebang. 
Gosh,  she  was  a  bird !  She  was  usually  too  tired  to  talk  much, 
but,  Lord,  how  she  could  nurse !  She  wasn't  much  of  a  looker 
though ;  she  was  thin  an'  wore  an  ole  gray  sweater  that  hung 
down  to  her  knees  an'  her  skirt  sagged  an' " 

Suddenly  he  looked  at  Miss  Mulville's  smartly-tailored  out- 
door uniform,  then  up  to  her  already  twinkling  gray  eyes. 

''Gosh,  lady !"  he  gasped,  "You're  her !" 

When  the  Chautauqua  season  closed  in  November,  more  than 
a  million  and  a  half  people  in  all  parts  of  the  United  States 
had  heard  the  story  of  the  Red  Cross  Nursing  Sersdce  in  war 
and  peace  from  the  lips  of  a  participant.  Two  thousand  four 
hundred  and  two  Chautauqua  audiences,  averaging  from  thirty 
to  five  thousand  persons  each,  had  listened  to  the  nurses'  lec- 
tures since  tlu^  preceding  January.  In  Nebraska,  Red  (^ross 
nurses  had  addressed  199,  and  in  Ohio,  1Y9  audiences.  Miss 
Besley  and  Miss  JMaltby  held  the  season's  record;  they  had  each 
delivered  over  two  hundred  and  fifty  speeches,  six  speeches 
weekly  covering  a  period  of  nearly  forty  weeks. 

The  Chautauqua  campaign,  as  it  was  called  at  National 
Headquarters,  gave  marked  impetus  to  the  Red  Cross  public 
health  nursing  and  class  instruction  program  and  offered  a 
striking  example  of  nurses'  versatility. 

The  Chautauqua  campaign,  with  its  posters,  pamphlets  and 
newspaper  plate  material,  was  the  most  ambitious  publicity 
project  which  the  Nursing  Service  had  hitherto  undertaken 
largely  under  its  own  auspices.  True,  Dr.  Green  of  the  Speak- 
ers' Bureau  and  John  Mumford  and  Marion  G.  Schcitlin,  in 
turn  Red  Cross  Directors  of  Publicity,  had  guided  Miss  Noyes 
and  her  own  publicity  representative,  Elizabeth  Pickett,  in  the 
initiation  of  the  campaign,  but  during  the  late  spring  and 
summer  the  Nursing  Ser\dce  itself  carried  the  larger  proportion 
of  the  work.  The  success  which  greeted  the  campaign  instilled 
in  ]\Iiss  Noyos  and  the  members  of  the  National  Committee  con- 
sidoral)le  confidence  in  general  publicity  methods  and  made 
them  zealous  to  acquaint  tlie  public  with  the  need  existing 
from  1920  on,  for  young  women  to  enter  schools  of  nursing. 


DEMOBILIZATION  1059 

One  of  the  piiiiiphlets  which  nurses  had  distributed  from 
the  Chautauqua  phitforms  was  a  small  folder,  "How  May  I 
liecoine  a  Nurse  C  written  in  popular  vein  and  with  the  intent 
to  interest  girls  among  the  rural  and  small  town  audiences  to 
enter  schools  of  nursing.  The  distribution  of  this  pamphlet 
formed  the  first  special  effort  of  the  K(!d  Cross  in  this  field. 

A  s<'('()nd  experiment  in  publicity  of  this  type  was  undertaken 
in  1!)20  in  the  Delaware-Pennsylvania  Division.  Miss  Francis 
wrote : 

Upon  the  completion  of  the  Roll  Call  last  year,  we  realized 
that  the  interest  of  our  Chapters  in  public  health  nursing  was 
far  greater  than  our  ability  to  secure  public  health  nurses  who 
were  prepared  to  establish  these  services.  At  the  same  time, 
the  number  of  students  in  a  large  majority  of  the  training 
schools  for  nurses  was  seriously  below  normal.  Appreciating 
that  we  could  never  meet  the  dem?.nds  of  our  chapters  for 
public  health  nurses  if  the  supply  at  its  source  was  so  seriously 
crippled,  we  decided  to  bring  to  the  attention  of  the  people  of 
this  division  the  need  for  public  health  nurses;  to  educate 
them  to  an  appreciation  of  the  op})ortunities  offered  to  stu- 
dents through  admission  to  a  training  school  of  nursing;  and 
also  to  develop  a  better  understanding  of  the  principles  con- 
stituting sound  nurse  education. 

With  the  endorsement  of  the  Pennsylvania  State  Board  of 
Examiners,  Miss  Francis  worked  out  an  itinerary  based  on  the 
numbers  and  geographical  divisions  of  Kcd  (Jross  Chapters, 
branches  and  Auxiliaries  and  assigned  Elizabeth  Walsh  to  speak 
at  each  town  listed  on  the  itinerary.  Miss  WalslTs  success 
on  a  Redpath  Chautauqua  circuit  the  previous  summer  had 
already  won  luu-  eager  listeners  in  the  Keystone  State. 

During  January  rnd  February,  1920,  Miss  Walsh  addressed 
seven  thousand  two  hundred  and  sixty-nine  persons  in  thirty- 
one  towns  in  Pennsylvania.  Her  audiences  assembled  in 
churches,  business  colleges,  public  and  private  secondary  schools 
and  factories.  Through  her  efforts,  thirty  girls  w(>re  definitely 
known  to  have  intcu'viewed  superintendents  of  schools  of  nurs- 
ing with  a  view  toward  entering  training. 

The  experiment  undertaken  by  ^Miss  Walsh  attracted  consid- 
erable attention  in  nursing  ranks  and  in  the  late  spring  of  1920, 
the  Joint  Xational  (\)nnnittee  on  Nursing  Headquarters  ap- 
pointed  a  special   committee  which  was  charged   with   respon- 


1060  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

sibility  for  developing  and  conductino;  a  nation-wide  movement 
to  recruit  student  nurses.  Major  Julia  Stimson  was  chairman 
and  Miss  Albaugh  a  particularly  zealous  member  of  this  com- 
mittee. Plans  were  drawn  up  and  Miss  Noyes,  herself  a  member 
ex-offieio  of  the  committee,  secured  from  the  Red  Cross  Execu- 
tive Committee  an  appropriation  of  thirty-five  thousand  dol- 
lars ($35,000)  "of  which  so  much  as  may  be  necessary  shall 
be  expended  by  the  Director  of  the  Department  of  Nursing 
during  the  six  months  ending  December  31,  1920,  to  provide 
for  all  expenses  at  National  Headquarters  and  in  the  Divisions, 
in  connection  with  the  recruiting  campaign  for  student  nurses, 
as  outlined  in  the  plan  developed  by  a  special  committee  repre- 
senting the  American  Red  Cross,  the  American  Nurses'  As- 
sociation, the  National  League  of  Nursing  Education  and  the 
National  Organization  for  Public  Health  Nursing."  -^ 

The  plan  referred  to  above  called  for  the  organization  in 
local  communities  of  a  student  nurse  recruiting  committee,  to 
be  composed  of  representatives  of  such  local  groups  as  the  Red 
Cross  Chapter  or  Branch ;  the  governing  and  auxiliary  boards 
of  the  hospitals ;  hospital  and  training  school  superintendents ; 
medical  and  nursing  organizations,  physicians ;  the  board  of 
education ;  the  press ;  the  chamber  of  commerce ;  and  women's 
clubs.  The  duties  of  the  committee  were  outlined  in  full  and 
included  the  slow  and  steady  dissemination  through  a  number 
of  years,  of  propaganda  directed  toward  interesting  the  general 
public,  and  young  women  especially,  in  the  nursing  profession. 
The  publicity  material  included  the  distribution  of  an  ef- 
fective poster,  a  pamphlet  and  application  forms  to  be  filled  out 
and  sent  by  interested  young  women  to  superintendents  of 
schools  of  nursing.  Four  motion  pictures  on  nursing  subjects 
had  been  produced  by  National  Headquarters  and  they  were 
used  also  in  the  recruiting  movement,  especially  one  which  was 
called  'Tn  Florence  Nightingale's  Footsteps"  and  which  visual- 
ized the  training  of  a  nurse.  Newspaper  "feature"  stories  were 
prepared  and  sent  out  to  the  local  committees  which  were 
charged  with  the  responsibility  of  having  these  appear  in  the 
local  press. 

One  of  the  aims  of  the  movement  was  to  bring  to  the  general 
public  better  appreciation  of  sound  nurse  education  and  the 
special  leaflet,  which  was  called  "A  Challenge  to  the  Young 

"See  Advice  of  Appropriation  No.  203,  August  3,  1920,  National  Head- 
quarters,  Washington,   1).   C. 


DEMOBILIZATION  1061 

Women  of  America,"  had  this  aim  in  view.  On  one  side  of 
the  fonr-pag:e  leaflet  was  printed  a  list  of  questions  which  every 
prospective  student  was  urged  to  ask  the  superintendent  of  the 
school  which  she  expected  to  enter;  on  the  opposite  page  were 
the  answers  which  should  be  given  by  the  superintendent  of  any 
well-organized  training  school.  The  student  was  thus  equipped 
with  knowledge  which  would  enable  her  to  discriminate  to  some 
extent  between  a  school  of  low  or  high  educational  standards. 

Copies  of  the  *'plan"  and  full  publicity  material  were  sent, 
with  appropriate  letters  requesting  cooperation,  to  all  presi- 
dents of  State  Nursing  Associations;  to  the  editors  of  medical 
and  nursing  publications ;  to  the  presidents  of  American  na- 
tional medical  and  nursing  associations ;  and  to  Red  Cross 
Division  managers  for  distribution  to  Chapters  and  Branches. 
The  following  letter  written  July  20,  1920,  by  Frederick  C. 
Monroe,  then  general  manager  at  National  Headquarters,  to 
all  Red  Cross  Division  managers,  is  illustrative  of  these  letters 
of  transmittal: 

As  you  are  aware,  we  are  facing  a  critical  shortage  of 
graduate  nurses  for  all  types  of  work,  particularly  public 
health.  The  increasing  demands  of  modern  medicine,  the 
continuing  needs  of  the  late  war  and  epidemics  of  disease 
consequent  upon  the  war  are  taxing  the  nursing  resources  of 
the  nation  to  the  limit.  In  one  nursing  bureau  alone,  there 
were  recently  five  hundred  more  requests  for  nurses  to  fill 
positions  in  institutional  and  public  health  fields  than  there 
were  nurses  availal)^.  This  condition  will  probably  grow 
worse  instead  of  bettor.  .  .  . 

The  Ked  Cross  is  deeply  concerned  in  this  situation  and  has 
the  traditional  duty  to  help  in  every  way  possible  to  meet  it. 
Xot  only  is  tbis  true,  but  if  the  Red  Cross  is  to  succeed  in  the 
public  health  field,  it  must  liave  a  constant  and  ever  increas- 
ing supply  of  well-trained  nurses  to  carry  on  its  nursing 
activities.  The  nurse  training  school  is  the  only  source  from 
which  qualified  nurses  may  be  obtained.  We  nnist.  therefore, 
stimulate  recruiting  ior  these  schools.  Yet  the  extraordinary 
conditions  now  prevailing  are  a  serious  handica]).  Commer- 
cial and  industrial  life.  l)y  offering  great  and  immediate 
rewards,  is  drawing  heavily  upon  the  young  womaidiood  of 
the  country. 

localizing  the  seriousness  of  the  situation,  groups  of  nurses 
themselves  have  coiiporated  with  states,  communities  and  bos- 
pitnls  in  local  endeaxors  to  stimulate  the  enrollment  of  stu- 


1062  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

dent  nurses.  Eecently  also  the  three  national  organizations 
of  nursing  ,  .  .  have  joined  with  the  Red  Cross  in  developing 
a  national  movement  for  the  enrollment  of  student  nurses. 
It  is  this  national  movement  which  you  are  now  called  upon 
to  assist  in  every  way  possible.  .  .  . 

Then  followed  detailed  administrative  instructions.  The 
Division  Directors  of  Nursing  took  hold  of  the  movement  with 
interest  and  developed  it  extensively.  In  the  following  months, 
several  ideas  of  considerable  originality  were  put  into  use.  Miss 
Van  de  Vrede  of  the  Southern  Division  appointed  Miss  Maltby 
to  initiate  the  movement  in  her  office.  On  March  21,  1921, 
Miss  Maltby  wrote  Miss  Noyes  of  the  work  accomplished : 

We  first  sent  each  active  chapter  a  letter  with  sample  leaf- 
lets and  one  poster.  To  this  there  was  some  response.  We  are 
now  approaching  them  through  "Briefs"  [the  Division  bul- 
letin] 

To  all  our  public  health  nurses  and  local  committees,  we 
have  sent  two  newspaper  articles,  with  the  request  that  they 
be  published  in  the  high-school  papers  through  the  efforts  of 
the  local  publicity  chairmen,  or  failing  that,  that  they  receive 
space  in  the  local  newspaper.  These  two  articles  have  gone  to 
ninety  publications  in  the  division. 

To  college  presidents  and  to  Y.  W.  C.  A.  presidents  in  col- 
leges in  the  division,  we  have  written  and  enclosed  a  poster 
and  a  recruiting  article,  asking  that  it  be  published  in  the 
college  papers.  Wo  have  also  offered  to  send  a  personal 
representative  to  address  the  colleges  on  nursing  as  a  pro- 
fession. The  colleges  are  responding  well  to  the  suggestion 
and  a  representative  will  probably  start  in  April.  .  .  . 

In  the  Lake  Division,  Pearl  Kamerer  was  appointed  to 
develop  student  nurse  recruiting;  she  organized  committees  in 
Kentucky,  Indiana  and  Ohio  in  connection  with  the  state  grad- 
uate nurses'  association.  On  April  8,  1921,  she  wrote  Miss 
Albaugh : 

.  .  .  The  Ohio  State  Recruiting  Committee  engaged  Miss 
Mary  1*].  CJladwin  to  speak  for  a  period  of  three  months, 
beginning  March  1,  to  the  young  women  in  the  different  Oliio 
colleges  and  to  as  many  high  schools  and  groups  of  men  and 
women  as  possible.  To  finance  the  speaker,  the  accredited 
schools  of  nursing  were  asked  to  contribute  one  dollar  for 
each  pu])il  in  training.    A  few  of  the  larger  Red  Cross  cbap- 


DEMOBILIZATION  1063 

ters  were  also  asked  to  assist.  There  was  hearty  response  from 
the  schools  and  the  chapters  .  .  .  and  most  of  the  districts 
feel  that  their  committees  will  be  interested  in  doing  some- 
thing definite  towards  recruiting  each  year. 

A  novel  idea  was  developed  in  Sanilac  County,  Michigan, 
by  Elba  L.  ^lorse,  Hed  Cross  supervising  nurse  for  Michigan. 
Three  '^mother  and  daughter  banquets"  were  held  with  a  total 
attendance  of  eight  hundred  and  fifty  mothers  and  daughters, 
and  on  these  occasions  the  traditions  and  advantages  of  nursing 
were  presented.     Miss  Morse  described  the  type  of  program : 

The  county  nurse  outlined  the  program  and  twenty-six  high- 
school  girls  took  part.  The  teachers  assisted  in  choosing  the 
girls  and  in  rehearsing  them,  so  it  took  very  little  time.  The 
play  was  called  The  Scope  of  Nursing  and  was  given  by 
twenty  girls  dressed  in  white,  each  girl  representing  a  phase 
of  nursing  such  as  hospital  superintendent.  Army  nurse, 
Kavy  nurse,  Hed  Cross  nurse.  As  each  appeared,  she  told  the 
pleasant  duties  of  the  branch  she  represented.  When  the 
twenty  lined  up,  each  with  their  cards  telling  what  phase  they 
represented,  so  the  mothers  saw  plainly  the  wide  scope  of  the 
profession. 

Next  came  lumian  pictures, — "the  greatest  mother  in  the 
world,"  the  pul)lic  health  nurse  as  '"the  foster-mother  of  the 
race";  "the  Lady  with  the  Lamp."  .  .  . 

Otiier  phases  of  the  banquets  were  music  and  addresses  by 
prominent  nurse  leaders.  In  one  town  the  banquet  was  free; 
the  committee  solicited  funds  mostly  from  the  wartime  worker 
and  invited  every  niothor  and  daugliter  in  the  town.  Four 
hundred  and  fifty  atteiulod  and  the  ]\Iethodist  Church  was 
crowded  as  it  liad  not  been  since  the  war.  One  other  town 
sold  tickets  at  fifty  cents  and  the  third  at  seventy-five  cents. 
Both  towns  had  to  restrict  the  number  of  tickets  to  two  hun- 
dred, but  could  have  sold  many  more.  In  one  place  it  was 
voted  that  a  similar  banquet  be  held  as  an  annual  affair  each 
year  to  different  nurses  from  that  locality  who  had  died  over- 
seas, the  extra  proceeds  of  the  banquet  to  be  used  as  a  scholar- 
ship for  a  local  high  school  girl  entering  training.  .  .  . 

Twenty  girls  entered  schools  of  nursing  in  the  fall  of  1021  as 
a  result  of  the  "mother  and  daughter  banquets."  The  indirect 
results  of  such  educational  effort,  however,  went  on,  for  the 
ideal  of  altruistic  nursing  service  had  been  planted  in  the 
impressionable  minds  of  young  girls  and  was  not  to  be  wliolly 
forgotten. 


1064  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  movement  to  recruit  student  nurses  was  not  confined 
to  definite  time  limits  but  was  intended  to  be  a  steady  con- 
structive upbuilding  of  public  interest  and  judgment  of  nursing 
education.  At  the  present  writing,  it  is  too  early  to  estimate 
the  efi^ect  of  the  movement  upon  the  profession. 

Throughout  the  period  of  demobilization,  an  acute  shortage 
of  nurses  in  all  phases  of  service  was  experienced.  Schools  of 
nursing  reported  to  the  Red  Cross  Bureau  of  Information  and 
later  to  National  Nursing  Headquarters  special  difficulty  in 
securing  adequately-trained  nurse  instructors.  The  dearth  of 
this  type  of  personnel  was  particularly  serious  because  such  a 
condition,  if  not  remedied,  would  check  the  supply  of  properly- 
trained  nurses  at  the  very  source,  the  school ;  so  at  Miss  Noyes' 
request,  National  Headquarters  appropriated  funds  to  be  used 
as  scholarships  for  nurses  desiring  to  take  post-graduate  courses 
to  fit  themselves  to  teach  in  schools  of  nursing.  Twelve  such 
scholarships  and  four  loans  were  granted  in  1921  to  enable 
nurses  to  take  courses  at  the  department  of  nursing  and  health 
at  Teachers'  Colleges. 

Perhaps  the  outstanding  accomplishment  of  the  nursing  pro- 
fession during  the  period  of  demobilization  was  the  winning  of 
assimilated  rank  of  Army  nurses.  This  accomplishment  was 
brought  about  by  the  persistent  efforts  of  nurses  and  friends 
of  nurses  in  the  face  of  strong  opposition  from  the  War  De- 
partment. While  the  American  Red  Cross  officially  took  no 
part  in  this  legislative  struggle,  individual  leaders  of  the  Red 
Cross  Nursing  Service  were  staunch  sponsors  of  the  movement. 
For  this  reason  and  also  because  the  new  law  materially  affected 
the  Red  Cross  in  that  its  nurses  are  the  reserve  of  the  Army 
Nurse  Corps,  a  brief  account  of  this  movement  belongs  in  a 
history  of  the  American  Red  Cross  Nursing  Service. 

An  early  request  which  the  nursing  profession  made  to  the 
War  J)epartment  for  definite  status  and  authority  for  Army 
nurses  was  as  follows: 

The  American  Nurses'  Association,  in  convention  assembled 
in  riiiladelphia  on  tliis  first  day  of  May,  1917,  would  offer 
the  following  resohiiion : 

Whereas,  it  is  true  that  nurses  wlio  are  responsihle  for  the 
actual  nursing  of  the  yjatieiits  in  the  military  liospitals  have 
no  autliority  to  regulate  hygienic  conditions  therein;  and 


DEMOBILIZATION  1065 

Whereas,  this  situation  tends  to  discourage  nurses  from 
undertaking  the  work ;  and 

Whereas,  this  is  a  danger  to  the  hospitals'  population ;  and 

Whereas,  it  has  been  found  essential  in  representative  civil 
hospitals  to  place  upon  the  nurses  the  responsibility  for  the 
care  of  the  patients,  the  wards  and  operating  room  and  the 
cleanliness  and  order  pertaining  thereto : 

Therefore,  be  it  resolved :  that  it  is  the  sense  of  this  meeting 
that  the  proper  military  authorities  should  be  requested  to 
specifically  define  the  status  of  the  nurse  and  confer  upon  her 
the  authority  necessary  to  control  the  situation,  to  the  end 
that  the  general  welfare  of  the  sick  may  be  promoted  and  a 
very  grave  danger  to  the  well  averted. 

Early  in  the  summer  of  1917,  the  War  Department  issued 
the  following  regulation  defining  the  status  of  Army  nurses: 

As  regards  medical  and  sanitary  matters  in  connection  with 
the  sick,  members  of  the  Army  Nurse  Corps  and  Army  Nurse 
Corps  Reserve  are  to  be  regarded  as  having  authority  in  mat- 
ters pertaining  to  their  professional  duties  (the  care  of  the 
sick  and  wounded)  in  and  about  military  hospitals  next  after 
the  officers  of  the  Medical  Department  and  are  at  all  times  to 
be  obeyed  accordingly  and  to  receive  the  respect  due  their 
position. 

The  phrase  "in  matters  pertaining  to  their  professional 
duties  (the  care  of  the  sick  and  wounded)"  permitted  individ- 
ual interpretation  on  the  part  of  commanding  officers  of  mili- 
tary hospitals  as  to  whether  the  nurse's  authority  did  or  did 
not  extend  beyond  the  person  of  the  patient.  Thus  the  authority 
over  ward  matters  such  as  ventilation,  light,  temperature,  sani- 
tary conditions,  supplies  and  other  questions  was  not  definitely 
granted  Army  nurses  and  the  regulation,  nurses  felt,  did  not 
meet  their  demands  for  definite  authoritative  status.  Their 
struggle,  therefore,  continued. 

One  of  tlie  first  organized  moves  to  secure  rank  for  Army 
nurses  came  in  the  summer  of  1917  from  a  group  of  prominent 
New  York  woukmi  who  formed  a  committee  later  known  as  the 
New  York  Committee^  to  Secure  Kank  for  Army  jSTurses.  ^Mrs. 
Harriot  Stanton  IMatch  was  chairman  and  ^Irs.  H.  ().  Ilave- 
meyer  an  enthusiastic  member.  This  committee  had  the  active 
support  of  leading  nurs(>s  in  New  York  (Mty,  among  whom 
Miss    ^Maxwell    was    perhaps    the    most    ardent.      Helen    Iloy 


1066  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Greeley,  a  graduate  of  Vassar  College  and  a  member  of  the  New 
York  Bar,  first  volunteered  her  services  as  counsel  and  later, 
when  nation-wide  organization  was  secured,  was  retained  by  the 
nursing   profession   to   represent   them. 

Early  in  1918,  bills  were  introduced  into  both  houses  of  Con- 
gress, in  the  Senate  by  Mr.  Chamberlain  and  in  the  House  of 
Representatives  by  Mr.  Dent,  which  purposed  the  general  re- 
organization of  the  Army  Nurse  Corps.  These  bills  called  for 
an  increase  in  the  number  of  executive  officers  in  the  Nurse 
Corps,  the  raising  of  compensation  of  Army  nurses  and  the 
collecting  in  one  place  of  all  regulations  regarding  Army  nurses. 

The  discussion  in  Congress  regarding  the  reorganization  of 
the  Army  Nurse  Corps  offered  opportunity  for  the  advocates 
of  rank  for  nurses  to  press  their  claims.  Two  bills  proposing 
absolute  rank  for  Army  nurses  were  introduced  into  the  House 
of  Representatives ;  the  first  one  was  introduced  by  Congressman 
Lufkin  on  March  27  and  proposed  commissioned  rank  with  the 
rates  of  pay  proposed  by  the  War  Department  reorganization 
bill ;  the  second  bill  was  introduced  by  Congressman  Raker  on 
April  5  and  proposed  the  pay  incident  to  the  rank. 

On  April  16,  the  House  Committee  on  Military  Affairs,  of 
which  Representative  S.  Hubert  Dent,  of  Alabama,  was  chair- 
man, held  the  first  meeting  on  the  question  of  rank  for  Army 
nurses.  Mrs.  Greeley  stated  that  the  object  of  the  committee 
was  to  secure  rank 

...  in  order  to  promote  the  efficiency  of  the  nursing 
service  of  our  boys  by  conferring  upon  the  nurses  some  out- 
ward, visible  sign  of  the  authority  which  is  supposed  to  be  in 
them,  a  sign  by  virtue  of  which  their  instructions  may  be 
promptly  carried  out  in  the  wards.  For  at  present  their 
authority  to  give  orders  is  continually  disputed  by  the  enlisted 
men  who  serve  as  orderlies  and  friction  and  dangerous  delays 
in  the  execution  of  orders  result.  We  believe  that  the  insignia 
of  rank  will  give  conclusive  notice  to  all  that  nurses  are 
officers  and  are  to  be  obeyed. 

Mrs.  Greeley  then  summarized  the  action  following  the 
introduction  of  the  Lufkin  and  Raker  bills ;  she  stated  that  after 
conference  with  each  other  and  with  General  Gorgas,  the  ad- 
vocates of  the  two  bills  had  agreed  to  abandon  their  bills  and 
support  a  proposition  for  relative  rank  in  the  form  of  an 
amendment  to  the  War  Department's  reorganization  bill.  This 
amendment  read : 


DEMOBILIZATION  1067 

Section  3.  (a)  That  the  members  of  said  corps  shall  have 
relative  rank  as  follows:  The  superintendent  shall  have  the 
relative  rank  of  major;  the  assistant  superintendents,  director 
and  assistant  directors  the  relative  rank  of  captain;  chief 
nurses  the  relative  rank  of  first  lieutenant;  and  nurses  the 
relative  rank  of  second  lieutenant;  and  as  regards  medical  and 
sanitary  matters  and  all  other  work  within  the  line  of  their 
professional  duties  siiall  have  and  shall  be  regarded  as  having 
authority  in  and  about  military  hospitals  next  after  the  medi- 
cal oHicers  of  the  Army  and  shall  wear  the  insignia  of  the  rank 
in  the  army  to  which  their  rank  corresponds. 

The  meaning  of  the  term  "relative  rank"  was  next  defined 
by  Mrs.  Greeley: 

You  will  notice  that  this  amendment  differs  from  the  Luf- 
kin  and  Ixaker  bills  in  asking  for  relative  rank  instead  of 
absolute  rank.  The  term  "relative  rank"  has  two  meanings. 
It  may  mean  simply  relative  position,  or  it  may  mean  a  kind 
of  rank  which  lacks  one  or  more  of  the  essential  elements  of 
absolute  rank  and  so  is  quasi  instead  of  actual,  relative  instead 
of  absolute.  We  are  using  the  term  in  this  second  sense.  The 
relative  rank  here  conferred  is  only  quasi  rank.  It  lacks 
several  of  the  essential  elements  of  absolute  rank — it  does  not 
call  for  a  commission;  it  does  not  carry  the  pay,  the  allow- 
ances or  the  emoluments  of  absolute  rank ;  and  it  makes  no 
attempt  to  confer  the  power  of  command  incident  to  a  line 
office  of  similar  grade.  The  only  incidents  of  absolute  rank 
which  the  relative  rank  contemplated  in  this  amendment  will 
confer  are : 

1.  The  dignity  incident  to  the  name  of  the  rank. 

2.  The  right  to  wear  the  insignia  thereof. 

3.  The  eligibility  to  exccise  authority  within  the  limits 
set  forth  in  the  law,  which  are  as  follows : 

As  regards  medical  and  sanitary  matters  and  all  work  in 
the  line  of  their  duties,  they  shall  have  and  shall  be  regarded 
as  having  authority  in  and  about  military  hospitals  next  after 
the  medical  othcers  of  the  Army.  .  .  . 

Among  the  nnrses  present  at  the  hearing  was  ^fiss  Delano, 
and  !A[rs.  Greeley  called  npon  her  to  testify.     !Miss  Delano  said: 

!Mr.  Chairman,  for  a  number  of  years  T  was  superintendent 
of  the  Army  Xnrse  Corps  when  Surg.  Gen.  Torney  was  Sur- 
geon General  of  the  Army.  As  the  superinterdeut  of  tlie 
Army  Xurse  Corps  1  inspected  all  of  the  military  hosjiitals  in 


1068  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

this  country,  Honolulu  and  the  Philippines,  and  had  ample 
opportunity  to  watch  the  working  out  of  this  plan  in  times  of 
peace.  Now,  I  believe  that  what  was  true  under  conditions 
which  obtained  then  would  hold  true  to  a  greatly  increased 
degree  now  in  time  of  war.  I  had  a  basis  of  comparison, 
because  before  I  came  into  the  Army  Nurse  Corps  I  was  for  a 
number  of  years  superintendent  of  what  was  at  that  time  the 
largest  training  school  in  the  United  States,  that  at  Bellevue 
Hospital. 

When  1  went  into  the  military  hospitals  I  found  an  absolute 
lack  of  coordination  of  the  activities  in  the  wards.  I  found 
division  of  responsibilities  and  more  or  less  friction;  a  tre- 
mendous amount  of  adjustment  necessary  on  the  part  of  the 
nurse;  a  tremendous  amount  of  yielding  of  things  they  con- 
sidered important  for  the  sake  of  peace.  I  found  this  adjust- 
ment constantly  necessary,  and,  even  in  time  of  peace,  great 
difficulties.  .  .  , 

I  will  cite  one  instance.  .  .  .  We  had  notice  from  the 
tuberculosis  hospital  at  Fort  Bayard  that  a  number  of  the 
nurses  were  reported  as  having  incipient  tuberculosis.  I  was 
sent  to  Fort  Bayard  to  look  into  the  matter.  ...  I  found  the 
head  nurses  of  the  wards  absolutely  without  responsibility  for 
the  cleanliness  of  the  wards.  I  had  again  a  basis  of  compari- 
son, because  we  had  a  large  tuberculosis  service  at  Bellevue, 
and  I  was  entirely  familiar  with  the  methods  necessary  to 
prevent  the  spread  of  tuberculosis  or  the  reinfection  of  pa- 
tients. I  found,  so  far  as  I  could  determine,  no  systematic 
plan  for  preventing  the  spread  of  contagion  in  the  hospital  at 
Fort  Bayard  because  the  cleanliness  of  the  ward  rested  abso- 
lutely in  the  hands  of  the  corps  men. 

!N[iss  Delano  next  discussed  the  regulation  given  above  which 
defined  the  status  of  the  Army  nurse : 

Efficient  organization  in  any  hospital,  civilian  or  military,  is 
in  my  opinion  to  be  secured  only  by  placing  definite  responsi- 
bility upon  one  person  in  the  ward. 

In  the  matter  before  us  I  do  not  believe  that  any  regulation 
will  eireet  the  purpose  we  desire.  First,  because  we  have 
back  of  us  the  traditions  of  years.  We  have  the  corpsmen, 
we  have  even  the  officers  themselves  and  perhaps  the  nurses, 
with  these  traditions  of  divided  responsibility,  and  we  have 
this  tradition  of  the  Hospital  Corps  man,  who  in  the  past  has 
not  been  placed  definitely  under  the  nurse.  Now,  a  new  regu- 
lation is  made,  but,  as  Mrs.  Greeley  said,  the  interpretation  of 
that  regulation  depends  entirely  upon  the  temperament  of  the 


DEMOBILIZATION  10G9 

commanding  oflicer  or  of  the  person  to  whom  he  delegates  the 
duties  regarding  it.  .  .  . 

Mrs,  Greeley  then  called  Julia  Lathrop,  chief  of  the  Chil- 
dren's Bureau,  who  spoke  in  favor  of  the  proposcid  amendment. 
Mrs.  Highbee  was  the  next  speaker.  She  brought  forth  the 
comparative  powerlessness  of  the  nurse  to  deal  with  an  insub- 
ordinate orderly.  !Miss  Goodrich  was  the  next  speaker.  She 
pointed  out  among  other  things,  that  in  the  view  of  the  fact 
that  personnel  of  the  Hospital  Corps  was  constantly  changing, 
it  was  highly  important  that  the  authority  of  the  head  nurse 
should  be  so  clear  to  all  with  whom  she  came  in  contact  that 
no  loss  of  time  should  result  in  teaching  the  new  men  her  real 
status.  Rank  would  immediately  establish  this  authority  with- 
out words  or  written  regiilations.  Mrs.  Greeley  then  read 
letters  supporting  rank  from  nurses  in  foreign  service,  and 
called  upon  additional  speakers.  Among  these  were  Colonel 
Victor  C.  Vaughan,  Medical  Corps,  National  Army;  ]\Iajor 
^Fartin,  then  a  member  of  the  Advisory  Commission  of  the 
Council  of  National  Defense ;  Miss  Thompson  of  the  Army 
Nurse  Corps;  Major  W.  J.  Mayo;  Dr.  William  M.  Geer, 
Vicar  of  St.  Paul's  Chapel,  New  York  City;  Mrs.  Harriot  S. 
Blatch,  representative  the  New  York  Committee  to  Secure  Rank 
for  Nurses;  and  ]\Irs.  Harriot  Blaine  Beale,  of  the  District  of 
Columbia.     The  hearing  was  then  adjourned. 

On  April  20,  the  Military  Affairs  Committee  heard  General 
Gorgas'  opinion  regarding  the  proposed  amendment  to  the 
medical  reorganization  bill;  the  Surgeon  General  stated  that  he 
"'did  not  see  the  necessity  or  the  advisability  for  commissioning 
the  great  number  of  nurses, — it  would  be  over  .^0,000  as  second 
lieutenants.  I  do  not  see,"  he  said,  "that  it  is  necessary  for 
their  functioning.  We  can  give  them  all  the  authority  they 
want  in  the  war  now.   .   .   ." 

The  reorganization  of  the  Army  Nurse  Corps,  which  was 
finally  contained  and  passed  in  the  Army  appropriation  bill 
for  1!>1!»,  became  law  on  July  9,  1018,  but  rank  for  nurses 
was  not  includc^l  therein.  The  failure  of  the  proposed  amend- 
ment providing  for  rank  to  be  included  in  the  Army  Reorganiza- 
tion bill,  was  largely  due  to  the  opposition  of  th(>  War  De- 
partment. 

Th(>  nursing  profession  was  resolute  in  their  claims  for  rank 
and  continued  to  agitate  the  (juc^stion.     On  .luly  <>,  11»1S.  Rcprc^- 


1070  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

sentative  Raker  introduced  a  bill  into  the  House,  H.  R.  12698, 
which  read  as  follows: 

Be  it  enacted  by  the  Senate  and  House  of  Representatives 
of  the  Ignited  States  of  America  assembled,  that  the  members 
of  the  Army  Nurse  Corps  shall  have  relative  rank  as  follows : 
The  superintendent  have  the  relative  rank  of  major;  the 
assistant  superintendent,  director  and  assistant  directors  the 
relative  rank  of  captain;  chief  nurses  the  relative  rank  of 
second  lieutenant;  and  nurses  the  relative  rank  of  second 
lieutenants;  and  as  regards  medical  and  sanitary  matters  and 
all  other  work  within  the  line  of  their  professional  duties  shall 
have  and  shall  be  regarded  as  having  authority  in  and  about 
military  liospitals  next  after  the  medical  officers  of  the  Army 
and  shall  wear  the  insignia  of  the  rank  in  the  Army  to  which 
their  rank  corresponds. 

This  bill  was  referred  to  the  House  Committee  on  Military 
Affairs.  In  the  pressure  of  the  times,  the  bill  was  lost  sight 
of  until  late  in  1918  when  the  subject  of  rank  for  Army  nurses 
again  began  to  claim  interest. 

With  the  return  of  nurses  from  foreign  service  early  in 
1919,  rank  for  Army  nurses  became  the  foremost  nursing  issue 
of  the  demobilization  period.  A  National  Committee  to  Secure 
Rank  for  Army  Nurses  was  formed  by  the  addition  of  new 
members  to  the  old  ISlew  York  City  Committee  of  which  Mrs. 
Blatcli  had  been  chairman.  Among  these  new  members  were 
the  presidents  of  the  national  organizations  of  nursing,  the 
membiirs  of  the  former  Committee  on  Nursing  of  the  Council 
of  National  Defense  and  influential  lay  men  and  women,  Mr. 
Taft  was  the  honorary  chairman.  Miss  Noyes  vice-chairman 
and  ]\Irs.  Greeley  was  secretary  and  counsel. 

At  its  midyear  conference  in  New  York  in  1919,  the  Board 
of  Directors  of  the  American  Nurses'  Association  voted  to  sup- 
port the  movement  to  secure  rank,  drew  up  with  the  aid  of  the 
National  (Taft)  Committee  a  plan  for  state  organization  and 
instructed  their  secretary,  Katharine  DeWitt,  to  write  to  all 
State  Nurses'  Associations  asking  their  cooperation.  On  Janu- 
ary 28,  li)19,  ]\[iss  DeWitt  wrote  in  part  as  follows  to  the 
officers  of  all  State  associations,  asking  their  active  support  to 
the  following  plan : 

1.  That  the  State-wide  committees  to  be  formed  should  be 
the  State  Branches  of  the  National  (Taft)  Committee  to 
Secure  l^ank  for  Nurses. 


DEMOBILIZATION  1071 

2.  That  these  state  communities  should  be  composed  about 
twenty  of  lay  persons  and  nurses,  the  chairman  i)referably  a 
lay  person,  either  a  man  or  a  woman. 

3,  That  the  State  Committee  raise  enough  money  through 
voluntary  subscription  to  finance  its  own  work  and  to  con- 
tribute a  quota  of  $250  for  the  1919  campaign,  to  the  National 
Headquarters  in  Washington,  payable  as  soon  after  ^larch  4, 
1919,  as  possible. 

By  April,  1919,  only  twelve  state  committees  had  been  or- 
ganized. In  the  April  issue  of  the  Journal,  Miss  Noyes,  as 
president  of  the  American  Nurses'  Association  and  vice-chair- 
man of  the  National  Committee  to  secure  rank,  addressed  the 
presidents,  other  officers  and  members  of  state  associations, 
outlined  again  the  plan  of  organization  and  closed  her  letter 
with  a  strong  plea  for  cooperation.  In  the  same  issue,  the 
Journal  spoke  in  the  editorial  columns  for  rank  and  from  then 
until  the  passage  of  the  Lewis-Raker  bill,  was  a  persistent  and 
eloquent  advocate. 

On  June  G,  1919,  a  bill  similar  in  wording  to  that  of  the 
second  Raker  bill,  was  introduced  in  the  Senate  by  Senator 
Jones,  was  referred  to  the  Senate  Committee  on  Military  Affairs 
and  was  published  as  Senate  bill  No.  17-37.  From  then  until 
the  end  of  the  legislative  struggle,  the  bills  proposing  rank  were 
referred  to  as  the  Jones-Raker  bills. 

Throughout  the  summer  and  fall  of  1919,  the  nurses  or- 
ganized their  forces  in  the  field.  At  Washington,  ]\[rs.  Greeley 
organized  extensive  office  headquarters  and  from  there  di- 
rected the  work  in  the  field  and  "on  the  Hill"  with  persistent 
cheerfulness  and  vigor.  Sara  E.  Parsons,  veteran  nurse  edu- 
cator and  war  loader,  volunteered  her  services  at  Mrs.  Greeley's 
office  and  during  the  fall  and  winter  of  1919  and  1920  spent 
much  time  in  bringing  to  the  attention  of  Congressmen  the 
vexations,  experiences  and  privations  to  which  nurses  had  been 
needlessly  subjected  overseas  on  account  of  lack  of  rank.  Expert 
publicity  advice  was  secured  and  a  news  service  established  at 
Mrs.  Greeley's  office  which  issued  bulletins  periodically  to  the 
press  and  to  State  Committees  to  secure  Rank  for  Army  Nurses. 
Hundreds  of  nurses  who  had  had  foreign  service  sent  in  affi- 
davits recounting  the  difficulties  which  they  had  experienced 
in  the  performance  of  their  duties,  in  traveling,  in  questions  of 
quarters  and  even  in  recreational  matters,  due  to  their  lack  of 
dignified  and  authoritative  status  in  the  Army.     These  letters 


1072  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  affidavits  were  published  in  the  Journal  throughout  the 
campaign  and  copies  of  them  were  sent  to  Congressmen  with 
urgent  letters  asking  for  rank.  ''Ever  since  April,"  stated  the 
editorial  columns  of  the  (November,  1919)  Journal,  "a  stream 
of  letters,  resolutions  and  petitions  has  been  trickling  into 
Congressmen's  offices  from  nurses,  lay  persons  and  organiza- 
tions, recently  from  doctors,  too.  .  .  .  Not  only  has  a  pleasing 
proportion  of  the  whole  Congress  promised  to  vote  for  rank 
when  it  reaches  the  floor,  but  a  goodly  number  of  influential 
men  on  both  Committees  [on  Military  Affairs]  are  pledged  to 
its  support  in  committee.  Both  chairmen.  Senator  Wads- 
worth,  of  New  York,  and  Representative  Kahn,  of  California, 
have  become  avowedly  sympathetic." 

Early  in  the  fall  of  1919,  Congress  undertook  a  general  re- 
organization of  the  Army.  The  Senate  Committee  on  Military 
Affairs  took  up  for  consideration  the  Jones  bill  proposing  rank 
and  submitted  it  at  the  War  Department.  The  following  letter 
was  written  on  August  28,  1919,  by  the  Secretary  of  War  to 
the  chairman  of  the  Committee : 

In  reply  to  your  memorandum  of  August  20,  1919,  in  which 
vou  request  to  be  furnished  with  the  views  of  the  War  Depart- 
ment relative  to  the  bill  (S.  1737)  "To  grant  rank  to  the 
Army  Nurse  Corps  and  for  other  purposes,"'  I  beg  to  inform 
you  that  the  War  Department  is  opposed  to  the  provisions  of 
the  proposed  bill. 

The  bestowal  of  the  relative  rank  upon  Army  nurses  as 
provided  for  in  the  bill,  while  not  actually  providing  them 
witli  commissions,  would  in  effect  result  in  placing  a  consid- 
eraljle  number  of  Army  nurses  alcove  a  large  number  of  x\rmy 
officers,  including  medical  officers  under  whom  they  are  serv- 
ing in  hospitals.  Tender  regulations  issued  by  the  War  De- 
partment, members  of  the  Army  Nurse  Corps  have  been  given 
rank  above  all  enlisted  men  in  the  Army  and  as  regards 
medical  and  sanitary  matters  and  work  in  connection  with  the 
sick  have  authority  in  and  about  hospitals  next  after  the 
officers  of  the  Medical  Department  and  are  at  all  times  to  be 
obeyed  accordingly,  and  to  receive  the  respect  due  to  their 
})ositio]i. 

The  enactment  of  tlie  proposed  legislation  would  not,  in 
my  opinion,  serve  any  useful  purpose. 

On  September  4,  General  Ireland  appeared  before  the  Senate 
Committee  on  ^Military  Affairs  to  discuss  the  reorganization 
of  the  Medical  Department  and  expressed  himself  as  opposed 


DEMOBILIZATION  1073 

to  rank.  Hitherto,  General  Ireland  had  been  a  staunch  advocate 
of  all  projects  which  seemed  to  better  the  condition  of  nurses  in 
the  Army ;  in  fact  he  was  perhaps  the  first  advocate  of  the  Army 
Nurse  Corps,  for  he  had  gone  down  to  the  beach  at  Siboney 
during  the  Spanish-American  War  and  had  asked  the  nurses  on 
the  Ked  Cross  ship  Texas  to  come  ashore  and  help  in  the  care 
of  the  sick.  This  request  of  his  had  been  a  very  radical  de- 
parture from  Army  precedence  and  the  services  of  the  nurses 
from  the  Texas  had  formed  one  of  the  entering  wedges  of  pro- 
fessional nursing  service  in  the  Military  Establishment.  But  at 
the  hearing  on  September  4,  1919,  General  Ireland  stated  that 
he  felt  the  nurses'  "idea  in  securing  rank  to  better  their  position 
would  be  altogether  wrong."  Even  if  General  Ireland  had  him- 
self believed  in  rank  for  Army  nurses,  it  would  have  been  highly 
embarrassing  for  him  to  have  advocated  it,  because  he  could 
not  well  have  opposed  the  Chief  of  Staff  and  the  Secretary  of 
War,  both  of  whom  were  vigorously  opposed  to  granting  rank 
to  Army  nurses. 

On  October  31,  the  Senate  and  the  House  Committees  on 
^Military  Affairs  met  jointly  to  hear  General  Pershing  express 
his  views  on  Army  reorganization.  General  Pershing  stated 
that  he  favored  the  bestowal  of  rank  upon  nurses  "up  to  and 
including  the  rank  of  second  lieutenant."  His  indorsement 
and  that  of  the  American  Legion,  gave  much  encouragement  to 
advocates  of  rank  and  the  campaign  went  on  spiritedly. 

Officially,  the  American  Ked  Cross  took  no  part  in  the  strug- 
gle. At  the  first  meeting  of  the  Xational  Committee  on  Ked 
Cross  Xursing  Service  after  the  signing  of  the  Armistice  Miss 
Palmer  read  the  following  resolution : 

^Vhercas — From  hundreds  of  nurses  and  doctors  of  all 
grades  of  rank  and  ability  returning  from  Army  service  to 
civil  life  we  have  heard  of  the  distressing  handicaps  put  upon 
the  Army  nurses  in  the  late  war  by  her  lack  of  suitable  officer's 
rank ;  and 

Mlicreas — That  handicap  not  only  appreciably  lowered  the 
efficiency  of  the  nursing  service  rendered  but  also  permitted 
discomfort,  discourtesy  and  disrespect  to  result  to  the  nurse  in 
all  her  relations,  ])r()fessional,  recreational  and  social ;  and 

Mlirrcns — X(>t  tlio  Army  alone  took  advantage  of  her  lack 
of  rank  hut  puhlic  institutions  unacquainted  with  her  position 
and  function  and  even  Ked  ('ross  agencies  themselves  at  times 
discriminated  a'^ainst  her  for  the  avowed  reason  that  she  was 


1074  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

not  an  officer,  Red  Cross  hotels  having  some  of  them  denied 
her  shelter  and  comfort  on  that  ground ;  and 

Whereas — The  lack  of  standard  treatment  by  the  Army, 
which  she  so  valiantly  served  in  no  conscript  capacity,  and  the 
failure  on  the  part  of  the  great  organization,  the  American 
Red  Cross,  to  support  her  in  her  great  need  for  rank  and  a 
clearly  defined  position,  have  altogether  bred  in  far  too  many 
of  our  Army  Xurse  Reserve  a  deep-seated  discontent ;  and 

^Yhereas — The  hardships  and  humiliations  complained  of 
seem  upon  analysis  to  have  resulted  in  no  wise  from  the  exi- 
gencies of  war,  but  from  purely  avoidable  causes;  now  there- 
fore be  it 

liesolved:  That  we,  the  Xational  Committee  on  Red  Cross 
Xursing  Service  in  annual  conference  assembled  this  9th  day 
of  December,  1919,  do  hereby  deeply  deplore  not  only  the 
unfortunate  conditions  that  have  existed  and  the  feelings  they 
have  aroused,  but  also  the  hitherto  omission  of  the  American 
Eed  Cross  to  lead  or  participate  in  any  effort  to  correct  these 
difficulties,  or  a  recurrence  of  them  by  the  elimination  of 
their  causes  and  the  establishment  of  rank  for  nurses;  and 
further 

Resolved:  That  we  express  to  the  Central  Committee  of  the 
American  Eed  Cross  our  deep  concern  that  in  the  absence  of 
cooperation  by  the  American  Eed  Cross  in  the  nurses'  present 
struggle  to  establish  a  suitable  and  dignified  officers'  status 
for  themselves  in  the  American  Army  comparable  with  that 
of  other  English-speaking  nurses,  there  may  be  little  heart  in 
the  nurses  of  America  for  continued  enrollment  in  the  Eed 
Cross  for  service  in  Lhe  Army  Eeserve ;  and  finally  be  it 

Besolved:  That  "we  therefore  invite  and  urge  the  Central 
Committee  to  a  most  serious  and  earnest  consideration  of  the 
obligations  of  the  American  Eed  Cross  to  American  nurses  in 
these  premises. 

This  resolution  had  been  drawn  up  and  signed  by  Miss  Max- 
well, Miss  ^•Tutting,  ]\riss  Palmer  and  Miss  Crandall.  After 
Miss  Palmer  had  tinishod  reading  it  ]\Iiss  Xoycs  stated  that  the 
Red  Cross  had  never  taken  any  active  part  in  legislative  work, 
but  she  believed  that  it  was  sympathetic  with  the  movement. 
Miss  ]\rinnigerodo  moved  that  the  resolution  be  adopted  and 
presented  to  the  Central  Committee  of  the  Red  Cross  for  con- 
sideration.     'J'his   motion   was   carried. 

On  JJeccmber  22,  ]\Iiss  Xoyes  transmitted  a  copy  of  these 
resolutions  to  Dr.  Farrand,  eliairman  of  the  Executive  Com- 
mittee, and  on  January  2,  1920,  he  acknowledged  receipt  of  them 


DEMOBILIZATION  1075 

and  asked  Miss  Xoycs  to  discuss  them  in  detail  with  him  at 
her  convenience.  Some  days  hiter,  she  and  Mrs.  Greeley  had  a 
conference  with  Dr.  Farrand,  at  which  he  stated  that  the  Red 
Cross  was  in  sympathy  with  any  movement  which  would  better 
the  condition  of  Army  Nurses  in  that  the  Red  Cross  Nursin^i; 
Service  was  the  reserve  of  the  Army  Nurse  Corps,  but  that  its 
policies  did  not  permit  it  to  take  part  in  any  legislative  struggle. 
He  stated  also  that  while  he  appreciated  that  grave  consideration 
was  due  to  formal  resolutions  passed  by  a  committee  as  power- 
ful and  representative  as  the  National  Committee,  yet  he  did  not 
think  it  advisable  to  present  these  resolutions  to  the  Executive 
Committee  for  action,  because  General  Ireland  was  a  member 
of  the  Executive  Committee  and  was  also  one  of  the  chief  op- 
ponents to  bestowing  rank  on  Army  Nurses.  Dr.  Farrand  said 
that  he  felt  that  if  these  resolutions  were  submitted  to  the 
Executive  Committee,  the  mc^mbers  would  naturally  seek  the 
advice  of  General  Ireland,  the  highest  medical  officer  in  the 
Army,  and  after  hearing  his  views  which  were  known  to  be  dis- 
tinctly hostile  to  rank,  would  in  all  probability  refuse  the  aid 
petitioned  by  the  National  Committee.  This,  he  felt,  would 
result  in  embarrassment  to  the  Red  Cross  and  in  harm  to  the 
cause  of  rank  for  nurses.  However,  he. advised  Miss  Noycs  to 
continue  her  individual  efforts  to  secure  rank  and  the  con- 
ference was  then  closed.  No  record»of  these  resolutions  appear 
on  the  !Minutcs  of  the  Central  and  Executive  Committees. 

The  legislative  struggle  was,  however,  nearing  an  end.  The 
clause  proposing  rank  for  Army  nurses  was  included  among 
the  provisions  of  the  bill  for  Array  reorganization  and  was 
introduced  as  such  in  the  Senate  on  January  0,  1920,  by  Senator 
Wadsworth.  It  was  also  included  in  the  House  bill  on  xVrmy 
reorganization.  After  five  weeks,  during  which  nurses  inter- 
viewed Congressmen  ''on  the  Hill"  while  other  nurses  and 
friends  of  nursing  brought  pressure  to  bear  on  the  committee 
men  from  the  field,  the  conference  committee  on  Army  re- 
organization finally  came  to  agreement  on  May  27  and  reported 
that  ''tlu>  provision  for  the  relative  rank  of  nurses  was  agreed 
to,  it  being  contained  in  both  bills."  The  House  of  Represen- 
tatives adopted  the  conference  report  on  ^lay  28,  the  Senate 
adopted  it  on  the  next  day  and  the  bill  for  Army  reorganiza- 
tion, with  its  clanse  bestowing  relative  rank  on  Army  nurses, 
was  signed  June  4  by   PresidcMif  Wilson  and  IxH-anie  law. 

The  conference  had  made  the  following:  chaui^es  in  the  word- 


10T6  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ing  of  the  original  Lewis- Jones-Raker  bill :  Head  nurses  were 
added  to  the  class  having  the  rank  of  second  lieutenant;  the 
clause  "and  shall  wear  the  insignia  of  the  rank  of  the  Army  to 
which  their  rank  corresponds,"  was  omitted  and  in  its  place 
were  inserted  the  words  "The  Secretary  of  War  shall  make  the 
necessary  regulations  prescribing  the  rights  and  privileges  con- 
ferred by  such  relative  rank." 

On  August  10,  1920,  the  Surgeon  General  was  notified  by 
the  Secretary  of  War  regarding  these  regulations  and  he  imme- 
diately placed  the  gold  leaves  of  a  major  on  the  shoulders  of  the 
Superintendent  of  the  Army  Kurse  Corps.  Other  nurses  in  the 
corps  donned  the  insignia  as  soon  as  orders  to  that  effect  could 
be  disseminated  through  American  Army  hospitals.  Thus 
was  ended  the  second  most  important  legislative  struggle  re- 
garding American  military  nursing  service  which  had  arisen  in 
the  United  States. 

In  retrospect,  it  will  be  seen  that  at  no  stage  of  its  develop- 
ment did  the  Red  Cross  Xursing  Service  take  a  more  important 
place  in  nursing  activities  than  during  the  period  of  demobili- 
zation. Miss  Xoyes'  dual  position  as  president  of  the  Ameri- 
can iSJ^urses'  Association  and  director  of  the  Red  Cross  Xursing 
Service  may  have  been  one  of  the  reasons  for  this ;  another  and 
perhaps  more  vital  cause  was  the  fact  that  the  American  Red 
Cross  from  1919  to  1922,  in  its  foreign  program,  its  public 
health  nursing  and  educational  activities,  was  the  organization 
employing  the  largest  numbers  of  nurses  in  the  world,  and 
therefore,  with  its  previous  war  responsibilities  and  its  newer 
peace  activities,  it  was  an  organization  heavily  charged  with 
professional  adjustment  and  advance. 

The  dual  projects  undertaken  by  the  Red  Cross  Xursing 
Service  and  outside  organizations  were  the  establishment  of 
the  Bureau  of  Information  and  its  subsequent  metamorphosis 
into  Xational  Xursing  Headquarters ;  the  creation  of  the  Xurse 
Corps  of  the  Public  Health  Service,  with  the  Red  Cross  Xurs- 
ing Service  as  its  reserve ;  the  hospitalization  and  reeducation 
of  sick  and  disabled  nurses;  memorials  to  nurses;  and  the  stu- 
dent nurse  recruiting  movement.  The  purely  Red  Cross  nursing 
projects  were  public  health  nursing,  class  instruction,  and  edu- 
cational work  through  the  Chautaiupia.  The  one  major  project 
of  demobilization  in  which  the  Xursing  Service  had  no  official 
part  was  the  struggle  for  rank. 


CHAPTER  XII 

THE    CLOSE    OF    THE    FOUEIGX    EMERGENCY    RELIEF    PROGRAM 

The  Commission  for  Europe — The  Commission  for  Poland — 
The  Commission  for  the  Balkan  States — Montenegro — 
Albania — Greece — North  and  South  Serbia — Roumania 
— Contraction  of  War  Organization 

Oi^  November  11,  1918,  the  American  Red  Cross  had  nine 
commissions  conducting  medical  and  general  relief 
activities  in  Europe  and  Asia ;  these  commissions  were 
operating  in  England,  France,  Belgium,  Italy,  Palestine,  North 
Russia,  Siberia,  Serbia  and  Greece.  Accounts  of  the  nursing 
service  rendered  by  these  commissions  have  already  been  given, 
with  the  exception  of  those  to  Serbia  and  Greece.  The  Com- 
mission for  Roumania,  it  will  be  remembered,  had  been  with- 
drawn previous  to  the  cessation  of  active  hostilities. 

During  the  post-Armistice  period,  the  immediate  task  before 
the  American  Red  Cross  was  to  bring  about  as  swift  a  re- 
trenchment of  foreign  activities  as  was  compatible  with  the 
ideals  and  obligations  previously  assumed  by  the  society.  The 
nations  of  western  Europe  were  well  able  and  eager  to  under- 
take their  own  reconstruction  and  by  the  beginning  of  the  year 
1020  the  American  Red  Cross  had  recalled  its  commissions  from 
England,  France,  Belgium  and  Italy. 

The  need  for  medical  and  general  relief  in  Poland  and  the 
Balkan  States,  however,  was  only  just  beginning.  The  war 
cloud  which  had  previously  shrouded  true  conditions  in  these 
countries  was  gradually  rolling  back  and  the  poverty  and  dis- 
ease which  existed  there  began  to  receive  cognizance  in  the 
minds  and  press  of  western  Europe  and  America.  In  June, 
11)1!),  the  Congress  of  the  United  States  authorized  the  Secre- 
tary of  War  to  transfer  to  the  American  Red  Cross  such  medical 
and  surgical  supplies  and  dietary  foodstuffs  in  Europe  as  should 
not  be  needed  by  the  American  Army  abroad  or  at  home,  "to 
be  used  by  the  American  Red  Cross  to  relieve  the  pressing  needs 
of  the  countries  involved  in  the  late  war." 

1077 


1078  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Thus  a  two-fold  foreign  problem  confronted  the  American 
Red  Cross :  First,  to  terminate  its  activities  in  the  countries 
where  a  continuation  of  such  service  was  no  longer  needed; 
second,  to  develop  a  constructive  program  in  countries  where 
such  service  was  needed  and  desired. 

Under  the  regime  of  the  War  Council,  the  form  of  organiza- 
tion for  American  Red  Cross  activities  overseas  first  contem- 
plated, had  been  a  Commission  for  Europe,  with  headquarters 
at  Paris  and  branches  operating  in  different  countries  of  the 
European  field.  Major  Murphy's  title,  it  will  be  remembered, 
was  that  of  Commissioner  for  Europe.  As  the  need  for  Ameri- 
can Red  Cross  relief  activities  developed  in  1917  and  1918  in 
different  countries  and  was  presented  to  the  War  Council,  new 
commissions  with  complete  quotas  of  personnel  and  supplies, 
were  organized  at  I^ational  Headquarters  and  sent  into  the 
field.  If  the  area  of  their  assignment  was  geographically  so 
situated  that  the  Paris  office,  the  headquarters  both  for  the 
Commission  for  Europe  and  for  the  Commission  for  France, 
was  the  logical  line  of  communication  with  National  Head- 
quarters, the  War  Council  linked  up  their  organization  with 
that  of  the  Commission  for  Europe ;  if  not,  as  was  the  case  with 
North  Russia  and  Siberia,  they  operated  independently  of  the 
Commission  for  Europe  and  reported  only  to  National  Head- 
quarters, 

On  January  29,  1918,  President  Wilson  notified  the  War 
Council  of  the  resignation  of  ]\lajor  Murphy  from  member- 
ship on  that  body.  Major  Murphy's  services  were  desired  by 
the  Array.  On  February  5,  Major  Perkins  was  appointed 
Commissioner  for  Europe.  The  Nursing  Service  at  National 
Headquarters  and  that  overseas,  however,  was  not  accorded  di- 
rect representation  on  the  staff  of  the  Commission  for  Europe. 
Miss  Delano  had  thought  that  Miss  Russell  would  occupy  such 
a  position  but  she  had  been  assigned,  instead,  to  duty  in  the 
Department  of  Military  Affairs  of  the  Commission  for  France 
and  there  she  had  stayed  until  her  resignation  and  the  subse- 
(juent  reorganization  of  the  Nurses'  Bureau  under  the  Bureau 
of  Women's  Hospital  Service.  In  lieu  of  other  representation, 
the  Chief  Nurse  of  the  Commission  for  France  had  also  served 
as  the  medium  of  communication  between  the  executives  of  the 
Nursing  Service  at  National  Headquarters  and  the  various  chief 
nurses  of  commissions  in  the  European  field  and  tlie  records  of 
duty  of  nurses  assigned  to  Belgium,  Italy  and  Palestine  were 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1079 

kept  in  the  j^urses'  Bureau  of  the  Commission,  for  France. 
Miss  Delano  and  i\liss  Xoyes  knew  that  this  form  of  organiza- 
tion was  not  perfect  but  it  had  been  uphill  work  to  get  even  that, 
as  has  been  stated  before. 

When  the  War  Council  went  out  of  office  on  February  28, 
1919,  the  Executive  Committee  was  confronted  with  the  need 
for  new  governing  machinery.  The  post-Armistice  reorganiza- 
tion at  Xational  Headquarters  has  already  been  described.  As 
a  form  of  organization  through  which  to  conduct  the  post- 
Armistice  progi'am  overseas,  the  Executive  Committee  voted  a 
continuation  of  the  form  of  organization  first  adopted  by  the 
War  Council, — a  Commission  for  Europe,  with  headquarters  of 
the  connnission  at  Paris  and  the  various  commissions  in  differ- 
ent countries  heading  up  through  the  European  Commissioner 
to  National  H(>adquarters,  Dr.  Farrand,  it  will  be  remembered, 
was  the  new  chairman  of  the  Central  Committee.  Dr.  Fred- 
erick Paul  Keppel,  one  time  Dean  of  Columbia  University  and 
during  the  participation  of  the  United  States  in  the  European 
War,  third  assistant  Secretary  of  State,  came  to  National  Head- 
quarters on  July  1,  1919,  to  act  as  vice-chairman  in  charge  of 
foreign  operations,  in  which  capacity  he  assumed  the  direction 
of  all  Am(>rican  Ked  Cross  work  overseas.  The  new  Commis- 
sioner for  Europe  was  Lieutenant  Colonel  Eobcrt  E.  Olds,  a 
lawyer  from  St.  Paul,  Minnesota,  who  had  formerly  served  as 
counselor  to  the  American  Ixed  Cross  Commission  for  France. 
He  took  up  his  new  duties  early  in  1919. 

In  ^fay,  1919,  tlu\Executive  Committee  formally  appointed 
a  Comniitte(^  .for  the  Iveadjustment  and  Liquidation  of  Euro- 
pean Activities.  This  committee  was  charged  with  the  respon- 
sibility of  selling  all  Ked  Cross  supplies  no  longer  needed  in 
Europe  and  of  reducing  all  activities  to  a  minimum.  The  com- 
mittee was  composed  of  L.  J.  Hunter,  comptroller  of  the  Ameri- 
can Ked  Cross,  and  A.  IL  Gregg,  director  of  the  former  Depart- 
ment of  ForcMgn  Atl'airs  at  National  Headquarters.  Both  of 
these  men  liad  been  in  France  working  on  the  problems  of  re- 
trenchment since  early  in  April  and  among  otlun*  duties,  they 
took  over  \ho  atl'airs  of  the  Commission  for  France. 

American  Ked  (h'oss  nursing  service  in  France  in  conn(>cti()n 
with  the  close  of  the  military  program  has  already  bocii  de- 
scribed. Of  the  trend  of  French  reconstruction  policy,  Miss 
Hall,  then  chief  nurse  of  the  American  Ked  Cross  in  France, 
wrote  Miss  Noyes  on  March  14,  1919: 


1080  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

It  appears  that  the  French  Government  has  not  asked  the 
American  Bed  Cross  to  assist  in  reconstruction  work  in 
France;  furthermore,  it  welcomes  instead  small  groups  work- 
ing directly  under  its  own  direction,  rather  than  the  work  of  a 
large  organization  like  ours,  which  wishes  to  formulate  its 
own  policies  and  to  carry  on  the  work  according  to  its  own 
methods.  An  illustration  of  this  is  given  in  the  fact  that  both 
the  Smith  and  Vassar  College  Units  have  now  been  severed 
from  the  American  Ked  Cross  and  are  engaged  in  reconstruc- 
tion work  under  the  French  Government.  There  is  every 
evidence  here  that  an  effort  is  being  made  to  bring  the  affairs 
by  the  Red  Cross  in  France  to  a  conclusion  as  rapidly  as  is 
consistent  with  the  size  of  the  organization  and  the  varied 
work  it  has  done. 

As  far  as  the  nurses  themselves  are  concerned,  it  has  seemed 
the  wiser  policy  to  return  as  many  as  possible  to  the  United 
States,  owing  to  the  need  for  nurses  at  home.  We  have  kept 
the  number  needed  for  other  European  commissions  and  also 
a  small  reserve  for  emergencies  here  in  France. 

On  December  1,  1918,  there  had  been  approximately  six  hun- 
dred American  Red  Cross  nurses  on  duty  with  the  various  com- 
missions in  Europe  and  all  administrative  details  in  connection 
with  their  service  had  been  carried  on  through  the  Bureau  of 
Nursing  of  the  American  Red  Cross  Commission  for  France. 
As  the  nursing  activities  of  these  commissions  were  brought  to 
a  conclusion  in  the  spring  and  summer  of  1919,  the  majority 
of  the  nurses  then  in  Europe  reported  back  to  the  Nurses'  Bu- 
reau at  Paris  and  were  returned  to  the  United  States.  On 
March  24,  Miss  Hall  wrote  ]\riss  Noyes : 

.  .  .  The  work  of  the  Nurses'  Bureau  is  being  brought  to  a 
close  and  the  major  part  of  it  will  be  finished  this  month.  A 
few  activities,  however,  will  continue  to  be  maintained  and  it 
will  take  perhaps  two  or  three  months  to  wind  up  these  pro- 
jects. To  carry  these  and  the  new  constructive  program,  it 
has  been  suggested  that  a  Bureau  of  Nursing  be  attached  to 
the  Commission  for  Europe  which  is  now  under  organization 
and  which  will  have  its  headquarters  at  Paris.  As  long  as 
there  are  nurses  on  duty  with  other  commissions  in  Europe, 
there  will  be  need  for  a  Nurses'  Bureau  in  Paris. 

In  this  letter,  ]\riss  Hall  asked  that  her  resignation  as  chief 
nurse  of  the  American  Red  Cross  in  France  be  accepted ;  she 
had  been  overseas  for  two  vears  and  desired  to  return  to  her 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1081 

former  work  in  the  United  States.  "May  I  suggest,"  wrote 
Miss  Hall  in  the  letter  of  March  24,  "that  Alice  Fitzgerald 
would  make  a  most  admirable  candidate  for  the  position  of 
chief  nurse  of  the  new  Bureau  ?" 

A  month  later.  Miss  Hall  wrote  Miss  Xoyes  of  the  further 
contraction  of  American  Red  Cross  activities  in  France : 

Great  pressure  is  being  brought  to  bear  on  the  Medical  and 
Surgical  Department,  including  the  Nurses'  Bureau,  of  the 
American  Eed  Cross  in  France,  to  bring  our  affairs  to  a  close 
and  to  get  our  personnel  started  for  the  States.  May  1  has 
been  named  as  the  date  for  the  nominal  closing  of  the  Xurses' 
Bureau.  I  have  pointed  out  the  demands  which  may  be  made 
upon  us  for  nurses  and  I  have  been  toid  that  the  Commissioner 
for  France  can  no  longer  be  responsible  for  the  further  assign- 
ments of  nurses  to  duty;  if  any  nucleus  of  this  bureau  is 
retained,  it  will  have  to  be  attached  to  the  office  of  the  Com- 
missioner for  Europe. 

Fifty-nine  nurses  were  released  and  sailed  for  the  United 
States  in  April ;  fifty-eight  others  left  in  May  and  in  June  and 
July  one  hundred  and  fifty  additional  ones  returned  home, 
^liss  Hall  left  Brest  late  in  May,  but  before  her  departure  from 
Paris,  she  made  recommendations  to  the  new  Commissioner  for 
Europe  regarding  the  organization  of  the  nursing  staffs  of 
future  Red  Cross  commissions  and  these  recommendations  be- 
came the  basis  of  future  American  Red  Cross  nursing  organiza- 
tion overseas.  The  release  of  nurses  continued  until  there 
remained  in  Europe  and  in  Paris  only  such  nurses  as  were 
needed  for  the  so-called  "constructive"  program. 

On  May  8,  1019,  Colonel  Olds  transmitted  Miss  Hall's  recom- 
mendations as  follows  to  all  departments  and  Bureaus  of  the 
Commission  for  Europe : 

The  Bureau  of  Xursing,  formerly  reporting  to  tlie  Com- 
missioner for  France,  will  be  transferred  to  the  Cumniissioner 
for  Eurojie  about  ^lay  10,  the  time  wlien  the  operating  tasks 
which  it  has  been  conducting  in  France  will  have  been  sub- 
stantially completed. 

Because  of  the  altered  work  of  the  American  Hed  Cross  in 
Europe,  tlie  activities  of  this  Bureau  will  l)e  substantially 
different  hereafter  than  they  have  been  heretofore.  Its  re- 
sponsibilities will  induce: 


1082  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

1.  Aid  to  each  operating  commission  in  securing  a  chief 
nurse  and  in  assisting  chief  nurses  in  obtaining  an  ade- 
quate force  of  workers. 

2.  General  advisory  service  to  the  chief  nurse  reporting  to 
each  commissioner. 

3.  Direction  of  any  nursing  operations  remaining  under 
the  Commissioner  for  France. 

4.  Continuance  of  the  nursing  records  already  established 
and  of  the  present  personal  service  to  all  nurses  in 
Europe. 

In  all  this  work,  the  Chief  Xurse,  in  direct  charge  of  the 
Bureau  of  Cursing,  will  work  in  close  cooperation  with  the 
Department  of  Nursing  at  National  Headquarters  and  will 
apply  the  general  rules  laid  down  by  that  Department  to  meet 
the  above  responsibilities,  she  shall  maintain  such  a  reserve 
force  of  nurses  as  may  be  required  to  meet  the  policies  of  the 
Commission  for  Europe  and  this  question  shall  be  given  con- 
sideration in  arranging  the  release  of  nurses  now  engaged. 

The  Chief  Nurse  shall  report  to  that  member  of  the  Com- 
missioner's staff  who  is  in  charge  of  medical  service,  at  present 
Lieutenant  Colonel  Taylor. 

Upon  Miss  x^oyes'  recommendation,  Colonel  Olds  on  May  10 
appointed  ]\[iss  Fitzgerald  chief  nurse  of  the  American  Red 
Cross  in  Europe  and,  as  such,  director  of  the  Bureau  of  Nurs- 
ing, and  suggested  that  she  immediately  get  in  touch  with  the 
chief  nurses  of  the  various  commissions  then  in  Europe. 

This  reorganization  of  American  Red  Cross  nursing  service 
in  Europe  marked  the  successful  culmination,  on  paper,  at 
least,  of  the  struggle  begun  bv  ]\Iiss  Delano  in  191-i  and  carried 
on  by  her,  by  Miss  Noyes  and  the  majority. of  chief  nurses  in 
the  field  during  the  ensuing  years,  for  a  digiiified  and  profes- 
sional status  of  American  Red  Cross  nurses  on  active  duty. 

On  ]\ray  22,  one  hundred  and  ninety-seven  nurses  and  twenty- 
one  nurses'  aides  were  on  duty  in  Europe,  makiiig  a  total  of 
two  hundred  and  eighteen.  Thirty  of  tlu^se  nurses  were  still 
serving  in  F'rance,  some  at  American  Red  Cross  Hospital 
No.  10l>,  the  maintenance  of  which  was  continued  for  the  benefit 
of  tlie  personnel  of  American  w(dfare  organizations  still  in 
F^ ranee ;  some  at  various  dispensaries;  others  in  the  Nurses' 
E([uipment  Shop  and  the  Salvage  Department;  and  still  others 
on  duty  at  the  Red  (^ross  dock  infirmaries.  Flight  nurses  had 
been  loaned  to  the  Rockefeller  Foundation;  eighteen  to  tlie 
C(  nunission  for  the  Relief  of  Belgium;  thirteen  to  the  Serbian 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1083 

Tuberculosis  Hospital ;  two  to  iVIontcncfp'o ;  and  one  to  the 
French  Army  as  a  radioj^rapher. 

The  nurses  on  duty  on  May  22  with  the  various  foreign  com- 
missions numbered  one  hundred  and  thirty-one.  Ninety  of 
these  were  serving  in  the  Balkan  States.  Late  in  October,  11)18, 
Xational  IIead(|uarters  had  organized  a  Commission  for  the 
Balkans,  of  which  Henry  W,  Anderson  was  chairman  and 
Helen  Scott  Hay  chief  nurse.  ^liss  Hay  arrived  in  Paris 
hea(l([uarters  in  December  and  recruited  from  among  the  nurses 
being  released  by  tlie  Army  Nurse  Corps  in  France  and  tlic 
Nurses'  Bureau  of  the  former  C\)mmission  for  France,  a  large 
staff  of  experienced  and  able  public  health  and  institutional 
nurses  for  duty  in  the  Baltic  States,  An  account  of  these 
activities  will  be  given  later. 

In  ^fay,  twelve  nurses  were  still  on  duty  in  Italy,  under 
^liss  Foley's  direction.  Nineteen  were  in  Palestine  but  had  no 
chief  nurse  and  as  the  affairs  of  the  Commission  for  Palestine 
were  then  being  concluded,  no  successor  to  ]\Iiss  ]\Iadiera  was 
appointed.  Eight  other  nurses  were  on  duty  in  Poland  and 
two  in  Prague,  C^zecho-Slovakia.  The  affairs  of  the  Commission 
for  Great  Britain  were  being  brought  swiftly  to  a  conclusion 
and  by  July  1,  all  American  Red  Cross  nurses  on  ^lajor  Endi- 
cott's  staff,  had  sailed  for  the  States  or  accepted  assigmnents 
under  the  cinnmissions  remaining  in  Europe. 

Among  the  unsettled  problems  of  the  former  Commission  for 
France  was  that  of  nurses'  equipment.  On  August  5,  Miss 
Fitzgerald   wrote   Miss  Noyes: 

As  long  as  we  had  supplies  here  in  Paris,  it  sceracfl  proper 
to  continue  to  equip  nurses,  but  the  time  is  coming  very 
shortly  wlien  we  will  not  have  enough  supplies  left  tu  do  so. 
I  have  discussed  the  question  thoroughly  with  Miss  KIkmIcs 
and  we  agree  that  several  or  even  one  depot  for  equipment 
would  be  very  expensive  and  woTild  not  l)egin  to  give  satis- 
faction to  all :  for  instance,  an  Equipment  llureau  in  Paris 
could  barely  reach  some  parts  of  the  Balkans  and  an  equip- 
ment de])Ot  in  the  Balkans  could  not  reach  Poland  or  Sil)(>ria. 
Transporiation  is  highly  uncertain  and  much  loss  of  time 
and  eipiijunent  would  inevitably  ensue. 

Owing  to  this.  1  have  suggested  that  a  dress  allowance  he 
made  to  each  nurse  assigned  under  the  l\'ed  Cross,  with  which 
she  is  expected  to  provide  the  outdoor  uniform.  All  the  other 
articles  she  will  ])rovide  at  her  own  expense.     An  allowance  of 


1084  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

one  hundred  dollars  would  cover  the  expense  of  a  suit  each 
year,  a  straw  and  felt  hat,  two  waists  and  perhaps  an  ulster 
one  year  and  a  raincoat  the  next.  What  are  your  wishes  in 
this  matter  ? 

This  recommendation  was  approved  bv  Miss  Noyes  and  the 
Commissioner  for  Europe.  The  Nurses'  Equipment  Shop  was 
closed  and  the  supplies  distributed  or  returned  to  the  Bureau 
of  Nurses'  Equipment  of  the  Atlantic  Division. 

The  close  of  the  Nurses'  Equipment  Shop  and  the  return  of 
nurses  from  Great  Britain,  Belgium,  Italy,  Palestine  and 
Siberia  marked  the  termination  of  the  pre-Armistice  nursing 
program.  The  true  post-Armistice  nursing  program  embraced 
three  distinct  types  of  nursing  service :  First,  emergency  nurs- 
ing to  alleviate  suffering  incident  to  the  war  in  Poland  and  the 
Balkan  States ;  second,  a  constructive  program  which  consisted 
in  the  establishment  of  schools  of  nursing  under  American 
standards  in  foreign  countries  and  the  development  of  nursing 
service  in  connection  with  health  units ;  and  third,  indirect 
stimulation  to  the  development  of  an  international  advisory 
nursing  service  in  the  League  of  Red  Cross  Societies.  These 
last  two  phases  of  the  post-Armistice  nursing  program  will  be 
treated  in  subsequent  sections.  This  section  of  this  chapter 
will  deal  only  with  the  emergency  nursing  relief  given  in  Poland 
and  the  Balkan  States. 

On  November  9,  1918,  the  Independence  of  Poland  had  been 
solemnized  and  on  June  28,  1919,  the  treaty  of  Versailles  had 
recognized  the  Republic.  When  Poland  was  opened  to  the 
Allies  in  December,  1918,  she  was  found  to  be  without  adequate 
food,  machinery  and  textiles  of  all  kinds.  Her  lands  in  the 
East  had  been  the  arena  for  much  of  the  heaviest  fighting 
between  Germany  and  Russia  in  the  early  days  of  the  war,  and 
reconstruction  there  had  not  yet  been  initiated.  The  political 
and  military  situation  was  a  seething  one  and  the  entire  popu- 
lation had  since  191G  been  the  prey  of  typhus,  cholera,  small- 
pox, trachoma  and  the  skin  diseases  due  to  inadequate  feeding 
and  unsanitary  housing  conditions. 

Some  insight  into  the  conditions  of  poverty  and  misery  which 
had  existed  in  Poland  since  the  collapse  of  Russia  were  known 
to  relief  organizations  in  the  United  States  during  1918,  but 
the    bristling   Teutonic   front   did   not   permit   the   sending   of 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1085 

Allied  relief  personnel.  However,  the  Polish  Reconstruction 
Committee  and  the  War  Work  Council  of  the  National  Board 
of  the  Young  Women's  Christian  Association  had  organized  and 
given  short  courses  in  elementary  nursing  and  social  service 
technique  to  a  group  of  young  Polish- American  women  then  in 
the  L^nited  States,  with  a  view  toward  assigning  them  to  relief 
work  in  Poland  as  soon  as  that  nation  would  be  opened  to  the 
Allies.  These  young  women  were  to  be  known  as  Polish  Grey 
Samaritans.  Recruiting  and  training  was  under  the  direction 
of  a  joint  committee;  JNladame  Laura  de  Gozdawa  Turczy- 
nowicz,  Madame  Marya  Przybylowska  and  Misses  Elizabeth 
Packard  and  Alice  Preston  represented  the  Polish  Reconstruc- 
tion Committee;  Mrs.  John  R.  Mott,  Miss  Sarah  S.  Lyon,  Mrs. 
Henry  P.  Davison  and  ^Irs.  Harry  M.  Bremer  represented  the 
Young  Women's  Christian  Association ;  Mrs.  Mott  was  chair- 
man. The  committee  had  at  its  disposal  the  sum  of  fifty  thou- 
sand dollars  with  which  to  finance  the  training  of  the  Samari- 
tans and  their  assignment  overseas.  Contact  between  the  com- 
mittee and  the  American  Red  Cross  had  been  established  in 
June,  1918;  Madame  Turcynowicz  had  written  Miss  Delano 
regarding  the  placement  of  Polish  Grey  Samaritans  in  hospitals 
where  they  might  assist  in  the  care  of  the  200,000  Poles  then 
in  the  American  Army  and  !Miss  Delano  had  referred  her  to 
Miss  Goodrich  and  the  Army  School  of  Nursing. 

The  first  contingent  of  Polish  Grey  Samaritans  went  to 
France  in  September,  1918,  under  the  direction  of  Madame 
Paderewski,  wife  of  the  distinguished  Polish  pianist  who  later 
became  president  of  the  Polish  Republic.  With  them  was  an 
American-trained  Polish  nurse,  Josephine  Jokaitis,  who  had 
done  public  health  nursing  under  the  Chicago  Infant  Welfare 
Society.  Mrs.  Jokaitis  was  enrolled  in  the  American  Red  Cross 
Xursing  Service  through  the  Paris  Committee  early  in  1919 
and  afterwards  played  an  important  part  in  American  Red 
Cross  nursing  service  to  Poland. 

A  second  group  of  one  hundred  Grey  Samaritans  sailed  from 
New^  York  on  April  19,  1919,  lor  service  in  Poland.  The  floint 
Committee  of  the  Polish  Grey  Samaritans  had  intended  to  as- 
sign a  nurse  to  take  charge  of  the  unit  and  broached  the  subject 
to  Miss  Albaugli,  but  arrang(>nients  were  finally  made  betv.-een 
the  Joint  Committee  and  ^liss  Xoyes  and  ^liss  Hall  whereby 
the  unit  would  bo  linked  up  in  Poland,  if  opportunity  developed 
there  for  their  services  under  the  American  Red  Cross,  with  the 


1086  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Chief  Nurse  of  the  American  Red  Cross  Commission  for 
Poland. 

In  February,  1919,  at  Paris  Headquarters,  an  American 
Red  Cross  Commission  for  Poland  was  organized,  of  which  Dr. 
W.  C.  Bailey,  of  Boston,  was  the  director.  The  nursing  per- 
sonnel was  composed  of  four  American  Red  Cross  nurses  and 
thirteen  Polish  Grey  Samaritans  of  Madame  Paderewski's 
group.  Emma  Wilson,  a  Hopkins  nurse  who  had  done  medical 
social  service  work  at  Bellevue  Hospital,  public  health  nursing 
at  Henry  Street  and  had  served  under  the  Commission  for 
France  in  the  Service  de  Sante  and  at  the  Bordeaux  dock  in- 
firmary, was  chief  nurse;  Mrs.  Jokaitis  was  her  assistant.  A 
second  Polish  nurse,  Marie  Suchowska,  who  had  also  been 
trained  in  the  United  States,  accompanied  the  unit.  The  two 
other  American  Red  Cross  nurses  were  Mary  Bartley  and 
Martha  S.  Clarke.  A  trainload  of  supplies  had  already  been 
sent  up  to  Poland  in  January  and  the  commission  took  another 
trainload  with  it  when  it  left  Paris  for  Warsaw,  in  two  sections, 
on  February  20  and  21. 

In  a  report  of  the  Nursing  Service  in  Poland  from  March 
to  June,  1919,  Miss  Wilson  wrote: 

On  March  3,  our  band  of  five  nurses  and  thirteen  aides 
reached  Warsaw,  and  on  April  26  three  more  Red  Cross 
nurses  arrived.  We  immediately  began  to  set  up  headquarters 
and  a  personnel  house.  .  .  . 

Calls  for  nurses  for  special  duty  came  early  and  have  since 
been  constant.  .  .  .  The  uncertainty  of  our  plans,  the  diffi- 
culties of  transportation  and  the  extent  of  the  territor}'  to  be 
covered  made  it  seem  undesirable  to  establish  a  hospital  at 
Warsaw  to  care  for  ill  members  of  the  commission.  On 
June  3,  we  had  given  twenty-six  weeks  of  private  duty  nursing 
to  our  own  personnel.  We  also  furnished  nursing  care  to 
British  officers  of  the  Inter-Allied  Commission  and  to  a 
Captain  of  the  Hoover  Food  Commission. 

Since  the  plans  of  the  Polish  Commission  were  in  a  forrnu- 
lative  state,  we  were  invited  to  help  at  the  large  military 
hospital  at  Warsaw,  the  Ujazdoivski  Spital.  On  March  10, 
one  half  of  our  nurses  and  aides  went  on  duty  there.  A-t  first 
the  conditions  seemed  unbelievable,  but  we  have  seen  much 
worse  since.  The  native  nurses  were,  of  course,  untrained 
and  their  hours  of  duty  seemed  very  short  to  us,  but  in  view 
of  their  insufficient  food  and  uncomfortable  quarters,  little 
more  could  have  been  expected  of  them. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1087 

There  was  no  soap,  no  bed  linen  ...  no  suitable  food  for 
patients  on  liquid  or  light  diet  and  practically  no  medicines 
or  nursing  appliances.  The  day's  rations  of  hard  black  bread 
was  placed  each  morning  on  the  bedside  table  of  the  con- 
valescent and  the  dying  alike.  Xo  Red  Cross  supplies  even 
were  available  for  our  nurses  or  their  patients  during  their 
three  weeks'  assignment  here,  but  the  American  nurses'  work 
won  for  them  many  friends. 

Late  in  March,  the  commission  decided  to  undertake  general 
relief  work  in  the  Department  of  the  East  and  the  cooperation 
of  the  Polish  Red  Cross  was  sought.  Twenty-two  young  Polish 
women  were  secured  to  act  as  interpreters  and  were  attached  to 
Miss  Wilson's  staff  as  nurses'  aides.  Of  their  assignment  to 
duty,  Miss  Wilson  wrote : 

We  divided  our  forty  nurses  into  four  units,  each  with 
American  Red  Cross  nurses  in  charge  of  numerous  aides,  and 
on  April  3  we  left  Warsaw  on  the  Commissioner's  supply 
train. 

On  April  2G,  nine  more  Polish  aides  and  on  IMay  14,  thirteen 
others  were  sent  from  Warsaw  into  the  field,  so  that  the  nursing 
staff  finally  numbered  seven  American  Red  Cross  nurses,  thir- 
teen Grey  Samaritans  and  forty-four  Polish  aides.  The  plan 
for  relief  work  embraced  the  assignment  of  American  Red 
Cross  personnel  to  the  Korel  district  from  whence  they  were 
to  work  north  through  the  regions  of  Brest-Litovsk  and  Bialy- 
stok.  ^lajor  11.  W.  Taylor  took  charge  of  the  work  in  thc^ 
Department  of  the  East  with  ]\rajor  A.  J.  Chesley  as  his  chief 
of  staff'. 

One  of  the  units  went  to  Maciejow,  a  village  with  a  popu- 
lation of  2()()(),  of  whom  the  majority  were  -Jews,  and  established 
a  small  hospital  and  dispensary  in  an  old  building  formerly 
used  as  a  German  hospital  and  bathhouse.  Food  and  supplies 
and  a  small  amoiint  of  nursing  and  dispensary  serA'ice  were 
distributed  from  this  base  to  the  surrounding  countryside. 

A  second  unit  went  to  Dolsk  and  established  a  dispensary 
and  canteen  in  buildings  foruu>rly  belonging  to  an  old  Polish 
estate.  ^Fiss  fjarthy  was  in  charge^  of  the  nursing  activities 
here  and  Mrs.  dokaitis  did  public  lu'alth  nursing. 

Th(^  third  unit  went  to  Pruzana.  a  village  located  a  few 
hours'  travel  north  of  Brest- Litovsk.  The  nnrs(>s  and  aides 
went  into  an  old  palace  which  was  half  occupied  by  the  military 


1088  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

authorities  but  found  conditions  such  that  little  medical  or 
nursing  service  could  be  rendered.  Instead,  Mrs.  Clarke,  the 
nurse  in  charge,  and  her  aides  did  the  housekeeping  for  the 
American  personnel  and  ran  a  canteen  which  daily  fed  eighteen 
hundred  people. 

North  of  Pruzana  was  located  Bereza  Kartusa  and  the  unit 
assigned  there  established  an  orphanage  for  sixty  Polish  children 
and  a  dispensary  from  which  medical  service,  public  health 
nursing  and  general  relief  was  extended  into  the  surrounding 
country. 

Early  in  June,  1919,  Miss  Wilson  returned  to  Paris  head- 
quarters. Conditions  in  Poland  were  chaotic.  The  nurses  had 
had  no  voice  in  the  determination  of  nursing  policies  and  the 
executives  of  the  commission  seemed  to  possess  little  idea  of  the 
possibilities  for  the  broad  and  varied  service  Avhich  nurses 
might  render.  The  leaders  of  the  commission  felt  that  a  speak- 
ing knowledge  of  the  Polish  language  was  of  paramount  im- 
portance, without  which  the  American  nurses  could  do  little, 
and  they  appeared  to  prefer  the  services  of  poorly-trained 
Polish-speaking  aides  to  that  of  American  Red  Cross  nurses 
working  with  interpreters.  ]\Iiss  Wilson  had  stood  out  for  the 
development  of  dispensaries  and  public  health  nursing  service 
under  the  direction  of  the  well-trained  American  nurses ;  but 
the  Commissioner  did  not  agTce  with  her  in  this  policy  and 
ordered  her  to  return  to  Paris  Headquarters.  She  understood 
that  tlie  nursing  program  in  Poland  was  discontinued  and  ex- 
pected that  the  American  nurses  and  Polish  aides  would  follow 
her  within  a  few  days,  if  not  on  the  next  train.  The  days 
passed  and  no  nurses  made  their  appearance.  Miss  Fitzgerald, 
anxious  lest  the  undire(*t(^d  group  should  come  to  grief,  sent  a 
cable  of  protest  to  the  Commissioner  for  Poland  regarding  the 
treatment  given  ]\Iiss  Wilson  and  requested  that  an  acting 
chief  nurse  be  appointed  at  once  who  would  communicate  with 
the  Nurses'  Bureau  at  Paris  IIead(]uarters  and  send  in  reports 
of  the  nurses'  conduct  and  welfare.  In  response,  Colonel 
Bailey  appointed  ^Irs.  fFokaitis  as  acting  chief  nurse  and  held 
the  nurses  in  Poland,  where  they  continued  to  do  civilian  relief 
work. 

During  the  summer  of  1010,  all  the  affairs  of  the  Commission 
for  Poland  were  in  a  somewhat  fluid  state.  On  August  11, 
(V)lonel  Cheslev  was  appointed  to  succeed  Colonel  Bailey  and  he 
immediately  drew  up  plans  for  the  development  of  an  extensive 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1089 

medical  and  luirsing;  pro-am  in  Poland.  Early  in  September, 
he  called  npon  the  Chief  Nurse  of  the  European  Commission 
to  secure  ten  Polish-speaking  American  nurses  for  service  in 
Poland  hut  several  days  later  had  countermanded  the  order, 
authorizing  instead  a  social  service  worker  to  go  to  the  United 
States  and  recruit  all  personnel,  professional  and  otherwise, 
for  the  reorganized  Polish  Commission.  In  place  of  the  usual 
salary  of  $70  a  month  for  Ked  Cross  nurses  in  foreign  service, 
^Major  Chesley  authorized  the  sum  of  $105  ;  he  also  stated  in  his 
letter  of  instruction  to  his  new  representative  that  "it  is  not 
essential  for  our  work  that  the  nurses  have  the  regular  nurses' 
uniforms,  as  those  issued  to  social  workers  will  be  satisfactory." 
^fajor  Chesley  wrote  on  the  same  day  to  Miss  Noyes,  that  he 
felt  that  '*it  would  be  better,  not  only  for  the  workers  but  for 

the  Ked  Cross,  to  have  Miss  personally  superintend 

the  recruiting  of  the  nurses  and  to  convoy  them  to  Warsaw  to 
us,"  rather  than  to  have  it  done  through  ^liss  Fitzgerald's  office. 

The  situation  which  ensued  possessed  certain  elements  of 
humor  which  !Miss  Xoyes  and  ^liss  Fitzgerald  would  have  been 
better  able  to  appreciate  if  their  patience  had  not  already  been 
overtaxed  by  the  seemingly  complete  ignorance,  on  the  part  of 
Red  Cross  foreign  commissioners,  of  the  standards  and  regula- 
tions of  the  Xursing  Service.  To  offer  nurses  a  higher  salary 
for  service  in  Poland  than  that  which  was  being  given  to  those 
working  under  other  Tied  Cross  foreign  commissions  was  mani- 
festly unfair.  To  delegate  to  a  lay  woman  the  choice  and  super- 
vision of  Ked  Cross  nurses  and  to  suggest  that  when  so  chosen 
they  wear  the  uniform  of  social  service  workers,  was  a  pro- 
cedure which  iiew  in  the  very  face  of  nursing  traditions.  ]\lonths 
were  consumed  in  tlie  adjustment  of  this  irr(\iiularity.  Finally, 
the  ten  Polish-speaking  nurses  were  recruited  through  the  Xurs- 
ing Service  at  National  Headquarters  and  in  tlu^  various  Di- 
visions, particularly  that  in  Chicago,  and  set  sail  from  Xew 
York  in  December,  under  the  leadership  of  Kdith  ]Merle  Benn, 
one  of  the  former  nurse  lecturers  on  the  Kadcliffe  Chautauquas. 

^liss  Fitzgerald's  last  piece  of  work  as  chief  nurse  of  the 
American  Ked  Cross  in  Europe  consisted  of  a  tour  of  inspection 
which  she  mad(^  in  Poland  ])(^tween  Octolx'r  2  to  October  17. 
Of  the  activities  of  the  connnission  in  Bialystok,  she  wrote: 

We  visited  two  vorv  large  warehouses,  one  of  which  was 
particularly  well  stocked  with  clothing,  medical  supplies  and 


1090  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

general  equipment.  We  visited  a  refugee  camp  to  which  the 
returning  natives  are  brought  for  cleansing,  are  kept  on  aji 
average  of  three  days  and  supplied  with  some  clothing  by  the 
American  Eed  Cross.  Some  of  the  soldiers  stationed  nearby 
have  also  received  clothing  from  the  organization.  We  also 
visited  a  typhus  hospital  of  five  hundred  beds  Avhich  has  been 
vastly  improved  through  the  guidance  and  advice  of  our 
physicians  and  to  which  some  equipment  has  been  given.  Xo 
American  Eed  Cross  personnel,  however,  is  assigned  there. 

Next  we  went  to  an  Army  hospital  of  one  thousand  beds  to 
which  the  commission  had  given  equipment,  and  also  the 
laboratory,  of  which  Dr.  Placida  Gardner  is  in  charge.  .  .  . 
Apart  from  the  equipment  given  to  the  hospitals,  no  American 
Eed  Cross  medical  work  of  any  sort  is  being  done  in  Bialy- 
stok.  .  .  . 

On  their  way  east,  Miss  Fitzgerald's  party  visited  the  village 
of  Slonim  to  which  the  commission  had  previously  given  equip- 
ment.    Miss  Fitzgerald  wrote : 

The  hospital  was  in  a  very  bad  condition  and  the  only 
person  who  seemed  to  be  at  all  responsible  was  one  native 
woman  wlio  took  us  around.  The  patients  were  not  cared  for, 
the  building  was  dirty  and  nothing  seemed  to  be  in  place.  I 
have  never  seen  a  more  striking  example  of  the  uselessness  of 
giving  equipment  to  a  hospital  without  providing  at  least  a 
temporary  loan  of  personnel  to  teach  the  natives  how  to  use 
that  equipment.  ...  A  very  elaborate  bathing  arrangement 
which  has  been  put  up  was  naturally  out  of  order  and  all  the 
water  which  should  have  been  in  the  boiler  or  in  the  tub  was 
on  the  floor. 

I  remarked  on  the  fact  that  a  nurse  or  nursing  aide  could 
do  a  great  deal  even  in  a  short  time  in  such  a  hospital,  but  it 
seems  that  that  kind  of  work  has  not  entered  into  the  scheme 
outlined  in  Poland  in  the  past. 

From  Slonim,  Miss  Fitzgerald  went  to  Baranovicci  and  found 
there  a  hospital  attached  to  a  military  camp  and  a  large  dis- 
tributing center.     Miss  Fitzgerald  wrote  : 

The  hospital  is  in  better  shape  than  any  I  had  previously 
seen.  ...  A  Polish  aide  was  on  duty  there  and  others  were 
busily  distributing  clothing  and  food,  going  in  carts  from 
one  village  to  another.  .  .  .  This  distribution  represents  a 
great  deal  of  work  and  requires  a  consideral)le  number  of 
people.    In  tlic  montli  of  September  alone  the  unit  stationed 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1091 

at  Baranovicci  reached  148  villao;es  and  distributed  clothing 
to  about  4(),()()0  people.  .  .  .  When  si(k  people  are  found  in 
the  homes  no  attempt  is  made  to  ^ive  them  medical  attention 
at  that  time,  but  if  very  ill  the  family  is  advised  to  take  the 
patient  to  the  nearest  hospital,  which  in  many  cases  is  a  long 
distance  away. 

From  Baranovicci,  Miss  Fitzgerald  went  to  Kobryn  and 
found  similar  work  being  carried  on.  From  there  she  proceeded 
to  Brest-Litovsk  and  thence  back  to  Warsaw.  She  then  made 
the  following  recommendations: 

There  is  practically  no  medical  work  being  done  by  the 
American  Ked  CVoss  in  Poland  and  I  feel  that  we  are  missing 
a  great  opportunity  by  not  placing  nurses  and  nurses'  aides  in 
the  Polish  hospitals.  There  is  no  reason  to  think  that  when 
this  method  has  succeeded  so  well  in  other  countries  it  would 
not  be  equally  successful  in  Poland.  .  .  .  Hitherto,  the  policy 
of  the  American  Red  Cross  in  Poland  lias  placed  the  question 
of  language  before  any  other  factor.  This  is  plainly  shown  by 
the  very  large  Polish  personnel  composing  the  commission. 
In  units  like  those  at  Baranovicci  and  Kobryn,  the  only 
American  people  are  the  doctor  and  one  stenographer ;  the  rest 
of  the  fifteen  or  twenty  women  are  Poles,  some  of  whom  were 
enrolled  in  America  but  many  of  whom  do  not  even  speak 
English. 

I  have  been  told  on  excellent  authority,  and  I  can  readily 
believe  it,  that  the  Polish  people  themselves  would  prefer 
American  workers  and  undoubtedly  these  would  carry  with 
them  a  ])restige  which  no  native  can  obtain.  It  is  not  always 
easy  to  determine  the  spirit  in  which  the  native  distributes 
assistance  and  there  is  always  the  danger  of  crippling  one's 
gift  through  a  patronizing  attitude. 

The  military  situation  in  Poland  early  in  1020  was  fayor- 
{ible  to  the  deyelopmcnt  of  an  American  Ivcd  Cross  program. 
In  April,  1020,  the  Republic  had  an  army  of  700,000  men  in 
the  field.  An  active  spring  offensive  was  ex])ected  on  the  part 
of  both  the  Poland  Army  and  the  Red  Guard  and  the  Aiucri- 
can  Red  Cross  commission  in  Poland  made  extensive  plans  to 
furnish  medical,  nursing  and  general  relief  to  Poland  during 
the  (Misuing  months. 

In  addition  to  the  unit  of  ten  Polish-sjK'aking  nurses.  Xa- 
tidual    ll('ad(|uarters  s(Mit  other  units  during  the  early  spring 


1092  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  1920,  so  that  by  June,  1920,  the  nursing  staff  of  the  Polish 
Commission  nnmbered  eighty-one  nurses  and  twelve  nurses' 
aides. 

On  iMay  19,  Miss  Hay  left  Paris  to  make  an  inspection  trip 
in  Poland  and  during  the  following  weeks  she  visited  the  chief 
centers  of  xVmerican  Red  Cross  nursing  activities  and  found 
that  the  Commission  for  Poland  had  developed  a  broad  program 
of  medical  relief  in  the  regions  dominated  by  Warsaw  in 
central  Poland ;  by  Vilna  and  Minsk  in  northeast  Poland ;  by 
Bialystok  and  Brest-Litovsk  in  central-eastern  Poland  and  by 
Lemberg  and  Cracow  in  southern  Poland.  The  resume  of 
nursing  activities  which  follows  is  based  largely  on  Miss  Hay's 
report  of  her  tour  of  inspection  made  in  May  and  June,  a 
report  submitted  to  Miss  l^oyes  on  July  15,  1920. 

In  Warsaw,  American  Red  Cross  medical  and  nursing  relief 
included  the  maintenance  of  a  typhus  research  hospital  and  a 
small  hospital  for  the  care  of  American  Red  Cross  personnel 
in  Poland. 

The  Typhus  Research  Hospital  had  been  established  in 
March  under  the  direction  of  the  League  of  Red  Cross  Socie- 
ties.^ The  patients  consisted  of  especially  typical  and  critical 
cases  of  typhus,  which  were  chosen  from  among  patients  of 
hospitals  in  the  field,  particularly  that  at  Stanislau,  and 
sent  to  Warsaw  for  observation  and  treatment.  The  capacity 
of  the  hospital  was  twenty-eight  beds.  The  nursing  staff  was 
maintained  at  an  average  strength  of  about  twelve  nurses  of 
the  Commission  for  Poland.  The  commanding  officer  was  Dr. 
r.  E.  Palfrey  and  the  head  nurse,  Stella  Mathews.  Miss 
Mathews  was  a  ]\Iilwaukce  nurse  who  had  organized  the  nurs- 
ing personnel  and  served  as  chief  nurse  of  Base  Hospital 
No.  22  and  Evacuation  Hospital  No.  20  at  Beau  Desert  Center, 
A.  E.  F.,  France. 

The  hospital  established  for  the  care  of  American  Red  Cross 
personnel  in  Poland  was  located  in  Praga,  a  suburb  of  War- 
saw, and  was  called  the  Praga  Hospital.  Lenna  H.  Denny 
was  head  nurse. 

Northeast  of  Warsaw  was  situated  the  Russian-Polish  city 
of  Vilna,  where  the  Polish  Army  opened  on  .^^arch  19,  1920, 
a  military  surgical  hospital.  The  American  Red  Cross  Com- 
mission for  Poland  furnished  ecjuipment  for  this  hospital  and 

^  For   a   complete    account    of    tlio   caiii})aiirn    aiiaiiist    tv])lms    in    Poland, 
see  the  Bulletins  of  tlie  Lca-'uc  of  Tvcd   Cross  Societies,  'l!)l!)-1920.  Vol.   1. 


A  ward  of  the  Vilna  ^rilitary  Surgical  Hospital,  Vilna,  Poland. 


The  American  Red  Cross  Orphanage  at  Liskow,  Poland. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1093 

assigned  twenty-seven  nurses  to  duty  there  with  Edith  Clen- 
denning  as  head  nurse.  The  hospital  was  housed  in  tents, 
barracks  and  a  hirgo  and  attractive  buihling  which  had  for- 
merly been  occupied  by  the  Russian  Military  School.  The 
capacity  was  three  hundred  and  fifty  patients,  with  an  emer- 
gency expansion  to  six  hundred. 

On  the  outskirts  of  Vilna  in  a  large  pine  forest  the  Vilna 
Railroad  had  maintained  (prior  to  the  outbreak  of  the  Euro- 
pean War)  a  hospital  for  the  benefit  of  its  employees.  The 
large  main  building  had  been  subsequently  wrecked  and  was 
not  usable,  but  the  hospital  establishment  included  detached 
cottages  wherein  infectious  cases  had  been  treated.  The  com- 
mission took  over  and  repaired  seven  of  these,  assigned  an 
American  Red  Cross  surgeon  and  seven  nurses  to  duty  there 
and  assisted  the  Vilna  Railroad  in  the  maintenance  in  these 
cottages  of  a  hospital  of  fifty  beds.  Like  the  Vilna  Military 
Surgical  Hospital,  this  institution  was  run  under  dual  man- 
agement, with  Dr.  ^rachcvsky,  the  head  physician  of  the  Rail- 
road of  the  Vilna  District,  cooperating  with  the  American 
Red  Cross  officer,  Captain  J.  J.  Donovan.  Louise  M.  Water 
was  the  head  nurse. 

Southeast  of  Vilna  was  the  former  Russian  province  of 
^linsk  and  in  it  was  located  the  city,  Minsk.  Here  during 
the  spring  and  summer  of  1920  Field  Unit  J^o.  Ill  operated; 
Marie  Suchowska  was  the  nurse  in  charge  of  several  Polish 
aides  and  under  her  direction  they  carried  on  a  certain  amount 
of  district  nursing  and  distributed  food  and  clothing  in  the 
Minsk  district. 

Southwest  of  ^liiisk  was  Bialystok,  headquarters  of  the 
American  Red  Cross  in  the  Department  of  tlie  East.  Here 
the  commission  had  established  early  in  January,  1920,  an 
orphaiuige  in  the  main  barracks  of  a  former  post  of  the  Rus- 
sian Army  and  by  July  1  had  collected  7S.3  children  there. 
The  childrcMfs  food  was  largely  supplied  by  the  Polish  Govern- 
ment and  the  American  Relief  Association,  with  supplemen- 
tary rations  from  tlie  warehouses  of  the  commission.  Classes 
in  car]K'ntrv,  j)luinl)ing,  cobbling  and  sewing  for  boys  and 
girls  were  organized  and  school  gardening  was  encouraged 
undin-  the  aus])ices  of  the  American  Junior  Red  Cross. 

In  connection  with  the  Rialystok  ()r])hanage,  a  hospital  of 
one  hundred  Ix'ds  was  maintained  for  th(>  care  of  the  children, 
"who  are  always  below  standard  upon  admission,"  wrote  Miss 


1094  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Hay,  "and  suffer  from  tuberculosis,  pink-eye,  measles,  mumps, 
whooping  cough  and  malaria."  On  June  25,  361  children  had 
been  cared  for  in  the  hospital,  while  at  the  dispensary  2224 
treatments  had  been  given.  The  nursing  staff  consisted  of 
fifteen  American  Red  Cross  nurses  and  the  head  nurse.  May 
L.  White.  In  addition  thirty-five  Polish  aides  were  on  duty 
in  the  orphanage.  Twenty-seven  of  them  were  employed  by 
the  commission  and  nine  by  the  Refugee  Bureau  of  the  Polish 
Government,  which  cooperated  with  the  American  Red  Cross 
in  the  maintenance  of  the  orphanage. 

At  the  Orphanage  Hospital,  instruction  was  given  to  Polish 
aides  in  elementary  nursing.  The  textbook  in  Home  Hygiene 
and  Care  of  the  Sick  was  translated  into  the  Polish  language 
and  was  used  as  a  basis  for  theoretical  teaching.  Dr.  Laleski, 
assistant  medical  chief,  supplemented  this  text  by  lectures  and 
one  of  the  Polish-speaking  American  Red  Cross  nurses,  Doris 
Wartosky,  conducted  practical  work  for  the  aides  in  the  wards 
of  the  Orphanage  Hospital. 

South  of  Bialystok  on  the  Bug  River  was  located  the  city 
of  Brest-Litovsk.  American  Red  Cross  Field  Unit  Xo.  II 
were  assigned  to  duty  there  early  in  1020  and  made  it  the 
headquarters  for  medical  and  general  relief  without  the  dis- 
trict. Eleanor  ^lettel,  an  American  Red  Cross  public  health 
nurse,  was  in  charge  of  several  Polish  aides.  The  work,  like 
that  of  Unit  Xo.  Ill,  consisted  largely  in  the  distribution  of 
relief  supplies,  but  Miss  !^[cttel  made  a  constructive  step  for- 
ward by  interesting  and  training  her  staff  of  Polish  aides  and 
the  local  midwives  in  more  adequate  care  of  mother  and  child. 

American  Red  Cross  Field  Unit  No.  IV  was  assigned  to 
the  town  of  Tarnopol,  situated  southeast  of  Brest-Litovsk  in 
Galicia  among  the  foothills  of  the  Carpathian  Mountains.  Tar- 
nopol was  in  1U20  a  city  of  some  ten  thousand  inhabitants  and 
had  suffered  considerable  destruction  and  consequent  demorali- 
zation during  the  war.  Field  Unit  Xo,  IV  was  engaged  in 
distributing  relief  supplies  there.  Alice  A.  Tanguay,  an 
American  Red  Cross  nurse,  was  on  duty  and  had  in  charge 
the  three  Polish  aides.  Two  hospitals  were  maintained  at 
Tarnopol,  l)i!t  not  by  the  American  R(>(1  Cross.  One  was  the 
Infectious  Hospital,  wliich  "in  cleanliness  and  care  of  the 
])atieiits,"  wrote  ^liss  Hay,  ''is  above  the  average."  The  other 
was  the  Muiiici])al  Hospital,  which  was  under  the  direction  of 
Sisters  of  St.  Vincent  de  Paul. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1095 

Southwest  of  Tarnopol  and  situated  among  the  Carpathian 
ranges  was  Stanislaii,  to  which  Field  Unit  No.  VI  was 
assigned.  A  large  typhus  hospital  was  maintained  here  by 
the  local  government  and  sent  cases  northwest  to  the  Typhus 
Research  Hospital  at  Warsaw.  The  services  of  the  American 
Red  Cross  nurse  and  Polish  aides  of  Unit  No.  VI  were  utilized, 
however,  for  civilian  relief  work. 

The  Galacian  city  of  Leml)erg  (Lwow),  which  was  northwest 
of  Stanislau,  was  the  headquarters  for  the  American  Red 
Cross  in  southern  Poland  and  the  warehouse  base  for  activities 
in  Stanislau  and  Tarnopol.  Here  Pauline  H.  Wilkouski, 
an  American  Red  Cross  Polish-speaking  nurse,  was  on  duty 
but  her  work  was  chiefly  in  the  field  of  civilian  rather  than 
medical  relief. 

West  of  Lemberg  was  located  Zakopane,  near  which  the 
Countess  Zamoyska  had  established  some  twenty-five  years  be- 
fore the  war,  a  School  of  ])(miestic  Science  for  Polish  Girls. 
In  her  report  of  a  tour  of  inspection  made  in  Poland  in  May, 
1920,  Miss  Hay  wrote: 

This  school  is  located  about  four  kilometers  from  Zako- 
pane, among  the  beautiful  foothills  of  the  Carpathian  Moun- 
tiiins.  The  main  building  is  a  three-story  one  and  there  are 
also  detached  cottages.  The  housekeeping  is  that  of  the 
thriftiest  housewife, — scrupulous  cleanliness,  tlioroughness 
and  thrift  are  apparent  everywhere.  Dairying,  poultry  rais- 
ing, gardening  and  agriculture  are  included  in  the  three  years' 
course  of  training. 

"One  must  eat  and  cooking  is  necessary,"  the  Countess 
Zamoyska  used  to  say,  "therefore  every  woman  should  know 
how  to  cook.  One  must  have  clean  surroundings,  therefore 
one  must  be  taught  how  to  make  the  home  clean  and  orderly 
and  to  keep  it  so.  One  must  have  clean  clothes,  so  one  must 
learn  to  wash  and  iron." 

With  practical  ideals  such  as  these,  the  Countess  and  her 
daughter  bave  established  a  course  of  training  of  great  benefit 
to  bundreds  of  young  Polisb  women,  and  as  tbe  scbool  has 
always  been  Irnhj  Polish  in  sju'rit.  it  has  become  a  fostering 
center  for  ardent  jiatriotism  and  love  for  Poland. 

On  ^Tay  1,  1020,  h'mily  Skorupa.  one  of  the  \en  nurses  of 
^fiss  B(Min's  unit  and  an  American-trained  ])ublic  health  nurse 
of  broad  experience  and  much  ability,  was  assigned  to  Countess 


1096  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Zanioyska's  School  to  organize  and  conduct  classes  in  Home 
Hygiene  and  Care  of  the  Sick.  Miss  Skorupa  had  herself  been 
graduated  from  the  school  before  she  had  come  to  the  United 
States,  so  her  assignment  there  was  a  particularly  happy  one. 

Miss  Skorupa  translated  the  Delano  textbook  on  Home 
Hygiene  and  Care  of  the  Sick  into  Polish  and  used  it  as  the 
basis  for  her  instruction  at  the  school.  The  course  was  eagerly 
received  by  teachers  and  pupils  alike.  Two  of  the  teachers 
received  special  instruction^  with  the  view  of  preparing  them- 
selves to  give  the  course  in  the  event  that  the  American  Red 
Cross  nurses  might  be  withdrawn  from  Poland. 

West  of  Zakopane  was  located  Cracow,  a  Galacian  city  which 
boasted  a  municipal  hospital  of  fifteen  hundred  beds.  In 
connection  with  this  institution,  a  group  of  Polish  women, 
among  them  Miss  Epstein,  had  endeavored  years  before  the 
war  to  establish  a  school  for  nurses,  but  the  plan  had  met  with 
scant  success,  if  judged  by  Anglo-American  standards  of  nurse 
education.  Early  in  the  spring  of  1020,  Stella  Tylski,  another 
Polish  American-trained  public  health  nurse  of  Miss  Bonn's 
unit,  had  been  loaned  to  the  Municipal  Hospital ;  she  had  gone 
on  duty  in  the  School  for  Xurses  and  tried  to  do  what  she 
could.  Of  the  conditions  of  poverty  and  misery  which  existed 
there  in  May,  1920,  Miss  Hay  wrote: 

We  visited  the  medical,  gynecological,  obstetrical,  chil- 
dren's and  eye  and  ear  departments.  The  medical  and  surgi- 
cal wards  are  large  and  light,  but  in  them  exist  frightful 
conditions  of  overcrowding.— two  adults  to  every  bed  even  in 
the  most  unclean  cases.  There  is  space  for  more  beds,  but 
there  is  no  money  with  which  to  purchase  them,  or,  for  that 
matter,  any  other  supjilios.  One  likes  to  picture  the  heavenly 
transformation  tliat  could  be  brouglit  about  here  with  a  mini- 
mum of  su])])lies  and  an  adequate  nursing  personnel. 

The  gynecological  department  is  located  in  one  of  the 
oldest  parts  of  the  building,  directly  under  the  dormer  roof. 
Crowded  as  it  is  witli  patients  in  intense  suffering,  dirty, 
with  no  nursing  care,  one  wonders  how  any  benefit  could  ever 
be  found  here  or  how  any  surgeon  could  daily  face  such  des- 
perate conditions. 

The  obstetrical  department  is  in  a  bigger  aiul  lighter  room, 
but  is  so  crowded  and  so  destitute  of  sup])lies  as  to  be  truly 
tragic.  "Clean"  ol)stetrics  woidd  seem  an  impossibility.  One 
shuddered  with  sympathy  when  they  weiglied  the  naked  little 
babies,  one  after  another,  in  the  cold  metal  scale  pan!     The 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1097 

nursing  service  is  under  the  Sisters  of  St.  Vincent  de  Paul, — 
good  and  patient  women  but  powerless  to  cope  with  the  many 
difliculties.  The  nursing  care,  except  for  that  coming  from 
the  Nursing  School,  is  given  by  domestics  of  the  most  slat- 
ternly and  indifferent  type.  Miss  Tylski  states  that  the 
patients  and  beds  throughout  swarm  with  vermin,  that  when 
bandages  are  removed  unspeakably  bad  conditions  are  re- 
vealed. ... 

In  these  departments  and  under  such  conditions,  the  stu- 
dent nurses  browse  about  in  search  of  whatever  scraps  of 
nursing  knowledge  they  may  chance  to  find.  Miss  Tylski  has 
done  what  she  could  to  help  them,  but  any  good  influence  or 
careful  lessons  from  her  are  likely  to  be  lost  in  the  objection- 
able conditions  abounding  everywhere. 

On  June  15,  1920,  Miss  Benn  resigned  as  chief  nurse  of 
the  American  Red  Cross  Commission  for  Poland  and  was  suc- 
ceeded by  ]\Iiss  Mathews,  formerly  head  nurse  of  the  Typhus 
Research  Hospital. 

Such  were  the  nursing  activities  of  the  American  Red  Cross 
in  Poland  during  the  spring  and  summer  of  1919.  National 
Headquarters  and  the  Commission  for  Europe  were  turning 
their  attention  from  the  widespread  distribiition  of  emergency 
relief  to  the  devc^lopment  of  a  more  permanent  and  constructive 
program.  One  of  the  major  phases  of  this  constructive  program 
included  plans  leading  toward  a  better  appreciation  in  foreign 
countries  of  the  value  of  the  professionally-trained  nurse,  and 
a  pioneer  attempt  along  these  lines  was  launched  in  July,  1920, 
at  Warsaw.  Tlie  Polish  Red  Cross  Society  maintained  there 
a  hospital  wherein  it  gave,  after  the  custom  of  other  continental 
Red  Cross  societies,  a  three  months'  course  in  the  theory  of 
military  nursing  to  young  women  who  were  called  Polish  Red 
Cross  "war  aides"  and  who  were  subsequently  assigned  to  ser- 
vice with  the  Polish  Army.  In  July  the  class  under  instruc- 
tion at  the  Polish  RcmI  Cross  Hospital  in  Warsaw  numbered 
lOf'3  students.  ^Fadame  Tdjukovska,  the  director  of  Xurses  of 
the  Polish  R(>d  Cross  Hospital,  calk'd  on  the  Chief  Xurse  of 
the  Commission  to  assist  her  in  giving  more  thorough  prepara- 
tion to  these  aides,  ^frs.  Jokaitis  and  Praxeda  Franczak,  a 
Polish-s])eaking  American  Red  Cross  nurse  who  had  gone  over- 
seas in  ^liss  Renn's  unit,  were  assigned  to  duty  there  and  tried 
to  develop  an  elemeiitarv  course  similar  to  that  in  Home  Hy- 
giene and  Care  of  the  Sick.     The  attempt  was  not  an  unquali- 


1098  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

fied  success.  The  American  nurses  went  into  the  wards  of  the 
Polish  Red  Cross  Hospital,  cleaned  them  and  gave  bedside  care 
to  the  patients,  but  this  service  resulted  in  loss  of  prestige  for 
the  Americans  in  the  eyes  of  Polish  aides  and  patients  alike. 
While  the  actual  care  of  the  sick  was  regarded  by  the  Ameri- 
can nurses  as  dignified  and  altruistic  the  Poles  regarded  it  as 
degrading  menial  labor  fit  only  for  domestics.  Thus  the 
American  nurses  could  maintain  little  discipline  and  their  en- 
deavors to  provide  instruction  through  theory  and  actual  dem- 
onstrations of  nursing  technique  were  received  with  scant 
enthusiasm. 

Early  in  August,  1920,  the  Polish  Armies  met  with  military 
reverses.  The  Soviet  Army  of  Russia  invaded  Poland  from 
the  north.  On  August  G,  Colonel  Olds  cabled  Xational  Head- 
quarters that  "owing  to  the  critical  situation  in  Poland,  thirty- 
seven  nurses  were  immediately  released.  .  .  .  Thirty-five 
others  are  being  held  in  Poland  for  any  emergency.  Future 
nursing  service  in  Poland,"  concluded  the  cablegram,  ''is  sta- 
tionary." On  August  11,  the  Red  Guard  cut  the  Danzig- 
Warsaw  Railroad  and  three  days  later  began  to  close  in  about 
Warsaw. 

The  military  crisis  wiped  out  American  Red  Cross  medical 
and  nursing  relief  in  northeastern  and  central-eastern  Poland 
and  caused  the  evacuation  of  personnel  and  supplies  from  W^ar- 
saw  to  Cracow.  One  of  the  picturesque  incidents  of  this  with- 
drawal was  the  removal  of  the  orphans  from  Bialystok.  The 
order  for  immediate  evacuation  allowed  Miss  Mathews  scant 
time  for  preparation.  She  applied  at  once  to  the  military 
authorities  for  transportation  and  in  spite  of  the  traffic  conges- 
tion and  the  great  need  for  rolling  stock,  they  allotted  her 
fifty-one  freight  cars.  Into  these  all  equipment  which  could  be 
moved,  clothes,  food,  cots  and  medical  supplies,  were  placed 
and  lastly  the  thousand  children.  Two  nurses  were  assigned 
to  oaoli  car  full  of  children.  During  the  four  days'  trip  south- 
ward through  the  panic-stricken  country-side  food  was  served 
from  an  American  Red  Cross  canteen  car  attached  to  the  long 
evacuation  train. 

Their  destination  was  the  village  of  Liskow,  near  the  south- 
western border.  When  the  youngsters  arrived,  there  were  not 
houses  enough  in  Liskow  to  shelter  them  all.  It  was  a  warm 
midsummer  night,  so  Miss  INIathews  had  the  cots  set  up  in 
the  fields,  and  the  young  Poles  rolled  up  in  their  American 


CLOSE  OF  THE  FORl'JGN  RELIEF  PROGRAM    1099 

blankets  and  slept  in  the  open.  The  next  day  temporary  billets 
for  them  were  found  in  Liskow  and  in  a<ljoinin<j::  hamlets  until 
the  erection  of  a  new  orphanaj^e  could  be  completed. 

The  Soviet  Army,  however,  luul  been  unable  to  hold  their 
gains  in  the  face  of  the  savauc  Polish  counter-offensive.  By 
August  11)  the  Poles  had  routed  the  Red  Gmird  from  tiie  War- 
saw District,  had  taken  10, 000  prisoners  (according  to  news 
dispatciies)  and  recovered  tenitory  in  east  central  Poland  in- 
cluding Brest-Litovsk.  During  the  late  days  of  August,  the 
victorious  Polish  Army  drove  the  Soviet  Army  completely  o\it 
of  Poland. 

Early  in  August,  the  American  lied  Cross  commission 
paused  in  their  evacuation  to  reconnoiter  in  Cracow  and  thei-e 
the  nurses  begged  so  hard  to  be  allowed  to  remain  in  Poland 
rather  than  to  be  sent  on  to  Paris  with  the  rest  of  the  Ameri- 
can women  personnel  that  tliirty  of  them,  with  ^[iss  Mathews 
as  their  chief,  were  permitted  to  stay.  When  Warsaw  had 
been  threatened,  vast  (puuititi(>s  of  American  Red  Cross  sup- 
plies in  the  Warsaw  and  Rialystok  districts  had  been  moved  to 
Cracow.  Five  railroad  tr;iins  were  secured  by  the  commission 
then  in  Cracow  and  were  loaded  with  food  and  clothing.  Can- 
teen and  dispensary  cars  to  which  doctors,  nurses  and  other 
personnel  had  been  assigned,  w^ere  attached  to  the  trains  and 
each  train  was  started  back  from  Cracow  at  different  tangents 
into  Poland.  The  trains  stopped  at  towns  and  villages  and 
fed  and  clothed  the  refugees  and  native  population  and  gave 
first  aid  to  many  who  had  been  wounded  in  the  Soviet  advance. 
"The  reports  of  these  railroad  units,"  stated  the  Annual  Re- 
port for  the  year  19:^1,  "show  that  they  cared  for  more  than 
1000  surgical  cases  weekly  and  fed  a  maximum  of  750,000 
persons  in  a  single  month.'' 

The  evacuation  of  hospitals  and  the  subsequent  withdrawal 
of  American  Red  Cross  personnel  from  Poland  to  Cracow 
marked  the  closc^  of  the  plan  for  nation-wide  medical  relief 
for  Poland  which  had  been  contemplated  by  the  commission. 
The  nurses  and  representatives  of  other  types  of  personnel  were 
not  returned,  however,  to  Paris,  but  were  k(^})t  in  Cracow  and 
lat(>r  Warsaw.  "Tii  Octol^er,  1920,"  wrote  :\liss  Hay,  "the 
nurses'  activities  in  Poland  were  largely  restricte(l,to  clash-work 
in  home  nursing  in  Cracow,  Posen,  Kornik  and  Warsaw.  In 
addition,  tluM-e  was  at  C^racow  a  day  nursery  av(M'agiiig  seven- 
teen babies;  a  tuberculosis  and  general  disptMisaries :  and  visit- 


1100  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ing  nursing  among  the  families  of  dispensary  patients."  The 
development  of  the  child  health  program  which  later  took  place 
in  Poland  will  be  described  in  a  subsequent  section. 

The  second  verdant  field  for  American  Red  Cross  emergency 
relief  during  the  post-Armistice  period  was,  it  will  be  remem- 
bered, to  be  found  in  the  Balkan  States.  In  October,  1918, 
Miss  Hay  had  been  released  from  her  work  as  director  of  the 
Bureau  of  Instruction  at  National  Headquarters  and  with  two 
nurses,  Marietta  Wilsey  and  Caroline  E.  Robinson,  had  sailed 
early  in  December  for  France.  In  London,  Rachel  Torrance 
had  joined  the  group  as  Miss  Hay's  assistant  and  the  four  had 
proceeded  to  Paris.  Miss  Hay  there  organized  a  unit  of  some 
fifty-three  nurses  who  were  then  being  released  from  duty  with 
the  Army  and  the  Commission  for  France  and  with  them  had 
gone  to  Rome.  Colonel  Anderson,  the  commissioner  for  the 
Balkan  States,  had  succeeded  in  recruiting  personnel  for  his 
staff  and  in  bringing  into  the  Balkan  States  approximately 
25,000,000  pounds  of  supplies  which  consisted  largely  of  food, 
hospital  supplies,  clothing  and  agricultural  implements. 

In  January,  February  and  March,  Headquarters  for  the 
Commission  for  the  Balkans  was  located  at  Rome ;  in  April, 
they  were  transferred  temporarily  to  Salonika,  Greece,  and 
later  to  Belgrade. 

Previous  to  the  arrival  of  Colonel  Anderson  and  his  staff  at 
Rome,  two  American  Red  Cross  commissions  were  already 
operating  in  the  Balkans  but  were  engaged  chiefly  in  civilian 
rather  than  medical  relief.  The  first  of  these,  the  Commission 
for  Serbia,  of  which  Dr.  Edward  W.  Ryan  was  in  command, 
had  been  engaged  in  distributing  supplies  tliere  since  the  spring 
of  1917.  The  second,  the  Commission  for  Greece,  of  which 
Lieutenant  Colonel  Edward  Capps  was  in  command,  had  ar- 
rived in  Athens  on  October  23,  1918,  with  large  supplies  of 
food  and  clothing.  Xo  American  Red  Cross  nurses,  however, 
were  on  professional  duty  with  either  of  these  commissions; 
Miss  Gladwin  had  assisted  Dr.  Ryan  in  the  distribution  of 
material  relief  in  Serbia  but  returned  to  the  United  States 
early  in  1919. 

The  organization  of  the  Commission  for  the  Balkans  followed 
in  miniature  that  of  the  Commission  for  Europe :  Colonel  An- 
derson and  the  heads  of  various  departments  who  formed  his 
staff  had  charge  of  the  ''enrollment  of  personnel,  the  acquisition 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1101 

and  movement  of  supplies  to  the  various  ports  and  similar 
service  outside  the  several  countries  .  .  .  but  on  arrival  of  per- 
sonnel and  supplies  at  the  ports,  they  came  under  the  control  of 
the  commissioner  or  unit  for  that  territory,  which  had  direct 
charge  of  the  work  in  its  given  state."  ^  The  line  of  communi- 
cation between  the  various  commissioners  to  the  Pavis  (3ttice 
and  National  Ileadiiuarters  was  through  Colonel  Anderson  and 
for  the  Nursing  Service,  through  Miss  Hay. 

]\Iiss  Hay  and  her  nurses  arrived  in  Home  in  January  and 
immediately  the  fifty-three  nurses  were  divided  into  units, 
each  with  its  head  nurse,  and  were  sent  into  the  Balkan  field. 
Additional  nurses  were  assigned  to  service  in  the  I^alkans  early 
in  1019  by  Miss  II all  and  Miss  Fitzgerald  and  on  June  .'iO, 
1919,  the  nursing  staff  numbered  ninety-eight  nurses  who  were 
working  under  six  units  assigned  to  ^Montenegro,  Albania, 
Greece,  North  and  South  Serbia  and  Roumania.  These  units 
were  attached  each  to  the  staff  of  the  commissioner  of  the 
country  to  which  they  were  assigned  and  the  head  nurse  worked 
in  as  close  cooperation  with  the  commissioner  as  could  be 
established. 

Such,  in  January,  1919,  were  the  organization,  the  personnel 
and  the  facilities  for  development  of  an  extensive  American 
Red  Cross  relief  program,  both  medical  and  general,  in  the 
Balkan  States.  Of  the  standards  of  nursing  care  which  existed 
there,  ]\riss  Hay  wrote  her  report  of  the  Nursing  Service  of 
the  Balkan  Commission,  November  1,  1918,  to  September 
30,  1919: 

The  trained  nurse  and  good  nursing  have  scarcely  been 
known  in  the  Balkans  until  the  recent  wars  and  the  influx  of 
foreign  nurt^ing  missions  so  splendidly  demonstrated  their 
value.^ 

Conditions  in  Balkan  hospitals  have  been  mo.^t  inadequate 
and  the  care  of  patients  deploral)le.  .  .  .  The  nursing  service, 
always  trifling  and  incidental,  has  degenerated  still  further 
from  the  increased  amount  of  work  and  the  scarcity  of  helpers. 
Where  with  fifty  patients  one  never  jdanr.ed  to  give  a  ])ed 
bath  or  do  ought  to  prevent  a  bedsore,  how  could  any  such 

'See  Annual   Report,    1919,   p.    124. 

'  For  an  account  of  the  foreign  units  gent  between  1914  and  1918  to 
Serbia,  British,  Scotch.  Russian,  French.  Bolieniian,  Danish,  (ireek  and 
American,  see  "l\epori  of  tiie  Nursing  Service,  iJalkaii  Coinmission.  Ameri- 
can Red  Cross,  November  1.  191S  to  September  .'50.  1919,"  by  Helen  Seott 
Hay.  i)p.  2-8,   Red  Cross  Archives. 


1102  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

extraordinary  activity  be  expected  with  five  hundred  patients? 
Medical  students,  both  men  and  women,  feldchers  (men  with 
a  limited  amount  of  medical  and  hospital  training)  and  mid- 
wives  were  able  to  assist  with  operations  and  dressings,  to 
prescribe  simple  remedies  and  to  tal-ce  temperatures,  but  none 
of  these  had  any  mind  for  nursing  tasks  themselves.  Neither 
did  they  know  or  desire  good  nursing  from  the  helpers  in  the 
wards,  who  were  men  and  women  of  the  lower  classes  and  who 
clattered  about  their  hospital  duties  without  training  or  super- 
vision of  any  kind.  .  .  . 

For  the  ills  of  the  neighborhood,  the  boils  and  malaria  and 
rheumatism,  there  are  the  old  hahas,  or  grandmothers  who 
incline  to  squash  poultices.  No  one  in  the  average  Balkan 
village  ever  bothers  himself  or  his  neighbors  with  questions  of 
prevention  or  any  public  health  propaganda. 

The  big  task,  therefore,  in  our  medical  relief  work  is  far 
less  one  of  dressing  so  many  wounds  and  washing  so  many 
babies,  and  caring  for  so  many  tuberculosis  patients,  as  it  is 
to  create  among  the  people  a  real  appreciation  and  desire  for 
an  improved  order  of  living :  for  the  sanitary  hospital,  for  the 
skillecl  care  of  the  typhoid  sufferer,  for  the  right  care  of  well 
babies  and  the  like.  Neighborly  assistance  and  foreign  skilled 
supervision  may  be  desirable  for  some  time  to  come.  But 
when  the  people  themselves  have  been  educated,  through  the 
example  of  doctors  and  nurses,  to  the  point  of  wanting  this 
improved  order  of  living,  on  that  day  they  will  be  able  them- 
selves to  carry  on  admirably  the  desired  activities. 

In  all  health  projects,  the  trained  nurse  or  trained  woman 
worker  is  essential.  .  .  . 

This  account  of  American  Red  Cross  nursing  service  in  the 
Balkans  during  the  period  previous  to  the  adoption  of  the 
policy  of  child  health  units,  a  period  lasting  from  January  to 
November,  1920,  will  begin,  for  geographical  reasons,  with  a 
brief  account  of  the  nursing  service  in  Monteiu^gro  and  will 
continue  with  accounts  of  that  developed  in  Albania,  Greece, 
North  and  South  Serbia  and  Roumania. 

The  Commission  for  ^Montenegro  arrived  late  in  January  in 
Podgoritza,  the  largest  city  in  jMontenegro  and  one  which  had 
a  population  of  about  fourteen  thousand,  and  established  its 
headquarters  there.  The  first  American  Red  Cross  commis- 
.sioner  for  Montenegro  was  ^fajor  Elliot  G.  Dexter;  he  resigned 
on  April  28,  10 ID,  and  was  siu'ceeded  by  a  Californian,  ]\Iajor 
Uenrv  R.  Fairclouiih.     The  first  head  nurse  of  the  unit  of  four- 


CLOSE  OF  THE  J^OREIGN  RELIEF  PROGRAM    1103 

teen  nurses  in  ^fontcnef^ro  was  Georgia  B,  Greene.  She  was 
succeeded  on  April  15  by  Lena  Margaret  Johnson. 

In  working  in  a  country  as  isolated  as  Montenegro,  where 
supplies  had  to  be  brought  in  ])y  camion  or  on  the  backs  of 
mules  or  porters  when  the  roads  grew  impassable,  the  American 
Red  Cross  personnel  naturally  met  with  primitive  living  con- 
ditions. The  plan  adopted  by  the  commissioner  of  such  a 
group  was  to  establish  upon  arrival  in  the  field  of  future  ac- 
tivities an  American  Red  Cross  personnel  house,  equip  it  with 
]{ed  Cross  supplies  and  charge  one  of  the  personnel  with  the 
duty  of  maintaining  the  household  in  cleanliness  and  providing 
adequate  meals.  Sometimes  this  housekeeper  was  a  nurse, 
sometimes  a  social  service  worker,  but  the  fate  which  had 
overtaken  the  Gevgeli  L'^nits  in  1915  in  Serbia  had  made  Xa- 
tional  Headquarters  especially  charge  each  commissioner  with 
the  responsibility  of  safeguarding  the  health  and  welfare  of 
his  personnel.  Another  plan  used  in  the  Balkans  was  the 
establishment  of  Red  Cross  central  mess  and  recreation  rooms. 
The  different  members  of  the  personnel  were  then  furnished, 
usually  througli  arrangements  by  the  Government  of  the  coun- 
try to  which  they  were  sent,  lodgings  close  at  hand.  They 
then  lived  in  those  lodgings  and  went  to  the  Red  Cross  head- 
quarters for  meals  and  diversion.  Such  a  plan  was  established 
at  Podgoritza  and  \\as  more  or  less  satisfactory.  "Two  of  the 
nurses,''  wrote  ]\liss  Hay,  '"were  quartered  in  houses  where  a 
pig  was  also  a  denizen.     The  others  were  very  comfortable." 

The  American  Red  Cross  established  in  Podgoritza  a  hos- 
pital of  sixty-bed  capacity.  This  was  first  located  in  an  old 
military  barracks,  but  was  moved  in  April  to  the  former  resi- 
dence of  Prince  ^lirko,  just  outside  the  city.  The  lower  floor 
was  used  for  ])ers()nnel,  the  second  one  for  operative  and  sick 
medical  cases  requiring  nursing  care  and  the  third  for  conva- 
lescents, "salvarsans"  and  (piarters  for  nurses'  aides,  tli(^  native 
housekeeper  and  orderlies.  The  house  was  lighted  by  kerosene 
lamps  and  was  heated  by  wood  stoves  but  had  no  running 
water.  Of  the  native  aides,  ^liss  Johnson,  the  chief  nurse 
in  Montenegro,  wrote: 

We  si'cured  throe  young  intelligent-looking  girls  of  a])Out 
eighteen  and  took  tluMU  into  the  hospital.  They  learned  some 
of  th(>  first  ])riii(iples  of  nursing  easily,  but  after  a  year's 
training:  neither  of  tliem  could  read  a  thermometer,  nor  eould 


IIOJ;  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

we  trust  them  to  carry  out  orders  unless  we  were  there  to  see 
that  they  did  it.  One  reason  for  this  is  that  the  word  of  a 
man  is  a  command,  so  when  a  man  patient  insists  on  getting 
up  immediately  following  a  laparotomy,  the  aides  in  fear  and 
tremhling  let  him,  and  when  an  hour  previous  to  an  operation 
he  madly  calls  for  food,  they  dutifully  get  it.  Xow  both  they 
and  the  patients,  however,  are  gradually  beginning  to  learn 
that  an  American  Avoraan"s  word,  if  she  is  head  of  the  ward  in 
which  he  happens  to  be,  is  as  good  as  that  of  a  man. 

In  connection  with  the  hospital  the  commission  maintained 
a  lively  dispensary  where  from  fifty  to  ninety  patients  were 
daily  treated.  A  dental  department  was  an  active  phase  of 
this  service.  One  nurse  was  on  duty  at  the  dispensary  and 
tw^o  others,  Mabel  Is^elson  and  Sara  McCarron,  did  visiting 
nursing  among  the  families  of  dispensary  patients.  The  city 
of  Podgoritza  was  bisected  by  a  small  river  into  the  ^"old"  and 
the  ''new"  towns.  The  '*old"  town  included  a  large  Turkish 
settlement  aiid  there  the  nurses  found  conditions  which  seemed 
unbelievably  wretched  to  the  Occidental  relief  worker.  Miss 
McCarron  wrote: 

When  we  arrived  in  Podgoritza  on  January  26,  1919,  it  was 
very  cold.  There  was  no  coal  and  little  wood.  .  .  .  Six  days 
later  I  started  out  to  do  district  work  and  my  first  patient 
Avas  a  bad  nephritis  case.  I  found  her  almost  on  top  of  the 
stove;  they  do  this  to  keep  warm.  The  family  was  in  fairly 
affluent  circumstances  and  could  provide  the  nourishment  she 
needed. 

We  visited  from  twenty  to  thirty  families  each  day.  My 
district  was  in  the  "old  town,"  tlie  Turkish  section,  or 
"Turkey-town,"  as  we  called  it.  It  was  five  hundred  years 
old.  A\  hen  we  first  arrived,  the  spirit  of  the  people  was  at 
low  ebb  and  they  were  slow  to  grasp  the  idea  that  we  were 
there  to  help,  but  when  they  did,  every  door  was  open  to  us, 
Christian  and  Turkish  alike.  The  poverty  was  stark  and 
terril)lo,  no  fires  in  some  of  the  homes,  the  people  scantily 
clad;  dirty;  no  soap;  hungry.  ]\Iany  had  no  beds  and  those 
who  bad  mattresses  to  lay  on  the  dirt  floors  were  considered 
Avell  off.  Otliers,  desperately  poor,  had  only  a  slip  of  burlap 
to  lie  on.     Oh,  it  was  heart-rending ! 

One  case,  a  widow  with  an  eight-year-old  girl,  was  suffering 
from  an  infected  foot,  and  I  got  there  at  twilight.  After  I 
had  closed  the  door,  which  was  the  only  means  of  light  they 
bad,  I   could  not  see  the  patient  huddled  in  a  corner  on  a 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1105 

bundle  of  filthy  rags,  reeking  with  pus  from  the  infected  foot. 
The  wound  had  been  discharging  for  two  years,  the  patient 
told  me.  We  sent  her  to  our  hospital  for  two  months.  When 
she  came  home,  she  found  that  the  walls  had  been  white- 
washed, a  small  hole  opened  in  the  ceiling  above  the  fireplace 
for  tlie  smoke  to  escape,  an  army  cot,  sheets,  blankets  and  food 
daily  until  she  could  get  work. 

Early  in  March,  the  two  public  health  nurses  in  Podgoritza 
started  school  nursing.     Miss  McCarron  wrote : 

The  five  hundred  children  in  tlie  primary  school  were  bare- 
footed, illy  clad  and  lonely.  The  school  was  not  heated  in 
any  way  and  they  sat  there  and  shivered,  too  cold  to  study.  I 
inspected  them  every  month  and  on  my  first  inspection  found 
over  two  hundred  cases  of  pediculosis;  numerous  ones  of 
scabies;  some  impetigo  and  nephritis;  no  trachoma;  one  case 
of  acute  conjunctivitis  and  on  a  later  inspection  two  of 
farus.  I  succeeded  in  having  thirty-one  bad  head  cases  shaved 
at  once,  more  than  1  could  ever  accomplish  at  home  in  ten 
months.  The  principal  and  teacher  were  splendid  in  their  co- 
operation. 

Spine  and  eye  cases  went  to  the  dispensary  for  treatment, 
also  pediculosis  victims  for  petrol  and  lard.  Talks  on  care  of 
the  teeth  and  mouth  were  given  by  Dr.  Wolf,  our  dentist,  and 
tooth  brushes,  handkerchiefs,  covers  for  drinking  glasses  and 
soup  were  distributed. 

All  tuberculosis,  malnutrition,  scurvy,  convalescent  pneu- 
monia, ])ronchitis  and  influenza  cases  in  the  district  were 
referred  to  the  dispensary  every  morning  at  nine  o'clock  and 
received  evaporated  milk,  jam,  eggs  and  any  other  article  of 
diet  the  doctor  ordered. 

A  large  soup  kitchen  was  maintained  at  Podgoritza  and 
"feeds  nearly  one  thousand  people  daily,"  wrote  Miss  Hay, 
"with  a  very  palatable  thick  soup  prepared  with  vegetables  and 
flavored  with  bacon.  For  ^rohanimedans  a  similar  soup  is 
furnished  which  contains  vegetable  oil  instead  of  bacon.  The 
daily  food  ration  is  a  liberal  half  pint  of  soup  and  one-sixth  of 
a  kilo  of  bread  and  many  of  the  recipients  sit  down  on  the 
sidewalk  and  eat  it  immediately.  One  day  Mr.  Tnekerman, 
the  Ked  Cross  man  in  charge  of  the  soup  kitchen,  called  my 
attention  to  two  cliildren  who,  while  waiting  for  their  soup, 
had  ])icked  uj)  a  bone  from  the  gutter  and  were  voraciously 
gnawing  at  it." 


1106  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

North  of  Podgoritza  was  located  Niksic,  a  city  of  some  five 
thousand  population.  There  the  commission  established  a  hos- 
pital of  thirty  beds  and  maintained  a  dispensary  and  visiting 
nurse  service ;  Emily  Chancy,  Emma  Robbins  and  Edith  Bur- 
gess were  on  duty.  Two  of  these  nurses  also  assisted  in  con- 
ducting the  soup  kitchen  'Svhere  we  saw  the  same  ragged  and 
underfed  people,"  wrote  Miss  Hay,  "and  many  children  shiver- 
ing in  the  cold  wind  which  comes  down  from  the  snowy 
mountains." 

The  Podgoritza  unit  endeavored  to  extend  its  work  to  Ko- 
lashin,  a  mountain  town  northeast  of  Podgoritza,  and  nurses 
and  other  Red  Cross  personnel  were  sent  up  during  the  spring 
of  1919.  Throughout  Montenegro,  the  American  Red  Cross 
hospitals  and  dispensaries  treated  many  peasant  farmers  and  in 
Kolaskin  the  nurses  tried  to  do  rural  visiting  nursing.  Local 
bandits  made  such  work  unsafe,  however,  and  finally  the  unit 
was  recalled  to  Podgoritza. 

South  of  Podgoritza  was  Cetinje,  capital  city  of  ]\Iontenegro. 
It  also  had  a  population  of  five  thousand.  The  iVmerican  Red 
Cross  Hospital  which  was  established  there  was  located  in  a 
building  known  as  the  Prince's  Palace.  Elizabeth  ^litchell, 
the  nurse  in  charge,  finally  transformed  the  Palace  from  a 
dirty  and  inadequately  equipped  hospital  into  one  which  was 
attractive  and  at  least  sanitary.  In  connection  with  the  hos- 
pital, a  day  nursery  for  children  of  working  mothers  and 
another  for  tuberculous  children  was  developed. 

At  Cetinje  a  ]Montenegrin  women's  club  had  organized 
the  only  orphanage  which  existed  early  in  1919  in  the  small 
principality.  ^liss  Alitchcll  became  interested  in  it  and  tlie 
commission  furnished  food,  clothing,  bedding  and  tooth 
brushes  (and  considerables  advice  in  the  use  of  these  articles) 
to  the  ragged  yet  happy  youngsters. 

One  of  the  American  Red  Cross  nurses  at  Cetinje  was  Ber- 
nice  Brady,  a  public  health  nurse.     She  wrote: 

Cetinje  docs  not  look  as  if  it  had  five  thousand  inhabit- 
ants, but  practically  every  room  housed  an  entire  family. 
Naturally,  sanitary  conditions  were  inipossil)le.  We  often 
ejaculated,  "What  a  hardy  race!"  but  wc  only  saw  those  able 
to  survive  the  crowded  housing,  the  scarcity  of  fuel,  the  lack 
of  clothing  and  food  in  winter  snows  and  cold  spring  rains 
and  hot  dry  months  when  water  is  of  necessity  rationed.    The 


An  American  Red  Cross  nurse,  Jeannie  Frasier.  instriictinpr  two  pupils 
of  a  Little  Mothers'  class  in  elementary  nursing  procedure,  Podgoritza, 
Montenefirro. 


wm  w  p  ■»  »> 


An  American  I'ed  Cross  nurse  and  her  interpreter  pivinp  a  lesson  in  Home 
Hygiene  and  Care  of  tlie  Sick  to  a  grouj)  of  refuurces  in  Tirana.  Albania. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1107 

country  is  mountainoiis  and  unproductive,  ricli  in  only  one 
thin<^, — history  and  tradition.  (Tlie  Albanians  say  that 
St.  Peter  was  horn  in  a  wayside  hovel  Ix'tween  Cetinje  and 
Podgorit/.a,  l)ut  do  not  ex])lain  his  subsequent  change  of  resi- 
dence.) The  story  of  Montenegro  is  one  of  constant  fighting 
to  retain  their  freedom  and  they  boast  that  they  have  never 
been  conquered. 

The  men  are  used  for  the  Army  and  the  women  do  prac- 
tically all  the  manual  labor.  'J'he  birthrate  is  low  and  the 
infant  mortality  high,  to  judge  from  observations.  Practi- 
cally no  records  are  kept  and  birth  registration  has  yet  to  be 
introduced.  Aside  from  a  fe^v  of  the  up])er  class,  women  have 
little  or  no  education.  Widows  predominate  and,  as  there  are 
no  industries  and  they  usually  have  several  small  children  to 
care  for,  they  earn  a  meager  living  by  buying  and  selling  in  a 
peddler  fashion,  journeying  over  the  mountains  on  foot  and 
returning  with  supplies  on  their  backs.  They  are  often 
absent  for  four  days  and  in  that  time  the  children  at  home 
fend  for  themselves. 

Many  of  the  poorer  people  live  in  stone  hovels.  When  they 
have  wood,  they  build  their  fire  on  the  dirt  floor  and  huddle 
about  it  in  rags  such  as  one  cannot  imagine  in  one's  wildest 
dreams  rf  poverty.  Even  with  all  the  patches,  many  are 
scarcely  covered. 

Wliorovor  ]\riss  Tlay  and  her  nurses  went,  they  carried  with 
tliem  the  i(l(>as  of  sanitation  and  orderly  living,  which  are  the 
Inundation  stones  of  sound  nurse  education,  and  they  strove  to 
}>ass  these  princi]>les  on  to  the  natives  with  whom  they  worked, 
^rontcnegro  in  1010,  lunvever,  was  not  a  fertile  field  for  such 
ideas  to  take  root.  At  Xiksic,  Miss  Chancy  and  Miss  Rohbins 
were  able  to  instruct  their  native  aides  with  considerable  suc- 
cess, but  the  brave  plans  for  introducing  the  class-work  in  Home 
IFygiene  and  ("an^  of  the  Sick  which  were  initiated  by  ^Fiss 
Hay  and  th(>  "Kolo  Society,"  a  women's  organization  at  Pod- 
goritza,  did  not  develop. 

The  American  Red  Cross  Commission  for  Albania,  of  which 
^Tajor  lutbcrt  C.  Dcniiisoii  was  tli(>  first  commissioner  and 
Caroline  K.  Robinson  sii])crvisor  of  the  fourteen  nurses,  ar- 
rived in  Albania  bite  in  T'ebruary,  1010,  and  (levelo])ed  in  six 
Albanian  cities  the  hos])ital,  dispensary,  visiting  nurse  and. 
civilian  relief  service  which  formed  the  chief  phases  of  Ameri- 
can lied  Cross  relief  ihrouirh  the  ]>alkans. 


1108  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

To  Scutari,  the  most  northerly  and  the  largest  city  in  Al- 
bania, one  of  which  had  a  population  of  about  thirty-two  thou- 
sand, the  commission  sent  a  unit  of  eleven  American  Red 
Cross  workers.  Four  of  these  were  nurses,  with  Ella  McGovern 
as  head  nurse.  Tlie  city  boasted  of  the  only  hospital  in  Al- 
bania and  to  it  the  commission  gave  supplies  and  raised  its 
capacity  to  one  hundred  and  thirty-five  beds,  instead  of  de- 
veloping a  separate  institution.  Xeed  existed,  however,  for  a 
dispensary,  so  the  commission  established  one  which  by  July  1 
had  treated  2606  cases. 

The  visiting  nursing  at  Scutari  which  was  first  developed  by 
Viola  Nohr  and  Leslie  Wentzel  was  comparatively  successful. 
By  July  1,  the  nurses  had  made  1349  calls.  Scutari  main- 
tained an  orplianage  for  thirty  girls  and  to  it  the  commission 
gave  food  and  clothing.  Miss  McGovern  lectured  there  on 
simple  questions  of  hygiene.  Similar  health  talks  were  given 
by  her  in  the  city  schools  and  in  the  American  Red  Cross 
sewing  rooms,  established  to  give  training  and  employment  to 
women. 

South  of  Scutari  the  Mati  River  flowed  to  the  Adriatic  Sea 
and  the  early  spring  rains  swelled  it  into  a  torrent.  During 
the  Austrian  invasion  in  1915,  the  only  bridge  spanning  it 
had  been  destroyed  and  in  1919  had  not  been  rebuilt.  Travel 
was  possible  only  by  motor,  carts  or  on  foot  and  the  roads  were 
poor.  AVhen  travelers  came  to  rivers  such  as  the  Mati,  they 
had  to  cajole  the  native  ferrymen  to  convey  them  across  at 
cost  of  many  words  and  numerous  coins.  Nevertheless,  the 
commission  strove  to  establish  dispensaries  in  small  and  iso- 
lated Albanian  towns  and  with  true  zeal,  the  nurses  and  other 
workers  started  out  over  the  rough  but  always  picturesque  and 
often  beautiful  mountain  rjads.  Such  a  town  was  Kroya, 
where  Marion  Echtcrnach  and  Sarah  Buchannan  did  'S'isiting 
nursing  and  were  on  duty  in  the  American  Red  Cross  dis- 
pensary, ^liss  Bnchannan's  report  contained  an  interesting 
description  of  the  quaint  life: 

On  April  8.  1919.  after  three  hours  of  mountain  climbing, 
we  found  ourselves  on  tlie  side  of  one.  in  the  little  village  of 
Kroya.  the  home  of  the  Alhanian  hero,  Skender  Bey.  The 
streets  were  too  narrow  and  rocky  to  allow  our  camion  to  come 
into  the  tc)wn.  so  we  walked.  .  .  . 

Our  house  was  a  typical  rural  Alhanian  one;  although  it 
was  now,  it  was  made  of  old  material.    When  we  arrived,  men 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1109 

were  layin<^  a  concrete  floor  in  a  large  room  on  the  ground 
floor,  but  it  never  dried.  We  had  two  small  rooms  above  for 
tiie  four  of  us,  the  doctor,  the  interpreter  and  the  two  nurses, 
^liss  Kchternach  and  J  shared  the  same  room  and  used  it  also 
for  kitchen  and  dining  room. 

We  cooked  with  charcoal  on  a  three-legged  affair  called  a 
mongal.  We  followed  the  Albanian  custom  of  sending  our 
meat  and  pudding  out  to  be  baked.  One  day  I  attem))ted  a 
pie ;  in  lieu  of  a  board,  I  used  a  large  sheet  of  paper  and  my 
rolling  pin  was  a  milk  bottle.  Marvelous  to  say,  the  pie  was 
voted  a  success. 

In  a  fair-sized  room  in  the  next  house,  we  establislicd  our 
dispensary,  and  during  six  weeks  treated  tliirtcen  hundred. 
!Many  skin  diseases,  tuberculosis  of  the  bone  and  gastric  con- 
ditions were  prevalent.  The  stomach  troul)le  we  attributed 
to  the  almost  exclusive  diet  of  poorly  baked  corn  bread  and 
sour  milk. 

Unfortunately  our  supply  of  drugs  was  limited,  but  we  had 
quinine,  phenacetine  and  epsom  salts.  We  made  cough  sirup, 
using  as  a  basis  sugar  and  lemon  juice.  The  people  in  the 
village  were  absolutely  drug  famished;  tlie  Austrians  had 
taken  everything  and  nothing  had  been  imported.  Some  came 
and  said  they  were  not  sick  but  wanted  medicine  for  the  time 
when  they  woidd  be.  Others  reported  having  been  ill  five  or 
ten  years  ago  as  a  pretext  for  begging  medicine  now. 

In  another  town  where  there  was  a  pharmacy,  the  doctor 
gave  a  written  prescription  to  a  man  and  explained  that  in 
return  for  the  paper,  if  presented  at  the  pharmacy,  he  would 
receive  six  pills  and  that  he  must  take  one  of  these  every  day. 
On  the  sixth  day,  the  doctor  was  much  surprised  when  the 
patient  presented  liimself  with  a  small  scrap  of  the  prescrip- 
tion, and  the  request  that  he  might  receive  another.  On 
questioning  him,  the  doctor  found  that  he  had  taken  one-sixth 
of  the  pai)er  each  day.  ^lost  of  our  drugs  were  in  powdered 
form  and  we  found  that  the  patients  invariably  took  })aj)er 
container  as  well  as  the  powder. 

Taken  as  a  whole,  the  people  of  Kroya  wore  appreciative 
and  solf-rospocting.  "We  have  no  beggars,"  wrote  ^liss  Bu- 
channan. 

South  of  Kroya  was  Tirana,  an  inaccessihlo  liill-town  of 
twelve  hundred  inliahitants.  ''The  only  mode  of  travel  to  this 
town,"  wr()t(»  ^liss  l>ucliannan,  "is  hy  horseback.  The  road 
was  in  many  places  the  merest  trail,  st(M»p  and  rocky,  with  a 


1110  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

precipice  on  either  side,  so  that  one  false  step  of  your  horse 
would  be  fatal." 

Six  American  Red  Cross  nurses,  including  Miss  Robinson, 
the  head  nurse  in  Albania,  were  on  duty  at  Tirana,  some  of 
them  in  an  American  Red  Cross  hospital  of  thirty  beds.  Miss 
Buchannan  at  one  time  was  among  these  and  she  wrote: 

We  had  four  native  women  of  the  gipsy  class  for  assistants 
and  we  were  able  to  teach  them  quite  a  bit.  The  women  of 
the  upper  classes  cannot  be  induced  to  come  out  of  their 
seclusion. 

The  majority  of  our  patients  were  men,  many  of  them  gun- 
shot cases.  These  mountaineers  are  constantly  fighting  over 
some  ancient  family  feud. 

At  Tirana,  the  American  Red  Cross  maintained  an  active 
dispensary  service.  Two  of  the  nurses  did  district  work.  An 
interesting  development  of  the  Tirana  dispensary  was  a  mobile 
unit  which  operated  in  the  hill-towns  in  the  vicinity.  At 
Singerc,  this  unit  treated  374  patients  in  four  days.  Lucy 
Joaquim  was  the  public  health  nurse  who  accompanied  the 
mobile  dispensary  on  its  journeying.  The  unit  at  Tirana  also 
furnished  supplies  and  medical  and  nursing  service  to  a  local 
orphanage. 

Westward  from  Tirana  and  located  on  the  Adriatic  shore, 
was  the  capital  city  of  Albania,  Durazzo.  Two  nurses.  Barbara 
Sandmaier  and  Emily  Chancy,  did  some  temporary  nursing- 
there  but  were  transferred  in  ]\Iay  to  Tirana.  Sarah  Buchan- 
nan assisted  there  in  distributing  supplies  in  March  to  sixty 
children  who  attended  a  school  which  was  located  on  a  hill 
above  the  bomb-wrecked  town.  ''W^e  redressed  all  the  small 
children,"  wrote  ]\liss  Buchannan,  "but  had  nothing  for  the 
larger  ones.  The  children  were  very  modest  in  being  re- 
clothed;  some  of  them  showed  extreme  embarrassment.  This 
modesty  in  children  T  have  found  everywhere  in  Albania  and 
it  is  charming  to  see." 

Southwest  from  Durazzo  and  Tirana  was  the  hill-village  of 
Elbasan  and  there  two  nurses,  Annie  Slack  and  ^Margaret  Gar- 
retson,  did  disp(Misary  duty  and  visited  anu)ng  the  needy  and 
appreciative  Albanian  peasants. 

From  Elbasan,  Miss  Buchannan  went  out  with  a  mobile  dis- 
pensary to  Kavaja  and  during  the  four  days  the  unit  was  on 
duty  there,  they  treated  about  three  hundred  pati(>nts.     '"JMany, 


1l    ^^ 


(Above)    Tlie  open  sewers  of  Tirana, 
Albania. 


(Center)    An    Amcriian    Ivcd    Cros-; 
dispensary  in  Albania. 


(Lower)    A  mosque  of  Tirana. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1111 

we  felt,"  wrote  Miss  Buchannan,  "came  out  of  curiosity.  We 
saw  the  usual  amount  of  tuberculosis  and  the  syphilitic  condi- 
tions which  existed  in  other  towns." 

Koritza  was  the  farthest  south  city  in  Albania  wherein  the 
commission  developed  a  hospital  dispensary  and  visiting  nurse 
service.  Among  its  eight  thousand  residents  were  many  Chris- 
tians and  numerous  Americans  and  Albanians  who  had  been 
in  the  United  States.  Accordingly,  the  American  Red  Cross 
work  met  with  success. 

American  Red  Cross  nursing  service  in  Greece  was  marred 
by  organization  difficulties  which  rendered  the  work  of  the 
nurses  ineffective  and  after  some  nine  months'  endeavor,  all 
emergency  nursing  service  was  discontinued.  The  Commis- 
sion for  Greece,  of  which  ]\Iajor  Capps  was  in  command,  had 
arrived  in  Athens  in  October,  1918.  The  nursing  staff  of  the 
commission,  as  organized  in  the  United  States,  numbered 
seven  nurses.  Three  of  them  were  American  Red  Cross  nurses: 
Lena  Margaret  Johnson,  chief  nurse,  ^larie  Clare  Glauber  and 
Mary  Margaret  T\^non ;  the  other  four  were  Greek  nurses  who 
had  been  trained  in  America :  Marie  Zacca,  Elene  Inglisaki, 
Marie  Kouroven  and  ^Fargaret  Chrvsakis.  These  Greek 
women  had  been  sent  to  America  by  the  Greek  Government 
and  were  under  contract  to  render  five  years  of  service  to  the 
G]-cek  Red  Cross  on  completion  of  their  training.  In  the  sum- 
mer of  1!>18,  arrangements  were  effected  between  ]\riss  Delano, 
Commissioner  Capps  and  the  Greek  ^Finister  whereby  the 
American  Red  Cross  agreed  to  enroll  these  four  women  as 
members  of  the  Xursing  S(>rvice  and  send  them  to  Greece  with 
the  commission.  Upon  their  arrival  there,  thev  were  to  remain 
in  service  with  the  conmiission  as  long  as  they  were  needed 
and  wvYO  finally  to  be  transferred  to  the  Greek  Government 
for  the  fulfillment  of  their  contract. 

The  nurses  arrived  in  Athens  in  Xovember,  1018.  On  De- 
cember 17  ^liss  Chrvsakis  was  transferred  from  the  commis- 
sion to  the  Greek  IumI  (^ross  in  accordance  with  the  terms  of 
her  contract.  T]w  remaining  six  nurses  were  assigned  to  tem- 
porary duty,  half  of  tliein  in  a  Greek  military  hospital  in 
Athens  and  the  otJiers  in  a  Greek  military  hospital  at  Salonika. 

In  flanuarv,  l'.Ul»,  tli(>  nursing  staff  of  the  Commission  for 
Greece  was  augmented  by  the  arrival  of  two  additional  units 
of   the   American    Red    Cross    nurses.      The   first   unit,   which 


1112  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

consisted  of  six  of  the  nurses  of  the  original  Balkan  unit, 
with  Miss  Phelan  as  head  nurse,  had  been  sent  to  Athens  by 
Miss  Hay  in  Rome.  The  second  unit  arrived  in  Greece  ten 
days  after  Miss  Phelan's  group;  it  consisted  of  three  nurses 
with  Sarah  Addison  as  head.  Thus  the  total  nursing  strength 
of  the  Greek  Commission  numbered  eighteen  enrolled  nurses. 

By  the  middle  of  November,  1918,  the  executives  of  the 
commission  had  outlined  a  program  of  general  and  medical 
relief  work  throughout  Greece,  so  the  nurses  were  recalled 
and  assigned  to  different  posts  of  duty  under  various  members 
of  the  Commissioner's  staff.  The  work  which  tliey  accom- 
plished falls  into  three  principal  groups;  first,  civilian  relief 
among  the  Greek  refugees  in  Bulgaria  and  on  the  Aegean  Isles 
of  Samos,  Mitylene  and  Chios ;  second,  medical  relief  in  Mace- 
donia, Athens  and  Crete ;  and  third,  health  and  social  surveys 
made  on  Samos  and  Mitylene.  The  civilian  relief  rendered 
by  American  Red  Cross  nurses  will  first  be  described,  begin- 
ning with  that  given  to  Greek  refugees  in  Bulgaria. 

During  the  last  two  years  of  hostilities,  the  Central  Powers 
had  deported  many  Greeks  and  held  them  in  Bulgaria.  These 
unfortunates  were  beginning  to  come  home  late  in  1918,  so  the 
commission  established  relief  stations  along  the  railroad  leading 
from  eastern  Macedonia  into  Bulgaria.  At  these  relief  sta- 
tions, dispensary  service,  food  and  clothing  were  furnished  to 
the  rapatries.  Miss  Johnson  was  assigned  to  the  station  at 
Tirnovo-Sienieu  and  held  the  position  of  chief  nurse  of  the 
eastern  Macedonian  district.  Miss  Zacea  went  to  the  station 
at  Dedeagatch  and  Miss  Kouroyen  to  that  at  Xanthi. 

The  three  nurses  left  Athens  on  December  5  bound  for 
Drama,  where  the  British  forces  gave  them  rations  for  two 
days.     Miss  Hay  ^\'Tote: 

From  Drama,  they  went  on  their  way  in  a  freight  car,  quite 
empty.  Through  the  ingenuity  of  one  of  the  American  men, 
a  modicum  of  comfort  was  acquired;  beds  were  made  from 
boxes,  blankets  were  tacked  up  to  give  some  privacy.  In  this 
car,  ^liss  Johnson  and  two  men  lived  for  six  weeks  and  hsre 
they  entertained  eri  pnsmnt  the  Bulgarian  ^Minister  of  War, 
the  commander  of  the  French  armies  in  Greece,  the  faculty 
of  Robert  College,  Constantinople,  and  French,  G^-eek,  English 
and  Bulgarian  officers  galore. 

At  each  of  the  three  railroad  centers,  Tirnova-Siemen, 
Dedeagatch  and  Xauthe,  quarters  were  arranged  in  a  house  or 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1113 

freight  car  for  a  cook-house,  a  dispensary  and  living  places 
for  the  American  Ked  Cross  personnel.  Needed  supplies  for 
the  daily  distributions  were  arranged  for  in  cars  alongside. 
Hot  soup  and  bread,  or  rice  and  bread  were  ready  when  the 
trains  of  rapatries  arrived.  The  task  was  to  get  to  every 
person  in  that  sorry  crowd  that  needed  food,  clothing  and 
medical  care.  To  make  sure  that  no  one  would  be  overlooked 
meant  quick  and  systematic  work.  All  were  in  a  sad  state, 
emaciated,  ragged  and  dirty.  With  no  food  for  two  or  three 
days,  sick,  weak  and  cold,  they  had  been  huddled  together 
sixty  to  severity-five  m  a  car. 

In  this  miserable  and  destitute  company,  births  and  deaths 
were  frequent  occurrences,  and  one  given  duty  of  the  Ameri- 
can Red  Cross  at  each  station  was  the  burial  of  the  dead.  To 
tlie  new  mother  were  given  extra  food  and  such  wonderful 
baby  clothes  as  were  not  to  be  hoped  for  in  those  days  of  bitter 
want. 

From  Tirnova,  ]Miss  Johnson  sent  a  list  of  patients  who 
had  received  special  treatment  or  needed  further  care  to  Miss 
Zacca  at  the  next  American  Eed  Cross  station,  Dedeagatch. 
After  good  food  and  kindly  treatment  there,  the  rapatries 
went  on  to  Xanthe,  where  Miss  Kouroyen  and  her  helpers 
gave  them  needed  final  assistance  before  their  arrival  in 
Greece,  just  over  the  border 

By  January  11,  1910,  all  Greek  refugees  were  reported  to 
be  out  of  Bulgaria  and  the  American  Red  Cross  relief  stations 
were  closed,  with  a  record  of  having  cared  for  48,000  refugees. 

The  storied  isles  of  the  Aegean  Sea,  Samos,  Chios  and  ^Hty- 
lene  were  the  other  scenes  where  American  Bed  (^ross  nurses 
did  notable  civilian  relief  work.  To  Samos  on  February  1, 
1019,  a  subnuirine  chaser  of  the  American  Xavy  brought  the 
two  nurses,  Laura  Bunting  and  ^lary  Frances  Mingane,  and 
two  social  service  workers.  The  nurses  assisted  in  the  direction 
of  a  large  workroom  and  in  the  distribution  of  supplies.  When 
the  American  Bed  Cross  workroom  was  closed  on  May  16, 
1010,  5425  refugees  and  poor  on  the  isles  of  Samos  and  Nicaria 
had  been  aided  and  11,704  garments  distributed. 

Xorth  of  Samos  lay  the  Isle  of  Chios.  Miss  Johnson,  the 
chief  inirse  of  the  commission,  was  assigned  to  duty  there  by 
Commissioner  C^ipps  on  February  17  and  with  Dr.  Harriet 
Chirk,  established  a  dispensary  which  daily  treated  sixty  cases. 
It  was  closed,  however,  in  two  weeks  on  account  of  a  lack  of 
medical  supplies,  so   Miss  Johnson  assisted  in  the  distribution 


1114  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  food  and  clothing  until  March  21,  a  date  on  which  all  sup- 
plies were  exhausted.  "A  total  of  3120  families  (11,000  per- 
sons)," reported  ]\Iiss  Johnson,  '^received  both  food  and  cloth- 
ing. One  thousand  and  fifty  families  (7000  persons)  received 
only  food." 

i^orth  of  Chios  was  situated  the  Isle  of  Mitylene  and  there 
two  American  nurses,  Blanche  Gilbert  and  Mary  Fleming, 
conducted  a  work  room  in  which  30,347  garments  were  made  in 
six  weeks  and  later  distributed  with  food,  to  refugees  and  the 
poor  of  Mitylene,  Tenedos,  Embros,  Samothrace,  Lemnos  and 
Nudros.  ''There  was  nothing  done  in  this  group  of  islands," 
wrote  Miss  Gilbert,  "of  a  medical  or  nursing  nature.  The  con- 
dition of  the  refugees  is  fairly  good.  There  is  little  sickness. 
The  housing  is  impossible  but  the  homes  for  the  most  part  are 
clean,  but  with  very  poor  sanitary  facilities.  The  unfortunate 
people  have  received  so  much  aid  that  many  of  them  seem  to 
have  lost  their  self-respect  and  will  willingly  beg." 

The  program  of  American  Red  Cross  medical  relief,  as  was 
previously  stated,  contemplated  the  establishment  of  dispensary 
and  visiting  inirse  service  in  Macedonia,  Greece  and  the  large 
isles  in  the  Aegean  Sea.  Four  nurses,  with  Miss  Addison  as 
head  nurse,  were  ordered  to  Macedonia  late  in  January.  Miss 
Addison  established  headquarters  in  Kavala  and  with  her 
nurses,  cleaned  and  equipped  a  small  civil  hospital  there  and 
assisted  the  American  Red  Cross  doctor  in  establishing  and 
maintaining  a  dispensary  there  which  in  four  months  treated 
3598  patients.  The  public  health  nurses  made  270  visits  dur- 
ing the  same  periods  to  homes  of  dispensary  patients. 

To  Rodolivas,  a  village  near  Kavala,  were  assigned  two 
nurses,  Emily  Porter  and  Mary  Frances  JNfingane.  In  addition 
to  "specialing"  one  of  the  American  Red  Cross  personnel  who 
had  typhoid  fever,  the  two  nurses  assist(>d  in  the  treatment  of 
1150  pati(!nts  at  the  American  Ived  Cross  dispensary,  made  25 
home  visits  and  gave  instruction  and  distributed  clothing  to  530 
school  children,  all  in  a  period  of  tliree  months.  In  addition, 
]\Iiss  Porter  organized  and  directed  a  small  workroom  which 
employed  eight  women. 

At  Prava,  in  the  Kavala  district.  Miss  Zacca  developed  a 
dispensary  service  which  treated  b(>tweeu  February  10  and  May 
3,  3805  pati(>nts.  She  also  gave  nursing  care  to  thirty  patients 
in  their  homes  and  supervised  the  nursing  of  the  children  of  a 
local  ()r])lianage. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1115. 

North  of  Kavala,  was  the  village  of  Drama.  Four  American 
Red  Cross  iiiirsos  were  assigned  to  duty  there ;  they  gave  nursing 
care  to  sixteen  hundred  patients  in  a  Greek  hospital,  in  the 
Ameriean  Red  Cross  dispensary  and  in  their  homes.  The  work 
at  Drama  had  been  interrupted  by  the  assignment  of  two  of  the 
nurses  to  ''special"  an  American  Red  Cross  social  worker  who 
had  a  severe  case  of  typhus.  They  had  no  sooner  returned  to 
Drama  than  they  were  recalled  again  to  Kavala  to  nurse  an 
American  Red  Cross  physician,  also  stricken  with  typhus. 

Serres  was  a  small  mountain  town  northwest  of  Kavala  and 
to  dispensary  and  nursing  service  there,  three  nurses  were 
assigned  at  various  times. 

Even  though  the  nursing  service  in  the  Kavala  district  was 
interrupted  by  the  nursing  care  given  to  the  American  Red 
Cross  personnel,  its  accomplishment  was  commendable  and, 
wrote  ^liss  Hay,  "was  the  only  piece  of  general  medical 
relief  work  attempted  in  Greece.  Nurses  should  not,  however, 
be  left  alone  in  such  work  in  any  stations  as  were  Miss  Zacca 
and  Miss  Porter,  although  the  attitude  of  the  nurses  them- 
selves, in  such  lonely  assignments  as  in  the  care  of  the  typhus 
cases,  was  soldierly." 

The  nursing  service  in  the  Greek  Peninsula  centered  at 
Athens  and  consisted  in  baby  welfare  work  and  in  the  establish- 
ment of  a  school  of  nursing,  to  be  treated  later  by  ]Miss  Noyes 
in  Athens.  The  infant  welfare  program  iiicludt^d  a  bi-weekly 
baby  clinic  and  instruction  to  mothers  at  the  clinic  and  in  their 
homes.  IMargaret  T_>Tnon,  the  nurse  in  charge,  al.«o  conducted 
classes,  the  first  of  ten  and  the  second  of  fifteen,  to  train  young 
Greek  women  to  assist  in  infant-welfare  work. 

When  the  time  approached  for  ]\liss  Tymon  to  return  to  the 
Ignited  States,  the  American  Red  Cross  physician  advised  the 
Patriotic  League,  the  Greek  organization  which  was  to  take 
over  the  management  of  the  clinics,  that  an  untrained  woman 
would  meet  the  American  R(m1  Cross  requirements  as  Miss 
Tymon's  successor.  This  Gre(^k  woman  had  had  no  training 
either  as  a  nurse  or  an  infant  welfare^  workc^r.  ]\Iiss  Hay  finally 
prevailed  on  the  commission  and  the  Patriotic  Leaiiiie  to  refer 
the  matter  to  ^liss  Xoyes  at  Xational  Headquarters. 

Opposite  Athens,  on  the  western  shore  of  the  Peninsula  of 
Greece,  was  the  ancient  s(\i-town  of  Patras  and  tlierc^  the  com- 
mission on  ^larch  7  S(Mit  Ijlanclic  Kaccna  t(^  open  an  infant 
welfare   clinic.      On    April    2;>,    Miss    Gilbert,    an    cxpericMiced 


1116  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

infant  welfare  nurse,  arrived  and  subsequently  developed  an 
active  center.  The  prospect  for  a  permanent  station  at  Patras 
was,  however,  not  bright  "because,"  wrote  Miss  Torrance  to 
Miss  Hay,  ''the  poor  have  little  means  and  desire  on  account 
of  the  more  spectacular  demands,  resulting  from  the  war,  to  im- 
prove their  own  living  conditions  and  the  more  educated  and 
responsible  class  have  yet  to  feel  that  such  living  conditions 
among  the  poor  ought  not  to  be  tolerated." 

The  only  other  infant  welfare  station  which  was  developed 
by  the  commission  was  located  at  the  Isle  of  Crete.  Miss 
Phelan  and  Miss  Fleming  arrived  on  April  7  at  Canea,  the 
second  largest  city  on  the  island,  and  developed  baby  clinics 
there  in  cooperation  with  the  local  branch  of  the  Patriotic 
League.  Miss  Phelan  left  Canea  early  in  June  to  return  to 
the  United  States ;  Miss  Fleming  took  over  the  direction  of  the 
station  and  another  nurse.  Alma  Hartz,  was  assigned  to  duty 
there.  The  station  was  turned  over  on  July  1  to  the  Patriotic 
League  and  the  American  Red  Cross  nurses  withdrawn. 

The  two  health  surveys  conducted  by  the  commission  were 
made  by  Miss  Phelan  on  the  Isle  of  Mitylene  and  by  Miss 
Bunting  and  Miss  ]Mingane  on  the  Isle  of  Samos. 

Such  were  the  activities  and  accomplishments  of  the  nursing 
service  of  the  Commission  for  Greece.  The  efficiency  of  the 
nurses,  as  it  was  said  before,  was  marred  by  administrative 
difficulties.     Miss  Hay  wrote : 

The  nurses  of  the  Greek  Commission  were  a  fine  body  of 
women,  representing  a  high  order  of  ability,  experience  and 
devotion.  They  have  good  reason  to  resent  the  treatment 
accorded  them  and  l"o  deplore  the  fact  that  their  accomplish- 
ment in  actual  nursing  service  was  so  pitiably  small.  Xo  one 
resents  the  fact  that  they  were  used  so  largely  for  civilian 
relief  work ;  that  may  have  been  necessary.  What  seemed 
deplorable  was  that  the  advice  and  special  services  that  they 
as  nurses  were  so  well  qualified  to  render  were  never  asked  and 
rarely  accepted.  .  .  . 

In  the  summer  of  1919,  Miss  Hay  recommended  that  the 
American  Red  Cross  nurses  assigned  to  duty  with  the  Greek 
Commission,  be  withdrawn  at  the  end  of  their  six  months' 
term  of  service  and  that  they  be  returned  to  the  United  States. 
The  recommendation  was  accepted,  but  a  subsequent  change  of 
plans  later  permitted  the  development  of  a  child-welfare  pro- 
gram. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1117 

In  Serbia,  the  nursiiif^  service  was  more  extensive  than  that 
rendered  bv  the  commission  in  any  of  the  Balkan  States.  The 
headquarters  of  the  American  lied  Cross  Commission  for  Serbia 
were  located  in  Belgrade.  Rachel  Torrance,  Miss  Hay's  assist- 
ant, was  chief  nurse.  In  northern  Serbia,  twenty-two  nurses 
were  assigned  to  duty  and  they  used  as  bases  for  activities  ex- 
tendinu:  into  numerous  villages,  the  two  cities  of  Kragujevatz 
and  J'ozarevatz,  and  four  towns,  Cuprija,  Kraljevo,  Palanka 
and  Petrovatz. 

Kragujcvatz  was  located  south  of  Belgrade,  a  city  of  some 
eighteen  thousand  population.  To  it  the  commission  assigned 
Dr.  Harriet  Gervais,  a  physician.  Dr.  Marion  Stevens,  a  dentist, 
and  ^lary  B.  Boss,  a  nurse  who  had  had  much  experience  in 
social  service  work  in  New  York  City.  The  three  women  estab- 
lished sewing-rooms  where  Serbian  women  were  given  employ- 
ment in  making  garments  to  be  distributed  among  the  needy 
when  completed.  They  gave  professional  care  and  many  supplies 
to  about  one  hundred  and  thirty  orphaned  children  who  were 
being  cared  for  by  a  local  Serbian  welfare  organization.  The 
orphans  were  housed  in  one  of  the  former  royal  residences. 

Southeast  of  Kragujevatz  was  the  village  of  Cuprya  and  here 
two  American  physicians,  Captains  John  Voor  and  Thomas 
Lowe,  and  three  nurses,  Kathryn  Williams,  Inez  Gilliland  and 
]\Iarv  Snow,  established  a  hospital  and  a  dispensary.  "The 
unit  is,  to  mv  mind,"  wrote  Miss  Ilav,  "one  of  the  strongest  in 
Serbia." 

In  Kraljevo,  a  village  southwest  of  Kragujevatz,  the  com- 
mission established  a  dispensary  and  a  chain  of  sewing  rooms. 
1'he  clinics  were  small  enough  to  require  the  attention  of  only 
the  American  Bed  Cross  physician,  IJr,  ^larv  Elliott,  so  the 
two  nurses,  ^larietta  Wilsey  and  Sybella  Haviland,  gave  their 
entire  time  to  supervising  the  manufacture  of  garments  in  sew- 
ing rooms  at  Kraljevo,  !Milanovatz,  Chachak,  Terznik  and 
Kruslicvatz  and  distributing  food  supplies  and  the  finished 
garments  to  the  destitute  in  these  and  neighboring  villages. 
Generous  supplies  of  linen  and  hospital  garments  were  made 
and  given  to  the  local  Serbian  Hospital. 

Xorth  of  Kragujevatz  was  situated  th(>  village  of  Palanka 
and  there  the  American  Bed  Cross  inirses  renovated  a  hospital 
where  conditions  existed  similar  to  those  encountered  by  the 
nurses  of  the  Gcn-geli  Fnits  of  l!tl4  and  in  d(\u're('  if  not  in 
extent,  bv  ]\Iiss  Xiu'htinii-ale  herself  at  Scutari.      Harriet  L(H'te 


1118  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

and  Lieutenant  McNabb  of  the  Balkan  Commission  inspected 
the  Palanka  Hospital  on  March  11,  through  the  courtesy  of  the 
one  over-worked  Serbian  physician  who  alone  was  trying  to 
meet  the  medical  needs  of  the  hospital  and  a  district  of  some 
hundred  thousand  residents.     Miss  Leete  wrote: 

In  front  of  the  Palanka  Hospital,  the  yard  was  filled  with 
mud  and  filth.  In  the  rear  were  trenches  which  were  used  as 
toilets.  Sanitary !  Yes,  there  were  toilets,  but  they  were  in 
an  impossible  condition. 

All  refuse  and  excreta  from  the  hospital  was  thrown  into  a 
ditch  which  emptied  near  the  open  well.  The  condition  of  the 
surrounding  fields  was  even  more  dangerous.  .  .  . 

The  hospital  was  a  military  one  and  was  filled  with  Serbs 
and  prisoners.  When  we  arrived,  there  were  297  patients  and 
thirty  beds.  The  main  corridors  were  fairly  clean,  but  lead- 
ing from  each  wing  were  outside  entrances  and  one  of  these 
halFways  was  used  as  a  toilet-room,  no  conveniences,  just  tlie 
floor,  part  of  which  was  tiling,  with  the  doorway  of  earth. 
From  the  hallway  the  stench  penetrated  throughout  the  long 
corridors. 

In  the  hallway  adjoining  the  other  wing,  Lieutenant 
JMcjSTabb  and  I  discovered,  apparently  thrown  in  and  piled 
one  upon  another,  at  least  twenty  bodies  of  patients  who  had 
died  in  the  hospital.  The  daily  death  rate  at  that  time  was 
from  ten  to  twenty  and  frequently  the  bodies  were  allowed  to 
remain  there  for  several  days.     It  was  a  ghastly  sight. 

In  the  wards  where  the  thirty  beds  were,  the  patients  were 
lying  on  the  few  mattresses  or  on  the  boards.  The  cots  had 
no  springs.  In  the  other  wards  they  lay  close  together  on  the 
floor,  sometimes  with  dirty  straw  for  bedding.  Tuberculosis, 
dysentery  and  pneumonia  cases  all  in  the  same  ward.  White 
faces!  White  as  the  ones  in  the  morgue.  ^Many  coughing, 
many  more  too  weak  to  move  and  apparently,  from  the  odors 
in  the  ward,  they  were  going  without  any  care. 

The  doctor  said  that  there  were  orderlies.  It  took  some 
time  to  discover  them,  as  they  were  soldiers  who  spent  most  of 
their  time  in  the  office  or  in  the  kitchen.  .  .  . 

On  ^Farch  14,  ]\riss  Leete  returned  to  Belgrade  and  asked 
that  she  be  reassigned  to  Palanka  with  supplies  and  a  sufficient 
number  of  nurses  to  clean  up  the  hospital  and  train  the  orderlies. 
Four  days  later,  she  and  another  nurse,  Faith  Denison^  reported 
to  Lieutenant  AlcXabb,  wlio  had  remained  at  Palanka,  and  they 
began  the  renovation  of  the  hospital.      Two   more   American 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1119 

nurses,  Ek^anor  Blackstone  and  !Marie  McDowell,  arrived  on 
]\Iarch  2()  and  the  Serbians  sent  ten  soldier-orderlies  and  sorno 
Serbian  nurses  from  Bel^ade.  By  April  .'5,  M  iss  Leete  and  her 
nurses  had  changed  conditions  to  such  an  extent  that  the  death 
rate  had  ceased,  ^fiss  Denison  came  down  with  typhus  on 
April  11  and  some  twelve  days  later,  j\Jiss  Ix^'te.  The  two 
other  American  nurses  cared  for  them  and  they  returned  in  the 
summer  of  1919  to  the  United  States.  All  American  Red 
Cross  activities  in  Palanka  were  discontinued  late  in  May. 

To  Betrovatz,  a  village  east  of  Palanka,  the  Commission  for 
the  Balkans  sent  two  physicians.  Alberta  Greene  and  Marjorie 
Buriduim,  and  two  nurses,  Anne  O'Hara  and  Laura  Lowe 
Kreigh,  They  developed  a  large  dispensary  service  at  Petro- 
vatz  which  treated  about  one  hundred  cases  a  day,  and  once  a 
week  held  clinics  in  the  neighboring  villages  of  Scotonje,  ]\Ie- 
lenica,  Pashanatz  and  Ilunovitch.  A  small  hospital  was  opened 
during  the  summer  in  an  old  building  outside  the  village. 

Xorth  of  Petrovatz  was  situated  Pozarevatz,  a  city  of  thirteen 
thousand  inhabitants,  and  here  the  commission  developed  a  gen- 
eral hospital,  and  dispensary,  a  tuberculosis  hospital  and  a 
bouncing  orphanage.  Two  physicians,  Egbert  Borgeson  and 
David  Kadesky  and  three  nurses,  Jennie  Hoagland,  head  nurse, 
Efiie  Swayze  and  ]Mary  Bicketts,  were  on  duty  there.  The  hos- 
pital was  of  thirty-four-bed  capacity  and  in  it  an  active  operative 
service  was  maintained.  At  the  dispensary  connected  with  it, 
clinics  averaging  forty  patients  daily  were  held.  Miss  Hay 
described  the  typo  of  cases  treated : 

An  Albanian  woman  with  inoperable  carcinoma,  who  en- 
treated the  doctors  to  operate  if  there  was  a  single  chance, 
stating  tliat  she  would  gladly  take  all  responsibility;  a  mini- 
ber  of  women  with  female  disorders;  eczema  of  the  breast; 
much  bont'  tuberculosis;  an  accident  case,  a  young  man  who 
had  fallen  from  a  hay  wagon  on  to  a  bay  fork,  dying  soon 
afterwards  from  a  ruptured  spleen;  a  badly  emaciated  child 
with  tender  abdomen  who  wailingly  refused  hospital  treat- 
ment. .  .  . 

On  t]\o  outskirts  of  the  town,  set  among  a  grove  of  trees  on  a 
slight  rise  of  land  was  the  attractive  and  well-equipped  Tuber- 
culosis Hospital.  There  were  accommodations  for  thirty  odd 
patients  but  when  Miss  Hay  inspected  it  in  -lune,  there  were  only 
fourteen.      **'rbe  discouragenuMit   in  the  work  thus  far,"'  wrote 


1120  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Hay,  "has  been  the  unwillingness  of  the  patients  to  stay 
long  enough  to  get  benefit  from  the  treatment." 

To  a  local  orphanage  where  thirty  young  Serbs  were  being 
cared  for,  the  unit  at  Pozarevatz  gave  food,  clothing,  linen  and 
medical  attention. 

South  Serbia  was  honey-combed  with  relief  activities  of  the 
American  Red  Cross.  In  nine  towns  and  their  outlying  vil- 
lages, the  commission  conducted  general  and  medical  relief. 
Thirty  American  Red  Cross  nurses  were  assigned  to  duty  there. 

Southwest  of  the  city  of  Nish  in  central-eastern  Serbia  was 
Pirot,  an  inaccessible  town  of  eleven  thousand  inhabitants  lo- 
cated near  the  Bulgarian  frontier.  Five  Americans  were  on 
duty  there,  the  physician,  Captain  Herman  Hundling,  two 
nurses,  Eva  Ferris  and  Mrs.  Maud  Metcalf,  the  nurse  who  liad 
served  in  Belgrade  in  1915,  and  two  civilian  relief  workers, 
Alida  Bigelow  and  Frangoise  de  Bacourt.  Pirot  had  a  clean 
and  well-run  civil  hospital  and  to  it  the  commission  gave 
many  supplies.  Captain  Hundling  maintained  a  dispensary 
which  treated  a  daily  average  of  fifty  patients  and  the  nurses 
aided  him  there  and  did  district-visiting.  The  nurses  also 
assisted  in  the  distribution  of  food  and  clothing  throughout  the 
Pirot  district. 

Leskovac  was  a  town  of  fourteen  thousand  population  and 
was  located  southwest  of  Pirot.  On  duty  at  Leskovac  were  two 
nurses  of  the  commission,  Sara  Crosley  and  Esther  Rose,  and 
an  enrolled  American  Red  Cross  nurse,  Phebie  Whedon,  who 
had  gone  to  Serbia  in  1!)11:  as  a  member  of  the  Franco-Serbian 
Relief  Association  and  had  later  worked  under  Dr.  Ryan  after 
he  had  taken  over  the  activities  of  the  Franco-Serbian  Relief 
Association.  Miss  Whcdon  had  charge  of  the  distribution  of 
supplies  and  Miss  Crosley  and  ^liss  Rose  were  on  duty  in  a 
military  hospital  where  two  hundred  and  fifty  Bulgarian 
prisoners  had  been  receiving  the  medical  and  nursing  care 
typical  of  Serbian  hospitals.  Although  the  advent  of  the  Ameri- 
can nurses  was  not  hailed  with  enthusiasm,  they  did  good  work 
in  clearing  up  the  building,  requisitioning  American  Red  Cross 
supplies  and  instructing  the  orderlies  in  the  use  of  them  and 
giving  the  patients  the  needed  surgical  nursing  care.  The  ma- 
jority of  the  Bulgars  were  invalided  home  in  May  and  the  two 
nurses  were  transferred  to  Vranja. 

This  town  of  eleven  th(uisand  souls  was  situated  south  of 
T-eskovac,  on  the  single  railroad  which  bisected   Serbia  loii^-i- 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1121 

tudinally  from  Gcvgeli,  on  the  Greek  border,  to  Belgrade,  on 
the  Anstro-llnngarian  frontier.  Medical  relief  work  at  Vranja 
centered  abont  the  Scottish  Women's  Hospital  and  ^liss  Crosley 
and  ^liss  Rose  conducted  an  extensive  dispensary  service  in 
connection  with  it.  The  Scottish  Women's  Hospital  Unit  on 
duty  at  Vranja  in  1919  had  come  to  Serbia  in  Sept^'mber,  1910, 
had  been  assigiied  to  duty  at  Ostrovo  and  after  an  active  service 
there  had  been  transferred  in  October,  1918,  to  Vranja  to  care 
for  typhus  patients. 

There  were  many  orphans  in  Vranja  and  the  commission 
maintained  there  soup  kitchens,  an  orphanage,  and  sewing  rooms 
for  girls.  Helen  King,  a  graduate  of  the  Massachusetts  Gen- 
eral Hospital  School  but  not  an  enrolled  American  Red  Cross 
nurse,  was  in  charge  of  this  work  and  was  assisted  by  a  young 
Scotch  woman,  Vida  Matheson. 

Southwest  of  Vranja  and  near  the  Albanian  frontier  was 
Prizren,  the  fifth  largest  city  in  Serbia.  Here  the  commission 
assigned  two  surgeons  and  a  physician  and  four  nurses,  includ- 
ing ]\Iildred  Williamson,  the  supervising  nurse,  and  they  de- 
veloped a  hospital  of  seventy-seven  beds,  an  orphanage  where 
eighty-four  young  Serbs  were  cared  for,  and  a  soup  kitchen 
which  daily  fed  five  hundred  people.  Captain  M.  R.  Bradner 
was  in  charge  of  these  activities. 

The  hospital  was  picturesquely  located  on  the  banks  of  a 
swift  mountain  stream.  It  maintained  an  active  operating 
room,  surgical  wards  and  two  isolation  tents  for  the  treatment 
of  tuberculosis  patients,  and  across  the  turbuknit  water-course 
and  reached  by  a  small  foot  bridge,  a  two-story  building  which 
housed  the  medical  wards.  "The  entire  hospital  at  Prizren,"' 
concluded  Miss  Hay,  "in  the  care  given  the  patients  both  by 
doctors  and  nurses  and  the  cleanliness  and  thrifty  management 
apparent  on  every  side,  is  pleasingly  American." 

In  all  the  Balkan  States,  the  American  nurses  and  surgeons 
did  the  work  closest  at  hand  and  most  deserving  of  immediate 
attention.  In  some  towns,  this  means  the  establishment  of  s()Uj> 
kitchens  and  dispensaries  for  the  civilian  population.  In  other 
towns  were  native'  military  hospitals  where,  like  festering  sores 
of  war,  the  wounded  were  still,  even  as  late  as  the  midsummer 
of  1919,  being  cared  for  in  the  haphazard  methods  which  char- 
acterized the  treatment  of  the  sick  and  wounded  throughout 
eastern  Kurope.  Such  a  town  was  Skoplje,  wliicli  was  located 
southeast  of  Prizi-cn  and  to  it  in  February,  1919,  went  a  unit 


1122  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  six  American  Red  Cross  nurses,  with  Eleanor  Wilson  as 
supervisor.  They  were  first  on  duty  in  the  Vardar  Hospital 
but  in  April,  all  the  patients  there  were  transferred  to  the  big 
Half  Moon  Serbian  Military  Hospital  in  the  western  section 
of  the  town.     Miss  Hay  wrote : 

In  such  a  report,  it  is  not  possible  to  portray  the  sweeping 
changes  that  were  made  in  the  departments  given  over  to  our 
nurses  in  both  the  Vardar  and  Half  Moon  Hospitals.  But 
they  worked  such  seeming  miracles  in  order,  cleanliness  and 
efficient  care  that  even  the  most  indifferent  of  the  officials  took 
notice  and  begged  for  the  continuance  of  their  services.  The 
infinitely  greater  comfort  and  the  more  kindly  treatment 
which  their  services  meant  for  the  patients  themselves  is  also 
a  thing  which  cannot  be  told. 

Gostivar  was  a  town  located  south  of  Prizren  and  southwest 
of  Skoplje.  A  unit  of  six  American  Red  Cross  workers  were 
assigned  to  duty  there;  Lieutenant  Theodore  Reed  was  the 
physician,  Eugenia  Bogart  was  supervisor  of  the  three  other 
nurses  and  Geneva  Bateman  was  in  charge  of  civilian  relief 
work.  They  established  a  hospital  of  twenty-five  beds,  a  dis- 
pensary with  a  daily  average  attendance  of  one  hundred  and 
twenty-five  patients  and  conducted  visiting  nursing  and  general 
relief  in  the  adjoining  mountain  villages. 

The  hospital  was  a  trim  and  thoroughly  model  little  Ameri- 
can institution  set  down  among  the  Serbian  foothills.  Even 
the  American  Red  Cross  personnel  house  reflected  ingenuity 
and  high  standards  of  cleanliness.  ''Althongh  there  is  no 
kitchen,"  wrote  ]\Iiss  Hay,  "and  the  meals  are  prepared  on  the 
porch,  regardless  of  wind  and  weather,  they  are  good.  Miss 
Bogart  acts  as  housekeeper.  One  chief  distinction  of  this  unit 
is  the  possession  of  a  big,  tin-lined  serviceable  bath-tub,  impro- 
vised from  a  tin-lined  tobacco  case  and  large  enough  to  accom- 
modate (with  careful  adjustment)  even  a  full  grown  man.  This 
tub,  like  other  conveniences  at  Gostivar,  is  due  to  Dr.  Reed's 
inventive  gifts." 

Monastir,  second  largest  city  in  Serbia,  was  situated  south 
of  Gostivar  in  the  southwestern  corner  of  the  small  principality. 
Two  groups  of  American  Red  Ch-oss  personnel  were  on  duty 
there.  The  first  group  consisted  of  four  nurses,  with  Elsie 
Jessnp  as  head,  and  they  served  in  the  American  Women's 
Hospital ;  the  second  group  consisted  of  one  nurse  as  supervisor, 


H  !i  II  1  i  n  g  the 

wouiided    in    carts    to 
\'ranja,  Serbia. 


An  American 
Rod  Cross  nurse 
hrinpin<j  in  a  pa- 
tient t<i  the  I)is- 
pensarv  at  Tirana, 
Albania. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1123 

Emma  Hart  Rogers,  and  two  civilian  relief  workers  and  they 
conducted  a  sewing-room  and  distributed  material  relief  among 
the  destitute  in  the  city. 

The  American  Women's  Hospital  was  of  fifty-bed  capacity 
and  WHS  under  the  direction  of  two  American  physicians  who 
had  been  in  Serbia  since  January,  1918, — Dr.  Regina  Keyes 
and  Dr.  Mabel  F.  Flood.  The  American  Red  Cross  nurses 
went  on  duty  in  the  hospital  in  January,  1919.  An  active 
dispensary  service,  averaging  150  patients  daily  except  on  mar- 
ket days,  when  the  numbers  ran  as  high  as  280,  was  maintained 
in  connection  with  the  American  Women's  Hospital,  but  the 
nurses  of  the  Balkan  Commission  were  not  on  duty  there. 

American  Red  Cross  civilian  relief  in  Monastir  consisted  in 
the  maintenance  of  a  sewing-room,  where  garments  were  made, 
and  of  a  bathhouse  which  the  Serbians  were  required  to  use 
before  they  were  given  the  Red  Cross  clothing.  Two  nurses 
were  in  charge  of  these  projects,  Kate  Macfadden  of  the  bath- 
house and  -Miss  Rogers  of  the  sewing-room  and  personnel  house. 

Kavadar  was  a  village  which  lay  north  and  east  of  Monastir. 
There  the  commission  developed  an  active  dispensary  and  an 
orphanage  and  conducted  general  district,  tuberculosis  and  in- 
fant welfare  nursing  service.  The  personnel  consisted  of  Cap- 
tain R.  ^r.  Blakely,  the  physician;  four  nurses  with  Maud 
Heath  as  head  nurse ;  and  one  civilian  relief  worker. 

The  dispensary  was  located  in  three  large  rooms  of  one  of 
the  municipal  buildings.  The  attendance  averaged  over  a  hun- 
dred, with  two  hundred  on  market  days.  The  patients  were 
usually  cases  suffering  from  the  explosions  of  ''duds" ;  bone 
tuberculosis  in  advanced  stages ;  tuberculosis  of  the  eyes ;  pel- 
lagra and  the  like.  A  branch  dispensary  was  maintained  at 
iS'egotin,  a  neigliboring  village. 

In  the  Kavadar  district  were  some  four  hundred  orphans 
and  among  thcni  were  stray  waifs  unclaimed  by  relatives  or 
friends.  For  these  the  American  Red  Cross  representatives 
establislied  an  orphanage  which  in  June  had  twenty-eight 
charges.  One  of  them  was  a  seemingly  timorous  Turkish  hid 
who  "was  afraid,"  wrote  ^liss  Hay,  "that  the  Serbian  boys 
would  whip  him  so  came  protected  with  a  dagger  concealed  in 
his  blouse." 

The  public  health  nursing  service  at  Kavadar  was  perhaps 
the  most  inten^sting  phase  of  American  Red  C^ross  endeavor 
there.     From  the  dispensary,  the  nurses  followed  their  patients 


1124  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

home  and  brought  into  many  south  Serbian  houses,  soap,  light, 
air  and  general  order.  This  union  of  old-world  customs  of 
living  and  new-world  methods  (for  public  health  nursing  was 
primarily  an  American  development)  was  often  full  of  uncon- 
scious pathos.     Miss  Hay  wrote: 

In  a  Turkish  family  where  the  mother  had  died  of  tuber- 
culosis, leaving  a  two-year-old  tuberculous  baby,  the  father 
did  his  best  to  carry  out  the  nurse's  instructions  and  on  the 
morning  we  called  M-e  found  him  gone  to  his  work  but  the 
baby  well  wrapped  up  and  sitting  out  of  doors  in  the  sunshine, 
getting  strong  and  well. 

During  the  month  of  April,  1919,  one  thousand  six  hundred 
and  fifty-three  patients  were  treated  at  the  Kavadar  dispensary 
and  twenty  per  cent  of  them  w^re  suffering  from  tuberculosis. 
These  cases  included  all  types  of  the  disease,  eye,  bone,  glandu- 
lar, pulmonary  and  that  of  other  internal  organs.  The  victims 
made  no  effort,  previous  to  the  advent  of  the  American  Red 
Cross  nurses,  to  treat  the  disease  according  to  modern  methods. 
''One  woman,"  wrote  Miss  Hay,  "brought  from  a  village  fifty 
kilometers  distant,  her  two  daughters,  both  of  whom  had  tu- 
berculosis of  the  left  hand.  The  wounds  had  never  been  dressed 
with  anything  other  than  leaves." 

The  infant  w^elfare  work  at  Kavadar  w^as  very  appealing  to 
the  American  nurses.  Ursula  Tibbels  was  the  nurse  in  charge 
of  it  at  Kavadar  and  Miss  Heath  at  Negotin  and  they  held  baby 
clinics  and  distributed  American  Red  Cross  layettes.  Miss 
Hay  wrote: 

Such  pitiful  rags  as  were  taken  off  the  wee  Serbian  babies, 
— rags  such  as  an  American  mother  could  never  imagine  as 
any  baby's  best  clothes.  And  in  place  of  these,  we  gave  the 
Red  Cross  layettes,  line  knit  shirts,  downy  flannelette  shirts 
and  dress  and  a  warm  baby  cape  and  hood;  soap,  talcum 
powder,  wash  cloths,  towels,  and  a  package  of  twenty-four 
diapers,  so  clean  and  new  that  we  could  only  with  ditticulty 
persuade  the  mothers  to  put  them  to  their  intended  use.  If 
the  baby  was  in  the  least  dirty,  or  if  the  clothes  or  rags  about 
the  baby  were  not  clean,  then  the  layette  was  withlield  until 
the  mother  had  remedied  these  faults.  Each  mother  was 
required  to  put  the  new  clothes  on  the  baby  to  .show  us  that 
she  had  really  profited  by  our  instruction  and  it  was  a  radiant 
and  wondering  baby  and  a  very  proud  mother  whidi  soon 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1125 

confronted  us.  It  was  a  fine  gift  to  the  patient  and  denying 
Serbian  mother,  tiiat  hiyette  from  American  women's  hands, 
but  best  of  all  it  meant  a  clean  and  comfortable  and  therefore 
a  happy  baby.  In  the  month  of  May  eighty-five  layettes  were 
given  out. 

South  of  Kavadar  and  the  ninth  town  in  southern  Serbia 
where  the  commission  developed  emergency  relief  activities  in 
1919,  was  the  border-town  of  Gevgeli.  Of  the  plight  of  the 
village  and  district  in  1919,  Miss  Hay  wrote: 

Situated  in  the  midst  of  an  important  fighting  center, 
Gevgeli  is  now  little  more  than  a  pile  of  stone  and  crumpled 
mud  walls.  Whatever  escaped  shot  and  shell  was  licked  up  by 
the  flames  of  the  retreating  Army  or  has  long  since  gone  to 
cook  the  soldier's  soup  or  to  warm  a  shivering  family.  Such 
a  burned-out  ruin  is  the  big  tobacco  factory  in  which  was 
located  in  1914  the  Military  Hospital  wherein  the  American 
lied  Cross  nurses  and  doctors  fought  typhus.  In  the  cemetery 
nearby  is  Dr.  Donnelly's  grave.  .  .  . 

The  Gevgeli  district  consists  of  seven  townships  and 
twenty-one  villages,  with  a  total  of  '^000  families  and  10,000 
population.  .  .  .  Helen  Lydia  Bailey  was  the  nurse  in  charge 
of  all  work  there  and  was  for  a  month  the  only  American 
Eed  Cross  representative.  In  this  time,  she  treated,  quite 
alone,  some  five  hundred  patients;  she  was  altogether  without 
a  doctor's  advice,  a  state  of  affairs  which  should  not  be,  as  the 
responsibility  of  life  is  too  great.  On  April  18,  Edith  L. 
Wood,  a  nurse,  arrived  and  took  over  the  dispensary  work 
and  some  of  the  visiting  nursing,  and  on  ^fay  13,  Eleanor 
Wilson  was  sent  down  and  took  charge  of  the  sewing-room  in 
Gevgeli  and  the  organization  of  similar  ones  in  adjoining 
villages.  Dr.  Smith  arrived  about  ]\Iay  1  and  Dr.  Frost  also 
stayed  in  Gevgeli  for  a  few  weeks. 

Stark  poverty  prevailed  throughout  the  Gevgeli  district. 
The  American  Red  Cross  personnel  there  distributed  large 
quantities  of  flour,  pork,  beans,  rice,  lard,  soap,  and  clothing 
and  later  even  hoes,  spades,  shovels  and  grindstones. 

In  addition  to  Montenegro,  Albania,  (Jreece  and  Serbia,  the 
other  state  in  the  Balkan  group  in  which  the  American  lied 
(^ross  conducted  nation-wide  emei-gency  rc^lief  in  llUl'  was 
Koumania.  The  four-fold  military  occu])ation,  by  (icrnian, 
Bulgarian,  Turkish  and  liussian  tro(>})s,  had  wrung  the  country 
drv.     When  the  sec(Uid  Auicrican   Red   Cross  conmiissinn   ar- 


1126  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rived  in  Bucharest  on  February  25,  with  Lieutenant  Colonel 
H.  Gideon  Wells,  of  Chicago,  in  command,  they  found  horses 
dead  from  starvation  on  the  streets,  children  and  adults  alike 
in  rags  and  gaunt  with  hunger,  going  barefoot  in  the  snow, 
and  typhus,  pellagra,  war  dropsy,  eye  troubles  and  tuberculosis 
pandemic.  Only  the  iron  constitution  of  the  Roumanian  peas- 
ant prevented  a  much  further  decimation  of  the  Roumanian 
population  than  has  been  described  in  a  previous  section. 

When  an  entire  nation  is  hungry,  the  people  want  food,  not 
toothbrush  drills  or  other  devices  of  health  education.  Thus 
the  American  Red  Cross  program  in  Roumania  was  a  feeding 
and  clothing  program  on  a  national  scale  and  a  subsidy,  on 
equally  large  proportions,  of  drugs,  linen  and  food  to  Rou- 
manian hospitals. 

In  any  emergency  relief  program,  a  public  health  nurse  is 
an  able  instrument,  because  a  good  public  health  nurse  is 
trained  to  estimate  both  the  social  and  medical  needs  of  those 
whom  she  is  endeavoring  to  aid.  Several  of  the  fifteen  Ameri- 
can Red  Cross  nurses  of  the  second  Commission  for  Roumania 
were  women  highly  skilled  in  public  health  nursing  and  medi- 
cal social  service,  such  as  Florence  Patterson,  the  chief  nurse, 
Katharine  Holmes  and  Evelyn  Obear.  The  others  were  in- 
stitutional nurses  who  were  well  fitted  to  go  into  a  Roumanian 
hospital  and  prepare  the  requisition  lists  of  drugs,  blankets, 
linen  and  food  which  were  necessary  to  put  that  hospital  again 
into  operation.  Thus  while  the  American  nurses  in  Roumania 
established  no  American  Red  Cross  hospitals  per  se,  and  oper- 
ated few  dispensaries  on  a  scale  comparable  to  that  which  pre- 
vailed in  the  other  Balkan  States  and  did  practically  no  visiting 
nursing,  their  services  certainly  may  be  said  to  have  been  util- 
ized in  a  professional  capacity.  They  were  not  tucked  away 
in  isolated  sewing-rooms  and  civilian  relief  stations  in  Rou- 
mania ''to  keep  them  out  of  mischief"  as  in  Greece,  but  were 
given  authority  and  a  field  to  cover  which  was  almost  unbe- 
lievably broad.  Miss  Patterson,  in  addition  to  her  duties  as 
chief  nurse,  was  the  assistant  director  of  civilian  relief  of 
the  commission. 

The  method  in  which  the  second  Roumanian  Commission 
attacked  its  tasks  is  well  illustrated  by  a  brief  description  of 
the  work  of  several  units.  In  Bucharest,  ]\riss  Patterson  and 
Dr.  Bayne  worked  out  a  civilian  relief  program  which  supplied 
food,   clothing,   drugs,   and  equipment  during  the   spring  and 


Roumanian  refiifreoa  living  in  mud  dug-outs  in  the  devastated  war  zones. 


An   American    l\ed   Cross   nurse   serving   soup   to   Roumanian    refugees. 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM   1127 

early  summer  of  1919  to  eleven  Roumanian  hospitals;  sixteen, 
schools  and  children's  aid  societies;  twenty-four  orphanages; 
and  fourteen  asylums  and  sanatoria.  Three  special  canteens 
were  established  aiul  by  the  end  of  July,  191!),  had  served 
168,118  portions  of  thick  soup  and  bread,  and  had  been  aided, 
either  with  this  food  or  by  gifts  of  clothing,  53,140  persons 
who  were  not  included  in  the  ;ibove  list  of  institutions  aided. 

To  develop  the  program  in  rural  sections  of  Roumania,  units 
were  organized  and  sent  out  into  the  field  each  with  its  ([uota 
of  villages  to  cover.  Such  a  unit  was  the  Focsani  Unit  which 
established  its  headquarters  at  Focsani,  a  city  of  some  twenty- 
five  thousand  population  which  was  located  in  south-central 
^foldavia  near  the  boundary  line  of  Wallachia.  Captain  Ar- 
thur 1).  Fulton,  Katharine  Holmes  and  Josephine  Ellett  com- 
posed the  personnel  of  the  unit  and  their  territory  consisted 
of  eighty-five  villages,  fifty-seven  of  which  had  been  bombed. 
The  two  nurses  and  Captain  Fulton  established  canteens  in 
each  one  of  these  fifty-seven  villages.  From  these  canteens  a 
daily  ration  of  thick  soup  and  white  bread  was  served  to  an 
average  of  one  hundred  people. 

An  example  of  the  effect  which  resulted  from  the  distribu- 
tion of  sanitary  supplies  and  a  judicious  amount  of  advice  by 
the  American  Red  Cross  representatives,  was  found  in  the 
village  of  Odobesti.  During  their  occupancy  there  the  Germans 
had  built  a  good  bathhouse  but  in  the  absence  of  soap  and 
towels  the  Roumanians  in  1919  were  not  using  it,  though 
typhus  was  epidemic  in  the  community.  Captain  Fulton 
urged  the  local  authorities  to  put  the  baths  into  operation  and 
]\fiss  Holmes  and  ^liss  Ellett  distributed  soap  and  told  the 
recipients  to  go  and  use  it  at  the  public  baths.  Within  due 
season  the  effects  of  an  adequate  diet,  as  partially  sup])Iie(l  by 
the  canteens,  and  the  use  of  the  soap  began  to  bear  fruit  in  a 
diminution  of  ty])hus  cases. 

The  distribution  of  supplies  and  drugs  to  already  establisluHl 
but  im])overish(Hl  Roumanian  hospitals  was  described  in  a  re- 
port covering  the  activities  of  the  Tlfov  Unit:  Ruth  Weir,  a 
graduate  of  the  Roosevelt  Hospital  and  a  nurse  who  had  served 
at  American  Red  Cross  Hospital  Xo.  1,  was  a  member  of  this 
group.     The  official  report  was  in  part  as  follows: 

We  found  at  T^udesti   (a  village  in  the  Rudiarest  district) 
a  Eoumauian  liosjjital  witli  eiglity-twu  cases  of  tyitlius.     The 


1128  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hospital  had  nothing  in  the  way  of  equipment  but  some  iron 
bed  frames,  with  boards  laid  across  them.  In  many  cases,  we 
saw  as  many  as  five  people  trying  to  lie  on  one  bed ;  they  were 
wrapped  in  bits  of  carpet  and  in  rags.  Men,  women  and 
children  were  all  crowded  together.  One  old  woman  lay  dying 
while  her  three  bedfellows  shrank  as  far  from  her  as  possible 
to  remain  on  the  bed. 

The  doctor  in  charge,  a  capable  appearing  young  man, 
showed  us  the  linen  which  had  been  turned  over  to  him ;  it 
consisted  of  shapeless  bundles  of  rags.  He  had  no  medicines, 
no  means  of  transportation  to  visit  outside  cases  and  prac- 
tically no  food  for  his  hospital  patients.  They  were  trying  to 
make  sugar  from  some  old  beets  to  add  to  the  diet.  We  left 
him  pajamas,  convalescent  robes,  blankets,  soap,  food  supplies, 
a  little  medicine  and  some  advice. 

The  general  relief  administered  by  the  Ilfov  Unit  consisted, 
by  the  first  week  in  July,  of  forty-one  canteens  which  were 
serving  food  to  418,030  people  in  114  villages.  "Our  clothing 
distributions,"  stated  the  writer  of  the  Ilfov  report,  ''ran 
neck  to  neck  witli  the  aid  given  through  canteens  and  hos- 
pitals and  we  finally  covered  the  people  before  they  died  of 
sunburn.  Xo  matter  how  well  conducted  our  distributions 
were  at  the  beginning  they  always  ended  in  a  riot  wlien  our 
most  numerous  clients,  the  Tiganes,  began  to  think  there  would 
be  nothing  left  for  them.  When  the  last  shirt  was  gone,  we 
dashed  for  the  car,  guarded  by  gendarmes  and  special  con- 
stables who  love  the  opportunity  of  wielding  the  big  stick." 
In  this  respect,  ]\riss  Holmes  was  much  horrified  during  her 
early  weeks  of  service  to  see  the  local  authorities  trying  to 
keep  the  Roumanian  peasant  women  from  stampeding  the  piles 
of  layettes,  by  lashing  tliem  with  ox-wliips,  treatment  which 
had  little  effect  upon  the  somewhat  over-eager  mothers. 

Early  in  June,  1019,  Colonel  Wells  resigiicd  as  commis- 
sioner for  lioumania  and  returned  to  the  United  States. 
Colonel  Anderson  then  moved  the  headquarters  of  the  Balkan 
Commission  from  Belgrade  to  Bucharest  to  be  able  to  keep 
general  oversight  of  the  work  in  Boumania. 

The  summer  of  1019  saw  the  com])lete  reorganization,  in 
policy  at  least,  of  the  Commission  for  the  Balkans.  By  that 
date  the  paralysis  of  trade  with  the  Balkan  States,  due  to  the 
enemy's  submarine  activities  in  the  ^lediterranean,  was  ended 
and  after  an  interval  of  four  years,  ships  were  again  bringing 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1129 

supplies  into  the  Balkan  ports.  ^loreover,  the  crops  of  1919 
were  being  harvested  by  the  women  and  a  time  of  compara- 
tive plenty  was  again  at  hand.  The  national  temperament 
of  the  various  Balkan  principalities  was  one  of  great  physical 
stamina.  Accustomed  as  they  were  to  almost  constant  war- 
fare and  quick  to  feel  its  ravages,  the  peoples  of  the  different 
countries  and  especially  Roumania  were  equally  swift  in  re- 
sponding to  the  piping  times  of  peace  and  with  their  heredi- 
tary enemy  crushed,  they  attacked  reconstruction  with  hope. 

The  autumn  of  1919  seemed  an  auspicious  time  for  the  close 
of  the  emergency  relief  as  undertaken  by  the  American  Red 
Cross  in  the  Balkans  and  throughout  Europe  and  for  the  initia- 
tion of  a  constructive  program  limited  to  the  field  of  health. 
^lany  of  the  nurses  and  surgeons  of  the  Balkan  Commission 
had  been  overseas  since  1917  and  desired  to  return  to  the 
United  States.  Even  more  important  was  the  fact  that  the 
large  quantities  of  the  Red  Cross  general  and  American  Army 
medical  supplies  which  Colonel  Anderson  had  brought  to  the 
Balkan  States  in  January  had  been  distributed  and  the  finances 
of  the  society,  in  the  estimation  of  the  executives  at  National 
Headquarters,  did  not  permit  the  purchase  of  new  supplies 
with  which  to  continue  emergency  relief  of  an  international 
scale.  Thus  the  personnel  was  slowly  withdrawn,  leaving  only 
a  nucleus  in  various  dispensaries  and  welfare  stations  around 
which  was  soon  to  be  built  the  constructive  program  in  the 
field  of  child  health. 

During  the  summer  of  1919,  the  development  of  the  League 
of  Red  Cross  Societies  progressed  rapidly  and  on  ^Xovember 
17,  1919,  ^liss  Fitzgerald  resigned  her  duties  as  chief  nurse 
of  the  American  Red  Cross  in  Europe  to  assume  those  of  the 
Director  of  Xursing  of  the  League.  Florence  ^I.  Waters 
served  for  some  months  as  acting  chief  nurse  of  the  European 
Commission,  but  in  January,  1920,  came  to  the  LTnited  States 
for  a  short  vacation  preparatory  to  returning  to  Europe  as 
^riss  Fitzgerald's  assistant  in  Geneva. 

A  happy  sequence  of  events  followed.  The  ]\rinutos  of  a 
meeting  held  December  23,  1919,  of  the  Commission  for  Europe 
recorded  statements  that 

.  .  .  Colonel  ()](]■>  announeorl  that  Colonel  Kniorson  is 
about  to  go  to  Sprl)ia  with  autliority  to  make  arraiiLrcnioiUs 
with  Miss  Jlay  to  establish  her  headquarters  in  Paris,  as  chief 


1130  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nurse  of  the  commission.  So  far  as  the  work  in  the  Balkans 
is  concerned,  it  has  seemed  that  she  could  handle  these  details 
fully  as  well  from  Paris  as  from  Belgrade. 

Miss  Hay's  experience  in  the  Balkans  subsequently  proved 
to  be  of  invaluable  assistance  in  working  out  the  details  of 
American  Red  Cross  nursing  service  in  connection  with  the 
child  health  units  and  the  establishment  of  schools  of  nursing 
in  foreign  countries.  Her  powers  of  administration,  always 
considerable,  had  increased  with  her  years  of  Red  Cross  ser- 
vice;  in  fact,  a  Red  Cross  colonel  had  once  said:  ^'JMiss  Hay 
is  the  biggest  man  in  the  Balkans."  Her  detailed  knowledge 
of  local  conditions  often  seemed  truly  amazing  to  those  with 
whom  she  worked,  but  the  reasons  for  this  were  simple:  She 
had  assisted  her  nurses  in  dispensaries  and  hospitals  in  iso- 
lated Balkan  villages,  she  had  gone  with  them  into  dark  and 
poverty-stricken  homes,  she  had  struggled  alike  with  arrogant 
commissioner  and  insubordinate  nurse,  with  avaricious  native 
politicians  and  easy-going  public  officials,  and  she  actually 
knew  whether  the  initiation  of  a  permanent  welfare  program 
would  not  be  practicable.  Thus  she  was  able  to  render,  in 
her  new  office,  service  of  a  broad  and  high  order. 

Of  the  six  American  nurses  who  received  the  Florence  Xight- 
ingale  Medal  of  the  International  Red  Cross,  four  of  them  had 
had  service  at  some  time  during  the  European  War  in  the 
Balkan  States.  At  a  meeting  held  December  10,  1919,  the 
Xational  Committee  had  passed  a  motion  that  the  chairman 
appoint  a  sub-committee  to  consider  candidates  for  this  medal 
and  submit  its  recommendations  to  the  Xational  Committee. 
This  sub-committee  nominated  Helen  Scott  Hay,  Martha  Rus- 
sell, Florence  Johnson,  Alma  Foerster  and  Linda  K.  Meirs, 
and  renominated  Mary  E,  Gladwin,  whose  name  had  been  pre- 
viously brought  forward  by  the  Xational  Committee.  Dr. 
Farrand  forwarded  these  nominations  on  March  2G,  1920,  to 
the  International  Committee  at  Geneva  and  the  medals  were 
subsequently  conferred  on  these  nurses. 

The  last  months  of  1919  saw  the  close  of  the  American  Red 
Cross  cmorgcncy  relief  program  in  the  T^alkan  States,  Palestine 
and  Si])eria.  Conditions  in  the  l^alkan  States  had  reached  the 
stage  favorable  to  the  initiation  of  a  constructive  health  pro- 
gram.    In  Palestine  and  Syria  the  American  Committee  for 


CLOSE  OF  THE  FOREIGN  RELIEF  PROGRAM    1131 

Relief  in  the  Near  East  assumed  major  responsibility  for  the 
alleviation  of  suffering.  Political  conditions  in  Xorth  Russia 
had  already  made  necessary  the  withdrawal  from  Archangel 
early  in  1*.)1U  of  the  American  Red  Cross  repr(!sentatives.  In 
Siberia,  Bolshevik  victories  also  caused  the  withdrawal  of  al- 
lied forces  and  the  American  Red  Cross  late  in  11)1!)  and 
early  in  1920.  The  only  commissions  remaining  overseas 
and  operating  on  the  old  pre-Armistice  policies  of  nation-wide 
general  and  medical  relief  was  that  in  Poland  and  the  close 
of  this  phase  of  service  has  already  been  described.  The  Euro- 
pean Commission,  with  its  headquarters  at  Paris,  was  serving 
chiefly  as  the  clearing  house  through  which  w^ere  being  admin- 
istered the  details  coincident  to  the  close  of  the  emergency 
relief  and  the  initiation  of  the  new  child  health  program. 

With  the  termination  of  the  emergency  relief  program  and 
the  withdrawal  of  the  commissions  per  se  from  Great  Britain, 
France,  Belgium,  Italy,  Montenegro,  Albania,  Greece,  Serbia, 
Roumania,  Palestine,  North  Russia  and  Siberia,  the  overseas 
service  of  the  American  Red  Cross  immediately  incident  to 
the  European  War  may  be  said  to  have  been  ended.  On  June 
30,  1920,  only  one  hundred  and  sixteen  American  Red  Cross 
nurses  were  on  duty  overseas. 

In  the  sixteen  months  which  had  passed  after  the  resigna- 
tion of  the  War  Council  on  February  28,  1919,  an  appreciable 
contraction  in  American  Rod  Cross  war  organization  had  taken 
place.  On  February  28,  1919,  the  number  of  persons  in  Red 
Cross  em])loy  in  the  United  States  and  overseas  totalled  14,- 
625,  1921  of  whom  w^re  volunteers  (un])aid  workers).  On 
June  30,  1920,  the  number  of  persons  totalled  5517,  of  wliom 
thirty  were  volunteers.  The  American  Red  Cross  administra- 
tive, clerical  and  field  staff  had  thus  l)eon  rcMluced  by  the  r(^sig- 
nations  of  9108  individuals,  1891  of  whom  liad  been  volunteers. 
As  to  the  Chapter  and  membership  strength  of  tlu^  society,  on 
February  28,  1919,  the  American  Red  Cross  had  had  3,724: 
active  Chapters  and  an  adult  membership  of  20, OOO, ()()()  per- 
sons; on  .Jiuie  30,  1919,  the  society  had  3.<)72  active  Cha])ters 
and  an  adult  membership  of  8,988,140  persons.  Tlie  decrease 
shown  by  tli(>s(>  figures  was  of  52  Cha])ters  and  11,()11,S(U) 
adult  niemb(n*s. 

In  tliis  figure  which  gives  ihv  loss  of  eleven  million  nuMiibcrs. 
there  was  a  ])at(Mit  reason  for  the  tenninatioii  of  tlic  t'orcliiu 
relief  })rogram.      In  the  minds  of  the  Anieriean  public,  the  war 


1132  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  over  and  the  need  for  American  Red  Cross  activity  ac- 
cordingly ended.  To  the  average  American,  the  Red  Cross  was 
primarily  a  war  organization,  so  defined  by  the  main  clauses 
of  its  Congressional  Charter,  so  understood  by  the  man  on  the 
street.  Some  eight  millions  in  1919  had  caught  the  idea  of 
the  need  for  continued  support  of  an  American  Red  Cross  for- 
eign and  domestic  program,  but  eleven  millions  had  not. 

Unquestioning  and  universal  public  support  from  the  Ameri- 
can people  is  perhaps  the  most  powerful  genie  in  the  world  and 
with  it  the  American  Red  Cross  had,  indeed,  accomplished 
wonders.  The  society  in  some  respects  may  be  compared  to  the 
lamp  of  Aladdin.  Xear  the  close  of  the  nineteenth  century, 
Clara  Barton  had  found  the  lamp  in  Switzerland  and  had 
brought  it  to  the  United  States.  From  1905  to  1914,  it  had 
been  held  tenderly  in  the  hands  of  Miss  Boardman  and  a  few 
influential  friends  and  had  then  possessed  but  comparatively 
meager  financial  resources  with  which  to  perform  its  services, 
chiefly  in  domestic  disaster  relief.  Then  the  European  War 
had  burst  upon  a  startled  civilization  and  Miss  Boardman  had 
prevailed  upon  the  still  comparatively  feeble  genii  of  the  lamp 
to  organize  and  finance  the  Mercy  Ship  Expedition.  A  brief 
period  of  comparative  rest  followed.  In  1917,  however,  the 
national  emergency  brought  about  a  changed  aspect  of  the 
American  Red  Cross  and  it  became  an  organization  deserving 
the  unqualified  and  universal  support  of  the  American  public. 
President  Wilson  appointed  the  War  Council.  Mr.  Davison  as 
chainnan  vigorously  rubbed  the  lamp  and  lo,  the  American  pub- 
lic responded  in  twenty  months  with  a  total  contribution  of  four 
hundred  million  dollars.  The  society  was  reorganized  on  the 
basis  of  a  Rockefeller  corporation  and  expended  in  foreign 
and  domestic  relief  two  hundred  and  seventy-three  of  those 
millions.  Then  in  turn  the  emergency  subsided,  the  fickle 
genie  of  American  public  support  turned  its  attention  to  other 
matters  and  the  lamp  was  handed  back  to  the  Executive  Com- 
mittee, still  possessed  of  many  lesser  genii  who  could  be  com- 
manded to  do  useful  things,  to  be  sure,  but  with  the  all-powerful 
genie  of  universal,  unquestioning  public  support  gone  until 
anoth(>r  national  emergency  would  again  automatically  com- 
mand its  service. 


CHAPTER  XIII 

PARTICIPATION    IX    INTERNATIOXAL    XTRSIXO    EDI'CATION" 

Tranxit'ion — League  of  Red  Cross  Societies — Schools  of  Nurs- 
ing— Miss  Noycs'  Trip  Overseas — Child  llealih  Coders — • 
Nursing  Activities  in  Insular  and  Foreign  Possessions  of 
the  United  States 

FOLLOWING  the  Armistice  the  general  impression  that 
the  American  Ked  Cross  had  fulfilled  its  mission  in 
Europe  seemed  to  have  prevailed.  The  commissions 
which  had  hecii  estahlished  in  practically  all  the  conntries  of 
the  Allies  were  gradually  withdrawn  until  early  in  1920,  with 
the  exception  of  the  Commission  for  Poland,  there  were  none 
left. 

These  commissions  had  been  largely  occupied  with  questions 
of  general  relief  and  medical  nursing  care  of  both  the  civilian 
and  military  sick.  General  relief  activities  predominated  and 
included  the  distribution  of  supplies  of  all  kinds, — clothing, 
food,  hospital  furnishings,  linen,  surgical  instruments,  drugs, 
etc. ;  also  raw  materials  of  all  kinds,  sewing  machines,  sewing 
materials— needles,  thread,  thimbles,  buttons,  tape — in  order 
that  employment  might  be  given  to  the  women  of  the  country. 
Hospitals  and  dispensaries  were  opened,  child  welfare  work 
established,  also  visiting  nursing;  mother  clubs  were  started 
and  Red  Cross  classes  in  Home  Hygiene  and  Care  of  the  Sick 
were  conducted  (juitc  widely. 

Into  all  this  work  the  Red  Cross  nurse  was  introduced.  With 
the  uncertainty  attendant  upon  the  (hn'elopment  of  a  clear-cut 
program,  nurses  fre(juently  found  themselves  assigned  to  work 
in  which  tlunr  professional  training  seemed  partially  wasted, 
such  as  supervising  workrooms  and  soup  kitchens,  the  distribu- 
tion of  supplies  and  tlu^  housekeeping  in  personnel  houses.  Xot 
infrequently  did  the  nurse  do  her  day's  work  in  a  nursery  or 
clinic  and  at  the  same  time,  cook  three  meals  a  day  for  the  entire 
personnel,  attend  to  all  the  buying  and  look  after  the  cleanliness 

1133 


1134<  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  the  house,  for  unless  the  doctors,  nurses  and  other  personnel 
had  comfortable  living  quarters,  with  well-cooked  food,  they 
ran  serious  dangers  from  infection;  and  native  cooks  unless 
trained  by  some  one  were  ignorant  of  the  American  method  of 
preparing  and  cooking  food.  When  members  of  the  personnel 
fell  ill,  the  nurse  assumed,  in  addition  to  her  regular  duties, 
their  nursing  care.  Instances  of  hours  of  night  work,  added 
to  an  already  overcrowded  day,  were  so  common  as  to  excite 
no  comment.  Good  sports  as  they  were,  the  nurses  assumed 
these  extra  responsibilities  without  faultfinding  and  with  a 
cheerfulness  truly  commendable.  It  was  part  of  the  service, 
they  were  the  ones  prepared  and,  because  of  their  special 
preparation,  they  accepted  the  responsibilities  without  question 
or  complaint. 

That  advantage  was  taken  of  them  goes  without  saying. 
Instances  where  guests  in  large  numbers  were  brought  in  with- 
out warning  by  the  members  of  the  unit  were,  alas,  only  too 
frequent.  Under  these  circumstances,  the  nurses  did  not  shine 
as  social  lights  at  such  simple  festivities  as  occurred  in  the 
evening.  They  were,  moreover,  painfully  conscious  of  the  fact 
that  they  suffered  in  this  respect,  by  comparison  with  the  other 
women  members  of  the  unit,  social  and  clerical  workers  and 
teachers.  In  spite  of  their  philosophy  as  a  group,  there  were 
some  heartbreaks  on  this  account  and  individuals  here  and 
there  found  it  difficult  to  maintain  their  equanimity  and  poise. 

Following  the  withdrawal  of  the  commissions,  a  stream  of 
workers,  nurses,  doctors  and  others  poured  back  from  Europe 
to  America,  leaving  here  and  there  a  worker  or  two,  to  supervise 
specific  pieces  of  work,  to  guard  warehouses  filled  with  Red 
Cross  supplies,  including  those  turned  over  by  the  Medical 
Department  of  the  Army,  and  to  develop  Junior  Red  Cross 
activities. 

Red  Cross  officials  at  headquarters  both  in  Paris  and  in 
Washing-ton  were  deeply  conscious  of  the  fact  that  the  war-torn 
countries  of  central  and  eastern  Europe  were  still  in  dire  need. 
They  were  practically  without  the  necessities  essential  to  sup- 
port and  maintain  life.  ^Icdical  and  nursing  assistance  were 
needed  fully  as  much,  if  not  more,  during  the  reconstruction 
period  than  during  the  period  of  active  hostilities.  The  dis- 
courag(>ment  of  the  people  facing  this  situation  almost  without 
supplies  of  every  kind  and  with  so  depreciated  a  currency 
that  it  was  practically  impossible  to  go  outside  of  Europe  to 


INTERNATIONAL  NURSING  EDUCATION       1135 

buy  them,  was  quite  understood  by  the  American  Red  Cross. 
This  condition  was  greatly  complicated  by  the  overwhelming 
problem  of  the  refugees;  each  country  had  its  own  and  the 
enormous  numbers  from  Russia  iiicreased  their  difficulties. 
Further  than  that,  the  problem  of  war  orphans  in  large  num- 
bers in  each  country  seemed  almost  unanswerable. 

With  full  and  intimate  understanding  of  the  situation,  execu- 
tives at  National  Ileadipiarters  were,  nevertheless,  obliged  to 
listen  to  questions  raised  by  members  of  the  American  Red 
Cross  throughout  the  country,  who  had  been  working  at  con- 
siderable tension  even  before  the  United  States  became  one  of 
the  combatant  nations  and  at  high  speed  from  then  on.  "The 
war  is  over,"  they  said,  ''so  why  should  we  continue?  We 
want  to  go  back  to  our  own  affairs."  Although-  there  were 
still  large  quantities  of  supplies  in  European  warehouses  of  the 
American  Red  Cross  and  money  left  from  the  war  budget  for 
European  work,  a  strong  feeling  existed  on  the  part  of  many 
individuals  in  the  United  States,  even  though  they  were  sympa- 
thetic, that  the  countries  of  Europe  should  assume  the  question 
of  rehabilitation  for  themselves. 

To  Red  Cross  officials,  the  question  was  a  perplexing  one. 
An  operation  of  such  proportions  as  that  being  conducted  by  the 
American  Red  Cross  in  Europe  could  not  be  stopped  imme- 
diately. The  warehouses  which  w^ere  filled  with  Red  Cross 
supplies  in  various  parts  of  Europe  and  to  w^iich  the  War 
Department  in  1919  turned  over  large  consignments  of  supplies 
and  dietary  foodstuffs  as  authorized  by  Congress,^  had  to  be 
guarded  and  plans  developed  for  a  systematic  and  efficient 
method  of  distribution,  while  particular  activities  such  as  the 
Junior  Red  Cross  work,  child  welfare  activities  in  Greece,  and 
the  varied  phases  of  service  in  Poland  could  not  be  immediately 
discontinued  without  destructive  results  to  the  countries  con- 
cerned. However,  the  executives  at  Xational  Headquarters 
knew  that  they  must  take  cognizance  of  the  trend  of  American 
public,  opinion.  Governed  largely  by  the  factor  of  the  sup- 
plies in  European  warehouses,  they  tinally  decided  on  a  re- 
stricted and  clearly  defined  program  of  a  constructive  character. 
The  nursing  service  of  this  program  embraced  four  distinct 
phases:  Indirect  stimulus  to  the  nursing  service  of  the  League 
of  Red  Cross  Societies ;  schools  of  nursing ;  nursing  service  in 

^  Bulletin  No.  23,  War  Department,  July  19,  1919.  Army  Appropriation, 
Act   of   Con;iri'ss. 


1136  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

connection  with  child  health  centers;   and  nursing  activities 
in  the  insular  and  foreign  possessions  of  the  United  States. 

Sentiment  at  National  Headquarters  "  after  the  Armistice 
was  pointing  toward  the  participation  by  the  American  Red 
Cross  in  a  broad  and  general  program  in  which  all  the  Red 
Cross  societies  of  the  world  might  become  participants.  On 
December  3,  1918,  President  Wilson  wrote  as  follows  to  Mr. 
Davison : 

Pursuant  to  our  conference  of  yesterday,  I  am  writing  to 
ask  you  if  you  will  not  be  kind  enough  to  make  arrangements, 
if  possible,  to  come  to  France  at  an  early  date  for  the  purpose 
of  conferring  with  me  and  others  there  as  to  the  international 
relations  and  cooperations  of  the  Eed  Cross.  I  sincerely  hope 
that  you  will  give  the  most  serious  consideration  to  this  and 
that  you  will  arrange  to  come,  if  it  is  at  all  possible. 

When  ]\rr.  Davison  arrived  in  France  in  December,  1918,  he 
endeavored  to  develop  a  league  which  included  in  its  member- 
ship the  Red  Cross  societies  of  the  world  and  had  as  its  aim  the 
betterment  of  humanity.  He  was  appointed  by  the  American 
Red  Cross  as  chairman  of  an  American  Red  Cross  International 
Commission  and  resigned  on  March  1,  1919,  as  chairman  of 
the  War  Council.  A  large  siim  of  money  was  appropriated  by 
the  American  Red  Cross  for  this  International  Commission. 
Mr.  Davison  endeavored  to  get  the  Peace  Conference  at  Ver- 
sailles definitely  to  endorse  the  plan  for  a  League  of  Red  Cross 
Societies.  They  declined  to  do  so,  but  with  the  assistance  of 
President  Wilson,  it  was  possible  to  secure  the  insertion  of 
Article  XXV  in  the  Covenant  of  the  League  of  Nations.  It 
is  to  be  noticed  that  this  article  does  not  refer  at  all  to  the 
League  of  the  Red  Cross  Societies  but  to  National  Red  Cross 
societies  throughout  the  world : 

The  members  of  the  League  agree  to  encourage  and  pro- 
mote the  estal)lishment  and  cooperation  of  duly  authorized 
voluntary  national  lied  (Voss  organizations  having  as  pur- 
poses improvement  of  health,  the  prevention  of  disease  and 
the  mitigation  of  suffering  throughout  the  world. 

^On  Xovcmber  27,  11)18,  a  confidential  personal  letter  was  addressed  to 
President  Wilson  by  a  bifrh  ofTieial  at  National  Headquarters  wbicli  struck 
a  prophetic  note.  T'nfortunately  the  carbon  of  tliis  letter  is  nnsifrned  and 
varions  men  tlien  in  hif^h  antliority  at  National  Headquarters  have  since 
disclaimed  autliorship  of  it.     Hence  it  is  not  quoted. 


INTERNATIONAL  NURSING  EDUCATION      1137 

Shortly  after  Mr.  Davison's  appointment  representatives  for 
the  Red  Cross  societies  of  Great  Britain,  France,  Italy,  Japan, 
and  the  United  States  formed  a  committee,  which  established 
headquarters  at  Cannes  for  the  purpose  of  studying  the  situa- 
tion. The  committee  finally  decided  to  call  for  conference, 
experts  in  health,  medicine,  economics,  and  nursing  from  all 
parts  of  the  world,  in  order  to  prepare  an  extended  program 
of  Red  Cross  activities,  in  the  interest  of  humanity,  to  be  pre- 
sented at  a  meeting  of  the  International  Red  Cross  Committee 
at  Geneva  to  be  held  thirty  days  after  Peace  was  declared. 

This  conference  finally  took  place  from  April  1-11,  1019  at 
Cannes.  Miss  Delano  had  fallen  ill  some  weeks  before  this,  but 
it  was  expected  that  she  would  make  an  early  recovery  and  be 
able  to  represent  the  American  Red  Cross  Xursing  Service 
when  the  meeting  was  called.  In  fact  she  did  attend  one  pre- 
liminary conference  held  at  Mr.  Davison's  house  at  Cannes 
for  the  purpose  of  advising  on  nursing  questions  to  be  presented 
at  the  conference,  and  also  on  nursing  representation  from 
other  countries.  As  the  time  for  the  conference  approached, 
however,  the  possibility  of  ^liss  Delano's  attendance  was  dissi- 
pated and  it  became  necessary  to  provide  for  a  suitable  substi- 
tute. The  American  Red  Cross  had  been  requested  by  ]\Ir. 
Davison's  committee  to  send  IMiss  Lillian  Wald  to  represent 
the  Federal  Children's  Bureau,  Department  of  Labor,  L^.  S.  A. 
As  ^liss  Wald  had  been  a  member  of  the  liational  Committee 
on  Red  Cross  Nursing  Service  since  its  early  days,  it  was  deter- 
mined that  she  should  represent  as  well  the  American  Red 
Cross  Xursing  Service. 

While  arrangements  to  this  effect  were  being  made  at  I^a- 
tional  Headquarters,  Mr,  Davison,  appreciating  ^liss  Delano's 
condition  and  not  waiting  for  advice  from  Washington,  asked 
^liss  Stimson,  then  director  of  the  Army  Xurse  Corps  in 
France  and  formerly  chief  nurse  of  the  American  Red  Cross  in 
France,  to  attend,  ^liss  Plall,  who  had  followed  Miss  Stimson 
as  chief  of  the  Nurses'  Bureau  at  Paris  headquarters,  was 
present,  ^fiss  Fitzgerald  was  also  in  attendance,  not,  how- 
ever, as  a  nursing  delegate,  but  because  of  her  linguistic  ability 
as  an  interpreter  and  translator. 

Great  Britain  was  represented  by  ]\Iiss  A.  ^l.  Gill,  then 
sup(n-intendent  of  nurses.  Royal  Infirmary,  Fdinburgh,  and 
president  of  the  Scottish  ]\latrons,  and  by  ^liss  Alicia  Lloyd- 
Still,    the    head    Matron    of    St.    Thomas'    Hospital,    London. 


1138  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Countess  de  Roussy  de  Sales,  of  the  French  Red  Cross,  was  the 
representative  of  France.  Italy  was  represented  by  Professor 
Emilia  Malatesta  Anselmi  and  the  Countess  Nerina  Giglincci, 
both  of  whom  were  volunteer  nurses  of  the  Italian  Red  Cross. 
Miss  Stimson  acted  as  chairman  of  the  nursing  representatives. 
The  Report  prepared  on  lines  suggested  by  the  Executive 
Committee  of  the  Cannes  Conference  is  in  the  main  as  follows : 

A.  More  important  existing  nursing  organizations:  In 
regard  to  international  and  national  organizations,  both  offi- 
cial and  voluntary,  the  field  is  so  vast  and  available  informa- 
tion so  inadequate  that  it  is  thought  best  that  the  preparation 
of  such  a  survey  of  the  position  be  postponed,  subject  to  the 
consideration  of  a  larger  and  more  representative  gathering. 

B.  Indications  for  international  Ked  Cross  action:  The 
proposed  Central  International  l?ed  Cross  Bureau  should 
include  a  Nursing  Department.  The  chief  objects  of  this 
Department  should  be : 

1.  To  act  as  an  intelligence  center,  to  collect,  analyze  and 
distribute  information  regarding  all  matters  pertaining 
to  nursing,  and  to  women's  work  in  public  health,  such 
as  infant  welfare,  housing,  social  service,  etc. 

2.  To  undertake  propaganda  in  countries  where  trained 
sick  nursing  and  public  health  work  are  not  at  present 
fully  develo])ed. 

3.  To  seek  out  in  these  countries  (Par.  2)  suitable  per- 
sonnel for  training  both  in  sick  nursing  and  in  public 
health  work,  to  advise  and  assist  thom  to  o])tain  the 
necessary  training,  and  to  return  them  to  their  own 
countries  as  pioneers. 

4.  To  arrange  for  conferences  of  representative  nurses  and 
health  workers  from  all  countries  for  the  interchange  of 
ideas. 

C.  L^tilization  of  existing  Ped  Cross  assets:  It  is  recog- 
nized that  the  Ped  Cross  at  the  ])resent  time  is  in  possession 
of  a  very  valuable  asset  in  existing  personnel.  This  personnel 
includes : 

1.  Fully  trained  professional  nurses. 

2.  In  Franc'C  and  Italy,  volunteer  trained  nurses. 

3.  I'ntrained  and  partially  trained  workers,  known  in 
.America  as  nurses'  aids  (under  the  lied  Cross),  and 
social  workers;  and  in  England  as  V.  A.  D.'s  (under  the 
Ped  Cross),  Special  ^Military  Probationers,  and  health 
visitors:  and  in  France  and  Italy,  auxiliary  nurses. 

D.  Permanent  Ped  Cross  nursinfj  or<i:anizations: 


INTERNATIONAL  NURSING  EDUCATION      1139 

1.  Jntoriiational — It  is  recommended  that  in  connection 
with  the  proposed  International  Red  Cross  Bureau  tliere 
be  a  Department  of  Nursing,  with  a  resident  secretary, 
who  shall  be  a  representative  of  the  nursing  profession. 
The  probable  duties  of  such  a  secretary  are  indicated 
under  paragraph  B. 

2.  National — It  is  recommended  that  in  addition  to  their 
present  duties,  national  Red  Cross  organizations  keep 
permanent  registers  of  trained  nurses  available  for  any 
national  or  local  emergency,  and  that  they  also  keep 
registers  of  Eed  Cross  workers,  with  data  of  their  expe- 
rience, for  similar  service. 

The  Report  concluded  with  the  statement  that  "we  feel 
that  many  of  the  subjects  under  discussion  are  very  far-reach- 
ing and  must  necessarily^  affect  large  bodies  of  workers  and 
that,  therefore,  no  decisions  should  be  arrived  at  by  a  few  in- 
dividuals, but  that  these  subjects  should  be  referred  to  a  larger 
and  more  representative  body  of  professional  women  and  should 
be  considered  preferably  after  the  Committee  of  Red  Cross 
Societies  has  concluded  its  deliberations  and  outlined  the  future 
activities  of  the  International  Bureau.  .  .  ."  The  nursing 
delegates  then  suggested  the  following  subjects  for  discussion : 

1.  The  utility  of  the  trained  nurse  for  public  health  work, 

2.  The  ])ossible  shortage  of  nurses  for  this  class  of  work,  and 
how  the  shortage  can  be  made  good. 

3.  Whether  it  is  necessary  for  all  health  workers  to  be  fully 
trained  nurses. 

4.  Special   courses   of   training   in   public   health   work   for 
nurses  and  others. 

5.  Scholarships  and  other  forms  of  assistance. 

To  the  Report  of  the  nursing  delegates  was  appended  the 
following  set  of  Ivesolutions  : 

1.  T?esolved.  That  the  TTealtli  Bureau  collect,  analyze 
pu!)lish  and  distribute  information  pertaining  to  nursing  and 
women's  work  in  pu'nlic  health,  e.g..  relation  to  such  sul)jo(ts 
as  tul)ercul()sis,  child  welfare,  the  prevention  of  hlindiies.«, 
pre-natal  care,  social  service,  etc 

2.  Hesolv(>(l.  That  ju-opagaiida  bo  undertaken  as  soon  as 
practicable  in  thos(>  couiitrii^s  wlicre  trained  sick  inirsing  and 
])ublic  health  nursing  are  not  as  yet  dovcHoped.  to  encourage 
the  establishment  of  traininir  schools  for  jiurscs. 


1140  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

3.  Eesolved.  That  suitable  personnel  for  instruction,  both 
in  the  care  of  the  sick  and  public  health  nursing,  be  sought 
and  trained  so  that  such  personnel  may  return  subsequently  to 
their  own  countries,  qualified  to  inaugurate  and  direct  move- 
ments for  the  establishment  of  training  schools  and  for  the 
training  of  nurses. 

4.  Resolved.  That  a  system  of  scholarship  be  established 
to  make  it  possible  for  trained  nurses  to  receive  the  necessary 
supplementary  education  to  qualify  them  as  public  health 
nurses  and  as  teachers. 

5.  Eesolved.  That  information  in  regard  to  the  importance 
of  public  health  nurses  and  the  lack  of  adequate  facilities  for 
their  training  be  widely  disseminated;  that  there  be  wide- 
spread information  so  that  the  courses  of  training  in  existing 
schools  may  be  adjusted  to  meet  the  requirements  of  public 
health  nursing;  and  that  special  schools  may  be  established 
to  qualify  women  for  the  great  opportunity  for  service  open 
to  them  in  this  field. 

It  was  significant  that  while  the  importance  of  public  health 
nursing  was  stressed,  the  emphasis  was  placed  on  the  establish- 
ment of  schools  of  nursing. 

Out  of  the  Cannes  Conference  grew  the  League  of  Red  Cross 
Societies.  The  relation  of  the  League  to  the  International  Red 
Cross  Committee  at  Geneva,  with  special  reference  to  duplica- 
tion, was  explained  by  Mr.  Davison  at  the  first  meeting  of  the 
General  Council  of  the  League,  which  was  held  in  March,  1920. 
The  two  fundamental  principles  of  the  Constitution  of  the 
International  Committee  were  neutrality  and  universality  and 
these  principles  made  it  impossible  for  the  International  Com- 
mittee to  assume  in  1919  the  program  proposed  for  the  League. 

The  spring  of  1919  was  a  busy  one  for  the  newborn  League. 
Its  first  venture  in  the  nursing  field  took  place  in  June,  1919. 
Ten  nurses,  with  Emma  Wilson  as  head  nurse,  were  released 
from  service  under  the  Xurscs'  Bureau  of  the  Commission  for 
Europe  at  the  request  of  the  medical  director  of  the  League 
and  were  assigned  under  the  Bureau  of  Hygiene  and  Public 
Health  of  the  Polish  Government,  to  work  in  typhus  hospitals 
in  Poland.  In  a  letter  written  June  30  to  ]\riss  Xoyes,  ^  Miss 
Fitzgerald,  then  chief  nurse  of  the  American  Red  Cross  in 
Europe,  de^^eribed  the  plan : 

'Diplikiiifx  the  use  of  tho  personal  pronoun  7  and  finding  the  term  "Na- 
tional Director  of  the  Red  Cross  Nursing  Service"  awkward  because  of  its 
lengtli.  the  writer  of  this  chapter  has  decided  to  use  the  phraseology  "Miss 
Koycs." 


INTERNATIONAL  NURSING  EDUCATION      1141 

The  nurses'  salaries  are  to  be  ])aid  by  the  League  and 
transportation  from  Paris  to  Poland  and  back  again  will  bo 
the  responsibility  of  the  Polish  Government.  The  length  of 
contract  is  for  four  months  and  the  plan  of  work  involves  the 
assignment  of  one  American  Ked  Cross  nurse  and  an  English- 
speaking  Polish  aide  to  a  Polish  hospital,  where  our  nurse 
will  act  as  chief  and  will  train  native  nurses  to  do  the  work 
there.  Of  the  eleven  nurses  who  are  going,  eight  of  them  have 
already  seen  service  with  foreign  commissions  and  two  others 
in  the  Service  de  Sante. 

The  ten  nurses  were  assigned  to  various  Polish  typhus  hos- 
pitals and  did  the  best  they  could  for  the  four  months'  term  of 
their  contract.  Late  in  November,  1919,  they  returned  to 
Paris  headquarters,  and  of  the  work  accomplished  by  them, 
.Miss  Fitzgerald  wrote  in  her  report  of  a  tour  made  by  her  in 
Poland,  October,  1919: 

The  Polish  hospital  which  I  visited  showed  the  effect  of  the 
good  work  done  here  by  two  of  our  American  Red  Cross 
nurses  assigned  to  the  Polish  Government.  Neither  of  them 
spoke  Polish  and  no  interpreter  had  been  secured  for  them, 
but  they  had  been  able  to  clean  up  the  hospital ;  to  obtain 
equipment  for  it  from  Colonel  Gilchrist;  to  train  native 
women  and  put  them  in  a  neat  uniform;  and,  above  all,  to 
secure  the  full  confidence  and  cooperation  of  the  Polish  doctor 
in  charge.  The  same  can  be  said  of  all  the  units  where  these 
nurses  have  been  placed.  .  .  . 

The  Polish  Government  cited  the  nurses'  work  as  "devoted 
and  fruitful." 

The  League  had  not  yet  appointed,  as  recommended  in  the 
nursing  resolution  adopted  at  the  Cannes  Conference,  a  director 
of  nursing.  Much  concern  because  of  this  delay  was  felt  by 
l)oth  Miss  Xoyes  and  ^liss  Fitzgerald,  as  will  be  seen  by  read- 
ing the  correspondence  that  passed  between  them  at  this  time. 
A  letter  of  July  22  from  Miss  Fitzgerald  emphasized  this 
point : 

I  assure  you  that  T  have  not  been  idle  about  trying  to  have 
a  nursing  representative  attached  to  the  League  of  Uvd  Cross 
Societies.  1  think  that  the  Commission  for  Europe  as  a  liody 
is  keenly  anxious  to  have  this  done  and  the  departure  of  the 
unit  for  Polaiul  was  used  as  a  special  argument  in  favor  of 
having  this  new  development  announced  l)y  tlie  League.     A 


1142  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nursing  unit,  such  as  the  one  to  Poland,  which  does  not 
actually  come  under  our  jurisdiction,  must  necessarily  be  cast 
quite  adrift,  unless  the  League  of  Ked  Cross  Societies  assumes 
the  responsibility  of  supervising  this  unit  and  other  units 
which  we  may  have  in  the  field. 

This  crossed  a  letter  from  !Miss  I^oyes  which  indicated  that  she 
too  was  anxious 'and  was  even  then  preparing  a  communication 
to  the  League  upon  this  question.  Because  of  this  lack  of 
proper  preliminary  investigation  and  centralized  direction,  the 
unit  sent  to  Poland  was  not  able  to  render  service  of  as  far- 
reaching  a  type  as  had  been  hoped.  The  recall  of  the  unit 
ended  further  joint  enterprises  of  this  nature  in  Poland. 

In  the  appointment  of  a  Director  of  Nursing  of  the  League, 
the  N^ational  Committee  on  American  Red  Cross  ISTursing  Serv- 
ice took  an  indirect  part.  As  the  plans  for  an  extensive  nursing 
program  were  developed  by  the  League,  Miss  Noyes  became 
anxious  lest  a  person  of  inadequate  preparation  be  selected  as 
director.  This,  she  felt,  would  not  only  create  very  definite 
difficulties,  should  the  American  Red  Cross  withdraw,  which 
then  seemed  possible,  leaving  certain  undertakings  under  the 
supervision  of  the  League,  but  would  tend  to  break  down  the 
standards  already  established.  As  the  American  Red  Cross 
had  standardized  its  ISIursing  Service  and  had  supplied  approxi- 
mately 20,000  graduates  for  actual  service  during  the  war,  it 
seemed  quite  proper  that  it  should  take  the  initiative  in  advis- 
ing the  LeagiTO  upon  as  important  a  matter  as  the  selection  of 
a  Director  of  Nursing  of  the  League. 

A  mooting  of  the  Advisory  Committee  of  the  National 
Committee  was  called  and  a  special  letter  was  prepared  and 
sent  through  the  chairman.  Dr.  Farrand,  offering  the  facilities 
of  the  National  Committee  to  the  League.  This  letter  was  sent 
by  him,  with  a  letter  of  transmittal,  to  Mr.  Davison,  the  chair- 
man of  the  League.  The  offer  was  quickly  accepted  and  a  cable 
soon  followed  from  the  League  asking  the  National  Committee 
to  submit  names  of  nurses  suitable  for  appointment  as  Nursing 
Director.  It  is  interesting  to  note  that  practically  every  one 
of  the  National  Committee  gave  in  recommendation  the  name 
of  ]\Iiss  Fitzgerald.  Thus,  Miss  Fitzgerald's  name  in  recom- 
mendation was  transmitted  to  the  League  by  cable.  In  a  letter 
of  October  27,  191!),  Dr.  Richard  P.  Strong,  then  medical 
director  of  the  League,  expressed  his  appreciation  of  the  ser- 
vice of  the  National  Committee.     It  is  of  interest  to  note  how 


INTERNATIONAL  NURSING  EDUCATION       1143 

far  the  influence  of  the  National  Committee  had  been  ex- 
tended since  its  creation  in  1909  and  the  appointment  of  a 
Director  of  Nursing  of  the  League  of  Red  Cross  Societies  ten 
years  hiter. 

On  November  17,  1919,  ^liss  Fitzgerald  resigned  as  chief 
nurse  of  the  American  Red  Cross  Commission  for  Europe  to 
become  Director  of  the  Division  of  Nursing  of  the  League.  Of 
the  early  organization  of  the  League,  Miss  Fitzgerald  wrote : 

...  In  the  sunnner  of  1919,  the  League  of  Red  Cross 
Societies  had  olHeially  established  itself  in  an  historical  old 
house  in  Geneva,  Switzerland,  under  the  protective  wing  of 
the  Cathedral.  By  this  time,  Sir  David  Henderson  had  been 
appointed  as  Director  General  and  Dr.  Richard  Strong  as 
(ieneral  ^ledical  Director.  The  dill'erent  sections  of  the  ]\Iedi- 
cal  Department  were  the  divisions  of  Tuberculosis,  Medical 
Information,  Library  of  Public  Health,  Sanitary  Engineering 
and  Nursing,  Child  Welfare,  Vital  Statistics  and  ^lalaria. 

On  November  17,  I  reported  for  service  with  the  Lea;^ue 
and  I  doubt  if  any  one  ever  accepted  a  position  with  so  slight 
a  knowledge  of  what  it  entailed,  with  lesser  oj)portunities  for 
following  any  established  precedents  and  with  less  data  on 
whicli  to  build  a  program.  ]\Iost  of  us  felt  very  new  and 
unequal  to  the  task  which  had  been  set  before  us  by  the 
Resolutions  passed  by  the  Cannes  Conference,  but  we  made  up 
in  enthusiasm,  ciiprit  de  corps  and  loyalty  to  our  ideals  our 
lack  of  experience  in  international  service  and  the  absence  of 
any  helpful  guidance  or  precedent. 

In  ])lanning  for  the  work  of  the  Division  of  Nursing,  my 
first  step  was  to  try  and  secure  as  much  information  on 
nursing  as  I  could  gather  from  the  different  countries.  One 
dominant  fact  impressed  itself  on  my  mind  through  those 
months  of  ])reliminary  work  in  antici})ation  of  our  lirst  assem- 
bly was  the  ditlieulty  of  understanding  and  being  understood, 
internationally  s])eaking.  Words  were  used  by  many  nations 
with  entirely  different  meaning  in  each  case,  comparative 
studies  of  re]iorts  were  therefore  of  no  value  and  1  felt  that  I 
was  not  trctting  on  the  right  road  to  '"internationalize  nurs- 
uvX'  according  to  the  needs  and  resources  of  different  coun- 
tries. 1  therefore  prejiared  a  report  for  the  Assembly  which 
embodied  the  ]irogram  of  my  department  along  general  lines 
and  otferinsi  the  choice  of  several  nu_>tliods  in  carryinu-  out  my 
idea  of  oll'ering  a  training  in  nursing  and  preparing  (iualilic(l 
young  wouKMi  in  the  countries  where  such  traininir  was  not 
alreadv  a\ailable. 


1144  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Early  in  March,  1920,  the  League  held  at  Geneva  its  first 
General  Assembly,  and  representatives  of  twenty-seven  national 
Red  Cross  societies  were  present.  At  a  meeting  of  the  medical 
section,  Miss  Fitzgerald's  Report  on  Nursing  was  read  and 
the  following  resolution  was  voted: 

Resolved :  That  the  League  of  Red  Cross  Societies  urge  the 
establishment  in  Europe  of  one  or  more  model  training  schools 
for  public  health  nurses,  but  that  until  this  can  be  realized 
there  be  founded  under  the  supervision  of  the  League  nursing 
scholarships  for  the  national  Red  Cross  Societies  of  those 
countries  where  no  such  facilities  exist,  in  a  city  chosen  as 
being  most  appropriate. 

Of  the  development  of  this  scholarship  project,  Miss  Fitz- 
gerald wrote: 

...  I  went  to  London  and  arranged  for  a  course  in  prac- 
tical and  theoretical  public  health  nursing  which  was  given 
at  King's  College  for  Women  with  affiliations  with  the  dif- 
ferent child  welfare  centers,  tuberculosis  dispensaries, 
school  nursing  and  other  associations  for  rural  nursing, 
district  nursing,  etc.  The  League  of  Red  Cross  Societies 
offered  ten  scholarships  and  asked  National  Red  Cross  soci- 
eties to  offer  others  to  enable  nurses  to  go  to  London  and 
study  public  health  nursing  as  a  post-graduate  course. 
Twenty  nurses  representing  the  following  eighteen  countries 
answered  the  first  call:  The  United  States  of  America  (two 
nurses),  Canada,  A^enezuela,  Peru.  England.  France,  Italy, 
Portugal,  Belgium,  Denmark,  Sweden,  Switzerland,  Poland, 
Czecho-Slovakia,  Serbia.  Roumania,  Greece,  Russia.  These 
nurses  were  most  carefull}'  selected  by  the  different  Red  Cross 
societies  according  to  directions  issued  from  Geneva: 
Age:  Twenty-three  to  forty  years  of  age. 
Education :     Evidence  must  be  produced  showing  continuous 

education  up  to  the  age  of  eighteen  years. 
Training:     The  student  must  possess  a  diploma  or  certificate 

as   regulated   by  the   highest  nursing  standards   of  the 

country  which  she  represents. 
Health :    A  medical  certificate  of  general  good  health  must  be 

produced. 
Reference :     Should  l)e  given  in  evidence  of  good  character 

and  efficiency.     Tn  selecting  students  particular  attention 

must  be  paid  to  the  necessity  for  unusual  intelligence  to 

enable  them  to  profit  by  a  course  which  is  necessarily 

intensive. 


INTERNATIONAL  NURSING  EDUCATION       1U5 

Language:  The  students  must  be  sufficiently  familiar  with 
the  Knglish  language  to  follow  lectures  and  take  notes. 

Form  of  Application :  Must  he  filled  in  and  returned  to  the 
Director  of  the  Department  of  Nursing  of  the  League  of 
Red  Cross  Societies. 

It  was  felt  that  this  method  of  training  in  public  health 
was,  for  the  present  at  least,  our  best  way  for  keeping  to 
standardized  nursing  in  its  branches  and  the  course  in  Lon- 
don is  being  repeated  with  thirteen  nurses  present  from  the 
following  countries:  England,  Canada,  ^Mexico,  Japan,  Xew 
Zealand,  Austria,  Hungary,  Bulgaria,  Latvia,  Lithuania,  Ice- 
land and  Czeclio-Slovakia.  This  course,  like  the  first  one,  is 
under  the  direction  of  Miss  F.  M.  Waters. 


The  general  progTani  of  the  Department  of  Nursing  of  the 
League  included  as  one  of  the  duties  of  its  director  careful 
''follow-up"  supervision  of  nursing  activities  developed  bv  na- 
tional branches  of  the  League.  IMiss  Fitzgerald  also  supervised 
some  child  welfare  activities  which  had  been  developed  and 
financed  by  local  agencies  in  Roumania  and  Czecho-Slovakia 
but  the  medical  direction  of  which  had  been  placed  under  the 
^fedical  Department  of  the  League.  Of  the  development  of 
schools  of  nursing,  ^fiss  Fitzgerald  wrote: 

A  training  school  for  nurses  in  Belgrade,  Serbia,  was 
organized  under  a  special  committee  comprised  of  representa- 
tives of  the  Serbian  Ked  Cross,  the  Serbian  Cliild  Welfare 
Committee  of  America,  the  Serbian  Minister  of  War,  Minister 
of  Health,  military  hospital  and  civil  hospital.  I  was  privi- 
leged in  meeting  several  times  with  this  committee  and  I 
assigned  Miss  l"]nid  Newton,  a  British  trained  nurse  of  ex- 
tended e\j)erience,  to  be  director  of  the  new  school  in  answer 
to  the  request  that  the  League  of  Red  Cross  Societies  take  an 
active  part  in  its  administration. 

The  development  of  this  international  advisory  nursing  ser- 
vice was  fraught  with  many  difhculties  and  considerable  dis- 
couragement.    Miss  Fitzgerald  wrote: 

.  .  .  PtThajis  the  greatest  obstacle  to  quick  action  and 
rapid  results  will  contimie  to  l)e  tlie  distances  wliich  separate 
our  lieudciuarters   from  many  of  our  member  societies.      Let- 


1146  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ters  travel  slowly,  wires  are  expensive  and  unsatisfactory,  and 
personal  visits  prohibitive  in  many  cases.* 

The  Department  of  Nursing  of  the  League  of  Red  Cross 
Societies  finds  some  encouragement  in  the  fact  that  it  has 
established  a  personal  contact  with  nurses  from  thirty  dif- 
ferent countries,  many  of  whom  will  act  as  pioneers  in  nursing 
under  the  flag  of  their  own  Red  Cross  society  and  with  what 
help  we  of  the  League  of  Eed  Cross  Societies  can  give  them. 

The  League  of  Red  Cross  Societies  lost  the  services  of  Miss 
Fitzgerald  in  the  autumn  of  1921.  After  an  absence  of  six 
years  from  the  United  States,  she  had  returned  for  a  much- 
needed  rest,  and  also  with  the  hope  of  arousing  some  interest 
on  the  part  of  philanthropic  individuals  and  "foundations"  in 
the  nursing  service  of  the  League.  While  she  was  in  the  coun- 
try some  changes  in  League  policies  influenced  Miss  Fitz- 
gerald's resignation.  She  was  succeeded  by  her  assistant,  Miss 
Katherine  M.  Olmsted,  an  American  Red  Cross  nurse  who  had 
shortly  before  been  appointed  to  advise  in  public  health  nursing 
matters  of  the  League  program. 

At  the  second  meeting  of  the  General  Council,  held  in 
Geneva,  starch  28-31,  1922,  the  nursing  program  of  the  League 
was  discussed.  In  this  discussion  emphasis  appeared  to  be  laid 
on  public  health  nursing  at  the  expense  of  nurse  education, 
which  is  necessary  as  a  sound  fundamental  basis  to  any  nursing 
service.  This  caused  some  anxiety  to  those  who  were  inter- 
ested in  the  development  of  the  nursing  program  of  the  League. 
The  change  of  name  of  the  Bureau  from  that  of  "Department 
of  Nursing"  to  "Department  of  Public  Health  Nursing" 
seemed  a  clear  evidence  of  misplaced  emphasis,  and  appeared 
to  suggest  a  drawing  away  from  the  resolution  adopted  at  the 
Cannes  Conference. 

By  the  date  of  the  second  meeting  of  the  General  Council 
of  the  League,  the  "experimental  period"  ^  of  its  existence  may 
be  said  to  have  been  ended.  In  the  light  of  past  experience,  it 
became  possible  in  1922  to  define  "with  relative  confidence"  ^ 

*  The  fact  that  each  Red  Cross  society  was  permitted  to  interpret  tlie 
qualifications  of  the  students  led  to  lack  of  uniformity.  The  Canadian 
or  American  nurse  found  herself  a  member  of  a  class  which  contained 
women  with  Red  Cross  certificates  it  is  true,  but  who  could  hardly  be 
retiaided  as  ^'raduate  nurses.  Recent  reports  show  that  an  effort  has  been 
made  to  adopt  a  mininuim  standard,  but  so  far  without  success. 

'^  See  "Second  -Meetinjf  of  the  General  Council,  League  of  Red  Cross 
Societies,"'  Vol.  TI.  p.    18. 

"Ibid.,  p.   19. 


INTERNATIONAL  NURSING  EDUCATION       1147 

the  type  of  service  which  tlie  League  could  most  eifectively 
render.  This  service  was  thought  to  be  chiefly  in  an  advisory 
capacity  rather  than  in  the  development,  as  first  contemplated 
by  the  Cannes  Conference,  of  the  League  as  an  international 
health  organization  or  of  an  extensive  program  in  the  field  of 
medical  research.  This  change  of  policy  involved  a  substantial 
reduction  in  the  entire  program  of  the  League,  and  in  this  re- 
duction the  Division  of  Nursing  shared. 

Miss  Hay  attended  the  Council  meeting  as  a  representative 
of  the  American  lied  Cross  Nursing  Service,  and  in  a  speech 
made  at  that  time  emphasized  the  necessity  of  nurse  schools  as 
the  only  safe  basis  for  a  general  or  special  public  health  service : 

It  seems  to  me  wc  should  lose  an  unusual  opportunity,  even 
ne<i;lcet  a  very  important  duty,  if  this  body  did  not  put  itself 
on  record  as  making  most  conspicuous  this  idea,  that  for  pub- 
lie  health  nursing  and  for  the  best  development  of  public 
health  nursing  in  any  country  we  must  have  the  assistance  of 
thoroughly  trained  nurses.  .  .  . 

The  nursing  delegates  had  under  consideration  the  publica- 
tion of  a  pamphlet  which  would  set  forth  the  activities  that 
might  be  undertaken  by  the  League,  and  Miss  Hay  suggested 
that  a  statement  such  as  the  following  be  introduced  into  it : 

In  the  more  essential  nursing  activities  which  the  League 
can  conduct,  it  is  recommended  that  the  League  shall  under- 
take to  stinuilate  the  organization  of  nursing  schools  of  the 
highest  standards  in  countries  where  these  do  not  now  exist. 

.This  recommendation  of  Miss  Hay's  was  in  line  with  the 
efforts  of  the  American  Red  Cross  to  introduce  into  European 
countries  the  Nightingale  System  of  nurse  education.  An  ac- 
count of  the  schools  of  nursing  subsidized  by  the  American 
Ived  Cross  follows. 

In  Prague,  Czecho-Slovakia ;  in  Poscn  and  Warsaw,  Po- 
land; in  Constantinople,  Turkey,  and  in  Port-au-Prince,  Haiti, 
the  American  Tied  Cross  established  schools  of  nursing.  In 
Athens,  Greece  and  Sofia,  Bulgaria,  similar  attempts  were 
uuide  but,  at  the  date  of  writing  of  this  history,  were  un- 
successful. 

At  the  request  of  Dr.  Alice  ]\fasarvk,  the  daughter  of  the 
pn^sident  of  the  new  republic  of  Czecho-Slovakia,   ^liss   Fitz- 


1148  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

gerald  visited  Prague  on  July  3,  1919,  for  the  purpose  of  con- 
ferring with  ])r.  !Masaryk  on  the  subject  of  a  school  of  nursing. 
Dr.  Masaryk  placed  an  interpreter  at  Miss  Fitzgerald's  disposal 
and  she  visited  the  general,  maternity  and  children's  hospitals 
in  Prague.     In  the  report  of  her  trip  Miss  Fitzgerald  wrote : 

...  I  then  had  a  final  interview  with  Dr.  Masaryk.  The 
question  in  my  mind  at  the  time  was  as  to  the  advisabiUty  of 
taking  over  the  present  training  school  |  the  State  School 
which  was  finally  selected],  where  some  students  are  now 
awaiting  their  graduation,  and  reorganizing  it,  or  whether  to 
start  an  entirely  new  organization.  The  former  plan  appealed 
to  me  because  it  would  avoid  duplication  of  efforts  and  the 
fact  tliat  pioneer  work  had  been  doiie  miglit  make  it  easier 
for  the  new  people  coming  in.  Dr.  Masaryk  agreed  with  me 
in  this  matter  and  1  made  it  very  plain  to  lier  that  the  success 
of  the  sclieme  wouhl  depend  entirely  upon  two  things — first, 
the  possibility  of  enrolling  the  proper  class  of  students,  i.e., 
girls  of  fair  education  and  of  higli  moral  qualifications;  and 
secondly  the  matter  of  obtaining  not  only  the  full  cooperation 
of  the  medical  ])rofession,  but  of  seeing  a  thorough  change  in 
their  present  point  of  view,  so  that  they  would  themselves  sec 
the  necessity  for  a  training  school.  .  .  . 

Dr.  ]\Iasaryk  seemed  willing  to  guarantee  that  all  these 
above  conditions  would  be  complied  with  and  seemed  to  have 
no  doubt  in  her  mind  that  this  could  be  done  at  an  early  date. 

The  plan  as  finally  drawn  up  was  stated  as  follows  by  !Miss 
Fitzgerald  in  a  letter  written  July  18,  1!)19,  to  Miss  ISFoyes : 

We  are  to  send  two  trained  nurses  to  Prague  for  a  period  of 
three  years  to  start  a  training  school  for  nurses  in  that  city. 
At  the  same  time  i\Iiss  Masaryk  is  to  pick  out  two  well- 
educated,  well-qualified  and  representative  young  women  of 
the  Czecho-Slovak  race,  able  to  speak  English,  to  come  to 
America  to  take  the  nurses'  training  there.  When  they  finally 
receive  their  diplomas,  they  will  then  be  ready  to  return  to 
Prague  and  carry  on  the  work,  when  we  are  ready  to  withdraw 
our  two  nurses  from  there.  The  scheme  has  been  approved 
by  the  Commission  for  Europe,  and  is  now  awaiting  final 
endorsement  from  Washington  to  become  a  defhiite  ])lan.  As 
1  told  you  in  my  last  letter,  1  think  that  Miss  Marian  Parsons 
would  be  a  very  good  person  for  this  piece  of  work,  would  she 
be  willing  to  undertake  it.  One  thing  which  makes  nu'  very 
optimistic  about  the  final  outcome  of  this  plan  is  the  fact  that 
the  medical  profession  in  Prague  is  of  a  very  high  standing. 


INTERNATIONAL  NURSING  EDUCATION      1149 

Miss  Fitzgerald  presented  a  budget,  which  included  the 
salaries  for  three  years  of  a  head  nurse  and  one  assistant, 
with  a  maintenance  appropriation  of  twenty  francs  a  day  and 
traveling  expenses.  It  also  included  a  monthly  allowance  of 
$25  for  each  of  the  two  students  for  two  years,  with  travel- 
ing expenses.  The  total  appropriation  called  for  something 
over  twenty  thousand  dollars.  It  afterwards  developed  that 
two  nurses  were  not  sufficient  to  develop  the  school,  so  two 
additional  were  assigned,  one  to  develop  a  public  health  course 
which  formed  part  of  the  student  course,  the  other  as  supervisor 
of  the  practical  work  in  the  wards.  A  copy  of  the  communi- 
cation was  sent  to  Red  Cross  Headquarters,  Washington,  D.  C. 
The  plan  was  immediately  considered  and  a  cable  of  approval 
was  transmitted  on  July  29,  1919,  by  Dr.  Farrand. 

As  the  lied  Cross  was  expecting  to  terminate  its  general 
relief  work  in  Europe,  Dr.  Farrand  felt  that  a  commitment 
covering  general  supervision  for  longer  than  one  year  might 
place  the  Red  Cross  in  an  awkward  position  should  it  decide 
to  close  its  Paris  office.  The  question  of  some  other  organiza- 
tion acting  as  the  liaison  between  National  Headquarters  and 
the  school  was  discussed  and  suggested  in  the  cable.  The 
necessity  for  this  was  remote,  as  direct  communication  and' 
direction  from  National  Headquarters  in  Washington  was  quite 
practicable. 

After  returning  to  this  country  for  a  brief  rest,  ^fiss  Par- 
sons, accompanied  by  her  assistant,  Alotta  Lentell,  went  back 
to  Europe  and  assumed  the  responsibility  of  organizing  and 
directing  the  School  of  Nursing  at  Prague.  ]\riss  Parsons  was 
born  in  Maine  and  was  a  graduate  of  the  School  of  Nursing  of 
the  Boston  City  Hospital.  After  several  years  of  executive 
experience  in  various  New  England  institutions,  she  took  a 
two  years'  course  at  Teachers  College  in  training  school  ad- 
ministration. She  joined  the  Army  Nurse  Corps  as  a  memV)er 
of  Base  Hospital  No.  7.  She  served  abroad  with  this  unit  and 
was  released  October,  1919.  ^[iss  Parsons'  experience  and 
thorough  preparation  eminently  qualified  her  for  this  exceed- 
ingly difficult  and  arduous  undertaking. 

Thus  the  first  8te})s  were  taken  by  the  American  Red  Cross 
toward  a  more  constructive  post-war  program  in  Europe,  one 
bound  to  be  far-reaching  in  its  results  and  influence.  Nc^^otia- 
tions  were  also  immediately  opened  with  the  ^rassachusetts 
General  School  of  Nursinii'  and  arrana-ements  made  with  it  to 


1150  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

receive  the  two  graduates,  Bozena  Brezinova  and  Franciska 
Ruzickova  of  the  State  School,  for  instruction  covering  a  period 
of  two  years,  a  credit  of  one  year  to  be  given  them  for  the  time 
spent  in  the  State  School  at  Prague."^  The  two  yonng  women 
arrived  in  this  country  in  August,  1920.  But  their  knowledge 
of  English  was  found  inadequate  and  special  tutoring  became 
necessary ;  thus  their  admission  to  the  school  was  delayed  until 
January  1,  1921.  Unfortunately  Miss  Brezinova  suffered  a 
nervous  breakdown  almost  immediately  and  was  sent  to  the 
McLean  Hospital  for  treatment,  where  she  remained  until  the 
autumn  of  1921,  when  she  was  returned,  unimproved,  to  her 
own  country.  In  the  early  summer  of  1921,  Vilma  Cerna,  who 
had  graduated  that  spring  from  the  State  School,  partially 
trained  under  Miss  Parsons,  replaced  Miss  Brezinova.  She 
spent  the  summer  in  the  wards  at  the  Presbyterian  Hospital, 
New  York,  acquiring  American  methods  and  entered  Teachers' 
College  at  Columbia  University  in  the  autumn  as  a  special 
student  in  administration  of  schools  of  nursing.  Here  again 
the  handicap  of  imperfect  English  made  special  tutoring  almost 
imperative,  which  jMiss  Nutting,  through  private  means,  sup- 
plied. The  summer  of  1922  was  spent  by  Miss  Ccrna  in  the 
wards  at  the  Massachusetts  General  Hospital,  in  order  to  secure 
further  practical  experience.  She  returned  September  16  to 
Czecho-Slovakia  to  serve  as  assistant  to  ^liss  Parsons  until 
the  termination  of  the  contract.  At  the  time  of  writing  this 
chapter,  ]\[iss  Ruzickova  had  not  yet  finished  her  course;  all 
reports  indicated  that  she  was  a  good  student  and  interested 
in  her  work. 

Miss  Noyes  on  her  tour  of  inspection  in  the  autumn  of  1920 
visited  the  School  of  Nursing  at  Prague.  The  two  most  serious 
defects  at  that  time  were  inadequate  facilities  for  teaching 
practical  nursing  in  sucli  wards  of  the  hospital  as  had  agreed 
to  admit  the  students,  and  an  insutiieiont  dietary  for  the  nurses. 
In  making  rounds  through  the  liospital,  ]\Iiss  Noyes  was  struck 
by  tlie  lack  of  proper  equipment.  The  linen  and  clothing 
supply  was  most  inadequate,  and  in  the  tuberculosis  wards 
particularly  patients  shivered  under  but  one  blanket.  This 
made  it  almost  impossible  to  keep  the  windows  open  and  to 
obtain  fresli  air. 

'  Major  Herbert  S.  Joluisdn  of  ]5oston,  former  Ainerieaii  Red  Cross 
Commissioner  to  C'zoeho-Slovakia.  was  not  only  interested  in  the  project 
but  was  rc'sp(jnsiblo  for  its  origin. 


INTERNATIONAL  NURSING  EDUCATION      1151 

In  the  wards  a  corner  was  usually  set  off  with  a  half-parti- 
tion to  niake  a  so-called  room  in  which  the  nurses  had 
formerly  slept;  here  at  the  time  of  Miss  Noyes'  inspection 
they  were  occupied  by  the  ward  maids  or  attendants.  The 
nurses'  home  was  a  fairly  good  building.  The  sleeping  rooms 
had  been  comfortably  furnished;  usually  there  were  two  or 
four  students  in  each  room.  The  historic  porcelain  stove  occu- 
pied a  corner  of  each.  The  scarcity  of  coal,  however,  made  it 
impossible  to  have  fires  except  in  the  living  room.  Miss  Par- 
sons had  fitted  up  this  room  in  a  very  attractive  manner  and 
had  secured  equally  pleasing  class  rooms  and  a  library, 

'J'he  dining  room,  however,  was  a  cheerless  place.  Connected 
with  it  was  a  good  kitchen  where  the  food  from  the  hospital, 
provided  for  the  nurses,  was  served.  As  Miss  Hay  and  Miss 
Noyes  lodged  in  the  school,  they  were  given  ample  opportunity 
to  sample  the  food.  A  day's  menu,  more  or  less  typical,  was 
about  as  follows :  A  large  piece  of  heavy,  black  bread,  without 
butter;  substitute  coffee,  without  milk,  but  with  sugar,  provided 
to  the  nurses  before  they  went  on  duty  in  the  morning.  Upon 
this  meager  diet  they  were  expected  to  work  until  noon.  For 
the  mid-day  dinner  usually  thin  soup,  cabbage,  broad  without 
butter,  and  for  dessert  a  large,  heavy  bun,  made  of  compara- 
tively white  flour,  which  contained  in  the  center  some  sour 
cheese  and  a  scanty  s])riiikling  of  sugar.  For  supper  tea, 
bologna  sausage  occasionally  and  bread  or  plain  boiled  potatoes, 
generously  sprinkled  with  caraway  seeds,  or  by  way  of  variety, 
sour  cheese.  If  jiotatoes  were  given  no  bi*ead  was  provided. 
Twice  a  week  meat  was  served  for  dinner.  Thus  with  little  or 
no  variety  the  wearisome  routine  was  followed  day  after  day. 
Tlie  students  and  gi-aduate  nurses  looked  pale  and  anemic  and 
it  seemed  rnarvi^lous  that  upon  so  meager  a  diet  they  were  able 
to  drag  through  a  day's  work  on  the  wards  where  anything  but 
hygienic  and  sanitary  conditions  prevailed. 

Two  reconnnendations  were  made  to  the  Paris  office: 

1.  That  an  allowance  of  18,000  francs  be  given  to  Miss 
Parsons  to  supplement  the  food  for  all  the  school  until  June, 
]!)"^M.  when  tlie  Czecho-Slovak  Ked  Cross  had  agreed  to  assume 
this  resiionsihijity. 

■?.  That  instead  of  providing  cooked  f()f)d  from  the  hos- 
pital, the  eciuivalont  in  money  i)C  given  ^liss  Parsons  to  buy 
tlu'  food  and  have  it  cooked  in  tlie  kitchen  under  her  own 
direction. 


1152  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  recommendation  requesting  an  appropriation  for  food 
was  granted  by  the  American  Red  Cross  and  the  second  recom- 
mendation hiter  became  effective.  The  result  was  tliat  a  more 
generous  diet,  palatably  cooked  and  served,  was  procured  for 
the  nurses,  with  a  corresponding  increase  in  their  physical 
well-being. 

Another  observation  of  Miss  Noyes  was  that  only  two 
pieces  of  soap,  two  inches  square  and  filled  with  irritating 
alkali,  due  to  scarcity  of  raw  material  and  cost,  was  issued  to 
the  wards  weekly.  This  served  all  purposes,  for  the  hands  of 
doctors  and  nurses,  for  bathing  the  patients  and  for  general 
cleaning  purposes.  Despite  these  limited  supplies  the  wards, 
sunny  and  bright,  looked  exceedingly  tidy  and  clean,  with 
white  well-scrubbed  floors  and  polished  bits  of  brass  here  and 
there;  and  even  though  the  linen  was  scanty,  permitting  only 
of  a  weekly  change,  the  beds  looked  fairly  coniforta])le  and 
clean. 

The  faculty  of  the  school  at  that  time  consisted  of  Miss 
Parsons,  Miss  Lentell  and  Blanche  Kacena,  a  Bohemian- 
American  nurse,  who  had  been  prepared  at  Teachers  College, 
and  who  spoke  the  Czech  language.  Miss  Kacena  was  detailed 
to  the  supervision  of  the  instruction  in  the  hospital.  Pansy 
Besom,  a  public  healtli  nurse,  formerly  with  the  New  England 
Division  of  the  American  Red  Cross,  was  assigned  to  develop 
a  public  health  nursing  course,  and  was  at  that  time  making 
a  survey  of  the  resources  of  the  city.  ^lay  Louise  White  was 
acting  as  an  assistant.  j\lary  H.  Bethel  was  instructing  in 
Homo  Hygiene  and  Care  of  the  Sick  in  connection  with  the 
Czech  Rod  Cross. 

The  organization  of  the  school  consisted  of  a  Board  of  Man- 
agers of  nine  membt^rs,  upon  which  the  Czecho-Slovak  Red 
Cross,  the  Ministry  of  Hygiene,  the  faculty  of  the  University 
of  Prague  and  the  military  group  were  represented;  the  super- 
intendent of  the  kState  Hospital  and  the  American  Nurse 
director  were  also  members. 

The  curriculum  consisted  of  a  two  years'  and  four  months' 
course  which  had  hoon  arranged  by  the  director,  and  the  ma- 
jority of  the  subjects,  because  of  the  language  difficulties,  had 
to  bo  given  by  physicians,  members  of  the  medical  department 
of  the  University  of  Prague  or  of  the  hospital  staff.  Instruc- 
tion by  the  American  Red  Cross  nurses,  except  that  by  Miss 
Kacena,  was  given  through  an  interpreter,  but  the  results  were 


INTERNATIONAL  NURSING  EDUCATION      1153 

surprisingly  good.  Gradually  ^liss  Parsons  was  able  tp  add 
to  the  c'urricnlum  a  thorough  course  in  invalid  cookery  and 
nutrition,  a  course  in  bacteriology ;  and  finally  to  give  the 
students  the  advantages  of  American  textbooks ;  because  of 
the  lack  of  nursing  textbooks  written  in  Czech  language,  she 
introduced  a  course  in  English. 

Athliations  that  would  enable  the  students  to  obtain  added 
experience  were  gradually  developed  with  the  University 
(State)  IIos])ital.  Here  practical  nursing  experience  in  four 
departments — medicine,  surgery,  gynecology  and  dermatol- 
ogy— was  given.  The  Children's  Hospital,  a  private  institu- 
tion, afforded  training  in  pediatrics  and  field  work  in  public 
health  nursing  in  connection  with  the  child  health  centers  de- 
veloped by  the  American  Jled  Cross,  was  arranged. 

An  important  step  in  the  history  of  hospitals  and  the  educa- 
tion of  nurses  in  Czecho-Slovakia  consisted  in  the  placement  of 
wards  of  the  State  Hospital  under  the  direction  of  the  Amer- 
ican nurses  of  the  Prague  School.  Previous  to  1920  the  School 
of  Nursing  had  had  no  nursing  control  of  any  department  of 
the  State  Hospital  and  many  of  the  duties  commonly  assigned 
to  nurses,  such  as  taking  pulses  and  temperatures  and  giving 
hypodermics,  had  been  assumed  by  the  young  physicians,  A 
leading  internist  connected  with  the  State  Hospital,  impressed 
by  !NHss  Parsons'  arguments  and  the  better  methods  and  re- 
sults, offered  the  school  two  of  his  wards  as  a  teaching  field. 
As  the  type  of  nursing  which  was  done  in  these  two  wards  be- 
came known,  the  school  was  gradually  rocpiestcd  to  assume 
charge  of  the  nursing  in  surgical  and  gynecological  wards  as 
well. 

As  to  the  students,  it  was  observed  that  they  appeared  to  be 
drawn  from  the  middle  classes.  A  tuition  of  seventy  kronen 
per  month  was  required  from  the  outset  from  all  student  nurses. 
The  prejudice  against  nursing  as  a  profession  for  gentlewomen 
still  prevailed  in  Czecho-Slovakia.  The  attitude  of  the  medical 
profession  in  many  instances  was  discouraging;  they  appeared 
quite  willing  to  acce])t  nurses  of  the  poorest  grade,  and  some 
were  inclined  to  show  some  antagonism  to  the  ])lan  of  a  modern 
school.  Witli  the  backing,  however,  of  President  ^lasarvk, 
his  progr(^ssive  daughter,  J)r.  Alice  ^Fasaryk,  and  tlu^  best 
elenuMit  in  the  medical  ])r(ifessi(m,  sentiment  in  this  dir(H'tio:i 
gradually  cliaiiged  until  an  increasingly  better  class  of  candi- 
dates were  admitted. 


1154  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  American  Red  Cross  contract  with  the  State  School  at 
Prague  called  for  gradual  withdrawal  of  the  American  nurses 
from  the  school.  Two  nurses  were  prepared  in  the  schools 
of  the  United  States  to  succeed  them.  The  foundation  was 
carefully  built  and  the  school  at  Prague  bade  fair  to  compare 
favorably  with  any  modern  school  in  America.  The  American 
nurses  were  prepared  to  pass  the  torch  to  their  Czech  sisters 
who  had  been  taught  under  their  auspices  and  to  give  them 
the  courage  as  has  been  the  case  in  the  history  of  all  such  move- 
ments, to  "carry  on"  as  pioneers  in  a  country  where  a  system 
of  modern  nursing  was  still  a  matter  of  wonder  to  the  large 
part  of  the  population.  That  the  school  was  maintained  at  all 
was  an  accomplishment  of  no  mean  proportions.  During  the 
years  following  the  European  War,  Czecho-Slovakia  was  mak- 
ing a  mighty  effort  towards  reconstruction  and  improvement 
of  its  economic  conditions.  Surrounded  as  it  had  been  by 
enemy  countries,  over-run  by  armies  which  had  lived  upon  it, 
stripping  it  bare  of  everything,  was  it  a  cause  for  wonder  that 
its  hospitals  were  destitute  of  the  bare  necessities  ?  The 
Czechs,  a  proud  people  with  unbroken  spirit,  were  well  aware 
of  the  situation  and  were  making  a  desperate  and  apparently 
highly  successful  effort  to  improve  conditions. 

Although  the  idea  of  introducing  the  jSTightingale  System  of 
nurse  education  in  Poland  was  conceived  at  an  early  date  fol- 
lowing the  signing  of  the  Armistice,  the  development  of  a  school 
was  slow.  In  her  first  communication  from  the  League  head- 
quarters under  date  of  November  20,  1918,  Miss  Fitzgerald 
wrote  to  ]\liss  Noyes:  "I  believe  that  the  American  Red  Cross 
(i'ommission  for  Poland  is  planning  to  start  a  training  school 
for  nurses.  The  country  is  not  yet  ready  for  it,  and  I  tried  to 
persuade  Colonel  Chesley  [then  commissioner]  that  they  should 
not  undertake  such  a  piece  of  work  until  they  at  least  had  the 
advice  and  co(")peration  of  a  nurse  of  experience."  This  was 
the  first  hint  tliat  a  school  for  nurses  was  occupying  the  thought 
of  the  Commission  for  Poland.  From  time  to  time  during  the 
winter  and  spring  of  1920,  letters  first  from  Miss  Waters,  who 
served  as  acting  Director  of  Nursing  at  the  Paris  head- 
qiuirters  during  the  interval  succeeding  ^liss  Fitzgerald's 
resignation  and  Miss  Hay's  appointment,  then  from  ^liss  Hay 
and  Miss  Benn,  contained  references  to  such  a  project. 

During  the  summer  of  lt»20,  Dorotlu^a  Hughes,  a  student 
nurse  in  the  Army  School  of  Nursing  at  Walter  Reed  Hospital, 


INTERNATIONAL  NURSING  EDUCATION       1155 

wrote  to  the  Kod  Cross  office  that  through  friends  she  had  be- 
come greatly  interested  in  Poland  and  desired  to  be  of  help  to 
it;  that  as  she  had  entered  a  training  school  for  patriotic  reasons 
she  would  like  to  assist  with  the  organization  of  a  school  in 
Poland,  and  was  ready  to  subscribe  $10,000  a  year  through  the 
American  Ked  Cross  for  three  years  for  that  purpose.  Miss 
Noyes,  knowing  that  Poland  was  asking  for  assistance  in  this 
direction,  assured  Miss  Hughes  that  she  had  written  at  an 
opportune  time.  Advice  of  the  offer  was  transmitted  to  Miss 
Play,  and  npon  the  assurance  that  the  money  was  available,  she 
submitted  on  July  1,  1920,  a  careful  plan  for  a  school  in 
Warsaw,  based  upon  her  survey  of  nnrsing  activities  and  needs 
in  Poland  made  in  ,J\\r\e  to  Major  Honeij  of  the  ^Medical  Staif, 
American  Ked  Cross  Commission  for  Poland.  This  plan  was 
to  be  presented  with  a  detailed  letter  of  transmittal  from  ^liss 
Hay  to  Madame  de  Bisping,  then  president  of  the  Polish  Red 
Cross.  The  best  laid  plans  dependent  npon  members  of  the 
hnman  race  to  execute  often  miscarry,  as  will  be  seen  from  the 
following  extract  in  a  letter  from  Miss  Hay  to  Miss  Noyes 
dated  July  ;}0,  1!)20: 

^liss  Fitzgerald  returned  this  week  from  her  trip  to  Poland 
and  Prague,  and  brings  back  valuable  reports.  She  may 
write  you  direct  on  the  question  of  the  training  school  in 
Warsaw,  but  the  facts  in  the  case  are  these:  That  Dr.  lloneij 
instead  of  giving  Mnie.  de  Bisping  my  letter  to  her  regarding 
the  school,  sent  it  v/itliout  further  explanation  or  conference, 
quite  contrary  to  wliat  he  had  said  he  would  do.  ]\riss  Fitz- 
gerald reports  that  Mnie.  de  Bisping  was  somewhat  con.^ter- 
nated  at  the  bigness  of  tlie  plan,  and  the  fact  that  the  Poli-h 
Ped  Cross  was  little  ])repared  to  give  any  material  assistance 
to  such  a  plan  regardless  of  how  much  they  wanted  the  school. 

This  may  have  been  one  reason  for  the  fact  that  but  little  was 
heard  on  the  subject  of  the  Warsaw  school  for  a  time,  although 
the  l^olsheviki  drive  in  the  summer  of  10:^0  claimed  the  full 
attention  of  the  Polish  lied  Cross.  The  (juestion,  however,  was 
not  allowed  to  die. 

In  October,  1!)20,  Miss  Hay  and  ^liss  Xoyes  visited  Cracow, 
where  the  local  authorities  had  ex])ressed  a  d('sir(>  that  the 
American  Tied  Cross  develo])  a  school.  A  brief  survey  of 
local  hospitals  was  nuule  that  infornuition  might  be  fully  in 
hand  should  tho  Cracow  authorities  urge  this  des'ic  of  theirs. 


1156  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Hay  and  Miss  Noyes  left,  after  two  days,  for  Warsaw, 
where  in  addition  to  making  a  fairly  comprehensive  study  of  the 
general  conditions,  specific  consideration  was  given  to  the 
question  of  the  development  of  the  school  of  nursing,  toward 
which  Miss  Fitzgerald  and  j\liss  Hay  had  been  working  in  oi*- 
operation  with  the  Polish  Red  Cross. 

Conferences  were  held  with  representatives  from  the  Min- 
istry of  Health,  the  University  of  Warsaw,  the  Municipal 
Government,  with  Miss  Zlenkier,  a  nurse  who  had  built  in 
Warsaw  a  complete  and  modern  hospital  for  children  and  who 
had  taken  a  partial  course  of  training  at  St.  Thomas  Hospital, 
London.  Various  hospitals  were  visited ;  among  them  a  chil- 
dren's clinic,  where  an  unusual  opportunity  seemed  to  be  pre- 
sented for  the  development  of  a  central  school;  the  Infant 
Jesus  Hospital,  a  large  institution  which  had  been  under  the 
direction  of  Russian  authorities  and  from  which,  upon  their 
evacuation,  they  had  removed  all  the  furnishings.  This  hos- 
pital, unlike  others  which  had  been  visited,  was  quite  modern 
in  its  equipment,  with  lavatories  and  diet  kitchen  well  fur- 
nished. The  hospital  was  under  the  direction  of  Sisters  who 
were  good  housekeepers  and  possessed  comparatively  modern 
ideas  of  nursing,  as  the  cleanliness  of  the  wards,  beds  and  bed 
linen  clearly  indicated. 

The  local  authorities  interested  in  the  development  of  the 
school  presented  a  plan  which  had  been  prepared  by  the 
special  committee,  which  included  the  individuals  already 
mentioned  as  well  as  others.  This  plan  was  formulated  from 
suggestions  apparently  made  by  Miss  Fitzgerald  and  Miss 
Hay,  combined  with  local  ideas.  Included  was  the  Prussian 
system  of  keeping  a  hand  upon  the  graduates  after  the  com- 
pletion of  their  course ;  for  a  given  space  of  ten  years  they 
were  to  be  under  the  control  of  the  institution.  The  plan  also 
carried  with  it  insurance  for  invalidism  and  old  age ;  it  in- 
cluded a  Congregation  of  Sisters,  every  nurse  to  be  a  member 
of  this  Congregation,  etc.  The  merits  of  the  plan  were  dis- 
cussed at  a  conference  and  a  counter  one  was  prepared,  which 
with  modifications  was  used  as  the  basis  of  understanding  and 
contract  with  all  the  schools  sponsored  by  the  American  Red 
Cross.     The  six  main  points  of  the  plan  were  as  follows: 

1.  A  corps  of  instructors  of  broad  experience  and  unques- 
tioned ability.  At  least  four  trained  nurses  are  necessary  for 
the  class  and  practical  instruction  and  supervision.     A  fifth 


INTERNATIONAL  NURSING  EDUCATION       1157 

nurse  is  also  desired  to  organize  and  carry  on  some  public- 
health  activity,  so  that  preparation  for  this  important  field  of 
usefulness  may  he  made  a  part  of  the  school's  program. 

2.  A  nurses'  home  adequately  furnished  and  maintained. 
Such  a  home  must  be  large  enough  to  take  care  comfortaljiy 
of  the  total  pupils  decided  on  .  .  .  besides  rooms  for  the 
facidty.  for  classes,  ftudy,  recreation,  household  menage,  etc. 
It  should  be  attractive,  comfortable,  sanitary,  well  heated  and 
lighted,  and  with  sufficient  service  to  keep  it  immaculate. 
Because  pupil  nurses  have  large  demands  made  of  them, 
physical  and  mental,  the  food  should  be  ample  and  of  the  best 
quality.  Amj)le  laundry  and  bathing  arrangements  are  also 
necessary. 

3.  Uniforms,  textbooks  and  translation  of  same,  equip- 
ment for  class  work,  as  charts,  models,  etc.  It  is  possible  tiiat 
in  order  to  attract  a  sufficient  number  of  pupils,  a  small 
monthly  allowance  also  be  provided. 

4.  Ilospital  atliliation.  Such  hospital  affiliations  should  be 
secured  as  will  ensure  the  thorough  practical  training  of  the 
pupils  in  tiie  various  classes  of  disorders,  a.s  medical,  surgical, 
transmissible,  gynecological,  pediatric,  etc.  It  is  important 
that  the  directress  of  the  school,  with  her  assistants,  be  given 
the  nursing  control  of  such  hospital  divisions  as  are  secured 
for  this  practical  training. 

It  is  understood  that  rules  and  regulations  governing  the 
admission  of  pu])ils,  their  supervision  and  general  direction, 
may  safely  be  left  to  the  director  of  the  training  school  to 
develoj)  after  her  arrival.  Also  rules  governing  the  activities 
of  graduate  nurses  should  primarily  be  left  with  the  graduates 
themselves. 

In  this  connection,  it  is  important  to  state  that  any  rules 
binding  the  graduates  of  such  a  school  to  extended  service  or 
control  after  graduation  are  contrary  to  American  methods 
and  principles  and  are,  we  believe,  certain  to  react  unfavor- 
ably on  the  school  itself  and  to  reduce  materially  the  number 
of  desirable  candidates  available  for  the  training.  It  is  ex- 
pected that  the  director  of  the  school  and  an  interested  school 
committee  will  lend  every  assistance  in  securing  proper 
recognition  and  adequate  salaries  for  the  members  of  this 
new-l)orii  profession,  either  through  suitable  Xurse  Practice 
Acts,  registration  bv  the  Government,  or  in  such  ways  as 
would  jirotect  the  people  and  the  nurse  graduate. 

5.  C'o(")[)orati()n  of  the  medical  fraternitv.  or  leading  mem- 
bers of  it.  wlio  would  assist  in  securing  the  desired  h()S]utal 
affiliations,  as  also  in  various  le<ture  and  lal)oratory  courses. 

<!.    An    active    training    selio(d    committee,    composed    of 


1158  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

representatives  from  the  various  interested  groups,  leading 
physicians  and  others,  who  would  give  of  their  whole-hearted 
sympathy  and  support  toward  the  creation  and  maintenance 
of  such  a  school  of  the  iirst  class. 

The  help  and  influence  of  the  larger  body  is  needed,  but  that 
the  work  might  be  vigorously  pushed  forward,  such  a  larger 
committee  should  be  subdivided  into  smaller  working  com- 
mittees, as,  for  example,  a  Committee  on  Xurses'  Home, 
Committee  on  Curriculum,  on  Hospital  Affiliation,  etc.  It  is 
recommended  that  to  this  larger  committee  be  appointed  two 
nurses  residing  in  Warsaw,  who  have  had  training  in  two  of 
the  best  London  hospitals.  Miss  Szlenkier  and  Miss  Zarzycka ; 
also  tliat  the  Commissioner  for  Poland,  American  Red  Cross, 
the  Chief  of  the  Medical  Staff,  and  the  Director,  Department 
of  Xursing  of  the  Commission  for  Poland,  A.  R.  C,  be  ex- 
officio  members  of  the  committee.* 

Xo  doubt  the  suggestions  which  had  already  been  made,  in 
addition  to  the  plan  submitted  by  Miss  Noves  and  her  associ- 
ates, seemed  a  radical  one.  Time  was  needed  for  the  Polish 
committee  to  digest  it. 

Miss  Xoyes  visited  Posen  for  the  purpose  of  interviewing  a 
committee  who  were  interested  in  the  development  of  a  school 
of  nursing,  and  also  to  review  the  work  of  a  small  group  of 
nurses  located  at  Kornik  and  two  who  were  giving  instruction 
in  Home  Hygiene  and  Care  of  the  Sick  in  Posen  itself.  Upon 
her  arrival  a  conference  was  held  which  had  been  arranged  for 
by  Dr.  Zniniewicz,  president  of  the  Posen  branch  of  the  Polish 
Red  Cross,  an  able  w^oman  physician  vitally  interested  in  the  es- 
tablishment of  a  school  in  that  city.  There  were  representatives 
present  from  the  Municipality,  the  Department  of  Health,  the 
Division  of  Military  Hospitals  and  the  Posen  University ;  also 
Miss  Hay  and  ^liss  ]\lathews  were  there.  The  Posen  repre- 
sentatives stated  their  sincere  desire  to  help  in  every  way  pos- 
sible in  the  organization  of  a  school  of  nursing  with  American 
nurses  in  charge.  They  suggested  a  building  formerly  used  by 
a  German  physician  as  a  private  sanitarium,  which  was  at  that 
time  under  consideration  as  a  hospital  for  the  Government 
railroad  employees  and  their  families.  In  order  that  a  better 
understanding  of  tlie  American  standards  and  requirements 
might  1)0  had,  a  copy  of  the  plan  which  had  been  prepared  for 
the  Warsaw  Coniniitt(M'  was  given  to  the  Posen  group. 

'For  further  details,  see  '"Outline  of  School  for  Nurses  in  Poland, 
October   25,    1920,'*   Red    Cross   Archives. 


INTERNATIONAL  NURSING  EDUCATION      1159 

Out  of  the  plans  for  a  school  of  nursing  for  Poland,  two 
schools  instead  of  one  emerged.  The  Posen  Committee  lost 
no  time  in  putting  their  plan  into  shape  and  presented  it  on 
December  12,  1020,  through  two  important  railroad  officials,  to 
Miss  iMathews.  On  December  28  Miss  Mathews,  Miss  Skorupa 
and  Mr.  Barge,  then  commissioner  for  Poland,  made  a  visit 
to  Posen,  and  at  a  meeting  held  the  following  day,  the  "Direc- 
tors of  Railways"  offered  their  newly-furnished  Hospital  of 
sixty  beds  and  a  dispensary  as  a  practical  field  for  the  School. 
The  Department  of  Health  offered  the  cooperation  of  other 
hospitals  and  the  Dean  of  the  University  offered  their  newly- 
opened  clinics  and  teaching  equipment.  The  direction  and 
execution  of  the  plan  was  placed  in  the  hands  of  the  Polish 
Red  Cross,  which  in  turn  was  expected  to  contribute  furnish- 
ings. The  city  agreed  to  furnish  light,  and  the  railway  direc- 
tor, coal. 

On  December  30,  1920,  Miss  ^lathews  in  a  letter  to  ]\[iss 
Hay  recommended  that  two  American  Red  Cross  nurses  then 
in  Poland  and  a  third  nurse  be  sent  to  the  prospective  school  in 
Posen ;  these  nurses  were  Louise  Walter,  who  spoke  German 
fluently;  Stella  Tylski,  a  Polish-American,  and  ]\Iiss  Suchow- 
ska,  whose  enrollment  in  the  American  Red  Cross  Nursing 
Service  was  then  ponding.  The  approval  of  the  Commissioner 
for  Europe  was  finally  secured  and  the  nurses  sent  to  Posen. 

The  subsequent  months  were  difficult  ones  for  the  little 
group  of  imrses.  The  promises  of  the  Committee,  while  un- 
questionably made  in  good  faith,  did  not  always  materialize. 
Apparently  there  was  some  talking  at  cross  purposes.  "Living 
quarters"  to  an  American  nurse  meant  one  thing,  a  good  home 
or  good  rooms,  heated ;  to  members  of  the  Polish  Committee  it 
might  have  meant  a  corner  of  a  ward.  The  first  difficulty  was 
suitable  living  (juarters. 

The  promised  affiliation  for  obstetrics  was  at  that  time  not 
available.  The  Railroad  Hospital,  which  was  offered  as  a 
teaching  field,  had  already  a  nursing  staff  of  Catholic  Sisters, 
and  they  had  to  b(^  conciliated.  Then  certain  members  of  the 
medical  profession,  true  to  American  form,  became  concerned 
lest  the  graduates;  miuht  practice  medicine  after  graduation, 
and  sent  a  formal  connnunication  •'  to  the  Coinmitf(M>  which 
began  by  urging  lower  educational  entrance  reciuirenients, 

•Letter  bv   Drs.   Adaniski   and  :\Iiklasinski,   Aimust    IS.   1921. 


1160  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Miss  Ita  MacDonnell,  a  Red  Cross  nurse  who  had  been  sent 
as  director  of  the  school,  and  who  had  been  accustomed  to 
working  with  Sisters  in  America,  gradually  effected  an  arrange- 
ment whereby  the  Sisters  were  given  the  housekeeping,  pur- 
chasing of  supplies,  supervision  of  help,  and  laundry.  This 
meant,  however,  that  the  small  group  of  American  nurses  with 
the  assistance  of  ten  probationers  were  obliged  to  assume,  both 
day  and  night,  the  actual  nursing  work  in  the  wards.  The 
difficulties,  met  and  overcome,  would  have  discouraged  a  less 
enthusiastic  group.  Such  handicaps  as  bedbugs,  lack  of  water, 
shortage  of  linen  and  utensils,  low  beds,  poor  mattresses,  laun- 
dry only  every  two  weeks,  were  met  and  conquered ;  gradually 
order  and  cleanliness  were  secured.  The  type  of  student  admit- 
ted was  excellent,  and  a  two-year  course  was  arranged  to  the 
best  advantage.  The  school  was  formally  opened  on  Novem- 
ber 10,  1921. 

A  request  for  an  appropriation  of  $11,500  was  approved  by 
the  Executive  Committee  of  the  American  Red  Cross  in  1921, 
with  the  expectation  that  it  would  take  care  of  the  teaching 
faculty  for  two  years  and  six  months.  It  was  further  expected 
that  graduates  from  the  school  or  from  among  the  Polish 
students  brought  to  this  country  on  Rockefeller  Foundation 
Scholarships  and  placed  in  the  Massachusetts  General  School 
of  Nursing  would  at  the  end  of  that  time  be  available  for  this 
work.  In  April,  1922,  Dr.  Hill,  then  vice-chairman  in  charge 
of  foreign  operations  at  National  Headquarters  was  able  to 
increase  the  fund  to  $15,000  in  order  that  an  additional  in- 
structor, increasing  the  faculty  to  four,  might  be  provided, 
and  Lena  Johnson  was  added  to  the  staff. 

In  April,  1921,  plans  for  the  development  of  the  Warsaw 
School  had  reached  such  a  stage  that  Helen  Bridge,  whose  work 
with  the  Siberian  Commission  has  already  been  described, 
sailed  from  New  York  as  director.  The  project  was  financed 
by  Miss  Dorothea  Hughes.  On  ]\riss  Bridge's  arrival  in  Po- 
land, she  began  organization  of  the  committee,  selection  of 
buildings,  repairs  and  equipment,  preparation  and  printing  of 
circulars  and  application  blanks,  publicity,  interviewing  candi- 
dates, selection  of  staff  and  the  countless  details  incident  to  a 
project  of  this  nature,  difficult  in  a  well-organized  country  like 
America,  but  doubly  so  in  a  country  wasted  by  war  and  ham- 
pered by  a  thousand  economic  and  tradifional  obstacles.  A  less 
optimistic  person  than  ^liss  Bridge  might  have  lost  heart,  but 


INTERNATIONAL  NURSING  EDUCATION      1161 

she  believed  in  the  enterprise  and  so  did  her  conmiittee,  and 
she  forged  ahead. 

In  a  letter  to  Miss  Noyes  under  date  of  August  2,  1921, 
Miss  Bridge  wrote : 

You  will  be  delighted  to  know  that  up  to  the  present  we 
have  had  sixty-four  inquiries  concerning  the  school.  I  have 
accej)te(l  four  candidates  and  have  forty-five  applications 
pending.  We  are  quite  pleased  to  have  a  quality  of  applicant 
superior  to  that  which  I  anticipated.  The  first  applicant  was 
the  daughter  of  a  Polish  Countess^  a  splendid  girl,  but  too 
young.  She  has  withdrawn  until  next  year.  The  first  appli- 
cation to  be  completed  was  that  of  Mary  Pawlowiczowna. 
She  is  a  splendid  young  woman  who  has  had  one  year  at  the 
University  of  Warsaw.  Is  it  not  significant  that  our  first 
acce))tcd  candidate  should  come  to  us  so  well  prepared?  .  .  . 
Of  the  four  accepted  there  is  another  who  has  had  two  years 
at  the  university,  one  who  is  quite  ready  for  the  university, 
and  the  fourth  falls  short  of  having  a  certificate  from  the 
eighth  class  (the  equivalent  or  more  than  our  high  school) 
because  she  failed  in  French.  Almost  every  candidate  I  have 
interviewed  speaks  French  and  a  number  of  them  also  speak 
English.  .  .  . 

The  attitude  of  the  physicians  on  the  Council  and  others  in 
Warsaw  toward  the  school  seems  very  good. 

Each  succeeding  report  recorded  the  growth  of  interest  and  the 
betterment  of  conditions.  Finally' October  19,  1921,  was  de- 
cided upon  as  a  suitable  date  for  the  formal  opening,  which  in- 
cluded the  ancient  Polish  custom,  the  Blessing  of  the  House  by 
the  Cardinal.  ^'American  nurses,"  stated  an  address  of  wel- 
come written  bv  ^liss  Xoyes,  "extend  their  hands  across  the  sea 
and  welcome  this  new  school  as  they  would  a  new  relation." 

The  address  by  Dr.  W.  ]\Ieczkowski,  a  friend  of  the  school, 
showed  the  attitude  of  the  best  element  in  the  medical  profes- 
sion toward  this  project: 

Poland  is  now  like  a  bad  housekeeper  who,  having  an 
abundance  of  everything,  wastes;  many  children  are  born,  but 
the  nation  does  not  exert  itself  to  keep  them  alive.  Death 
takes  tbem  away  as  in  no  other  country  in  the  world,  and  the 
general  mortality  is  much  greater  in  Poland  than  anywliere 
else. 

There  must  come  a  time  for  us  to  open  our  eyes  and  see 
M"here  we  are  going.     We  must  begin  a  wise  and  planned  war 


1162  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

against  illness.  We  must  visit  our  ill  people  and  examine  the 
conditions  of  life  of  the  healthy ;  we  must  enter  the  homes  of 
the  peasants  and  the  town  dwellers,  we  must  render  popular 
the  idea  of  real  nursing,  we  must  increase  the  means  of  pre- 
venting disease,  we  must  take  care  of  women  during  preg- 
nancy and  after  childbirth,  and  we  must  provide  the  proper 
care  for  sick  people  in  their  homes  and  in  the  Hospitals. 

This  task  can  be  carried  out  only  by  an  intelligent  and 
devoted  nurse,  such  a  nurse  as  graduates  from  the  schools  of 
North  America  and  England,  Our  school  has  as  its  object 
the  production  of  such  nurses  who  must  be  pioneers.  Its  task 
is  to  produce  the  first  nurse  instructors  for  the  medical  in- 
stitutions, and  that  is  why,  in  accepting  our  iirst  candidates, 
we  have  been  so  exacting  in  regard  to  their  moral  and  edu- 
cational qualifications. 

After  thanking  the  Polish  Committee  members,  the  Ameri- 
cans and  others  who  had  made  the  school  possible,  he  con- 
tinued : 

Before  I  finish  I  wish  to  speak  to  the  pupils  of  the  School 
of  Nursing,  to  those  pioneers  who  on  graduation  from  this 
school  will  go  the  first  into  Polish  society,  taking  to  the 
villages  and  towns  the  rules  of  hygiene,  cleanliness  and 
order,  and  who  will  give  to  the  patients  in  the  hospital  and 
in  the  home  honest  and  wise  care.  Nursing — as  stated  in  our 
regulations — is  not  an  ordinary  profession.  For  us  it  is  like 
an  Order  which  demands  a  special  vocation.  Here  hard  work 
does  not  suffice,  there  must  be  sacrifice,  a  vow  to  give  oneself 
with  one's  whole  heart.  Tliis  high  task  of  giving  help  to  the 
poor  and  suffering,  of  preventing  disease,  will  be  your  reward, 
and  the  common  service  to  this  high  idea  will  create  among 
you  links,  sincere  sisterly  relations.  This  school  will  aid  you 
in  educating  your  heart  and  brain  and  in  developing  your  love 
of  mankind. 

The  report  for  January,  1922,  announced  the  sad  death  of 
Dr.  ]\re('zk()\vski,  whose  last  office  for  the  school  had  been  to 
secure  the  balance  of  4,000,000  marks  due  on  the  1921  appro- 
priation to  be  given  by  the  Polish  participants.  The  report  as 
well  indicated  the  completion  of  the  plan  for  hospital  affilia- 
tions. The  economic  situation,  affected  as  it  was  by  the  rapid 
depreciation  of  the  currency,  brought  financial  anxieties  and 
complications  that  greatly  increased  the  problem  for  ]\riss 
Bridge,  yet  so  well  h;ul  tluy  acconiplished  their  work  that  the 


First  class  of  tlie  Scliool  of  Nursing.  Warsaw,  Poland,  established  by  the 
American  Red   Cross. 


J-lMerior  of  the  School  ol   >siu>iii;^.   Warsaw,   roland. 


INTERNATIONAL  NURSING  EDUCATION      1163 

Administrative  Council  at  a  meeting  in  December  asked  the 
school  to  assume  responsibility  for  the  hous(!keeping,  kitchen, 
and  dietary  for  patients  and  the  laundry.  A  Hospital  Com- 
mittee was  also  suggested,  'i'hat  iMiss  iiridge,  supported  by 
Miss  JMathevvs,  appreciated  the  practicnl  ditHculties  as  well  as 
the  advantages  of  taking  charge  of  the  housekeeping  was  shown 
in  a  letter  to  Miss  Hay  under  date  of  December  20,  1921 : 

I  talked  the  whole  thing  over  with  !Miss  ^Fathews  and  she 
agrees  with  me  tliat,  while  it  is  a  large  order,  tliat  we  will 
probably  be  able  to  bring  up  the  standard  of  the  nursing  much 
more  quickly  if  the  housekeeping  is  under  our  control. 

This  same  letter  recommended  a  dietitian,  qualified  to  as- 
sume the  instruction  to  student  nurses  not  only  in  invalid 
cookery  and  nutrition,  but  in  household  administration,  includ- 
ing the  laundry ;  to  arrange  the  dietaries  and  to  take  charge  of 
the  buying  of  food.  Furthermore,  she  should  be  able  to  speak 
either  Polish,  French  or  German.  The  Paris  office  approved 
this  request,  and  a  cable  to  this  effect  was  sent  to  National 
Headquarters.  On  ^lay  G  Bertha  Holman,  an  enrolled  Ked 
Cross  dietitian,  left  the  United  States  for  Warsaw.  That  she 
was  needed  and  was  facing  heavy  res2:)onsibilities  was  plainly 
evident,  as  shown  in  a  letter  from  ]\Iiss  Bridge  of  April  17: 

Tlie  hospital  is  in  a  perfectly  wretched  condition,  very 
dirty  and  wthout  signs  of  anything  you  could  call  real  organi- 
zation. .  .  .  It  is  the  same  old  story  of  preceding  slowly  until 
you  have  won  local  confidence.  We  went  into  the  hospital 
with  eiglity-five  jiatients  to  care  for,  but  this  number  was 
quickly  increased  to  one  hundred  and  twenty.  .  .  . 

After  the  ))reliminory  course,  our  twenty-two  student  nurses 
went  into  the  wards.  I  shall  never  forget  the  picture  they 
made  on  that  first  morning  in  their  cris]>  new  uniforms  and 
tlieir  fates  bright  with  antici))ation.  Two  of  the  students 
who  had  never  heen  in  a  hos])ital  l)efore  were  so  frightened 
that  we  had  to  stay  with  them  in  the  wards  for  a  time  until 
the  first  sharp  vd^^e  of  their  fear  had  worn  off.  1  still  remem- 
ber the  fluslu'd  frightened  face  of  one  of  them. 

After  the  first  day,  the  patients  begged  the  students  to  stay 
with  them  all  night,  for,  they  said,  "we  have  heen  taken  care 
of  to-dav  hut  to-night  it  will  l)e  the  same  old  thiuir.  We  will 
rini:  and  vlw^  and  no  one  will  answer."' 


1164  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Fortunately  for  the  school,  three  of  Miss  Bridge's  assistants 
were  Polish  as  well  as  Roman  Catholics,  this  being  the  pre- 
vailing religion.  Consequently,  when  questions  arose  concern- 
ing attendance  at  mass  at  eleven  o'clock  in  the  morning  by  all 
the  students,  they  were  able  to  satisfactorily  explain  why  this 
was  not  possible. 

The  night  nursing  m  the  nospital  was  still  left  to  the  Polish 
Red  Cross  nurses.  There  was  little  or  no  system  and  no  dis- 
cipline. Such  nursing  attention  as  the  patients  required  was 
largely  left  to  the  sanitars  (orderlies),  who  waited  on  men  and 
women  alike,  even  performing  such  delicate  attention  as  giving 
bedpans  to  women  patients.  This  condition  troubled  the 
American  nurses,  as  they  were  accustomed  to  seeing  patients 
receive  the  same  careful  nursing  at  night  as  was  given  during 
the  day.  Miss  Bridge  expected  to  place  the  student  nurses 
upon  night  duty  as  soon  as  they  were  sufficiently  experienced, 
but  in  order  to  do  so  many  internal  changes  were  necessary. 
However,  at  the  time  of  the  completion  of  this  history  these 
changes  had  not  yet  been  made.  The  conditions  that  prevailed 
in  the  operating  room  made  it  impossible  to  give  student  nurses 
training  in  surgical  technique  and  operating  room  procedure. 
Here  the  felcher  (operating  room  orderly)  had  reigned 
supreme  regardless  of  sex  and  nature  of  operation.  It  became 
evident  that  student  nurses  could  not  be  assigned  to  service  in 
that  department  until  a  qualified  American  nurse  had  been 
secured  to  reorganize  the  work,  direct  the  nursing  and  instruct 
the  students  in  surgical  technique.  A  request  was  sent  to 
America  for  a  nurse  qualified  for  this  work,  which  would  in- 
crease the  teaching  personnel  in  the  school  to  six.  This,  how- 
ever, was  to  be  regarded  as  temporary. 

In  no  way,  however,  were  the  American  nurses  discouraged. 
In  the  period  of  slightly  over  a  year  during  which  tlicv  had 
been  at  work  they  accomplished  marvelous  things.  Their 
staff  included  four  graduate  nurses,  one  dietitian  and  thirty 
student  nurses.  They  had  an  attractive  residence,  well 
furnished,  with  suitable  class  rooms  and  good  teaching  equip- 
ment. Several  well  equipped  wards  offered  a  satisfactory  field 
for  practical  instruction.  Control  of  the  housekeeping,  laundry 
and  dietary  department  rounded  out  the  facilities  as  a  teaching 
field.  They  had  a  representative  school  committee  called  "The 
Administrative  Council,"  a  well  arranged  curriculum  with  a 
preliminary  course,  a  lecture  course  given  mainly  by  university 


INTERNATIONAL  NURSING  EDUCATION       1165 

teachers,  and  a  group  of  students  exceptionally  intelligent,  well 
educated  and  refined.  This  acconiplishnicnt  demonstrated  good 
and  efficient  management,  and  a  receptive  and  cooperative 
school  committee.  When  the  time  shall  arrive  for  the  with- 
drawal of  the  American  nurses  the  futr.re  of  the  school  would 
seem  to  be  assured.  History  repeats  itself,  for  as  it  has  been 
the  nurse  in  America  who  has  been  the  instrument  through 
which  nurse  education  and  institutions  for  the  care  of  the 
sick  have  boon  brought  to  their  present  state  of  excellence,  so 
it  will  probably  be  in  Poland,  if  educated  and  cultured  young 
women  enter  the  schools. 

The  school  at  Posen  differed  in  some  respects  from  that  at 
Warsaw,  the  latter  being  organized  on  a  basis  that  would  com- 
pare favorably  with  the  most  modern  school  in  America ;  the 
former,  excellent  in  character,  and  run  on  sound  principles, 
was  unable  because  of  certain  inherent  conditions,  such  as  liv- 
ing quarters,  to  develop  on  as  progressive  a  basis. 

The  July,  1922,  Keport  of  the  Posen  School  showed  a 
faculty  of  four  American  Pod  Cross  nurses,  two  of  them  of 
Polish  nationality;  fifteen  students;  a  two  years'  regular  course 
and  a  three  months'  preliminary  course;  arrangements  per- 
fected for  practical  experience  in  medicine,  surgery,  gynecol- 
ogy, children;  affiliations  in  obstetrics  and  communicable 
diseases ;  a  corps  of  instructors,  doctors  and  nurses. 

In  both  schools  a  tuition  fee  was  required ;  an  eight-houi 
working  day  prevailed  in  each ;  the  character  and  educational 
qualifications  of  the  students  were  excellent. 

A  school  of  nursing  had  been  discussed  by  the  American 
Red  Cross  Commission  for  Greece,  and  a  plan  had  been  pre- 
pared by  ]\[ajor  Carl  E.  Black  in  July,  1910,  and  presented 
by  him  to  Colonel  Capps.  This  plan  was  based  upon  Major 
Black's  survey  of  Greek  hospitals  and  a  study  of  Greek 
methods  of  preparing  nurses.  Afajor  Black  discussed  his  plan 
with  the  Greek  Pod  Cross,  Colonel  Capps,  physicians,  hospital 
authorities  and  others,  but  although  Miss  Ilolon  Scott  Hay,  a 
recognized  nurse  educator,  was  directing  all  Pod  Cross  nursing 
activities  in  the  l^alkan  States,  including  Greece,  she  was  not 
called  into  any  of  tlioso  conferences  or  shown  the  plan  until 
after  it  had  been  suljuiittod  to  American  and  Greek  Pod  Cross 
authorities.  She  had  ])re])ared,  at  Colonel  Anderson's  re(]uost, 
a  suggestive  outline  for  a  scliool  of  nursing,  it  is  true,  soh^ly 
as  a  basis  for  disciission  and  with  little  opportunity   for  study 


1166  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

of  local  conditions,  and  with  the  understanding  that  it  would 
not  be  regarded  as  a  complete  plan. 

Fortunately  Major  Black's  soundness  of  views  on  the  ques- 
tion of  educational  entrance  requirements,  as  well  as  on  the 
social  and  professional  status  of  the  graduate  nurse,  enabled 
him  to  present  recommendations  of  a  sound  and  dignified 
character.  His  plan,  which  was  an  ambitious  one,  called  for  an 
operation  covering  five  years  at  an  estimated  cost  of  about 
$12,000  per  year,  or  about  $60,000.  Matters  had  proceeded 
even  so  far  as  to  discussion  of  a  hospital  upon  which  to  graft 
the  school,  a  point  of  great  moment  to  such  American  nurses 
as  might  be  sent  to  carry  the  plan  through,  and  a  matter  upon 
which  the  advice  of  Miss  Hay  would  have  been  of  great  value. 
The  concluding  paragraph  of  Major  Black's  report  stated: 

At  the  time  of  leaving  Athens  for  America,  we  have  re- 
ceived no  answer  from  the  Hospital  Board,  and  do  not  know 
their  final  decision  when  confronted  by  the  terms  in  detail. 
The  matter  is  left  in  the  hands  of  Major  Dewing  for  final 
consummation  with  either  the  Evangelismos  Hospital  or  some 
other  hospital  in  Greece. 

Little  was  heard  of  the  project  of  the  Greek  school  of 
nursing  during  the  early  months  of  1920.  During  the  summer 
of  that  year  President  Venizelos  had  a  conference  with  Com- 
missioner Olds  in  Paris,  at  which  the  Commissioner  again 
offered  on  behalf  of  the  American  Red  Cross  to  assist  in  devel- 
oping a  school  of  nursing  in  Athens.  One  of  the  conditions 
of  the  offer  was  that  the  Greek  Red  Cross  should  provide  suit- 
able buildings.  The  finances  of  the  Greek  Red  Cross  did  not 
permit  them  to  assume  this  item  in  the  summer  of  1920.  In 
October,  however.  President  Venizelos  wrote  Commissioner 
Olds  that  a  member  of  the  Greek  Red  Cross  had  presented  a 
million  drachmas  to  the  Society  for  such  purposes;  that  in  his 
estimation  the  Greek  Red  Cross  was  prepared  to  accept  the 
offer  of  the  American  Red  Cross;  and  that  he  had  placed  the 
matter  in  the  hands  of  Mr.  J.  Athanasakis,  then  president  of 
the  Greek  Red  Cross.  In  November,  1920,  ]\fr.  Athanasakis 
wrote  Commissioner  Olds  that  the  Greek  Red  Cross  had  de- 
cided, however,  to  place  the  direction  of  the  school  in  tlie  liands 
of  two  of  its  volunteer  Red  Cross  nurses.  This  action  amounted 
practically  to  a  rejection  of  the  American  Red  Cross  oifer,  as 


INTERNATIONAL  NURSING  EDUCATION       1167 

in  its  training  school  contracts  the  American  Red  Cross  had 
reserved  the  privilege  of  appointing  American  nurses  trained 
under  the  Nightingale  System  to  direct  the  schools,  and  this 
clause  was  clearly  understood  by  the  officers  of  the  Greek 
Red  Cross. 

Such  was  the  state  of  affairs  when  Miss  Hay  and  Miss  Noyes 
arrived  in  Athens  late  in  November.  Great  excitement  then 
prevailed  throughout  Greece.  Political  changes  had  deposed 
the  "Commoner"  and  brought  back  King  Constantine.  Miss 
Hay  and  Miss  Noyes  tried  to  see  the  president  of  the  Greek 
Red  Cross  but  did  not  succeed.  Thus  a  final  settlement  other 
than  that  described  above  regarding  American  Red  Cross 
co(")peration  in  the  establishment  of  the  Athens  School  was  not 
effected. 

Bulgaria  was  again  in  1920  urging  the  reorganization  of  the 
school  started  in  11)15  under  the  direction  of  ]\Iiss  Hay  at  the 
Alexandra  Hospital  in  Sofia,  which  was  described  in  Chapter 
IV.  As  the  plan  presented  was  incomplete  and  somewhat  un- 
satisfactory, it  was  felt  that  a  conference  with  the  Bulgarian 
authorities  would  be  of  great  value.  When  Miss  Hay  and  Miss 
Noyes  reached  Bulgaria  they  found  that  the  situation  had 
changed  since  overtures  had  been  made  a  few  weeks  previous. 
The  Bulgarian  Red  Cross,  which  had  for  some  years  conducted 
a  so-called  school  of  nursing,  had  requested  the  Government 
to  lay  aside  the  plans  for  the  Alexandra  Hospital  School,  and 
to  pay  to  it  any  moneys  available  for  this  latter  project.  The 
bill  covering  this  change  in  plan  had  already  had  two  readings 
in  Parliament,  although  the  nurses  from  the  Alexandra  Hospi- 
tal School,  who  had  been  under  Miss  Hay,  and  many  physicians 
and  other  prominent  people  had  done  all  they  could  to  delay 
a  decision.  The  situation  was  critical.  Through  the  American 
Charge  d'Affaires  a  conference  was  secured  for  Miss  Hay  and 
]\liss  Xoyos  with  the  Acting  Prime  Minister  Dimitroff.  Prior 
to  this,  however,  they  had  been  invited  to  visit  King  Boris  and 
had  laid  the  reorganization  plan  before  him.  He  manifested 
the  greatest  interest,  and  gave  assurances  of  his  support.  The 
attitude  of  the  Prime  ^linister  was  wholly  non-committal,  but 
an  early  decision  was  promised.  However,  such  other  re- 
assurances were  given  to  the  effect  that  the  reorganization  of 
the  school  would  go  througii  with  the  passing  of  the  budget 
that  it  seemed  a  foregone  conclusion,  ^liss  Noyes  waited 
several  days  at   Sofia  with  the  hope  that  a  definite  decision 


1168  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

would  be  reached.     She  was  finally  obliged  to  leave,  but  before 
doing  so  submitted  the  following  recommendation: 

That  we  assist  the  Bulgarian  government  as  far  as  possible 
in  the  resumption  of  a  school  of  nurses,  providing  the  Bul- 
garian government  itself  is  ready  to  do  its  full  part,  finan- 
cially and  otherwise,  by  stating  that  it  would  seem  but  fair 
under  the  circumstances  that  we  should  select  and  provide 
salaries  for  not  less  than  two  American  nurses,  and  at  least 
partial  maintenance  for  not  less  than  two  years.  In  the  event 
of  failure  to  establish  the  school,  that  at  least  one  scholarship 
might  be  given  to  the  best  qualified  nurse  of  the  Queen's 
School,  so  that  she  might  complete  her  course  in  America  and 
be  better  prepared  to  assist  her  country  in  developing  nurse 
education. 

It  seemed  highly  desirable  that  there  be  a  modern  school 
in  Sofia,  not  only  to  perpetuate  the  plans  so  dear  to  the  heart 
of  Queen  Eleanora,  but  because  it  was  greatly  desired  by  a 
large  number  of  Bulgaria's  most  thoughtful  people.  The  Bul- 
garian Red  Cross,  however,  produced  one  argument  which 
apparently  was  most  convincing  to  the  Bulgarian  government, 
and  that  was  economy.  The  cost  of  maintaining  a  school  of  the 
first  order  necessarily  represented  more  outlay  than  people 
of  many  foreign  countries  were  accustomed  to  think  necessary. 
At  that  time  the  lev  was  selling  ninety  to  a  dollar,  and  failure 
to  secure  an  enthusiastic  acceptance  of  the  assistance  which 
the  Bulgarians  had  voluntarily  sought  might  be  ascribed  to  this 
cause. 

From  time  to  time,  however,  the  question  of  the  school  was 
again  raised  by  those  most  interested.  In  the  early  summer 
of  1922  a  final  cooperative  plan  based  on  the  preceding  recom- 
mendation seemed  a  foregone  conclusion,  and  an  appropriation 
to  cover  it  w^as  established  at  Xational  Headquarters.  The 
Bulgarian  authorities  were  notified  and  asked  to  submit  their 
reassurances.  At  the  time  this  history  goes  to  press  these 
have  not  been  received.  A  leading  citizen  of  Bulgaria  when 
discussing  with  ]\riss  Noyes  the  project  and  the  tendency  to 
procrastinate  said,  '*It  is  the  East."  This  may  explain  the 
present  delay. 

At  Constantinople  a  school  of  nursing  was  established  with 
which  the  American  Red  Cross  was  affiliated.  ]\[rs.  Anna 
Rothrock,  who  had  boon  assigned  as  chief  nurse  to  the  unit  of 
fifty-four  nurses  wliicli  had  been  organized  by  the  American 


INTERNATIONAL  NURSING  EDUCATION      1169 

Red  Cross  for  service  with  the  Near  East  Relief,  was  detached 
from  that  organization  in  the  spring  of  1J)20,  and  asked  to 
undertake  the  development  of  a  school  of  nursing  and  a  hos- 
pital in  Constantinople,  under  the  auspices  of  a  local  com- 
mittee. This  committee  included  representatives  from  the 
American  Red  Cross,  American  (^ollege  for  Women,  Roberts 
College  and  American  interests  such  as  the  Standard  Oil  and 
the  Near  East  Relief.  Substantial  assistance  was  given  them 
by  the  Xear  East  Relief  in  gifts  of  equipment;  also  by  the 
American  Red  Cross  Commission  and  the  American  Red  Cross 
Chapter  at  Constantinople,  of  which  Admiral  Mark  L.  Bristol, 
United  States  Navy,  high  commissioner  to  Constantinople, 
was  the  chairman.  The  institution  was  developed  in  "Old 
Stamboul,"  in  a  building  formerly  the  home  of  a  rich  pasha, 
a  large  three-story  house  with  two  distinct  divisions,  the 
Haremlik  and  the  Saremlik.  The  building  was  in  very  poor 
repair  with  deep  rooms  with  windows  only  upon  one  side. 
Rough  wooden  floors  and  total  absence  of  heating  facilities  and 
plumbing  made  the  question  of  proper  organization  of  the 
hospital  a  difficult  one.  Nevertheless,  with  the  supplies  which 
had  been  given,  the  building  was  put  in  good  shape.  Hundreds 
of  feet  of  stove  pipe  were  used  in  setting  up  stoves,  the  only 
means  of  heating  the  w^ards  and  the  living  quarters  of  the 
nurses.  While  marvels  were  accomplished  in  making  the  place 
habitable,  nevertheless  it  was  far  from  being  an  ideal  building 
for  either  a  hospital  or  a  school.  The  dangers  of  fire,  with 
no  means  of  control  should  one  occur,  the  long  steep  stairs  and 
the  general  unsuitability  as  far  as  arrangement  was  concerned, 
made  the  building  far  from  satisfactory  for  the  purpose. 

The  hospital  proper  consisted  of  wards  with  from  six  to 
twelve  beds,  and  five  private  rooms  of  one  or  two  beds,  a  total 
of  eighty  beds ;  two  large  halls  for  convalescents,  an  operating 
room,  a  pharmacy  supply  room  and  dispensary.  There  was  one 
kitchen  for  the  hospital  and  the  staffs,  with  a  single  Greek  cook. 
An  American  Red  (^ross  dietitian,  Nellie  Halliday,  was  in 
charge  and  was  accomplishing  astonishingly  good  results  with 
the  facilities  at  her  disposition.  The  water  supply  was  un- 
certain ;  there  was  no  laundry  except  an  outside  room  which 
had  originally  acconunodated  th(^  laundry  work  for  a  private 
family.  The  toilets  were  of  the  Tui'kish  variety,  marble  and 
in  good  repair.  Jn  tlu>  equipnuMit  was  a  Turkish  bath,  wliile 
inodcru  bathtubs  with  a  uuiiiue  stove  arrangement  t'(»r  luxating 


1170  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  water  were  installed  in  some  of  the  smaller  rooms.  The 
Dispensary  was  on  the  ground  floor  under  the  part  of  the  build- 
ing used  for  the  graduate  nurse  staff.  Linen  and  dressing 
rooms  and  sewing  rooms  adjoined.  The  home  for  the  student 
nurses  was  arranged  in  what  was  formerly  the  servants' 
quarters.  The  rooms  were  clean  and  sufficiently  large  for  two 
or  three  students.  A  combination  sitting  room  and  study  was 
provided,  the  pupils  taking  their  meals  in  the  personnel  house. 
The  faculty  consisted  at  that  time  of  six  American  nurses, 
all  of  whom  had  been  recently  engaged  in  the  care  of  refugees 
on  the  Island  of  Proti.  They  had  been  temporarily  loaned  to 
the  American  Hospital  upon  the  closing  of  work  on  Proti.  In 
November,  1920,  five  of  them  were  permanently  engaged  on 
the  regular  hospital  staff. 

The  school  course  was  finally  arranged  to  require  a  period 
of  twenty-eight  months.  The  minimum  educational  require- 
ment for  admission  was  that  the  applicant  should  have  com- 
pleted a  full  high  school  course  or  its  equivalent.  Anatomy, 
physiology,  bacteriology  and  chemistry  were  taught  by  an 
instructor  of  the  Constantinople  Women's  College.  Practical 
and  theoretical  nursing  were  taught  by  members  of  the  nursing 
staff.  While  this  school  was  not  strictly  speaking  a  Red  Cross 
enterprise,  American  Red  Cross  nurses,  some  of  whom  were 
partially  or  entirely  paid  by  the  American  Red  Cross,  had 
effected  the  organization,  and  had  brought  this  school  into 
line  with  other  schools  in  Europe  wliich  the  American  Red 
Cross  had  subsidized.  In  the  course  of  time  the  staff  was 
decreased  and  a  gradual  change  in  personnel  resulted. 

Upon  the  resignation  of  Mrs.  Rothrock  in  the  fall  of  1921, 
Miss  Lvda  Anderson,  who  was  acting  as  assistant  to  ,\riss  Hay 
in  the  Paris  office,  was  appointed  to  replace  her.  Under  !Miss 
Anderson's  administration  some  changes  gradually  took  place, 
the  course  of  instruction  was  reduced  from  three  to  two  years, 
and  a  definite  affiliation  was  being  sought  with  the  i\.merican 
College,  similar  to  university  affiliations  which  exist  in 
America.  The  type  of  student  admitted  to  the  school  gradu- 
ally improved  and  included  representatives  from  many  coun- 
tries. The  question  of  langiuige  was  a  serious  one,  and  as 
interpreters  were  out  of  the  question  classes  in  English  were 
given  in  order  that  the  students  might  not  only  avail  tliera- 
selves  of  the  best  textbooks  written  in  English,  but  ])rafit  by 
the  instruction  given  by  the  American  nurses. 


INTERNATIONAL  NURSING  EDUCATION       1171 

Tliere  were  in  1022  no  other  modern  schools  of  nursing  in 
that  part  of  tlie  worUl.  The  future  usefuhiess  and  importance 
of  this  school  not  only  to  Constantinople  but  to  a  large  sur- 
rounding area  is  self  evident.  A  new  hospital  and  school 
building  of  good  type  of  construction  was  imperative,  while 
many  improvements  had  been  made  to  facilitate  the  work  the 
inherent  defects  of  construction  were  of  such  a  nature  that  it 
would  have  been  useless  to  try  to  overcome  them  by  temporary 
repairs. 

From  the  beautiful  tropical  island,  called  indiscriminately 
Haiti  or  San  Domingo,  depending  entirely  upon  whether  one 
refers  to  the  western  one-third,  Haiti,  or  to  the  eastern  two- 
thirds,  Santo  Domingo,  there  came  early  in  1020  from  the 
(•overnment  a  requ(>st  for  four  Red  (!^ross  nurses.  In  1018 
a  school  of  nursing  had  been  organized  under  the  direction 
of  Commander  N.  T.  ^McLean  of  the  ^^ledical  Corps  of  the 
United  States  Xavy  in  connection  with  the  City  General  Hos- 
l)ital  in  Port-au-Prince.  The  protecting  arm  of  the  United 
States  Government  had  been  extended  under  the  treaty  of  1015 
to  the  "Black  Kepublic"  and  representatives  of  the  Medical 
Department  of  the  United  States  Xavy  had  been  assigned  to 
direct  the  sanitary  development  of  the  island.  Lucia  D. 
dordan,  assisted  by  -losephine  T.  Ray,  members  of  the  Xavy 
X'^urse  Corps,  under  difficult  conditions,  had  laid  a  substantial 
foundation  for  the  first  modern  school  of  nursing  on  the 
island,  but  in  1020  were  withdrawn.  Hence  the  request  of  the 
island  government. 

j\Iiss  Butler,  then  director  of  the  Xursing  Service  of  the 
Insular  and  Foreign  Division,  secured  as  director  of  the 
School  of  Xursing  at  Port-au-Prince  Vashti  R.  Bartlett,  whose 
name  and  record  has  appeared  in  previous  chapters,  and  two 
others,  Anna  M.  Ilansberry  and  ^Nlary  Griffith.  These  nurses 
were  paid,  transported  and  maintained  by  the  Haitian  Govern- 
ment. ]\liss  Bartlett,  with  her  training  school  experience, 
energy  and  enthusiasm  and  ability  to  speak  fluent  French,  was 
especially  well  (pialitied  for  the  task. 

The  little  grouj)  of  three  sailed  in  July,  1021.  Olive  M. 
Simons  followed  later.  They  found  Sisters  in  charge  of  the 
wards.  Later,  however,  the  Sisters  withdrew  from  this  work 
and  devotcvl  themselves  exclusively  to  the  housekee])ing.  Xotes 
in  Miss  l>artletr\s  iirst  report  to  the  sanitary  enginiM-r,  Com- 
mander McLean,   indicated  some  diseourai'Mnu-  features: 


1172  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

There  are  at  present  31  student  nurses  and  about  400 
patients.  .  .  .  The  school  having  started  with  a  two  years' 
course,  the  seniors  shouhl  have  graduated  in  October,  but  the 
date  ...  is  still  unsettled  pending  the  result  of  all  examina- 
tions and  a  policy  to  aid  nurses  in  starting  their  outside  work. 

Special  duty  was  considered  for  the  unemployed  graduates 
and  at  first  a  salary  of  $10.00  a  week  was  offered.  Oppor- 
tunities for  practical  experience  in  the  wards  were  limited, 
but  facilities  for  additional  experience  was  secured  in  a  special 
ward  where  Sisters  had  been  in  control.  Suitable  class  rooms 
and  better  sleeping  accommodations  were  secured  and  lesson 
plans,  the  translation  of  textbooks  and  the  preparation  of 
lectures  in  French  occupied  the  attention  of  all  the  nurses. 
The  future  of  the  graduates  continued  to  trouble  ]Miss  Bartlett, 
as  the  poverty  of  the  people  seemed  to  preclude  any  extensive 
use  of  qualified  nurses.  Not  the  least  of  the  difficulties  was 
a  distressing  epidemic  of  smallpox  described  by  Miss  Bartlett 
in  a  letter,  January  28,  1921: 

I  am  discouraged  about  the  school.  The  smallpox  has 
almost  disrupted  the  hospital.  From  60  to  70  patients  are 
admitted  each  day  and  so  many  nurses  are  needed  for  this 
work  that  the  other  branches  of  nursing  are  neglected.  We 
do  no  operating  except  emergency  cases  because  the  patient 
may  break  out  with  smallpox  the  next  day.  Some  of  the 
cases  are  awful ;  those  that  we  do  not  find  for  several  days 
come  in  in  l)ad  shape.  This  morning,  for  example,  three 
nurses  worked  for  several  hours  picking  worms  out  of  the 
sores  of  one  patient,  and  this  happens  every  day.  Many  times 
we  have  to  take  them  out  of  their  eyes.  In  one  ward  two  days 
ago,  where  our  illest  patients  are,  we  had  14  deaths  in  24 
hours.  I  think  we  have  about  600  smallpox  patients  and, 
with  14  nurses  leaving,  it  is  a  question  liow  to  give  them  the 
{•are  they  need,  and  T  fear  new  nurses  will  not  come  with 
conditions  as  they  are.  A  few  minutes  ago  they  telephoned 
and  asked  for  two  special  nurses  and  I  hardly  know  hov^  to 
spare  tliem. 

Yet  !Miss  Bartlett  with  characteristic  reserve  said  nothing 
of  the  heroic  work  done  by  the  American  Red  Cross  nurses 
who  worked  day  and  niglit  to  relieve  the  suffering  of  the  poor 
unfortunates. 

After    a    vear    of    eanie~r    work,    ]\Iiss    Bartlett    and    Miss 


INTERNATIONAL  NURSING  EDUCATION       1173 

Griffith  resigned.  Miss  Hansberry  was  appointed  director. 
Olive  Simons  with  Grace  White  and  Sara  S.  Smith,  who  had 
been  assigned  in  November,  1921,  completed  the  Red  Cross 
nnrsing  family. 

Early  in  1920  the  American  Red  Cross  appropriated  through 
the  Insular  and  Foreign  Division  $10,000  for  the  purpose  of 
erecting  a  suitable  building  as  a  house  and  school  for  nurses 
in  accordance  with  the  suggestion  of  the  ^ledieal  Department 
of  the  Navy.  Plans  were  submitted  to  National  IIead(iuarter.s 
and,  with  certain  minor  changes  suggested  by  ]\liss  Noyes, 
were  approved.  As  a  Red  (Jross  Chapter  existed  in  Haiti,  a 
committee  from  this  Chapter  was  appointed  to  supervise  the 
construction  of  the  building  and  the  expenditures.  This  com- 
mittee included  Commander  J.  M.  ^linter,  ]\I.  C,  U.  S.  Navy; 
Commander  A.  L.  Parson,  M.  C,  U.  S.  Navy,  as  well  as  repre- 
sentatives from  the  Chapter.  The  money  was  made  available 
in  the  autumn  of  1921  and  work  was  immediately  begun.  The 
school  building  grew  rapidly  and  soon  the  old  and  tottering 
building  was  torn  down. 

In  order  to  ap])reciate  the  discouragements  encountered  in 
attempting  a  project  of  this  nature  one  must  understand  the 
character  of  the  people  and  the  country  as  well  as  the  historical 
background.  Here  Columbus  first  landed,  finding  Indians  and 
gold,  which  the  Spaniards  coveted  and  gained.  Contact  with 
the  white  man  exterminated  the  Indian.  The  negro  from 
Africa  was  introduced,  the  beginnings  of  slavery  in  the  new 
world.  The  French  occupied  the  island  with  reforms  and 
general  improvement.  In  time  they  disappeared,  leaving  only 
their  language,  until  to-day  the  people  are  mainly  negroes,  with 
some  mixed  blood.  Revolution  followed  revolution,  debt, 
poverty,  misery,  banditry  and  disease  existed,  accompanied  by 
inevitably  low  standards  of  morality.  The  invited  and  accepted 
intervention  by  the  United  States  in  1915  brought  many  im- 
])rovements,  among  others  the  School  of  Nursing,  the  first  of 
its  kind  in  the  island.  In  1922  it  was  but  four  years  old,  a 
mere  infant,  but  growing  stronger  as  indicated  by  the  reports. 
From  the  records  of  the  school,  as  well  as  from  photograjjhs 
of  the  student  nurses  in  their  trim  uniforms,  all  negroe.-;,  a 
conclusion  may  be  drawn  that  in  spite  of  many  (litficnlties  and 
discouragenuMits,  tli(>  work  of  the  American  nurses,  i'our  of 
whom  aic  still  (l'.>22)  there,  has  not  been  in  vain.  They  are 
slowly  (l<'velo})ing  an  educational   systrin   that  will   ultinuitely 


1174  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

give  to  the  island  what  they  greatly  need,  a  well-trained  native 
nursing  personnel. 

These  were  steps  in  an  educational  program  of  the  American 
Red  Cross.  They  indicated  that  the  peoples  of  European  and 
other  countries,  perhaps  through  observation  of  the  work  done 
by  graduate  nurses  from  other  countries  during  the  war,  or  be- 
cause of  the  work  of  American  Red  Cross  nurses  with  children 
and  refugees  following  the  war,  were  intelligently  seeking 
assistance  for  the  purpose  of  developing  their  own  supply  of 
nurses.  And  the  American  Red  Cross  was  becoming  painfully 
conscious  of  the  fact  that  it  could  not  continue  to  provide 
nurses  and  supplies  indefinitely  to  the  stricken  countries  of 
Europe.  Furthermore,  the  Red  Cross  appreciated  that  its 
health  work,  especially  for  the  children,  would  not  be  con- 
structive if  native  nurses  were  not  ready  to  ^'carry  on"  when 
the  American  Red  Cross  nurses  had  to  be  withdrawn.  The 
League  of  Red  Cross  Societies  was  also  stimulating  interest 
in  schools  of  nursing  wherever  its  Director  of  Nursing  saw 
and  felt  that  it  w^as  practicable.  For  these  reasons  the  x\mer- 
ican  Red  Cross  was  deeply  interested  in  the  organization  in 
these  countries  of  modern  schools  of  nursing.  But  throe  years 
of  study  through  direct  participation  it  realized  that  educa- 
tional work  of  another  type  must  go  on. 

Quite  generally  in  the  countries  of  Europe  and  in  Haiti, 
where  American  Red  Cross  nurses  had  conducted  classes  in 
Home  Hygiene  and  Care  of  the  Sick,  or  had  established  schools, 
the  feeling  quite  generally  existed  that  routine  bedside  nursing 
procedures,  the  performance  of  such  housekeeping  details  as 
scrubbing  and  scouring,  sweeping  and  dusting  should  be  dele- 
gated to  servants.  The  war  and  the  example  of  graduate  nurses 
did  a  great  deal,  however,  to  change  this  attitude  of  mind.  In 
Poland  particularly  the  students  caught  the  idea,  and  began 
setting  an  example  that  will  inevitably  break  down  many  age- 
old  traditions.  Quite  generally  the  feeling  prevailed  that  the 
work  of  the  nurse  ended  with  the  application  of  a  few  surgical 
dressings ;  the  bathing  of  the  patient,  and  the  making  of 
his  bed  belong  to  a  servant.  Even  in  Haiti  it  was  noticed  that 
an  orderly  sent  on  an  errand  wliere  a  basket  or  bundle  must 
be  carried  would  press  into  service  for  a  few  pennies  a  man 
or  woman  tottering  with  age,  or  a  half-starved  child,  to  relieve 
him  of  this  burden.  American  nurses  'Svho  rolled  up  their 
sl(>evcs"  and  with  soap  and  water  and  plenty  of  energy  cleaned 


INTERNATIONAL  NURSING  EDUCATION       1175 

up  a  particularly  bad  situation  not  infrequently  lost  prestige 
thereby.  Until  the  principle  that  actnal  work  with  one's  hands 
is  dignified  and  honorable  and  uplifting  can  be  implanted  in 
the  minds  of  the  peoples  of  countries  where  autocratic  forms 
of  government  prevailing  for  centuries  have  developed  sharp 
class  lines,  modern  schools  of  nursing  or  other  democratic  sj'S- 
tems  of  education  \vi]\  make  but  slow  progress. 

In  line  with  other  educational  work  special  scholarships 
were  given  by  the  American  lied  Cross  to  three  members  of 
the  committees  organized  in  Italy  under  the  guidance  and 
direction  of  ^liss  Gardner.  One  of  these  was  given  to  Contessa 
Balzani  of  the  Rome  Committee,  one  to  Signorina  Bosio  of 
the  Florence  Committee,  and  one  to  Marchesa  Firmaturi  of 
the  Palermo  Committee.  This  group  reached  America  in 
the  late  summer  of  11)21.  After  visiting  schools  of  nursing, 
public  health  nursing  organizations  in  Boston,  New  York,  Chi- 
cago, Pittsburgh,  Washington  and  Baltimore,  they  returned  to 
Italy.  Scholarships  of  this  nature  were  developed  not  only  to 
strengthen  the  work  started  under  the  direction  of  the  Red 
Cross  in  Italy,  but  with  the  hopes  that  special  efforts  would  bo 
made  toward  the  establishment  of  schools  of  nursing  to  supply 
a  qualified  group  of  nurses  in  Italy  to  supervise,  direct  and 
extend  the  work  so  well  started  in  that  country.  Italy,  as  was 
the  case  with  many  other  countries  where  the  Red  Cross  had 
operated,  was  in  great  need  of  a  qualified  nursing  personnel  in 
order  to  continue  public  health   and  other  nursing  activities. 

Scholarships  had  also  been  given  in  the  year  1020  to  two 
French  nurses  from  the  city  of  Lille,  France,  to  ^Ille.  Matter 
and  Durrleman,  both  graduates  of  the  Xightingale  School  at 
Bordeaux,  for  the  purpose  of  studying  school  administration 
at  Teachers  College,  Xcw  York  City.  It  was  their  expecta- 
tion to  return  to  Lille  to  assist  wnth  the  organization  of  a  school 
in  that  city. 

Three  additional  American  Red  Cross  scholarships  had  been 
granted  to  enable  two  Italian  nurses  and  one  French  nurse  to 
attend  the  course  at  King's  College,  London,  which  was  de- 
veloped by  the  League  of  Red  Cross  Societies. 

Although  the  American  Red  Cross  had  be(>u  conducting  ex- 
tensive nursing  activities  overseas  since  li)14,  no  representative 
of  the  Xursing  Service^  who  possessed  a  knowledge  of  the  entire 
lield  had  by  1!)20  r(>viewed  the  work      Aliss  Delano  had  gone 


1176  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

overseas  for  this  purpose  but  her  illness  and  death  interrupted 
the  plan  before  it  had  been  begun.  In  1920,  requests  asking 
that  Miss  Noyes  come  overseas  were  reaching  National  Head- 
quarters and  it  was  finally  decided  that  she  leave  in  September. 
Three  particular  reasons  existed  for  this  tour  of  inspection; 
first,  to  inspect  existing  American  Red  Cross  nursing  activi- 
ties; second,  to  confer  on  the  nursing  aspects  of  the  proposed 
child  health  work ;  third,  to  advise  on  the  foreign  schools  of 
nursing  subsidized  by  the  American  Red  Cross.  As  president 
of  the  American  Nurses'  Association,  Miss  Noyes  took  with 
her  to  deliver  to  the  Trustees  of  the  Florence  Nightingale 
School  of  Nursing  the  terms  of  the  deed  of  gift  money  for  the 
American  Nurses'  Memorial.  Miss  Ida  F.  Butler,  then  as- 
sistant to  the  director  of  the  Nursing  Service,  was  left  in 
charge  of  nursing  activities  at  National  Headquarters  and 
Miss  Noyes  sailed  on  the  Aquitania  on  September  21,  landing 
in  Cherbourg,  France. 

After  a  few  days  spent  in  Paris  in  conference  with  ofiicials 
of  the  European  Commission,  Miss  Noyes  and  Miss  Hay  left 
Paris  October  4  for  Prague,  having  arranged  an  itinerary 
which  included  in  Poland  the  cities  of  Cracow,  Warsaw,  Bia- 
lystok  and  Posen ;  in  Austria,  Vienna ;  in  Serbia,  Belgrade ; 
in  Bulgaria,  Sofia ;  in  Turkey,  Constantinople ;  in  Greece,  Sa- 
loniki  and  Athens ;  in  Albania,  Valona,  Durazzo,  Tirana  and 
Scutari ;  in  Montenegro,  Podgoritza,  Danilograd,  Ragusa  and 
Zelenika,  and  in  Italy,  Florence.  The  League  of  Red  Cross 
Societies  had,  through  Miss  Fitzgerald,  invited  Miss  Noyes  to 
visit  Geneva,  to  confer  on  the  International  League  of  Red 
Cross  nursing  affairs.  She  wished  as  well  to  visit  King's  Col- 
lege, London,  but  these  visits  were  later  found  to  be  impossible. 

During  the  summer  of  1919  the  policies  which  were  to  gov- 
ern the  future  program  overseas  of  the  American  Red  Cross 
were,  as  it  has  been  said  before,  being  formulated.  Several  of 
the  commissioners  for  foreign  service  favored  the  continuation 
of  general  and  medical  relief  on  national  proportions;  some 
few  officials  desired  to  narrow  the  progam  to  one  which  cm- 
braced  only  preventive  health  measures  and  which  utilized  the 
dispensary  as  the  principal  operating  unit  in  the  field  rather 
than  the  large  surgical  hospital.  On  June  10,  1919,  Miss  Hay 
prepared  and  submitted  to  Colonel  Olds  the  following 
memorandum  of  nursing  activities  in  Poland  which  clearly 
sliows  that  an  extension  of  both  an  emergency  medical  program, 


INTERNATIONAL  NURSING  EDUCATION       1177 

as  evinced  in  the  reference  to  two  thousand  beds  for  Poland 
alone,  and  of  constructive  work  of  a  remedial  and  educational 
nature,  as  evinced  by  the  reference  to  the  establishment  of  dis- 
pensaries and  the  organization  of  classes  for  women,  was  still 
being  considered  by  American  Red  Cross  officials  overseas : 

Ilosintal  \Vorh:  With  the  contemplated  establishment  of 
approximately  2000  hospital  beds  throughout  Poland  by  the 
American  Ped  Cross,  American  nurses  would  of  necessity  be 
used  only  in  a  supervisory  capacity, — one  nurse  to  every  fifty 
patients  or  more  and  Polish  aides  to  assist  in  the  actual  care 
of  the  patients. 

Dispensary  and  Public  Health  \\'ork:  These  to  be  estab- 
lished in  outlying  Polish  towns  and  to  consist  of  one  or  more 
physicians  and  two  or  three  nurses  whose  duties  would  be  to 
assist  in  tlie  dispensary  and  develop  various  public  health 
activities  as  visiting  nursing,  baby  welfare,  school  visiting  and 
courses  in  Home  Hygiene  and  Care  of  the  Sick.  In  such 
centers,  the  emphasis  would  be  placed  on  (a)  the  thorough 
grounding  of  Polish  aides  in  their  duties  so  that  they  can 
carry  on  under  Polish  physicians;  (b)  such  awakening  of 
local  interest  in  health  problems  as  is  possible  through  various 
local  organizations  and  through  popular  instruction  of  women 
in  Home  Hygiene  and  Care  of  the  Sick. 

Health  Education:  The  organization  of  short  courses  in 
nursing  seems  to  appear  as  an  important  and  immediate  duty. 
This  educational  work  falls  into  three  classes:  (1)  an  inten- 
sive course  for  Polish  War  aides;  (2)  a  course  for  Polish 
aides  now  working  under  the  American  Red  Cross;  (3)  a 
popular  course  for  educated  Polish  women  in  Home  Hygiene 
and  Care  of  the  Sick;  (4)  the  establishment  of  schools  of 
nursing  along  American  lines  in  Poland,  to  be  treated  in  a 
later  chapter.  ... 

At  the  present  time,  there  are  in  Poland  seventy-eight 
nurses.  It  is  estimated  that  a  total  of  one  hundred  nurses 
could  be  well  engaged  in  carrying  out  satisfactorily  the  pro- 
gram recommended  above. 

The  necessity  for  the  shifting  of  the  emphasis  from  a  pro- 
gram of  general  medical  and  material  relief  in  Europe  to  a 
more  constructive  one  of  preventive  health  measures  with 
special  emphasis  upon  the  w(>lfare  of  children,  began  to  be  felt 
and  publicly  discussed  by  the  Anunncan  Red  Cross  officials  at 
National  Headquarters  in  the  autumn  of  1919.  Commissioner 
Olds  in   a  letter  dated  .lulv  1:2  submitted  t(^  th(>  chairman  of 


1178  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  Central  Committee  certain  general  considerations  relating 
to  the  future  work  of  the  organization  in  Europe.  In  this 
communication  he  emphasized  the  gravity  of  the  problem  of 
the  children  in  Europe.  In  a  cable  of  August  23  to  Commis- 
sioner Olds,  Dr.  Farrand  recommended  a  definite  plan  for  the 
establishment  at  available  points  in  Europe  of  ''child  saving 
centers,"  with  necessary  dispensaries  and  medical  and  nursing 
personnel.  The  recommendation  recognized  that  the  American 
Red  Cross  should  cooperate  with  other  organizations  operating 
in  the  field ;  it  further  set  forth  that  it  would  concentrate  upon 
the  field  of  undernourished  and  neglected  children  and  the 
prevention  of  epidemic  and  disease.  In  a  masterly  brief  pre- 
sented October  30,  Colonel  Olds  made  the  following  statement : 

We  rest  under  no  illusions  concerning  our  capacity  to 
handle  such  a  situation.  It  is  plain  that  the  American  Eed 
Cross  cannot  possibly  assume  to  take  up  more  than  a  small 
part  of  the  burden.  In  the  first  place  we  have  never  accepted 
any  responsibility  for  feeding  any  large  groups,  even  children, 
and  do  not  propose  to  do  so  now.  That  operation,  Ijasic  as  it 
is,  must  continue  to  be  an  obligation  of  governments  and  of 
other  organizations.  On  the  other  hand,  we  believe  the  Ameri- 
can Eed  Cross  may  well  undertake  a  health  service  for  chil- 
dren at  various  critical  points  on  a  scale  commensurate  with 
the  resources  at  its  disposal.  We  do  not  foresee  any  difficulty 
in  confining  our  responsibility  within  any  reasonable  limits 
which  may  be  imposed.  If  permission  to  proceed  is  given  we 
are  ready  to  go  ahead  with  a  definite  plan.  It  involved  the 
setting  up  of  field  units,  organized  on  the  simplest  and  most 
effective  lines,  to  furnish  health  service  for  children. 

While  some  delays  must  be  expected  when  there  is  a  shift 
from  one  program  to  another,  the  child  health  program  seemed 
slow  in  getting  under  way.  There  were  doctors,  nurses,  execu- 
tives and  other  workers  still  in  the  various  countries  of  Europe, 
especially  in  Poland,  who  wore  more  or  less  inactive.  ^ledical 
men,  including  children's  specialists,  were  being  sent  to  Europe 
and  requests  for  additional  nurses  were  being  received  at 
National  Headquarters.  Conference  followed  conference  at 
the  Paris  office,  cables  came  and  went,  but  still  the  ''curtain 
did  not  go  up,"  although  the  program  was  there  and  the  actors 
waiting.  A  clear-cut  plan  of  detailed  organization  and  opera- 
tion seemed  to  be  lacking,  and  what  was  more  significant,  the 


INTERNATIONAL  NURSING  EDUCATION       1179 

motive  power  and  force  to  swing  a  plan  into  action  in  the  field 
was  either  not  there  or  if  there  was  without  authority. 

Miss  Noyes**^  was  greatly  concerned  by  the  inaction,  especially 
when  she  found  a  group  of  twenty  nurses  waiting  in  Paris  for 
assignment.  Having  drawn  heavily  upon  the  nursing  resources 
of  America,  where  nurses  at  that  time  were  greatly  needed,  it 
was  disappointing  to  her  to  find  so  many  in  Europe  still  unas- 
signed.  This  was  still  more  distressing  when  it  could  be  ap- 
preciated that  a  great  opportunity  for  their  services  existed ; 
indeed  instances  were  later  noted  where  initiative  was  actually 
discouraged  on  the  part  of  public  health  nurses  because  of  the 
lack  of  knowledge  and  experience  on  the  part  of  the  individual 
medical  directors  and  other  officials. 

In  Poland  Miss  Hay  and  Miss  Noyes  found  many  sore 
spots.  Here  again  were  unassigned  nurses;  in  Cracow  but 
sixteen  out  of  twenty-eight  were  at  work.  An  effort  was  being 
made  to  use  nurses  in  Warsaw,  but  here  again  the  announced 
program  was  not  moving.  The  need  for  a  well-trained  public 
health  nursing  supervisor  was  apparent  and  a  recommendation 
made  to  that  effect.  Miss  Mathews  had  been  appointed  chief 
nurse  in  Poland,  but  because  of  a  lack  of  understanding  and 
experience  in  nursing  affairs  on  the  part  of  the  commissioner 
her  position  as  chief  nurse  was  not  only  uncertain,  but  at 
times  unrecognized.  It  was  necessary,  therefore,  to  prepare 
and  present  to  the  commissioner  a  definite  statement  defining 
her  relationship  to  the  commissioner,  nurses,  physicians  and 
other  personnel.  The  idleness  of  the  nurses  in  Poland  was  in 
a  measure  due  to  the  Bolsheviki  Advance  in  the  summer  of 
1920,  which  retarded  the  subsequent  development  of  the  child 
welfare  program.  The  disturbing  factor  was  that  in  spite  of 
this  situation  additional  nurses  were  still  being  requested  for 
Poland. 

In  Belgrade  but  one  Red  Cross  nurse  was  found.  Miss 
Rhobie  Wliedon,  who  was  then  in  charge  of  the  Belgrade  Or- 
phanage, which  was  being  run  under  the  auspices  of  the  Gov- 
ernment. Conferences  with  Dr.  Reeder  inspired  a  recommen- 
dation to  Colonel  Olds  that  the  American  Red  Cross  assist  the 
American    Child    Welfare    Association    as    far    as    possible    in 

'"Neither  Miss  Noyes  nor  Miss  Hay  regarded  themselves  as  experts  in 
public  health  nursin<r.  yet  their  familiarity  with  the  peneral  field  of  nurs- 
ing and  their  experience  as  administrators  had  given  them  preparation 
as  observers  and  advisors. 


1180  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

securing  and  maintaining  an  adequate  staff.  Later,  a  gener- 
ous appropriation  was  given  this  organization  by  the  American 
Red  Cross,  and  Red  Cross  nurses  were  selected  and  sent  from 
America  to  assist  in  the  development  of  the  child  welfare 
program. 

In  Constantinople  the  question  of  the  relationship  of  the 
American  Red  Cross  nurses  assigned  to  the  Near  East  Relief 
to  that  commission  was  adjusted.  Also  as  there  seemed  some 
probability  that  the  Near  East  Relief  might  withdraw  from 
child  welfare  work  and  as  so  fine  a  beginning  had  been  made 
by  Frances  McQuaide  and  Emma  Wood,  the  former  through 
child  w^elfare  stations,  the  latter  through  a  hospital  for  tubercu- 
lous children  and  as  chief  nurse  of  all  nursing  activities,  the 
following  recommendation  was  made : 

With  the  withdrawal  of  the  Near  East  Commission  from 
child  welfare  work  in  Constantinople,  it  is  recommended  that 
the  American  Bed  Cross,  through  its  Chapter  and  commis- 
sion, should  cooperate  to  have  this  important  work  carried  on. 
This  child  welfare  work  is  in  keeping  with  the  European 
program  for  1921,  and,  already  well  begun,  is  proving  of 
great  value  in  the  community.  Such  work  also  would  provide 
a  field  for  the  public  liealth  instruction  of  the  pupil  nurses  of 
the  American  Training  School,  a  plan  which  is  most  heartily 
approved  by  Admiral  Bristol  and  Commissioner  Davis,  as  well 
as  by  the  hospital  authorities. 

At  that  time  120,000  Russian  refugees  had  just  arrived  on 
various  types  of  boats,  having  been  driven  out  of  the  Crimea 
by  the  advance  of  the  Bolsheviki.  Among  the  Russian  refugees 
were  a  large  number  of  Wrangcl's  Army.  The  condition  of 
these  unfortunates  on  board  the  steamers,  with  little  food  and 
water  and  almost  no  shelter,  during  a  period  when  there  was 
much  rain  and  chilly  autumn  weather,  can  well  be  imagined. 
They  were  packed  in  the  boats  in  such  great  numbers  that  it 
was  impossible  to  relax  or  even  to  lie  down  and  rest.  The  ad- 
dition of  such  a  large  number  of  people,  almost  without  siip- 
plies  of  any  sort,  taxed  the  resources  of  an  already  overcrowded 
city.  The  utmost  effort  and  good  will  was  displayed  by  the 
relief  organizations  located  there  and  by  governmental  agencies, 
but  despite  that,  much  suffering  ensued.  For  the  sick  who  were 
in  need  of  hospital  attention  the  old  Russian  Embassy,  com- 
pletely ('(juipped  with  AuKu-ican  Red  Cross  supplies,  was  hastily 


INTEKNATIONAL  NURSING  EDUCATION       1181 

utilized.  An  adequate  supply  of  Ilussian  nurses  and  doctors 
were  available  to  staff  the  institution,  but  its  support  and  main- 
tenance had  to  be  provided  for  from  local  sources.  The  Ameri- 
can Hospital  opened  its  doors  to  the  American  Red  Cross  per- 
sonnel who  had  evacuated  Sebastopol,  and  Russian  sick,  both 
soldiers  and  civilians,  were  admitted  to  its  wards  to  the  very 
limit  of  its  capacity.  This  was  but  one  page  in  the  sad  history 
of  the  refugee  situation  in  Europe,  an  aspect  of  war  which 
brought  problems  and  suffering  immeasurable  in  extent. 

Leaving  Constantinople,  ^liss  Hay  and  Miss  Xoyes  pro- 
ceeded to  Greece,  shopping  first  at  Saloniki  for  a  day,  where 
quantities  of  American  Jied  Cross  supplies  were  located.  Three 
American  nurses  were  still  in  that  city,  Emily  Simonds,  Tessa 
d'Alberti,  and  jMary  1^.  Boyle,  but  the  American  Red  Cross 
relief  station  there  was  rapidly  being  closed  and  the  nurses 
were  soon  withdrawn. 

Proceeding  from  Saloniki,  Miss  Hay  and  Miss  Noyes  next 
visited  Athens.  It  will  be  recalled  that  child  welfare  work  had 
been  started  in  various  localities  in  Greece  under  the  commis- 
sion but  with  imperfect  success.  That  undertaken  in  Athens 
under  Miss  Tymon  was  probably  the  most  enduring  in  char- 
acter. 

With  the  closing  of  the  commission  in  the  summer  of  1919, 
the  child  welfare  work  was  left  under  the  direction  of  the  Patri- 
©tic  League  and  with  the  exception  of  occasional  advice  from 
Miss  Zacca  in  Athens,  whose  salary  was  being  paid  by  the 
Government,  was  entirely  without  professional  direction.  Re- 
quests, however,  transmitted  through  ]\rajor  Dewing,  who  had 
succeeded  Colonel  Capps,  were  received  at  Xational  Head- 
quarters, asking  for  a  qualified  director  for  the  child  welfare 
work  in  Greece.  The  Junior  Red  Cross  had  also  planned  to 
develop  its  program,  and  by  special  arrangement  Kathleen 
D'Olier,  a  Red  Cross  public  health  nurse  and  a  gi-adnate  of 
the  Rochester  General  Hospital,  Rochester,  Xew  York,  was 
secured,  and  acted  as  the  representative  of  both  the  Junior  Red 
(Voss  and  the  Xursing  Service. 

L'pon  her  arrival  ]\liss  D'Olier  began  the  reorganization  of 
the  child  welfare  work.  The  Patriotic  League  was  still  inter- 
ested, acting  as  the  intermediary  between  the  governniciit  and 
the  work.  A  group  of  young  women  from  the  Ix'st  families 
were  trained  to  act  as  assistants  in  the  clinics  and  for  home 
vitfitina'.     'i'lie  citv  was  divided  info  districts  and  about  seven 


1182  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

hundred  well  babies  were  admitted  to  the  clinic.  Layettes  were 
provided  for  the  newborn.  School  nursing  was  gradually 
started  under  the  direction  of  Ellen  Inglesaki,  a  Greek-Ameri- 
can Red  Cross  nurse ;  Charlotte  Heilman,  a  former  member 
of  the  Italian  Commission,  was  appointed  as  her  assistant,  and 
Miss  Zacca  was  secured  for  clinic  work.  Miss  D'Olier  resigned 
in  December,  1920,  after  a  year's  service,  leaving  Mrs.  Heilman 
in  charge.  At  the  time  of  the  arrival  of  Miss  Hay  and  Miss 
Noyes  the  change  in  government  was  causing  great  concern, 
and  the  continuation  of  American  Red  Cross  child  welfare 
work  seemed  to  hinge  entirely  upon  the  attitude  of  the  new 
Government  toward  the  program.  Members  of  the  Patriotic 
League  and  the  home  visitors,  sympathizing  with  Venizelos, 
were  about  to  resign,  feeling  that  unless  they  did  so,  they  would 
be  asked  to  anyhow.  The  daily  supply  of  milk  which  had  been 
furnished  to  the  babies  had  not  been  provided  for  two  weeks. 

A  conference  with  Prime  Minister  Rhallis  was  secured. 
After  expressing  his  deep  appreciation  of  the  work  he  gave 
assurances  that  the  assistance  of  the  Government  would  be 
continued.  He  expressed  his  desire  that  the  American  nurses 
deal  directly  with  the  Government.  Miss  Noyes  then  recom- 
mended to  Commissioner  Olds  that  the  American  Red  Cross 
continue  its  support  of  the  infant  welfare  station  at  Athens 
for  six  months  longer,  with  the  understanding  that  at  the  close 
of  this  period  the  salaries  of  the  nurses  would  be  assumed  by 
the  Committee  of  the  Patriotic  League  and  the  station  con- 
tinued. The  recommendation  was  approved  and  on  July  1, 
1922,  Mrs.  Heilman's  salary  was  assumed  by  the  Patriotic 
League  and  she  remained  in  Athens  in  charge  of  the  station. 

During  an  enforced  stop  at  Vallona,  Albania,  Miss  Hay  and 
Miss  Noyes  had  an  opportunity  to  make  some  particular  obser- 
vations on  health  conditions.  They  were  entertained  at  the 
Hospital  Civile,  the  only  livable  place ;  here  only  men  were  in 
evidence,  except  in  the  laundry,  where  a  few  native  women  with 
but  few  facilities  managed  to  take  "off  the  rough"  and  send  the 
sheets  and  clothing  back  to  the  wards  sadder  and  duller  in  hue 
than  they  were  when  sent.  But  there  seemed  to  be  great  pos- 
sibilities for  good  work  in  Albania  as  well  as  in  Montenegro. 
In  the  former  at  Durazzo,  at  Tirana  and  Scutari,  nurses  were 
already  developing  school  nursing  and  home  visiting  in  co- 
operation with  Junior  Red  Cross  school  activities,  and  were 
giving  considerable  attention  to  the  ever-present  refugee.     In 


INTERNATIONAL  NURSING  EDUCATION      1183 

Montenegro,  at  Podgoritza  and  at  Danilograd,  the  same  type 
of  work  was  progressing.  At  Ragiisa  and  Zelonika  on  the  Dal- 
matian Coast,  about  15,000  Russian  refugees  from  Constanti- 
nople were  gradually  being  disembarked  and  were  claiming  the 
attention  of  a  relief  unit  of  doctors  and  seven  nurses,  three  at 
Ragusa  and  four  at  Zelenika.  This  unit  had  been  temporarily 
diverted  from  JMontenegro,  where  they  were  being  sent  to 
develop  health  work. 

The  opportunities  for  child  health  work  in  both  Albania  and 
^Montenegro  were  evident,  and  as  a  number  of  Red  Cross  nurses 
were  working  in  various  places  in  those  countries,  the  following 
recommendation  seemed  practical  to  submit: 

1.  Tlie  poverty  of  this  country  and  cry'ing  need  of  more 
assistance  is  everywhere  emphatic.  Valona,  with  a  good  hos- 
pital cottage  plant,  built  by  the  Italians,  would  seem  to  be  an 
excellent  field  for  a  health  unit,  carrying  out  the  general 
policies  of  the  11)'^  1  program. 

At  Durazzo,  Tirana.  Scutari,  our  nurses  are  doing  most 
useful  work.  If  more  healtli  units,  however,  could  be  sent  to 
Albania,  each  of  those  centers  would  be  a  desirable  field  for 
the  development  of  various  public  health  activities,  at  least 
two  nurses  being  assigned  to  each  unit.  The  nurses  would 
then  have  no  connection  with  the  Junior  Red  Cross,  except 
that,  as  a  part  of  their  activities,  would  be  included  the  care  of 
any  school  children,  or  other  cooperation  desired. 

2.  That"  a  chief  nurse  be  appointed,  to  include  in  her 
activities  both  Montenegro  and  Albania. 

While  travel  is  somewhat  difficult,  it  is  believed  that  this 
could  be  quite  satisfactorily  arranged  as  a  whole. 

3.  In  the  development  of  the  work  of  any  puldic  health 
units  sent  there,  as  also  in  the  present  school  nursing  pro- 
gram, that  the  public  health  field  organizer,  connected  with 
the  Paris  office,  should  assist  in  standardizing  the  work  and 
raising  this  to  its  highest  degree  of  efficiency. 

From  liagusa.  Miss  Hay  and  Miss  Xoyes  went  to  Florence, 
where  a  conference  was  held  with  members  of  the  special  com- 
mittee organized  by  ^liss  Gardner  for  the  purpose  of  arranging 
that  three  members  be  chosen  from  these  committees  to  visit 
the  United  States  as  guests  of  the  American  Red  (^ross  to  study 
nursing  education  and  public  health  nursing  methods.  One 
of  the  clinics  organized  under  the  auspices  of  the  Italian  Com- 
mission was  visited  and  found  to  be  in  an  active  and  efficient 
state. 


1184  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Upon  the  completion  of  the  tour  of  inspection  in  late  De- 
cember, 1920,  some  definite  recommendations  were  presented 
to  Colonel  Olds,  These  were  based  upon  observation  of  condi- 
tions as  found  in  each  country  by  Miss  Hay  and  Miss  Noyes. 
As  a  full  report  of  the  schools  has  already  been  given,  this  sec- 
tion will  only  treat  of  observations  in  general  and  of  child  wel- 
fare work. 

It  was  urged  that  nurses  not  needed  for  work  in  connection 
with  the  training  schools  be  withdrawn  from  Czecho-Slovakia. 
As  an  instance  of  the  wisdom  of  this,  the  case  was  presented  of 
a  group  of  ten  nurses  who  had  been  requested  for  typhus  work 
but  who  had  found  upon  their  arrival  that  they  were  not  needed. 
Some  of  them,  indeed,  had  been  given  temporary  work,  most  of 
it  excellent  in  character,  but  none  of  it  related  to  the  announced 
program ;  and  two  of  the  nurses  were  unassigned. 

It  was  a  keen  disappointment  to  Miss  Noyes  that  she  had 
to  leave  Europe  without  completing -final  arrangements  for  the 
organization  of  all  the  proposed  schools  of  nursing.  That  her 
visit  to  Poland  probably  gave  an  impetus  to  the  plan  is  dem- 
onstrated by  the  rapidity  with  w^hich  the  project  materialized. 
At  the  date  of  writing  this  history,  Bulgaria  is  still  considering 
the  proposition  and  Greece  has  not  yet  replied  to  the  communi- 
cation of  December  1,  1920. 

]\Iiss  Noyes  left  the  child  welfare  work,  with  the  exception  of 
Greece,  and  places  here  and  there  where  the  mirses  in  a  more 
or  less  detached  manner  were  doing  some  good  public  health 
work,  in  much  the  same  condition  as  she  found  it.  Little  prog- 
ress had  been  made. 

At  the  close  of  her  tour  of  inspection  ]\riss  iS^oyes  made  the 
following  general  recommendations  to  Commissioner  Olds : 

Eecommended  that  a  supervising  nurse  for  all  public 
health  activities  in  Europe  be  appointed,  who  shall  be  a 
woman  of  broad  experience  and  training  in  all  branches  of 
public  health,  and  who  shall  act  as  field  organizer  of  all 
public  health  activities. 

That  it  is  important  that  personnel  houses  be  arranged  in 
which  all  American  Red  Cross  personnel  should  be  required  to 
live.  It  is  only  fair  that  if  some  are  required  to  live  in  a 
house,  all  should  be,  and  people  with  the  right  Ked  Cross 
spirit  have  no  good  argument  for  holding  out  against  such  a 
requirement.  These  houses  should  in  every  case  be  made  at- 
tractive. 


INTERNATIONAL  NURSING  EDUCATION      1185 

Every  house  should  have,  as  a  house  mother,  a  woman  of  the 
highest  qualifications,  who  would  not  only  be  a  good  chaperone 
for  the  women  personnel  but  who  would  have  the  ability  to 
make  a  most  attractive  home  and  to  give  a  diet  in  which 
economy  and  adequacy  are  satisfactorily  combined. 

Recommended  that  the  term  "health  units"  be  used  instead 
of  "medical  units," 

That  salary  rates  and  all  perquisites,  as,  for  example,  main- 
tenance, uniforms,  vacations,  etc.,  should  be  made  as  uniform 
as  possible  for  all  women  of  equal  experience  and  capabilities. 

In  addition  to  these  general  recommendations,  Miss  N'oyes 
prepared  some  special  suggestions  regarding  the  small  health 
unit,  which,  under  date  of  January  4,  1921,  were  presented 
to  Colonel  Olds.    Extracts  are  given: 

I  had  begun  long  before  I  left  America  to  think  in  terms 
of  simple  working  groups.  .  .  .  Small  nursing  groups  with- 
out elaborate  offices  or  other  personnel  are  in  a  better  position 
to  do  constructive  public  health  nursing  work  than  can  be 
done  in  connection  with  a  big  organization.  It  is  the  old  story 
of  not  being  able  "to  see  the  forest  for  the  trees."  I  can  only 
say  that  my  views  have  been  strengthened  since  my  tour. 

While  a  health  unit  of  any  character  may  need  supplies  of 
food  and  clothing  in  order  to  make  the  work  effective,  this 
should  usually  be  distributed  as  secondary,  and  a  supply  in 
accordance  with  local  needs  be  made  available.  .  .  . 

It  is  also  necessary  to  recognize  that  health  units  may  be 
of  several  varieties,  the  character  of  each  depending  upon  local 
conditions  and  facilities.  The  following  types,  modified  as 
occasion  demands,  have  occurred  to  me  as  practical  and 
possible : 

1.  Composite  unit,  such  as  that  suggested  for  Montenegro, 
where  doctors,  nurses.  Junior  Eed  Cross  and  "feeding" 
personnel  work  out  a  joint  program  with  the  simplest 
"overhead  organization." 

2.  A  health  unit  with  doctors  and  nurses  which  may 
work  out  a  simple  health  program  of  a  preventive  as 
well  as  curative  nature, — developing  the  work  tlirough 
dispensaries  that  may  exist  or  be  developed  by  the  unit. 

3.  A  ])ublic  health  nursing  unit  without  any  American 
Eed  Cross  doctors  or  office  personnel.  The  head  nurse 
of  the  unit  acting  as  the  manager,  financial  agent,  etc., 
such  as  the  cliiUl  welfare  unit  in  Atiiens. 


1186  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

N.  B.  This  unit  is,  I  believe,  securing  better  results 
with  less  expenditure  of  Red  Cross  money  than  any  that 
I  have  seen, 

4.  A  unit  of  nurses,  possibly  Red  Cross  doctors,  although 
not  absolutely  necessary  as  local  physicians  might  be 
available,  supplementing  the  working  of  other  organi- 
zations such  as  the  Hoover  Feeding  Program;  nurses 
attached  to  a  food  station,  selecting  delicate  children, 
following  them  to  their  homes,  arranging  for  treatment 
if  necessary,  supplying  food,  looking  into  home  condi- 
tions and  general  health  of  family.  This  was  suggested 
for  the  Whiting  feeding  work  in  Montenegro  and  seems 
to  offer  wonderful  possibilities  at  little  expense. 

5.  The  relief  unit,  such  as  that  at  Vienna  and  Budapest; 
while  not  health  units,  the  relief  units  are  so  closely 
related  that  they  can  be  included  in  the  list. 

In  any  plan,  but  most  particularly  the  fourth,  local  facili- 
ties, doctors,  nurse  assistants,  dispensaries  and  cooperation  of 
other  organizations  should  be  utilized  and  sought,  and  estab- 
lished promptly.  Chief  nurses,  field  supervisors  and  consult- 
ant American  Red  Cross  doctors  will  probably  be  required. 

I  am  firmly  convinced  that  our  work  is  incomplete  and  not 
constructive  if  we  do  not  make  every  possible  effort  for  its 
perpetuation, — building  up  local  interest  and  initiative,  by 
means  of  local  committees  or  through  organizations  already  in 
existence,  utilizing  local  physicians  and  nurse  assistants,  urg- 
ing governmental  help  such  as  appropriations,  buildings,  sup- 
plies, etc. 

I  appreciate  the  fact  that  this  idea  is  not  new  and  has  been 
carried  out  in  many  places.  For  example,  the  three  hospitals, 
Tirana,  Scutari,  Podgoritza,  organized  and  equipped  by  the 
American  Red  Cross,  are  being  continued  in  a  fairly  efficient 
manner  by  local  authorities.  The  child  welfare  work  at 
Athens  can,  I  believe,  be  entirely  carried  locally  in  six  months 
or  a  year,  tapering  off  gradually. 

As  I  am  assuming  that  you  are  in  sympathy  with  these 
views,  it  seems  therefore  quite  unnecessary  to  add  further 
arguments.  I  believe,  however,  that  the  simplicity  of  the 
small  unit  resulting  in  financial  saving  by  reduction  of  per- 
sonnel and  complicated  overhead  management,  is  the  strongest 
argument  in  their  favor. 

One  last  thought :  It  is  quite  possible  t©  conduct  a  health 
unit  without  a  Red  Cross  doctor.  Athens  and  Kornik,  near 
Posen,  are  two  good  illustrations  of  this  type  in  Europe.  We 
have  some  in  other  countries,  and  many  in  America,  co- 
operating with  local  doctors  wliere  indicated.  .  .  . 


INTERNATIONAL  NURSING  EDUCATION       1187 

Upon  IVfiss  Noyes's  return  to  National  Headquarters  the 
latter  part  of  January,  11)21,  she  found  that  social  workers 
had  boon  authorized  for  the  child  health  work  in  Europe  and 
that  ^fr.  Homer  Folks  of  New  York,  a  recognized  authority 
on  social  questions,  and  ^liss  Margaret  Curtis  of  Boston  were 
to  proceed  to  Europe  to  advise  as  to  how  they  might  be  utilized. 
Some  difference  of  opinion  existed  as  to  the  wisdom  of  intro- 
ducing social  workers  into  a  child  health  program,  limited 
to  a  fairly  short  period.  Many  of  the  medical  men  connected 
with  the  Red  Cross  in  Europe  had  expressed  themselves  as 
opposed.  They  argued  that  in  the  general  dearth  of  local 
agencies  through  which  the  social  worker  is  accustomed  to 
function  they  might  not  fit  into  the  plan,  and  that  this  might 
prove  a  source  of  embarrassment  rather  than  a  help.  Never- 
theless, a  group  of  forty-one  social  workers  was  selected  and 
arrived  in  Europe  during  the  spring  and  summer  of  1921. 

After  making  an  official  report  to  Dr.  Farrand,  ^[iss  Noyes 
recommended  that  a  public  health  nurse,  recognized  as  an 
authority  on  public  health  nursing,  be  sent  to  Europe  to  study 
public  health  nursing  in  connection  with  the  child  welfare 
units.  She  felt  that  the  same  type  of  specialized  advice  for 
the  nursing  service  was  required  as  had  been  deemed  necessary 
for  the  social  service.  This  request  was  granted,  and  !Mary  S. 
Gardner  was  secured  and  left  early  in  May.  1921,  arriving  in 
Paris  ]Nray  24  and  returning  September  21.  ^liss  Gardner 
visited  Czecho-Slovakia,  Poland,  the  Baltic  States,  Austria, 
Serbia  and  Prance;  also  the  cities  of  London  and 
Constantinople. 

At  a  meeting  of  the  Central  Committee  held  at  National 
Headquarters,  January  29,  1921,  Dr.  A.  Ross  Hill  had  been 
elected  vice-chairman  in  charge  of  foreign  operations.  Dr. 
Hill  was  a  Nova  Scotian  by  birth,  had  studied  in  Germany  in 
1893  and  1894,  and  the  following  year  had  taken  his  Ph.D. 
from  Cornell.  Subsequently  he  taught  in  various  American 
universities,  the  subjects  claiming  his  special  attention  being 
psychology  and  education.  In  1907  he  was  dean  of  the  College 
of  Arts  and  Sciences  at  Cornell,  and  the  following  year  became 
president  of  the  University  of  iNfissouri,  a  post  in  which  his 
abilities  as  administrator  came  into  full  play.  Dr.  Hill  laid 
down  his  ])resi(l(Mitial  rol^es  after  twenty-five  years  of  university 
s(M-vi('e,  to  come  to  tlie  American  Red  Cross.  He  is  a  trustee 
of  the  Carnegie  Foundation,  was  formerly  a  member  of  the 


1188  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

^National   Research   Council,   and  one   time   president   of  the 
Western  Philosophical  Association. 

On  March  12  Dr.  Hill,  accompanied  by  Mr.  H.  S.  Bird  and 
Mr.  James  K,  McClintock,  left  the  United  States  for  Europe; 
Mr.  Charles  Scott,  Jr.,  followed  on  a  later  steamer.  They  were 
all  members  of  a  body  known  as  the  European  Inquiry  Com- 
mittee, which  had  been  appointed  some  months  before  for  the 
purpose  of  studying  and  advising  upon  the  operations  of  the 
American  Red  Cross  in  Europe.  Dr.  Hill,  with  characteristic 
thoroughness  and  singleness  of  purpose,  began  a  study  of  the 
existing  organizations  at  the  Paris  office  before  he  attempted 
to  study  that  of  the  separate  Bureaus  or  the  field  work  in  con- 
nection with  this  proposed  child  health  program.  The  result 
of  his  study  was  a  report  which  restated  the  program  of  the 
American  Red  Cross  in  Europe  and  grouped  the  future  opera- 
tions under  two  distinct  projects: 

1.  The  carrying  on  of  the  child  health  program. 

2.  The  definite  liquidation  of  the  general  relief  program. 

After  thus  establishing  a  definite  working  basis,  Dr.  Hill 
returned  on  May  6,  1921,  to  the  United  States  to  present  his 
report  to  the  Central  Committee  for  their  consideration.  The 
recommendations  were  approved  and  he  returned  to  Europe 
the  first  of  June  to  make  a  study  of  field  work  and  to  install 
the  child  health  program.  Colonel  Olds  and  Colonel  Emer- 
son resigned  from  the  European  Commission  June  30,  1921. 
Until  a  new  commissioner  was  selected  in  August,  1921,  Dr. 
Hill  discharged  the  duties  of  that  office.  In  August,  however, 
Mr.  Ernest  Bicknell  was  appointed  as  acting  commissioner 
and  in  ISTovember,  the  Executive  Committee  appointed  him  as 
commissioner. 

Miss  Gardner  completed  her  tour  by  September,  but  did  not 
see  Dr.  Hill  until  he  also  returned  to  Paris  from  his  survey  of 
the  field  operations,  when  they,  together  with  Miss  Hay,  con- 
ferred. This  was  unfortunate,  but  under  the  circumstances 
could  not  be  helped. 

At  that  time  the  date  for  terminating  the  health  work  of 
the  Red  Cross,  while  under  consideration,  had  not  been  fixed. 
Miss  Gardner's  observations,  however,  were  made  with  the 
knowledge  tliat  the  work  was  temporary  in  character.  Intelli- 
gent evaluation  under  these  circumstances  was  very  difficult. 


INTERNATIONAL  NURSING  EDUCATION      1189 

As  Miss  Gardner's  report  covered  the  plan  of  the  activities, 
much  of  it  will  be  incorporated.  In  every  country  she  met 
the  majority  of  the  staff  nurses  both  in  conference  and  as  indi- 
viduals. She  saw  the  other  American  Red  Cross  personnel 
and  local  men  and  women  interested  in  the  work.  At  that  time 
ninety-eight  American  Red  Cross  nurses  were  in  Europe, 
exclusive  of  those  with  the  Near  East  Relief.  Miss  Gardner's 
report  follows: 

There  is  a  certain  similarity  in  the  child  health  programs 
of  the  three  more  northern  countries  visited,  the  Baltic  Prov- 
inces, Poland  and  Czecho-Slovakia.  Serbia  will  also  be  con- 
sidered with  this  group  because  though  work  in  Serbia  is 
carried  on  by  the  Serbian  Child  Welfare  Association,  the 
stations  are  supported  by  Red  Cross  subsidy,  and  the  nurses 
are  Eed  Cross  nurses.  In  all  these  countries  child  health 
stations  have  been  established  where  American  nurses  are  at 
work  with  native  doctors,  and,  in  all,  attempt  is  being  made 
to  train  in  a  short  period  of  time  native  young  women  to 
carry  on  the  work,  after  the  withdrawal  of  the  American 
personnel,  pending  the  graduation  of  nurses  from  the  newly 
established  nurses'  training  schools.  Details  differ  somewhat. 
In  the  Baltic  provinces  over  a  hundred  child  health  stations 
were  already  established  before  the  arrival  of  the  American 
nurses.  "S westers,"  native  women  possessing  varying  degrees 
of  nursing  experience,  are  employed  for  dispensary  work  (sick 
and  well  baby  clinics)  and  home  visiting.  The  work  of  the 
American  nurses,  therefore,  in  the  Baltic  provinces  will  con- 
sist not  in  establishing  health  stations  but  largely  in  teaching 
this  existing  group  of  women  the  American  technique  of 
their  work.  The  American  nurses  had  arrived  in  the  Baltic 
provinces  but  a  few  days  previous  to  my  visit,  and  actual 
work  had  not  yet  begim,  though  all  was  in  readiness  for  it. 

In  Poland  the  plan  is  one  of  demonstration,  a  nurse  and  a 
social  worker  going  to  a  town  for  the  primary  purpose  of 
establishing  a  dispensary  and  milk  station  (possibly  also  a 
small  hospital  if  such  is  needed)  and  moving  on  as  soon  as 
these  needs  are  obtained,  subsequent  visits  supplying  the  nec- 
essary stimulation  to  further  effort. 

In  Czecho-Slovakia  the  program  implies  the  establishment 
of  twenty-two  centers  (Government  geographical  units)  of  a 
model  type,  a  number  of  well  equipped  rooms  with  laboratory 
facilities,  babies'  bathtubs,  etc..  in  addition  to  the  usual 
dispensarv  equipment.  As  in  Poland  a  nurse  and  social 
worker  work  togctlier  in  the  establishment  of  tliese  centers, 
but,  unlike  Poland,  the  American  personnel  remains  to  run  the 


1190  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

centers  after  establishment.  In  the  latter  part  of  June,  the 
time  of  my  visit,  none  of  the  centers  were  in  actual  operation 
owing  to  delays  in  securing  rooms,  equipment,  etc.  The 
nurses  and  social  workers  were,  however,  for  the  most  part,  in 
their  centers,  busy  about  the  necessary  preliminaries.^^ 

In  Serbia  the  problem  presented  is  somewhat  different,  in 
that  Serbia  is  essentially  an  agricultural  country.  The  sta- 
tions, ten  in  number,  are  all  located  in  small  villages  and 
serve  a  large  surrounding  rural  area.  At  each  station  are  two 
nurses,  one  working  in  the  dispensary  and  one  doing  the 
school  work  and  home  visiting.  Home  visits  are  made  by 
l-o1a  (ox  cart)  or  on  horseback  and  often  involve  many  hours 
of  travel  for  a  single  patient.  In  Serbia,  adults,  both  men 
and  women,  are  cared  for  at  the  dispensaries  and  by  the  visit- 
ing nurse. 

In  all  four  countries  classes  are  held  for  mothers  and 
expectant  mothers,  also  for  little  girls  (''little  mothers"). 

The  question  of  governmental  support  has  been  variously 
met.  In  the  Baltic  provinces  the  governments  have  been 
asked  to  make  no  immediate  promises,  but  to  study  for  them- 
selves the  workings  of  the  centers  with  a  view  to  a  later  take- 
over. As  the  American  Red  Cross  commission  to  these  coun- 
tries has  been  peculiarly  happy  in  its  relation  to  the  govern- 
ments and  has  succeeded  in  interesting  them  greatly  in  its 
health  work,  later  government  support  seems  exceedingly 
probable. 

In  Poland,  governmental  support  has  not  been  sought  for 
various  well  considered  reasons.  The  work  in  Poland  is 
carried  on  largely  through  a  Polish  national  society,  the 
P.  A.  K.  P.  D.  (Polski  Amerykanski  Komitet  Polocy  Dzie- 
ciom — Polish-American  Society  for  the  Promotion  of  Chil- 
dren), which  has  branches  throughout  all  of  Poland.  It  is 
through  the  P.  A.  K.  P.  D.  that  the  American  Relief  Associa- 
tion has  worked  in  its  big  task  of  feeding  the  children  of 
Poland. 

In  Czecho-Slovakia  governmental  support  was  assured  be- 
fore launching  the  program. 

In  Serbia  an  interesting  situation  exists  peculiar  to  the 
country.  The  first  start  of  the  commission  was  through  local 
committees  of  the  National  Public  Health  Society,  a  body 
which  fortunately  proved  too  weak  both  centrally  and  locally 
for  the  purpose.  About  the  time  of  my  visit  it  was  decided  to 
work  instead  through  the  Peasants'  Cooperative  Society,  a 
strong  national  organization  which  has  been  in  existence  for 
twenty-five  years  for  the  purpose  of  cooperative  bujing,  and 
"Eight  centers  open   Sept.   1. 


INTERNATIONAL  NURSING  EDUCATION       1191 

on  which  it  seems  possible  to  graft  a  health  program,  so 
making  use  of  a  familiary  organization  which  has  already 
gained  the  confidence  of  the  people  it  serves.  Its  local  com- 
mittees are  composed  of  the  peasants  themselves.  Though 
non-governmental,  this  society  is  closely  allied  to  the  Govern- 
ment. 

Austria  presents  a  problem  quite  different  from  the  four 
countries  already  spoken  of.  Austrians  are  excellent  organ- 
izers, and  before  the  war  their  child  health  work  M-as  of  a  high 
standard.  The  work  of  the  American  Ked  Cross  in  Austria 
has  been  largely  confined  to  subsidy  and  the  supply  of  hospital 
and  dispensary  equipment  and  the  child  health  stations  are 
already  served  by  women  of  superior  type.  The  Austrian 
doctor  in  charge  of  the  child  health  stations  subsidized  by  the 
American  Red  (^ross  has,  however,  asked  for  the  services  of  an 
American  pu))lic  health  nurse  to  demonstrate  American 
methods  of  home  visiting.  At  the  time  of  my  visit  to  Vienna 
the  American  nurse  had  very  recently  arrived,  but  the  pros- 
pect of  effective  work  of  this  type  seemed  hopeful. 

The  effort  to  train  in  a  short  period  of  time  young  women 
to  replace  the  American  nurse,  pending  the  time  when  native 
graduate  nurses  will  be  available,  has  been  in  every  country 
the  most  ditlicult  part  of  the  health  programs,  and  quite 
naturally  so,  l^ecause  the  work  required  of  such  an  individual 
does  not  differ  from  that  at  present  being  done  by  the  Ameri- 
can nurse  who  has  required  years  of  preparation  for  the  task. 
Two  methods  have  been  used,  individual,  teaching  in  the 
actual  field  of  work,  and  the  opening  of  courses,  four  to  six 
months  in  duration,  wliich  are  attended  by  groups  of  students 
who  live  at  a  central  headquarters,  and  learn  through  both 
field  and  class  work  the  rudiments  of  health  visiting.  The 
girls  available  have  for  the  most  part  beeen  somewhat  below 
the  grade  desirable  for  the  nurses'  training  schools.  Whether 
this  type  of  woman  can.  after  a  short  period  of  training,  even 
})artially  and  temporarily  fill  the  place  required  of  her  can 
only  be  proved  by  a  longer  period  of  actual  experience. 

At  present,  evidence  from  different  localities  is  conflict- 
ing. .  .  . 

Miss  Gardner  visited  the  five  schools  of  nursing,  all  of  which, 
with  the  exception  of  the  one  at  Belgrade,  had  been  organized 
by  American  Red  (/ross  nurses. 

In  commenting  upon  them  she  stated : 

I  will  first  speak  briefly  of  the  training  school  .  .  .  though 
not  j)riinurily   my  object  of  study.  Init  as  all  })uhlir  health 


1192  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

work  is  dependent  upon  the  production  of  qualified  nurses 
and  the  present  child  welfare  programs  of  the  various  coun- 
tries all  imply  some  form  of  trained  native  personnel  for  their 
continuance  seemed  desirable.  .  .  . 

There  are  many  difficulties  involved  in  the  starting  of  a 
training  school  in  a  foreign  country,  some  fundamental  and 
common  to  all  the  schools,  others  more  peculiarly  local.  I 
feel  though  that  none  of  these  difficulties  are  insurmountable 
and  that  the  American  nurses  engaged  in  this  work  are  per- 
forming a  task  in  the  highest  degree  useful  and  construc- 
tive. .  .  . 

The  establishment  of  training  schools  would  seem  in  this 
sense  to  be  in  the  highest  degree  constructive,  for  it  is  planned 
to  train  women  who  when  graduated  will  take  over  the  re- 
sponsibility of  future  development  in  their  own  countries. 
Expenses  are  already  shared  or  met  by  the  local  communities, 
and  the  Avork  is  everywhere  being  done  with  a  minimum  of 
American  personnel.  .  .  . 

Miss  Gardner  concluded  her  report  with  some  specific  recom- 
mendations which,  in  view  of  the  time  consumed  in  her  trip 
and  the  peculiar  conditions  which  governed  the  undertaking, 
were  exceedingly  comprehensive  and  helpful: 

The  public  health  programs  present  a  far  more  complicated 
problem  than  the  schools.  A  number  of  inhibitions  to  success- 
ful accomplishment  naturally  present  themselves. 

1.  The  new  programs  replace  the  former  infinitely  simpler 
and  naturally  more  popular  programs  of  relief.  Such  a 
change  is  fraught  with  difficulties  in  countries  brought  by  war 
and  sufi^ering  to  the  easy  acceptance  of  material  assistance. 

2.  The  personnel  for  the  new  programs  have  in  many 
instances  not  been  changed,  and  men  and  women  engaged 
for  quite  other  work  are  now  involved  in  a  most  difficult  form 
of  specialized  health  work  without  previous  preparation  for  it. 

3.  ^lost  of  the  efforts  toward  constructive  work  have  been 
built  on  the  American  conception  of  a  local  committee,  and 
its  assumed  feeling  of  responsibility  for  community  welfare. 
In  some  of  the  countries  altruism  seems  to  take  other  forms.^ — 
tlie  military  conce])tion  of  patriotic  service,  for  instance,  and  a 
committee  composed  of  the  so-called  representative  people  of 
a  comnnmity.  who  themselves  derive  nothing  from  the  jiro- 
posed  subject,  is  a  less  familiar  vehicle  for  sustained  helpful- 
ness tlian  Americans  always  realize. 

4.  A  type  of  health  work  which  in  America  and  England 
is  of  exceedingly  slow  growth  is  in  Europe  being  undertaken 


INTERNATIONAL  NURSING  EDUCATION       1193 

within  a  time  limit  which  would  at  home  be  considered  pro- 
hibitive. 

5.  Most  of  the  programs  are  based  on  the  American  public 
health  nurse  as  a  vital  factor  in  its  accomplishment.  None  of 
the  countries  except  perhaps  Austria  possess  iier  prototype — 
years  of  education,  training,  and  discipline  have  gone  into  the 
making  of  an  American  nurse,  and  she  cannot  be  reproduced 
in  any  short  period  of  preparation. 

().  I'ossibly  most  important  of  all  is  the  different  estimate 
placed  in  some  of  the  countries  upon  human  life,  and  espe- 
cially child  life.  When  all  is  said  and  done  the  saving  of  an 
individual  child's  life  is  not  always  considered  a  matter  of 
great  importance,  an  attitude  of  mind  difficult  for  Americans 
to  understand  but  one  having  a  vast  influence  upon  the  whole 
situation. 

That  these  difficulties  and  inhibitions  have  been  met  and 
overcome  as  successfully  as  they  have,  speaks  well  for  the 
American  workers.  The  degree  of  artificial  stimulation  em- 
ployed, however,  should  be  a  matter  for  serious  consideration. 
Stimulation  has  its  place,  but  is  only  of  any  permanent  value 
if  it  can  ultimately  be  withdrawn  with  safety. 

The  readiness  of  the  countries  to  receive  the  kind  of  help 
offered  is  of  course  the  crux  of  the  whole  matter.  The  fact 
that  suc;h  a  desire  has  had  to  be  artificially  stimulated  in 
every  country  but  Austria  does  not  necessarily  militate  against 
the  plan,  i)ut  clear  analysis  is  made  difficult  by  the  fact  that 
a  certain  amount  of  material  benefit  in  the  way  of  supplies, 
subsidy,  etc.,  has  necessarily  formed  a  part  of  the  educational 
effort. 

A  big  piece  of  demonstration  work  has  been  carried  on  over 
a  wide  area  of  European  territory.  Many  of  the  demonstra- 
tions have  been  good,  some  have  served  their  purpose  in  that 
they  have  been  closely  and  intelligently  watched  by  those 
likely  to  profit  by  the  object  lessons.  .  .  . 

For  the  future,  ^liss  Gardner  felt  that  several  courses  were 
open: 

1.  A  complete  withdrawal  of  all  American  personnel  and 
money  within  the  next  ten  or  twelve  months.  This  could 
probably  be  r.ccomplished  without  loss  of  Ked  Cross  dign:ty 
or  prestige  if  j)lans  were  inaugurated  at  once. 

2.  A  prolonged  stay  of  a  number  of  years  with  less  stimu- 
lation and  less  intensive  effort.  This  would  imply  a  wbolly 
different  point  of  view  on  the  part  of  the  personnel,  an  atti- 
tude more  n(>arly  approaching  that  of  the  niissionarit's  who 


1194  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

neither  seek  nor  expect  immediate  results,  but  who  measure 
success  by  decades,  and  who  expect  to  give  years  of  continuous 
service. 

Between  these  two  extremes  were  two  others: 

A.  After  the  retirement  of  the  American  commissions  a 
limited  subsidy  could  be  left  to  be  administered  by  native 
groups  under  certain  stipulated  conditions. 

B.  In  addition  to  such  subsidy  or  without  it,  a  tiny  Ameri- 
can personnel  could  be  left,  not  more  than  two  or  three 
people,  one  of  whom  should  be  a  well  equipped  public  health 
nurse  who  would  act  in  an  advisory  capacity  either  to  the 
subsidized  bodies  or  to  those  desiring  such  assistance. 

The  last  plan,  though  possessing  many  advantages,  should 
not,  I  believe,  be  unreservedly  recommended  for  all  countries. 
I  think  the  time  will  soon  have  come  when  a  cessation  of 
outside  stimulation  is  to  be  desired.  If  at  the  end  of  another 
eight,  ten  or  twelve  months  such  an  American  advisory  service 
is  not  very  generally  and  sincerely  wanted  and  asked  for,  it 
should  not,  in  my  opinion,  be  offered,  certainly  not  for  the 
mere  object  of  tying  a  string  to  a  subsidy. 

The  task  which  confronted  the  Red  Cross  administrative 
workers  in  Paris,  medical  directors,  nurses  and  social  workers 
in  the  field,  was  monumental.  It  meant  not  only  the  organiza- 
tion of  local  committees  and  the  building  up  of  local  interest, 
but  the  physical  task  of  organizing  and  opening  up  child  health 
centers.  Then  there  was  the  work  of  selecting  and  training 
local  nurses  and  health  visitors.  This  entailed  special  courses 
for  the  latter  at  Cracow,  Prague  and  elsewhere,  for  the  former 
a  preparation  by  special  courses  in  connection  with  the  new 
schools  of  nursing  at  universities,  of  which,  for  example,  the 
school  at  Dorpat,  Esthonia,  under  the  direction  of  Mrs. 
Vaughan,  was  one. 

While  the  child  health  work  had  been  discussed  since  early 
1920,  and  its  development  authorized,  a  final  plan  of  organi- 
zation had  not  been  formulated  until  1921.  Tlow^ever,  with 
the  simplification  of  central  administration  and  with  the  knowl- 
edge that  to  the  American  Red  Cross,  as  a  member  of  the 
European  Relief  Council  and  because  of  surveys  made  by  Red 
Cross  doctors  and  nurses,  had  been  allocated  the  medical  and 
social  care  of  the  children,  gradually  the  activities  seemed  to 
group  themselves  into  two  classes: 


INTERNATIONAL  NURSING  EDUCATION       1195 

First.  Child  Health  Centers. 
Which  mi<^ht  be  anibulatoria,  children's  hospitals  or  chil- 
dren's wards,  milk  stations,  clinics  for  the  examination, 
weighing  and  measuring  of  children,  also  special  areas  for 
intensive  pre-natal  work,  as  a  community  demonstration  were 
included. 

Second.  Educuiional  M'orl-. 
Pre-natal  and  post-natal  instruction  for  mothers,  instruction 
in  Home  Hygiene  and  Care  of  the  Sick,  care  of  children, 
child  health  })ropaganda  for  the  general  public,  and  instruc- 
tion in  public  healtii  nursing  to  graduate  nurses  as  in  Aus- 
tria, Baltic  States  and  ('zecho-Slovakia,  as  well  as  on  health 
visitors  at  Cracow,  in  order  that  personnel  should  be  devel- 
oped to  "carry  on"  after  the  withdrawal  of  the  American 
Ked  Cross. 

Modifications  of  the  general  plan  were  used  in  each  country 
where  the  American  Red  Cross  operated.  In  the  main,  the 
field  supervision  included  one  or  two  American  doctors,  a  su- 
pervising nurse  and  a  social  worker ;  to  the  centers  were  as- 
signed local  doctors,  an  American  nurse,  also  a  local  nurse 
where  one  existed  and  from  two  to  four  student  health  visitors. 
From  the  central  office  medical,  nursing  and  social  direction 
was  given  by  American  personnel,  which  included  well-known 
specialists  such  as  Dr.  J.  II.  ^lason  Knox  and  Dr.  Phillip 
Jeans  and  also  Dr.  Hugh  Manning  for  general  medical  supervi- 
sion. General  nursing  direction  was  given  by  qualified  public 
health  nurses,  ^Irs.  Elsbeth  Vaughan  for  Czecho-Slovakia, 
Poland  and  the  Baltic  States;  Miss  Sophie  C.  Xelsou  for  the 
Balkan  States,  Austria.  Hungary  and  Serbia.  Both  of  these 
nurses  had  been  assigned  as  assistants  to  ^liss  Hay  in  1921. 
With  tliis  organization  a  clearer  understanding  of  the  work 
was  gradually  acquired. 

In  Austria  one  hundred  and  one  centers  were  established. 
Here,  as  well  as  in  Hungary,  the  nurses,  with  the  exception 
of  the  supervisors,  were  natives.  In  the  Baltic  Stat(>s  there 
were  by  July  of  V^'2\  sixty-six  centers,  in  September  one 
hundred  and  forty,  tliis  rapid  expansion  occurring  before  tlie 
arrival  of  tiie  AnieiMcan  Ived  Cross  nurses.  These  centers 
were  reduced  on  January,  1!)22.  to  fifty-six,  by  ^[ay  of  1!>22 
all  the  centers  were  statFed  by  native  personnel.  In  Czecho- 
slovakia twenty-one  centers  were  established.  In  Hungary 
there  were  fiftv.      In   Montenc^irro  eleven  were  maintained.      In 


1196  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Poland  one  hundred  and  fifty-six  ambiilatoria  and  sixty-nine 
centers  were  organized  and  when  the  Red  Cross  withdrew 
over  twenty  thousand  children  were  registered  and  under 
supervision  and  two  thousand  expectant  mothers  were  receiving 
practical  instruction.  In  Roumania  the  American  Red  Cross 
work  passed  through  various  stages:  First,  the  American  Red 
Cross  commission  had  developed  general  and  medical  relief 
until  ld'20.  Then,  upon  the  withdrawal  of  the  commission, 
six  American  Red  Cross  nurses  had  been  left  with  Lady 
Paget's  Mission,  but  were  finally  withdrawn.  Later  one  Amer- 
ican Red  Cross  nurse.  Miss  Agnes  Von  Kurowsky,  was  as- 
signed to  Roumania  and  worked  with  the  Junior  Red  Cross 
until  November,  1921.  Later  the  Government  assumed  the 
responsibility  for  the  baby  clinic  at  Breaza,  which  she  had 
supervised.  In  Serbia  the  American  Child  Welfare  Associa- 
tion, subsidized  by  the  American  Red  Cross  and  supplied  with 
American  Red  Cross  nurses,  developed  ten  stations  and  con- 
ducted a  health  workers'  course.  In  connection  with  the  work 
local  committees  weie  formed,  contracts  were  made  with  local 
agencies  and  local  personnel  were  trained.  In  some  instances 
clothing  was  supplied  and  layettes  in  large  numbers  were  dis- 
tributed. Food  was  usually  distributed,  however,  through  the 
local  or  State  representatives  of  the  American  Relief  Associa- 
tion, such  as  the  P.  S.  K.  P.  D.  of  Poland  or  other  agencies. 
That  Dr.  Hill  had  his  mind  fixed  upon  a  given  date  as  an 
objective  toward  which  to  w^ork  is  best  told  in  his  own  words: 

In  organizing  the  child  health  centers  of  the  American 
Eed  Cross  in  Europe,  it  was  my  notion  in  July,  1921,  that  in 
some  countries  at  least  a  period  of  two  years  would  be  neces- 
sary for  effective  operation.  But  by  October,  after  I  had 
traveled  over  the  field  and  visited  the  centers  already  in  opera- 
tion, I  reached  the  conclusion  that,  while  it  would  probably 
take  more  than  two  years  for  the  American  lied  Cross  to  carry 
the  program  to  a  thoroughly  satisfactory  demonstration,  yet 
in  one  year  it  would  probably  be  possible  to  convince  local 
agencies  of  the  possibility  and  desirability  of  their  taking 
responsibility  for  the  continuation  of  the  work.  This  opinion 
was  confirmed  by  a  conference  with  ^liss  Gardner  just  before 
her  return  from  Europe. 

Accordingly,  throughout  the  year  an  effort  was  made  to 
encourage  local  participation  in  the  program  and  to  develop 
local  agencies  and  local  personnel.  From  correspondence 
with  the  Conmiissioner  for  I^urope  and  irom  the  reports  of 


INTERNATIONAL  NURSING  EDUCATION      1197 

the  directors  of  field  operations,  it  became  clear  that  the 
transfer  to  local  agencies  by  July  1,  V,)'^2,  was  not  only 
feasible  but  wise,  even  if  that  involved  the  granting  of  sub- 
sidies in  some  instances  to  these  local  agencies  for  the  first 
year  of  their  operation.  Accordingly,  the  Central  Committee 
at  a  meeting  held  February  17,  VJ22,  took  the  following 
action : 

That  it  is  the  sense  of  the  Central  Committee  that  the 
Red  Cross  sliould  conclude  its  work  in  Kurope,  with  the 
exception  of  certain  activities  of  the  Junior  Red  Cross, 
on  June  30,  19"2"^,  this  resolution  being  subject  to  the 
following  conditions : 

I.    It  is  recognized   in  order  to  secure  the  transfer  of 

Red  Cross  activities  to  other  agencies  with  the  least 

possible  loss  of  value  that  the  Red  Cross  may  continue 

a  certain  amount  of  supervision  and  in  special  cases 

render  temporary  assistance  of  an  incidental  nature 

to  the  agencies  taking  over  these  activities,  etc. 

Of  course  the  action  referred  to  had  reference  to  the  child 

health  program  only,  and  did  not  mean  the  discontinuance  of 

the  work   of  training  nurses,  nor  of  the  relief  to   Russian 

refugees  in  Constantinople,  nor  of  the  furnishing  of  medical 

and  hospital  supplies  to  Soviet  Russia. 

That  the  personnel  worked  as  a  team  is  demonstrated  by 
the  fact  that  by  July  1,  1922,  nearly  all  the  field  workers  were 
released.  The  exceptions  were  certain  nurses  whose  services 
were  in  connection  with  the  schools  and  ^Mrs.  Ileilman  in 
Greece.  The  American  Red  Cross  made  provision  for  Mrs. 
Ileilman's  salary  until  July  1,  1922,  a  date  on  which  it  was 
assumed  locally.  The  services  of  Miss  Elizabeth  Marshall 
were  retained  until  October,  1922,  in  Constantinople,  where 
she  had  been  assigned  to  develop  public  health  nursing  for  the 
school  of  nursing  there.  Also  here  and  there  in  Eastern 
Europe  was  left  a  nurse  advisor — Mrs.  Vauglian  for  the  l]altic 
States  and  Poland ;  Miss  Nelson  for  general  supervision  of 
the  Balkans,  Austria  and  Hungary;  ^fiss  Schaub  in  Hungary, 
and  ^riss  Torrance  in  Czecho-Slovakia.  Thus  the  nurses  who 
had  been  first  in  the  field  were  the  last  to  leave.  Miss  Hay, 
in  spite  of  her  desire  ''to  see  it  through,''  had  been  obliged  to 
return  to  America  June  4.  1922.  because  of  the  illness  of  a 
member  of  her  family.  Mrs.  Vaughan  was  left  in  general 
charge.  She,  however,  was  also  obliged  for  similar  reasons 
to  leave  in  September,   1922.     Miss  Xelson  thus  rcnnained  as 


1198  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  representative  of  the  Nursing  Service  until  such  time 
as  it  was  deemed  wise  to  leave  the  committees  without  special 
advice,  and  until  the  last  of  the  field  nurses  were  withdrawn. 
The  organization  of  the  child  health  work  under  the  Amer- 
ican Red  Cross  appeared  to  be  slow  in  getting  under  way,  but 
the  rapidity  which  characterized  its  later  development  and  the 
final  withdrawal  of  the  majority  of  the  American  workers  by 
July  1,  1922,  may  well  lead  to  speculation  as  to  its  real  value 
and  permanency.  As  a  demonstration,  even  though  there  may 
be  some  criticism  of  the  American  Red  Cross  for  trying  to 
develop  in  a  short  time  under  most  difficult  conditions  a  type 
of  work  that  usually  required  a  longer  period  even  in  America, 
we  believe  it  was  valuable.  The  minds  of  the  people  were 
directed  towards  positive  health  as  an  objective.  The  instruc- 
tion of  thousands  of  women  and  girls  in  personal  hygiene,  in 
the  care  and  feeding  and  proper  clothing  of  children  and  the 
emphasis  placed  by  the  American  nurses  by  precept  and 
example  upon  the  importance  of  good  nursing  service  to  the 
sick  as  well  as  health  nursing  cannot  have  been  entirely  lost. 

The  island  possessions  of  the  United  States  also  profited  by 
the  skill  and  devotion  of  American  Red  Cross  nurses.  Their 
services  were  first  called  for  in  1919  and  at  the  closing  date 
of  this  history,  June  30.  1922,  numerous  types  of  nursing 
activities  were  in  process  of  active  development.  Adminis- 
trative details  in  connection  with  this  insular  nursing  service 
were  conducted  through  the  Department  of  Nursing  of  the 
Insular  and  Foreign  Division  of  the  American  Red  Cross,  of 
which  Miss  Ida  F.  Butler  was  director.  The  islands  in  the 
Atlantic  Ocean  to  which  American  Red  Cross  nurses  were 
assigned  were  Santo  Domingo  and  Porto  Rico  of  the  West 
Indian  Group  and  the  Virgin  Islands,  which  were  located  east 
of  the  West  Indies ;  those  in  the  Pacific  were  the  Hawaiian 
and  the  Philippine  Islands. 

When  the  United  States  Marines  were  sent  in  1919  to  police 
the  Island  of  Santo  Domingo,  the  ]\Iedical  Corps  of  the  United 
States  Navy  sent  a  complement  of  Navy  surgeons,  sanitary 
officers  and  enlisted  men  with  them,  and  these  medical  men 
of  the  Navy  served  as  sanitary  officers  of  the  island.  Through 
them  the  Dominican  Republic  called  upon  the  American  Red 
Cross  to  assign  nurses  to  service  there,  the  Republic  to  provide 
salaries,  transportation  and  maintenance,  the  Nursing  Service 


INTERNATIONAL  NURSING  EDUCATION      1199 

to  select  the  nurses,  to  act  as  the  intermediary  for  the  Govern- 
ment and  to  advise  and  direct  the  nnrses'  work.  From  1919, 
and  up  to  June,  1922,  ten  American  Red  Cross  nurses,  Mary 
Muriel  Cameron,  Marie  F.  Falconer,  Mabel  Dershem,  Eliza- 
beth Wrif^ht,  Henrietta  Wiltzius,  Clara  J.  Farnsworth,  Eliza- 
beth Hunt,  ^lary  E.  Shaneman,  Agnes  Meyer  and  Elizabeth 
Miller,  were  on  duty  on  the  island. 

The  type  of  service  which  these  nurses  met  included  the 
reorganization  and  direction  of  hospitals,  the  establishment  of 
dispensaries  and  the  organization  of  classes  of  instruction.  In 
addition  there  was  the  actual  routine  of  nursing  work,  in  which, 
under  conditions  next  to  impossible,  they  performed  almost 
superhuman  nursing  tasks.  Some  attempt  was  made  to  train 
young  women  in  the  principles  and  practice  of  nursing,  but 
the  chief  accomplishment  in  this  field  lay  in  the  practical 
phases  and  little  was  done  toward  the  organization  of  schools 
or  the  standardization  of  nursing  education.  In  the  majority 
of  Dominican  hospitals  the  nursing  service  was  under  the 
management  of  religious  Sisterhoods. 

The  experiences  of  the  nurses  were  more  or  less  the  same, 
and  an  extract  from  a  letter  written  by  Miss  Wiltzius  to  Miss 
Xoycs  on  August  5,  1022,  will  serve  as  an  illustration  of  the 
difficulties  under  which  they  all  w^orked.  Miss  Wiltzius  was 
on  duty  at  the  hospital  at  Santiago.      She  wrote : 

When  T  tell  you  that  it  is  the  dirtiest,  most  neglected  place 
I  have  ever  been  in,  you  can  guess  that  it  is  terrible,  for  I  have 
seen  and  helped  ''clean  up"  a  few  unsightly  so-called  hospitals 
before  tliis. 

Not  one  room  is  in  any  kind  of  order.  The  bedside  tables 
serve  as  individual  medicine  cases,  clothes  lockers  and  food 
containers.  .  .  .  The  sanitary  arrangements  are  unspeakable. 
.  .  .  Soiled  linen,  garbage  and  used  gauze  are  thrown  out  of  the 
windows  or  in  some  corner.  When  a  new  bed  is  needed,  it  is 
set  up.  There  is  no  such  thing  as  spacing  the  beds  at  regular 
intervals  in  the  wards.  .  ,  . 

The  buildings  themselves  are  very  nice  and  when  they  are 
painted  and  connected  by  covered  corridors  I  tliink  this  can 
be  made  the  prettiest  hospital  on  the  island.  Located  as  it  is 
on  the  outskirts  of  the  town,  with  the  mountains  behind  it, 
the  situation  is  ideal. 

^liss  Wiltzius'  advent  had  not  been  greeted  with  enthusiasm 
by  the  native  doctor  in  charge  of  the  hospital  at  Santiago,  but 


1200  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

after  some  weeks  ''he  seems  to  have  ceased,"  wrote  Miss 
Wiltziiis,  "to  regard  the  American  nurse  as  a  necessary  evil 
and  the  air  is  not  as  frigid  as  on  the  first  day." 

Miss  Wiltzius'  living  quarters  were  almost  as  primitive 
as  were  conditions  in  the  hospital.     She  wrote: 

I  am  living  with  a  very  nice  native  family  downtown  be- 
cause the  hospital  is  in  an  undesirable  neighborhood.  This 
family,  however,  lives  at  some  distance  from  the  hospital 
but  I  have  a  "sea-going  hack"  which  takes  me  back  and  forth. 
The  arrangement  is  satisfactory  when  it  comes,  but  it  is  dis- 
couraging to  have  to  wait  and  then  walk.  The  two  rooms  I 
occupy  are  on  the  street  with  only  one  door  for  ventilation 
and  light.  I  did  feel  very  "shut  in"  after  Seybo  but  now 
that  I  have  a  cot  and  sleep  on  a  balcony,  it  seems  wonderful. 
Down  here  on  the  street  I  had  no  air  and  the  dust  just  pours 
in.     The  Marines  were  very  good  about  getting  me  "fixed." 

Commander  I.  S.  K.  Reeves,  Marine  Corps,  United  States 
Xavy,  whose  effort  to  improve  health  and  sanitary  conditions 
had  borne  such  fine  fruit,  spoke  appreciatively  in  a  letter  of 
June  27,  1922,  of  the  nurses  and  their  work: 

You  have  sent  me  nurses  of  the  most  superior  type.  They 
are  a  credit  to  your  organization  and  a  pride  and  Joy  to  mine. 
I  cannot  say  too  much  in  praise  of  your  choice  and  take  this 
opportunity  to  thank  you  again. 

Under  the  direction  of  the  United  States  iSTavy  doctors,  who 
acted  as  sanitary  officers,  and  because  of  the  energetic  and 
devoted  work  of  the  Red  Cross  nurses  the  hospitals  were 
gradually  developed  into  first-class  institutions.  Great  im- 
provement took  place  in  the  nursing  care  of  the  sick,  and 
through  dispensaries  a  better  knowledge  of  personal  hygiene 
and  health  conditions  was  disseminated. 

This  last  phase  of  the  sanitary  program  in  Santo  Domingo 
was  greatly  assisted  by  classes  in  Home  Hygiene  and  Care  of 
the  Sick,  which  was  given  by  Isabel  Hall  Basken.  Mrs.  Basken 
was  a  native  of  the  Dominican  Republic  and  a  graduate  of 
Lincoln  Hospital  Scliool  of  Nursing  in  New  York.  In  April, 
lt»20,  she  was  appointed  as  an  instructor  of  this  course  and  was 
energetic  in  organizing  classes  among  the  women  and  voung 
girls  of  that  country.     In  a  period  of  two  years  fifty  were 


INTERNATIONAL  NURSING  EDUCATION      1201 

instnictedj  fortj-one  received  certificates,  ^frs.  Basken  also 
translated  sections  of  the  textbook  on  Home  Hygiene  and  Care 
of  the  Sick  into  Spanish. 

Another  island  possession,  Porto  Ilico,  asked  in  the  early 
months  of  1J)21  for  a  public  health  nurse.  Here  there  was  a 
well  organized  Chapter  which  had  been  exceedingly  active 
during  the  war,  with  J\Ir.  Knowlton  ^lixer  as  executive  secre- 
tary. Kathleen  D'Olier,  whose  fine  work  in  developing  the 
child  welfare  work  in  Greece  has  already  been  described  and 
who  had  resigned  from  that  field  in  December,  1020,  was 
secured.  She  sailed  April  23,  1021,  and  in  her  first  report 
wrote ; 

The  Xursing  Center  of  the  Porto  Eico  Chapter,  American 
Bed  Cross,  opened  its  otlice  ]\[ay  '31.  The  staff  consisted  of 
the  supervising  nurse  [Miss  D'Olier],  two  staff  nurses  and 
two  part  time  doctors.  .  .  .  The  aim  of  our  work  is  the  reduc- 
tion of  the  infant  death  rate.  .  .  .  The  death  rate  among 
infants  under  one  year  in  Porto  Rico  is  146  per  1000  births. 
.  .  .  The  need  for  the  pre-natal  clinic  is  demonstrated  by  the 
death  of  a  large  num])cr  of  children  before  reaching  the  age 
of  one  month,  or  even  one  week.  .  .  .  While  we  are  chiefly 
interested  in  the  mother  and  baby,  once  we  enter  a  home  we 
make  the  family  the  unit  of  our  work. 

Miss  D'Olier  found  a  virgin  field  with  but  few  nurses, 
graduates  from  the  local  schools,  that  might  be  secured  to 
assist  her.  The  standards  of  nursing  were  low.  While  a 
registration  law  existed,  its  provisions  were  not  maintained  or 
enforced.  !Miss  D'Olier  urged  Red  Cross  participation  in  the 
organization  of  a  school  of  nursing  at  San  Juan  similar  to 
those  sponsored  by  the  Red  Cross  in  Europe.  A  plan  and 
recommendations  were  prepared  and  presented,  but  these  were, 
at  the  time  of  writing,  still  awaiting  confirnuitorv  assurances 
from  the  local  authorities  upon  certain  points  regarded  as 
essential  to  a  cor)})erative  enterprise.  After  a  year's  service, 
]\Iiss  D'Olier  returned  to  the  United  States  for  conference  and 
a  vacation.  The  climatic  conditions  and  tlic  (lifficulti(^s  iiuM- 
dent  to  a  field  where  8000  active  cases  of  tuberculosis  alone 
needed  attention,  the  charg(>  of  a  sanatorium  acconnnodating 
87,  with  a  waiting  list  of  400,  made  a  change  and  rest  advis- 
able.    After  a  month  in  this  counti-v  she  return(^(l  to  San  Juan. 

Two  Porto  Rican  nurses,  graduates  of  St.   Luke's  Memorial 


1202  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Hospital  School  at  Ponce,  were  brought  to  the  United  States 
on  Red  Cross  scholarships.  They  returned  in  June,  1922, 
and  were  assigned  to  duty  as  assistants  to  Miss  D'Olier.  This 
increase  of  staff  relieved  in  a  measure  the  strain.  Miss  D'Olier 
and  her  staff  helped  to  develop  clinics  of  various  types,  home 
visiting  and  courses  of  instruction,  three  phases  of  the  Red 
Cross  program  which  will  unquestionably  help  to  develop  a 
higher  sense  of  community  responsibility  and  a  better  under- 
standing of  good  health  requirements. 

Located  some  forty  miles  east  of  Porto  Rico  were  the  Virgin 
Islands,  which  the  United  States  had  purchased  from  Den- 
mark on  ]\Iarch  31,  1917,  with  a  United  States  Treasury  war- 
rant for  $25,000,000.^-  This  transaction  closed  a  question 
which  had  been  an  open  one  for  fifty  years.  Wireless  messages 
were  sent  on  that  day  to  the  Danish  and  American  authorities 
to  lower  the  Danish  flags  and  raise  the  Stars  and  Stripes.  A 
representative  of  the  !Na\'y  Department  was  assigned  by  Secre- 
tary Daniels  to  assume  governmental  responsibilities  until  the 
permanent  government  had  been  determined  upon  by  Cruze. 
The  total  area  of  the  islands  amounted  to  one  hundred  and 
thirty-eight  square  miles  and  the  total  population,  according 
to  a  census  taken  in  1911,  was  27,086  persons,  of  whom  a  large 
number  were  negroes.  The  chief  islands  of  the  group  were  St. 
Thomas,  St.  Croix  and  St.  John. 

Less  than  a  month  after  Secretary  Lansing  had  consummated 
the  purchase  of  the  Virgin  Islands,  the  United  States  declared 
war  upon  Germany.  Through  its  Insular  and  Foreign  Divi- 
sion, the  American  Red  Cross  subsequently  organized  Chapters 
for  war  work  in  the  newly-acquired  territory.  When  Mr. 
Frederick  A.  ^loran,  a  field  representative  of  the  Insular  and 
Foreign  Division,  made  a  visit  in  June,  1920,  to  the  Virgin 
Islands,  he  found  that  the  Chapters  at  St.  Thomas  and  St. 
Croix  were  still  active  and  were  interested  in  the  peace  pro- 
gram of  the  Red  Cross.  Ilis  first  report  to  ]^ational  Head- 
quarters urged  the  assignment  of  two  nurses,  one  to  St.  Thomas 
and  St.  Jolm,  the  other  to  St.  Croix. 

When  the  sanitary  officers  of  the  United  States  Navy  had 
first  come  to  the  Virgin  Islands,  they  luul  authorized  the  estab- 
lishment of  schools  of  nursing.  The  work  incident  thereto 
had   not,   however,   progressed   very   far   and   but   two   native 

""The  European  War,"  New  York  Times  Current  History,  Vol.  XI,  Ifll". 


INTERNATIONAL  NURSING  EDUCATION       1203 

nurses  had  boon  graduated.  With  the  support  of  the  other 
physicians,  Dr.  ^link,  Chief  Medical  Aid,  Navy  Department, 
urged  the  assigiinuMit  of  American  Rod  Cross  public  health 
nurses  to  inaugurate  health  work  in  the  public  schools.  Thus 
the  services  of  the  two  nurses  requested  by  Mr.  Moran  were  to 
be  utilized  in  school  nursing,  which  was  to  serve  as  an  entering 
wedge  until  the  training  school  project  could  be  taken  up 
again. 

]\Iiss  Butler  secured  Florence  C.  Freeman  and  Ruth  C. 
Watorbury  to  develop  the  nursing  program  in  the  Virgin 
Islands.  ^liss  Watorbury  was  a  graduate  of  the  Hopkins 
School  and  was  a  highly  qualified  public  health  nurse.  She 
was,  moreover,  familiar  with  the  American  Red  Cross  Nursing 
Service,  because  she  had  served  as  a  nurse  member  of  the  Com- 
mission for  Poland. 

The  two  nurses  arrived  at  St.  Thomas  on  November  4,  1920. 
IVIiss  Waterbury  had  been  instructed  to  act  as  supervisor  of 
all  the  nursing  work  in  the  islands,  so  she  set  up  headquarters 
at  St.  Thomas.  ]\riss  Freeman  proceeded  to  St.  Croix.  Both 
nurses  began  immediately  the  development  of  the  school  nursing 
program. 

Their  work  met  with  appreciation  and  success.  The  *S'/. 
Thomas  Mail  Notes  for  June  5,  1921,  contained  the  following 
statements  • 

I  would  further  call  your  attention  to  the  splendid  work 
in  the  line  of  school  nursing  aeeoniplished  in  the  past  year. 
Of  the  199"2  children  enrolled  in  all  the  schools,  public,  pri- 
vate and  parochial,  1701  have  been  carefully  examined  and 
in  the  cases  found  defective  appropriate  action  was  taken  to 
correct  such  defects. 

For  til  is  noble  work  we  are  indebted  to  the  Red  Cross  and 
most  especially  to  ^liss  Waterbury  of  that  service,  backed 
most  cordially  l)y  the  Government  and  medical  officers  and  all 
school  officials. 

Inevitably  there  were  many  discouragements. encountered  in 
a  new  venture  of  tliis  type  in  a  recently  acquired  possession 
where  many  of  the  ''left-over"  officials  from  the  previous 
regime  wore  certainly  not  enthusiastic,  if  not  openly  hostile 
to  now  methods  and  the  introduction  of  new  systems.  Hap- 
hazard,    easv-going    administrations    do    not    constitute    the 


1204  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

happiest  foundation  npon  which  to  build  a  more  rigid,  thorough 
and  progressive  system. 

In  the  late  summer  of  1921  Miss  Waterbury  began  to  feel 
the  strain  and  went  back  to  the  United  States  for  a  rest  and 
conference  with  National  Headquarters.  Miss  Freeman  had 
resigned  the  previous  May.  Miss  Waterbury  returned  to  St. 
Thomas  on  September  15  and  took  with  her  an  assistant  nurse, 
Elizabeth  S.  Robinson,  who  was  assigned  to  school  nursing  at 
St.  Croix  and  Frederiksted.  The  work  at  Frederiksted  de- 
veloped so  rapidly  that  another  American  lied  Cross  nurse, 
Alice  F.  Stenholm,  was  assigned  on  January  4,  1022,  solely 
for  duty  there.  As  the  months  passed  health  centers  were 
established  both  at  Frederiksted  and  Christiansted  in  addition 
to  school  nursing.  Classes  were  held  and  native  nurse  assistants 
were  secured  and  trained.  That  the  work  had  local  govern- 
mental support  is  shown  by  the  special  order  issued  by  the 
governor,  which,  under  date  of  September  25,  1921,  supported 
the  public  health  nursing  program,  announced  the  appoint- 
ment of  Miss  Waterbury  as  the  supervising  lied  Cross  school 
nurse  of  all  school  nursing  in  the  islands  and  indicated  the 
centers  of  development  as  St.  Thomas,  Christiansted  and  St. 
Croix.  Some  months  later  Miss  Waterbury  was  asked  to  serve, 
in  addition  to  her  work  as  supervisory  nurse,  as  the  general 
field  representative  of  the  American  Rod  Cross  in  the  Virgin 
Islands,  an  arduous  program  for  one  person  to  carry,  but  one 
for  which  her  training  and  enthusiasm  made  her  well  fitted. 
From  time  to  time  the  nurses  of  her  staif  returned  to  the 
United  States,  for  any  nursing  service  in  the  tropics  is  a  severe 
one,  and  new  nurses  were  sent  to  fill  their  places. 

From  the  date  of  IMiss  Waterbury's  return  to  the  Virgin 
Islands  in  September,  1921,  the  nursing  activities  there  de- 
veloped steadily  and  by  June  of  the  year  1922  the  improved 
condition  of  the  school  children  well  rewarded  the  nurses  for 
their  hard  work. 

Th(^  two  groups  of  islands  in  the  Pacific  Ocean  in  which  the 
American  Red  Cross  developed  various  nursing  activities  were 
the  Hawaiian  and  Philippine  Islands. 

In  Hawaii  a  local  Committee  on  Red  Cross  Xursing  Service 
had  been  organ izcnl  prior  to  the  war  and  an  active  Red  Cross 
Chapter  had  tilso  rendered  conspicuous  service  during  the 
period  of  hostilities.  When  the  post-war  program  in  public 
health  nursing  was  announced  the  Ililo  Pranch  of  the  Hawaii 


INTERNATIONAL  NURSING  EDUCATION       1205 

Chapter  voted  to  support  it  and  secured  a  California  public 
health  nurse,  (Catherine  S.  Eastin,  to  develop  a  community 
nursing  service.  Miss  Bastin  had  seen  service  overseas  at 
Dr.  Blake's  hospital  in  Paris  and  later  in  the  Army  Nurse 
Corps  in  France. 

In  a  letter  written  December  20,  1921,  Miss  Bastin  gave  an 
interesting  account  of  her  work : 

The  work  here  is  of  a  peculiar  nature.  Think  of  twelve 
nationalities  and  add  to  them  all  the  possible  mixtures,  and 
what  a  motley  crowd  it  becomes!  Japanese  are  the  predomi' 
nating  j)eople.  They  are  an  industrious,  quiet,  law-abiding 
race.  Tbey  have  their  own  customs  of  long  standing  and, 
although  very  polite  to  the  white  nurse,  they  seldom  let  me 
do  anything.  I  am  always  ushered  in  and  made  welcome, 
but  when  I  suggest  a  batli  or  some  other  treatment  for  the 
patient,  they  only  smile  and  bow  and  say,  "I  too  much  thank 
you"  but  I  am  not  allowed  to  give  the  bath.  The  Chinese 
and  Koreans  I  find  most  amenable.  The  Portuguese  are  dirty 
and  indilTerent,  as  a  rule.  The  Hawaiians  do  not  like  to  put 
forth  an  effort.  They  have  lived  very  contentedly  with  their 
fishing,  sweet  potato  and  tarrow  patches,  and  a  few  fruit  trees. 
Life  has  always  been  very  simple  to  them,  so  why  make  it 
complicated  by  a  lot  of  "newfangled"  ideas  about  food, 
clothes,  and  sanitation? 

j\Iuch  of  my  work  has  been  in  the  schools  as  there  is  no 
school  nurse  and  that  is  where  the  greatest  need  lies.  .  .  . 
The  infant  death  rate  is  very  high  in  these  islands,  and  so  I 
have  started  a  well  baby  conference,  which  I  hope  in  time 
w^ill  help  to  reduce  it. 

This  is  too  large  a  field  for  one  nurse,  but  I  can  see  no 
immediate  prospect  for  another  one  coming.  ,  .  . 

In  a  communication  a  few  days  later,  IMiss  Bastin  wrote 
that  she  cx])octcd  to  start  within  a  month  two  classes  in  Home 
Hygiene  and  Care  of  the  Sick.  One  course  was  to  be  given 
to  Hawaiian  women  and  the  other,  a  modified  course,  was  to 
be  conducted  in  the  high  school. 

Aliss  Bastin  was  also  much  interested  in  the  student  nurse 
recruiting  movement  and  distributed  the  recruiting  literature 
and  posters  throughout  her  territory.  By  ^lay.  1!)22,  she 
had  devclo])('d  a  well  organized  and  varied  program  of  com- 
munity service. 

In  tiu^  Philij)])ine  Islands  prior  to  the  Eur()]~»oan  War,  the 
American  Bed  Cross   Xursinii'  Service  had  oi-iiani/cd   a   Local 


1206  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Committee  for  enrollment.  The  large  numbers  of  American 
nurses  then  resident  on  the  islands  and  the  several  schools  for 
training  native  nurses,  which  had  as  their  superintendents 
well-trained  American  nurses,  constituted  a  supply  from  which 
the  Nursing  Service  hoped  to  draw  members.  An  active 
Chapter  has  also  been  organized  and  previous  to  1917  had 
rendered  good  service  in  the  field  of  disaster  relief.  During 
the  European  War  both  the  Local  Committee  on  Red  Cross 
Xursing  Service  and  the  Chapter  were  active  participants  in 
the  various  types  of  nursing  activities  and  chapter  production 
and  when  the  post-war  program  was  launched  the  Chapter 
took  up  the  development  of  public  health  nursing  and  of  class 
instruction  to  women  in  Home  Hygiene  and  Care  of  the  Sick. 

In  December,  1920,  Emmet  W.  White,  who  as  manager  of 
the  Insular  and  Foreign  Division,  was  then  on  a  tour  of  in- 
spection in  the  Philippines,  cabled  National  Headquarters, 
requesting  the  appointment  of  a  Director  of  Nursing  for  the 
Philippine  Chapter.  This  cable  was  followed  by  others  from 
him  which  suggested  various  individuals,  some  of  whom  were 
not  nurses,  others  not  enrolled  nurses.  Before  Miss  Butler 
and  Miss  Noyes  had  succeeded  in  securing  a  suitable  appointee, 
Mr.  White  on  February  28,  1921,  cabled  that  he  had  selected 
a  director.  It  was  found  that  she  had  been  in  the  Philippines 
•many  years,  but  was  not  enrolled  in  the  Red  Cross  Nursing 
Service ;  neither  did  she  meet  all  the  present  requirements, 
and  furthermore  she  was  without  public  health  experience  or 
training.  Her  preliminary  training,  received  many  years  ago, 
was  good,  her  knowledge  of  the  Philippines  and  the  people 
was  a  decided  asset  and  her  spirit  and  interest  were  unusual. 
On  the  other  hand,  she  lacked  a  background  of  Red  Cross 
nursing  experience  and  knowledge  of  Red  Cross  organization. 

The  issue  at  hand  between  Mr.  White  and  the  Philippine 
Chapter  and  Miss  Butler  and  the  Nursing  Service  at  National 
Headquarters  then  became  the  old  issue  of  "maintaining 
standards."  Possession  in  1922  of  the  coveted  badge  and 
appointment  card  of  the  American  Red  Cross  Nursing  Service 
was  a  definite  guarantee  to  whomsoever  it  might  concern  that 
tlio  owner  thereof  had  successfully  met  requirements  of  train- 
ing, experience  and  character  which  placed  her  among  the 
representative  women  of  her  profession.  In  justice  to  the 
many  nurses  whose  applications  for  enrollment  had  been  re- 
jected,  the  Nursing  Service  could  not,  on  the  whim  of  im- 


INTERNATIONAL  NURSING  EDUCATION       1207 

pctuoiis  Chapter  and  Division  officials,  set  aside  these  definite 
requirements  and  enroll  any  nurse  the  latter  might  choose  to 
select.  An  ironclad  regulation  of  the  Nursing  Service,  a  regu- 
lation of  the  greatest  protection  both  to  the  Chapter  and  the 
Nursing  Service  itself,  was  that  every  nurse  engaged  in  Amer- 
ican lied  Cross  nursing  service  should  be  an  enrolled  nurse. 
Thus  the  Local  Committee  at  Manila  could  not  recommend  nor 
could  the  National  Committee  at  National  Headquarters  ratify 
the  enrollment  of  Mr.  White's  appointee  as  Director  of  Nursing 
of  the  ^fanila  Chapter  and  the  nurse  herself  was  faced  with 
the  embarrassing  task  of  trying  to  develop  a  nursing  service 
without  the  aid  or  supervision  of  National  Headquarters. 

The  situation  which  resulted  was  chaotic.  Graduates  of 
schools  of  nursing  in  the  Philippines  which  did  not  meet  the 
requirements  for  enrollment  were  employed  by  the  Chapter 
and  called  American  Red  Cross  nurses.  Courses  of  instruction 
for  Red  Cross  aides  were  given  which  were  not  authorized 
Red  Cross  courses.  These  irregularities  were  not  only  con- 
trary to  all  instructions,  but  in  some  instances  constituted  an 
actual  infringement  of  the  law  established  to  safeguard  the 
use  of  the  Red  Cross  emblem. 

The  nursing  situation  in  the  Manila  Chapter  was,  indeed, 
little  more  than  the  old  struggle  which  had  seemingly  to  be 
fought  over  and  over  again  between  the  leaders  of  the  Nursing 
Service  at  National  Headquarters  and  each  new  commissioner 
or  Chapter  official  in  the  field,  struggles  as  wearisome  to  Miss 
Delano  and  ]\riss  Noyes  as  the  repeated  accounts  of  them  must 
be  to  readers  of  this  history.  Commissioners  and  officials  of 
remote  chapters,  who  had  been  in  Red  Cross  service  compara- 
tively overnight  and  who  did  not  choose  to  acquaint  them- 
selves with  the  long-established  methods  of  organization  and 
procedure  which  had  prevailed  for  many  years  at  National 
Headquarters,  took  up  their  duties  with  understandable  en- 
thusiasm and  as  a  first  gesture  of  their  new  authority  reorgan- 
ized or  initiated  anew  nursing  activities  in  line  witli  their 
own  and  local  ideas ;  as  a  result  they  set  awry  the  well-oiled 
machinery  of  a  long-established  professional  service.  Because 
nurses  wore  wcmien.  each  new  commissioner  or  official  seemed 
to  think  that  he  could  do  with  them  anything  he  wished.  It  is 
seriously  to  be  questioned  if  the  medical  phases  of  American 
Red  Cross  service,  a  fair  professional  comparison,  were  so 
dragged  about  by  the  ears  as  was  the  Nursing  Service.     The 


1208  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

executives  of  the  ^Nursing  Service  at  National  Headquarters 
were  answerable  to  the  American  Nurses'  Association,  which 
had  accepted  affiliation  with  the  American  Red  Cross  on  cer- 
tain definitely  defined  "professional  prerogatives,"  and  Miss 
Delano  and  Miss  Noyes  strove  to  defend  these  prerogatives  at 
cost  of  much  labor  and  weariness  of  spirit.  Certes,  they  grew 
as  tired  of  "fighting  for  standards"  as  their  opponents  must 
have  grown  of  having  them  fight !  The  most  discouraging 
aspect  of  the  whole  situation  was  that  it  seemed  as  if  every 
step  of  the  struggle  for  professional  status  had,  like  the  em- 
bryonic steps  in  the  evolution  of  the  race,  to  be  lived  through 
before  a  new  nursing  service  could  be  brought  into  being. 

To  return  to  the  Manila  Chapter:  As  the  irregularities 
increased,  it  finally  became  evident  even  to  Chapter  officials 
that  the  services  of  a  well  qualified  and  enrolled  nurse  should 
be  sent  to  supervise  their  nursing  activities  with  as  little  delay 
as  possible.  Accordingly,  Virginia  Mason  Gibbes,  a  graduate 
of  the  Roper  Hospital  School  of  Nursing,  Charleston,  South 
Carolina,  sailed  on  March  26,  1922,  to  assume  the  responsi- 
bilities of  Director  of  Nursing  for  the  Manila  Chapter.  As 
a  member  of  an  enrollment  committee,  as  an  instructor  in 
Home  Hygiene  and  Care  of  the  Sick,  as  a  Town  and  Country 
public  health  nurse  and  as  a  member  of  the  Southern  Division 
nursing  staff,  ]\Iiss  Gibbes  had  gained  a  rich  and  varied  back- 
ground of  Red  Cross  nursing  experience.  The  affairs  of  the 
Chapter  were  also  put  into  more  satisfactory  alignment  with 
the  organization  at  National  Headquarters  by  the  appointment 
of  Mr.  Knowlton  Mixer  some  months  previously  as  manager 
of  the  ]\ranila  Chapter.  Like  Miss  Gibbes,  he  was  experienced 
in  Red  Cross  organization  and  policies,  and  together  they  began 
to  study  the  situation  and  bring  the  Red  Cross  activities  into 
line.  Miss  Gibbes  began  a  study  of  local  affairs,  nursing 
schools,  resources  and  organization  as  a  necessary  basis  for 
all  Cliapter  nursing  activities. 

One  of  the  outstanding  difficulties  in  the  Philippines  was 
that  the  Chapter,  by  utilizing  the  services  of  poorly  trained 
nurses'  aides,  was  depriving  the  professionally  trained  nurses 
on  the  islands  of  employment.  ]\riss  Gibbes  soon  reported 
an  apparent  over-supply  of  graduate  nurses.     She  wrote:     "Of 

one  hundred  and  two  recent  graduates  of  the    

School,  twenty  have  no  prospect  of  immediate  employment.  As 
far  as  I  can  learn,  there  is  no  registry  for  nurses."     This  lack 


INTERNATIONAL  NURSING  EDUCATION       1209 

of  employment  was  one  of  the  chief  in]iil)itions  to  tlie  develop- 
ment of  professional  nursing  in  the  Philippines,  and  profes- 
sional nursing  service  was  one  of  the  vital  needs  there.  Miss 
Gibbes  immediately  "advised  the  development  of  nurses  and 
not  nurses'  aides,"  as  stated  in  the  ^finutes  of  a  meeting  held 
^fay  12,  1022,  of  the  Executive  Committee  of  the  Manila 
Chapter.  In  a  letter  addressed  on  June  8  to  Miss  Noyes  at 
National  Headquarters,  Mr.  Mixer  announced  an  important 
change  of  policy : 

.  .  .  The  Chapter  has  abandoned  its  plan  of  training  Red 
Cross  aides.  .  .  .  We  are  using  only  graduate  nurses.  ...  I 
believe  our  present  program  is  quite  in  line  with  your  ideas 
and  I  am  fully  convinced  that  we  will  obtain  better  results 
and  cover  a  wider  field  of  usefulness. 

It  is  true  that  a  few  aides  were  still  used  in  the  provinces, 
but  their  activities  were  to  be  supervised  by  graduate  nurses. 
In  connection  with  the  development  of  public  health  nursing  in 
the  Philippines,  several  native  nurses  came  to  the  United  States 
in  1921  and  1922  for  post-graduate  courses  in  public  health 
nursing.  Two  of  them  were  given  Red  Cross  scholarships 
and  entered  the  courses  at  the  University  of  California  in  San 
Francisco.  Two  entered  Teachers'  College  and  were  prepared 
to  return  to  ^lanila  to  engage  in  Red  Cross  work. 

While  Miss  Gibbes  and  ^fr.  ]\rixer  were  laboring  to  bring 
al)out  these  changes,  an  appointment  of  international  interest 
to  nurses  had  been  made  in  the  Philippines.  It  will  be  re- 
membered that  late  in  1921  Miss  Fitzgerald  had  resigned  as 
Director  of  Nursing  of  the  League  of  Red  Cross  Societies.  In 
^larch,  1922,  she  was  appointed  through  the  Rockefeller  Foun- 
dation to  membership  on  the  staff  of  General  Leonard  Wood, 
then  governor  general  of  the  Philippine  Islands,  for  the  pur- 
pose of  making  a  study  of  nursing  resources,  schools  of  nursing 
and  public  health  nursing  in  the  Philippines  and  also  to  act 
as  geiun-al  adviser  to  General  Wood  on  all  nursing  questions. 
That  a  nurse  should  have  been  appointed  as  an  adviser  on 
nursing  affairs  to  the  governor  of  a  state  or  province  was  a 
progressive  step  forward  in  the  cause  of  professional  nursing 
and  one  which  may  be  regarded  as  a  good  oiufMi.  indeed,  in  the 
development  of  sound  nurse  education  and  the  betterment  of 
nursing  care  of  the  sick. 


1210  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

With  the  close  of  the  emergency  relief  and  child  health 
programs,  the  American  Red  Cross  Nursing  Service,  as  it  has 
been  said  before,  withdrew  its  nurses  from  the  foreign  field 
and  left,  with  the  exceptions  already  mentioned,  only  the 
nurses  who  were  conducting  schools  of  nursing  in  Europe  and 
the  Island  Possessions  of  the  United  States.  During  the  four 
transitional  years  in  which  this  close  of  foreign  activities  and 
withdrawal  of  personnel  had  taken  place,  contraction  of  the 
organization  created  to  meet  the  military  needs  had  taken  place 
in  the  United  States.  The  number  of  Red  Cross  Divisions 
had  been  reduced  from  fourteen  to  five.  This  contraction  was 
one  of  administrative  machinery  alone  and  was  not,  in  any 
sense,  a  lessening  of  American  Red  Cross  nursing  activities  in 
the  United  States,  for  the  "peace-time"  nursing  program  of 
public  health  nursing  and  class  instruction  to  women  was  being 
developed  to  unprecedented  proportions,  as  may  be  seen  in 
subsequent  chapters. 

Death  alone  had  broken  the  ranks.  Jane  Delano  and  Henry 
P.  Davison,  outstanding  war  leaders,  had  died  during  this 
period,  both  of  them  from  practically  the  same  malady  and 
both  of  them  in  their  prime.  Ida  M.  Tice,  a  charter  member 
of  the  National  Committee  on  Red  Cross  Nursing  Service,  and 
Sophie  F.  Palmer,  a  woman  whose  keen  mind  had  piloted  the 
nursing  profession  through  the  stormy  waters  of  registration, 
one  of  the  first  nurses  to  sponsor  affiliation  with  the  American 
Red  Cross  and  the  first  advocate,  and  for  fifteen  years  the 
guiding  spirit  of  the'  Journal,  had  died  and  from  among  the 
rank  and  file,  as  a  direct  result  of  service  in  the  European 
War,  two  hundred  and  eighty  American  Red  Cross  nurses. 

But  the  vanguard  of  the  Nursing  Service  remained  and  was 
on  July  1,  1922,  serenely  and  powerfully  moving  on  to  the  ful- 
fillment of  its  destiny,  with  an  enrollment  of  thirty-nine 
thousand  nurses  and  a  National,  State  and  Local  Committee 
system  of  over  fifteen  hundred  nurse  volunteers.  "It  seems," 
wrote  one  of  these  forty  thousand  nurses  pledged  to  respond 
upon  call  for  altruistic  service,  "that  when  we  have  once  heard 
and  answered  the  call  of  the  Red  Cross,  we  ever  wait  and  listen, 
readv  to  come  when  needed." 


CHAPTER  XIV 

FKOM  RURAL  NURSING  TO  THE  PUBLIC  HEALTH  NURSING  SERVICE 

Outline  of  Early  Growth — Requirements  for  Applicants — 
Affiliation  Principles  Adopted — Growth  of  Central  and 
Branch  Units — Early  Affiliations — The  Interruption  of 
Wa  r — Scholarships. 

RURAL  nursing,  so  called,  or  the  extension  of  the  visit- 
ing nurse's  service  to  the  people  of  isolated  districts, 
has  long  been  carried  on  in  many  countries— in  Great 
Britain  and  Ireland  bv  the  staff  of  the  Queen  Victoria  Jubilee 
Institute ;  in  Norway  and  Sweden  by  Red  Cross  nurses ;  in 
Australia  ("bush  nursing")  by  a  nationally  organized  associa- 
tion ;  in  Canada  by  the  nurses  of  the  Victorian  Order,  and  to 
some  extent  by  various  groups  in  other  foreign  lands.  In  this 
country  a  pioneer  rural  nursing  association  was  founded  in 
180G  by  Ellen  ]\[.  Wood,  a  Johns  Hopkins  nurse,  in  Westchester 
County,  Xew  York,  where  she  volunteered  nursing  aid  to  the 
country  people  in  her  home  community.  Successful  from  the 
beginning,  it  grew  until  (by  1920)  it  had  extended  over  some 
twenty  villages.  Miss  Wood  died  abroad  (1900)  of  typhoid 
fever,  contracted  on  board  ship  while  nursing  a  sailor  smitten 
with  the  disease.  After  her  death  her  name  was  given  to  the 
association. 

Another  pioneer  was  Lydia  Holman,  a  Philadelphia  nurse, 
who,  having  visited  the  Kentucky  mountains,  made  her  home 
there  for  some  years  and  carried  on  an  individual  service  to 
the  Southern  Highlanders,  living  in  a  little  cabin  and  l)eing 
supported  mainly  by  the  voluntary  gifts  of  food  materials 
brought  by  her  patients.  She  was  later  able  to  develop  the 
Lydia  ^l.  Holman  Association  (1911),  her  chief  assistants 
being  medical  members  of  the  Johns  Hopkins  L^niversity  and 
Medical  School.  This  association  was,  however,  not  pen-manent 
and  had  been  dissolved  before  Red  Cross  plans  for  Rural 
Xursing  had  been  made  public.^ 
-Reports  of  tlio  Holman  Association. 

1211 


1212  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

In  1905,  when  the  Peace  Conference  following  the  Russo- 
Japanese  War  was  held  in  Portsmouth,  New  Hampshire,  the 
envoys  of  those  countries  made  a  gift  of  $20,000  to  the  State 
to  be  used  for  charitable  purposes.  Several  persons  then  tried 
to  have  this  gift  used  in  establishing  a  State-wide  system  of 
rural  nursing,  but  their  efforts  failed.^ 

The  service  carried  on  under  the  American  Red  Cross,  first 
called  The  Rural  Nursing  Service,  afterwards  renamed  "Town 
and  Country  Nursing  Service,"  and  still  later  the  "Bureau  of 
Public  Health  Nursing,"  had  its  inception  in  the  mind  of  a 
woman  especially  distinguished  for  a  combination  of  nursing 
talents  with  social  gifts  and  creative  energy.  This  was  Lillian 
D.  Wald,  founder  and  leader  of  the  well-known  Henry  Street 
Settlement  in  New  York  City,  first  called  the  Nurses'  Settle- 
ment. A  New  York  State  woman,  graduated  from  the  New 
York  Hospital  Training  School  under  Irene  Sutliffe,  Miss 
Wald's  venture  into  a  mode  of  life  which  combined  visiting 
nursing  with  all  the  other  interests  of  an  ardent  lover  of 
humankind  and  a  progressive  citizen,  has  been  made  widely 
familiar  through  her  book,  "The  House  on  Henry  Street."  In 
her  long  and  remarkable  service  she  has  done  more,  perhaps, 
than  any  other  one  American  woman  to  change  the  conven- 
tional form  of  visiting  nursing  into  those  varied  civic  and 
community  efforts  which  she  was  the  first  to  call  "Public 
Health  Nursing,"  thus  enlarging  Miss  Nightingale's  phrase 
"Health  Nursing." 

Miss  Wald  has  already  been  mentioned  as  one  of  the  Red 
Cross  members  in  New  York  State  before  the  reorganization 
of  1904-11)05.  It  has  heen  shown  that  she  gave  assistance  to 
the  New  York  Auxiliary  during  the  Spanish-American  War, 
and  afterwards  remained  faithful  to  the  work  of  enrollment, 
yet  she  felt,  and  expressed,  strong  dissatisfaction  at  seeing  so 
popular  and  potent  an  organization  as  the  Red  Cross  limited 
to  the  uncertain  and  irregular  service  of  relief  in  war  or 
calamity.  She  reflected  that  both  must  in  their  nature  be 
sporadic,  and  that  if,  in  time  of  peace,  there  were  no  absorb- 
ing interests  to  hold  the  enthusiasm  of  members,  they  would 
fall  away,  and  each  emergency  would  need  fresh  reorganiza- 
tion. ^Moreover,  it  seemed  to  her  wasteful  to  have  a  national, 
well-organized    society    periodically    inactive.       For(!ign    Red 

^"Flistory  of  Rural  Nursing":   Fannie  F.  Clement,  American  Journal  of 
Cursing,  April,   1913". 


Gray  dross,  cnpv  and  s(ra\v  hai    wdrii  li>-  AmcricaTi  lu'd   Crdss  nurses.     This 
unifdnn   is  also  worn   hy  Aiiicrican   lu-d  Cross  pulilic   licallh  nurses. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1213 

Cross  societies  had  to  train  and  maintain  their  own  nurses  in 
time  of  peace,  but  in  this  country  it  was  different.  She  con- 
ceived the  idea  that  the  Red  Cross  wouhl  be  the  logical  associa- 
tion to  promote  visiting  nursing  in  rural  districts  and  small 
scattered  towns  on  a  national  scale,  and  early  in  1908  she  had 
an  opportunity  to  bring  her  idea  forward.  There  was  in  that 
year  a  meeting  at  Mayor  George  McClellan's  house  in  New 
York  City  to  promote  tuberculosis  camp  work,  which,  follow- 
ing the  International  Red  Cross  resolution  at  the  Convention 
held  in  England  in  1907,  was  being  taken  up  by  the  Red  Cross 
societies  of  the  different  countries  and  states.  Miss  Wald  spoke 
at  that  meeting  and  though  she  kept  no  copy  of  what  she  said, 
her  plea  was  along  the  lines  here  indicated.  It  linked  well 
with  the  anti-tuberculosis  campaign  in  which  the  Red  Cross 
societies  were  then  ready  to  take  a  part,  and  though  no  immedi- 
ate result  followed  from  her  address  that  day,  she,  herself, 
waited  only  for  another  opportunity  to  press  her  point.  An 
influential  and  generous  member  of  the  Board  of  Incorpo- 
rators of  the  American  Red  Cross  was  Jacob  H.  Schiff,  one  of 
Miss  Wald's  family's  friends,  and  through  him  the  following 
letter  from  her  reached  the  annual  Red  Cross  meeting  in  Wash- 
ington in  December,  1910: 

My  dear  Mr.  Sciiiff  : 

...  It  seems  to  mo  particularly  appropriate  for  the  Red 
Cross  society  to  undertake  ultimately  in  America,  an  exten- 
sive and  systematically  organized  service  of  nursing  for  the 
scattered  dwellers  in  rural  regions,  such  as  we  now  find  well 
developed  in  Great  Britain  and  in  Canada.  In  the  older 
countries  armies  of  trained  nurses  arc  sent  into  remote  coun- 
try regions  to  nurse,  to  educate,  to  bring  scientific,  advanced 
humanitarian  and  sanitary  messages  to  the  public.  In 
America  in  a  few  sporadic  instances  only,  are  nursing  care 
and  protection  against  infection  possible  to  the  sick  country 
person.  After  developing  the  day  camp,  why  should  not  the 
liod  Cross  society  undertake  the  organization  of  a  vast,  far- 
reaching  sclieme  of  country  nursing,  getting  such  support  and 
cooperation  as  may  be  possible  from  the  dwellers  in  mountain, 
farming  or  lonely  desert  regions,  coordinating  and  guiding  all, 
and  bringing  tlie  help  of  the  nurse  to  scattered,  isolated 
families.  .  .  . 

There  could  be  no  larger  or  nobler  work  ])ossible  to  the  Eed 
Cross  soci(>ty  of  a  country  deilicatiMl  to  peace,  nor  could  there 
be  a  more  [)ractical  way  of  enrolling  under  the  IJeil  Cross  a 


1214  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

band  of  faithful  and  devoted  workers  held  together  between 
disasters  for  a  universal  need,  an  army  ready  to  be  enlisted 
for  an  extraordinary  disaster.  I  very  ardently  hope  that  the 
National  Ked  Cross  society  will  take  up  in  serious  manner 
the  organization  of  a  rural  nursing  system,  that  it  be  national 
in  its  scope.  ... 

I  believe  that  it  would  not  be  difficult  to  administer  a 
service  of  this  kind  even  on  so  large  a  scale.  Headquarters 
might  well  be  maintained  in  Washington  and  a  traveling 
supervisor,  a  trained  nurse  [be  employed], 

In  addition  to  this  traveling  supervisor,  there  should  be 
local  supervisors  and  possibly  county  local  chapters  to  supple- 
ment and  keep  in  touch  with  the  nurse  or  nurses.  Support 
of  the  nursing  organizations  should  come  from  the  central 
organizations  but  money  would  be  obtained  from  the  bodies  to 
be  sent  into  the  general  treasury.  .  .  . 

[There  should  be]  affiliation  .  .  .  perhaps  federation  with 
all  existing  societies.  This  I  think  would  not  be  difficult  to 
accomplish  as  the  country  nursing  associations  now  in  exist- 
ence feel  isolated  and  need  the  fellowship  of  similar  bodies. 

At  first  it  would  seem  a  most  difficult  matter  to  obtain 
suitable  women  for  this  work.  I  believe  this  is  not  insur- 
mountable. The  very  existence  of  the  association  on  so  great 
a  scale  would  stimulate  the  nurses  in  the  training  school.  .  .  . 
It  would  probably  develop  that  scholarships  could  be  given 
to  send  specially  fitted  young  women  to  the  post-graduate 
course  at  Teachers  (^ollege.^  This  course  was  established 
largely  for  the  purpose  of  equipping  women  to  do  work  of  this 
kind.  .  .  . 

In  my  opinion,  it  would  be  much  more  desirable  for  the  Eed 
Cross  society  to  take  up  this  work  than  it  would  be  to  organ- 
ize another  national  society,  for  reasons  that  are  so  obvious. 
I  do  not  think  the  United  States  would  need  much  stimidus, 
for  I  believe  that  the  cause  carries  its  own  appeal. 

(Signed)     Lillian  D.  Wald. 

The  members  present  when  this  letter  was  read  naturally 
could  not  decide  so  large  a  plan  off-hand.  The  majority 
opinion  was  that  enrollment  and  organization  should  be  the 
chief  object  of  concentration  for  some  time  longer,  hut  a  sub- 
committee was  appointed  to  talk  the  matter  ov'cr  with  ^liss 
Wald.      ISTo   records   were  kept   of  its   informal   and   intimate 

'The  post-firadiiate  work  at  Teachers  Colletie  here  mentioned  had  de- 
veloped broa(ily  from  its  first  plan  "Institutional  Manatrenient,"  but  it  had 
not  yet  undertaken  preparation  for  "Rural  Xursing." — ED, 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1215 

conferences,  but  the  results  are  evident  in  later  papers.  At 
the  annual  meeting  in  December  (11)11)  letters  were  read  in- 
dicating that  Mr.  Jacob  Schiff  and  Mrs.  Whitelaw  Ileid  offered 
generous  gifts  to  establish  a  fund  for  a  rural  health  nursing 
service.  Mr.  Schiff  ultimately  promised  that  if  rural  nursing 
was  practicable  he  would  give  the  Red  Cross  an  endowment 
in  securities  amounting  to  $100,000,  the  income  to  be  used 
for  the  service.  Until  permanently  established,  he  would  give 
$5000  yearly.  ^Irs.  Keid  promised  an  annuity  of  $1000  and 
later  increased  this  sum  to  $2000.  At  the  Executive  Com- 
mittee meeting  on  December  14,  Miss  Boardman  proposed  a 
special  committee  with  Miss  Delano  as  chairman  to  make 
a  study  of  the  subject  and  report.  On  February  6,  ^liss  Delano 
made  her  report  and  the  project  for  rural  nursing  was  approved 
in  principle  and  referred  to  the  National  Relief  Board.  A 
trial  year  was  agreed  upon.  On  November  1,  1912,  Miss 
Fannie  F.  Clement  was  appointed  superintendent.  The  year's 
work  was  successful.  At  'its  end  a  meeting  was  held  in  New 
York  at  Mrs.  Whitelaw  Reid's  house,  where  the  continuation 
of  the  Service  was  advised.  The  endowment  was  finally  ac- 
cepted, and  the  Rural  Nursing  Service  renamed  and  made 
permanent.^ 

^[iss  Delano  made  public  mention  of  the  new  field  at  the 
American  Nurses'  Association  meeting  in  Chicago,  June,  1012. 
She  then  said : 

There  is  one  pliai^c  of  the  Red  Cross  work  which  scarcely 
conies  in  here,  but  !  would  ask  especially  to  present  to  you 
the  possibility  or  the  fact  of  our  rural  nursing  service,  which 
is  soon  to  be  organized  and  the  possibility  of  the  need  of  many 
nurses  for  positions  in  this  service.  ^lay  1  urge  upon  those  of 
you  who  may  contemplate  taking  up  this  work  that  at  the 
earliest  moment  you  jilace  yourselves  in  line  for  some  form  of 
exj)erience  in  nursing  of  this  kind.  If  this  movement  is  estab- 
lished, we  sliall  need  hundreds  of  nurses  throughout  the 
country.  I  cannot  impress  upon  you  too  much  the  importance 
of  carrying  this  work  into  the  neglected  communities;  it  is 
work  tliat  I  am  sure  will  be  near  the  liearts  of  all  of  us. 
I'hose  of  you  who  may  consider  taking  this  up.  please  make 
arrangements  as  soon  as  possible  to  communicate  with  tlie 

*  Red  Cross  Report,  191.3.  See  letter  from  the  Secretary  of  War. 
traiismitt iii^r  tliis  Report  to  Congress.  Document  No.  1028,  House  of 
Rejjre^entat  ives. 


1216  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Eed  Cross  and  place  yourselves  in  line  for  experience  and 
instruction.^ 

The  Committee  on  Rural  Nursing  for  the  trial  year,  stood 
thus :  Mabel  T.  Boardman,  chairman ;  Jane  A.  Delano,  vice 
chairman ;  Lillian  D.  Wald,  ]\rrs.  Whitelaw  Reid,  Mrs.  Wil- 
liam K.  Draper,  Annie  \V.  Goodrich,  John  M.  Glenn,  Wick- 
liffe  Rose,  Dr.  Winford  Smith,  Surgeon  J.  W.  Schereschewsky, 
Public  Health  Service.  Miss  Clement,  the  chosen  superintend- 
ent of  Rural  Nursing,  was,  of  course,  always  present  as  an  ex- 
officio  member  of  the  committee,  and  acted  as  its  secretary, 
at  first  informally,  then  after  a  year  or  more  by  official 
appointment. 

The  first  meeting  of  the  committee  was  held  November  14, 
1912,  in  Mr.  Glenn's  office  in  the  Russell  Sage  Foundation 
Building,  New  York  City,  Miss  Boardman  in  the  chair.  There 
were  present:  Mr.  Rose,  Miss  Wald,  Miss  Delano,  Miss  Good- 
rich, Miss  Clement,  to  w4iom  the  direction  of  the  work  was 
confided,  and  Mr.  Glenn.  The  four  nurses  present  were  ap- 
pointed a  sub-committee,  of  which  Miss  Delano  was  chairman, 
to  draw  up  recommendations,  and  the  next  day  they^  proposed 
as  suitable  qualifications  for  applicant  nurses : 

1.  The  existing  requirements  of  the  Red  Cross  for  enrollment, 
omitting  reference  to  age. 

2.  A  course  of  four  months  (one-half  an  academic  year)  under 
supervision  of  a  recognized  Visiting  Xurse  Association. 

3.  Recommendation  by  such  association. 

Tlie  sub-committee  also  considered  the  financial  basis,  and 
for  this  they  advised  the  development  of  scholarships  and  loan 
funds,  suggesting  that  loans  be  made  siifficient  to  cover  the 
expenses  of  the  special  training,  to  be  repaid  on  favorable  terms 
and  that  a  limited  number  of  scholarships  be  ofi^ered.  Their 
suggestions  were  adopted  and  the  details,  as  will  be  set  forth 
later,  were  agreed  upon. 

At  the  annual  Red  Cross  meeting  (1012)  ^[iss  Delano  said: 

Following  a  resolution  passed  at  the  last  annual  meeting, 

measures  have  Ijcen  taken  for  the  establishment  of  a  Rural 

Nursing   Service.      The  organization   of  this  work  has  been 

placed  under  a  special  sub-committee  of  the  National  Relief 

'  Proc('('(lin;rs  American  Nurses'  Assoeiation,   1912. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1217 

Board,  but  it  is  hoped  that  the  Nursing  Service  committees 
already  in  existence  will  render  valuable  assistance  in  secur- 
ing a  personnel  for  Rural  Nursing.  A  more  extended  report 
of  this  work  will  be  given  by  Miss  Fannie  F.  Clement,  who 
has  recently  been  appointed  Superintendent  of  Rural 
Nursing.^ 

With  such  brevity  of  words  and  simple,  direct  action,  a 
service  was  begun  which  led  the  way  to  a  revolution  in  health 
conditions  in  our  neglected  country  areas. 

In  her  iirst  report  ^liss  Clement  outlined  the  activities  to 
be  looked  for  as  a  result  of  the  initial  year's  work,  and  empha- 
sized tiie  stimulant  effect  upon  educational  standards  that  might 
be  expected.     She  said  in  part: 

The  Red  Cross  Rural  Nursing  Service  is  to  be  concerned 
with  nursing  the  sick  in  rural  communities,  carrying  instruc- 
tion along  sanitary  and  humanitarian  lines  into  the  homes, 
and  dealing  with  environment  in  a  way  to  improve  living 
conditions.  It  hopes  to  cooperate  with  all  agencies  dealing 
with  questions  of  individual  and  public  health  and  the  many 
organizations  that  in  the  final  analysis  have  a  common  object 
in  view. 

The  unlimited  opportunities  for  humanitarian  and  educa- 
tional work  to  1)6  found  in  rural  communities  will  appeal  to 
nurses  who  understand  and  enjoy  country  life  and  people,  and 
who  are  interested  in  public  health  movements  and  social 
work. 

It  is  reasonable  to  expect  that  the  result  of  such  a  standard 
of  qualifications  will  not  only  assure  the  best  prepared  women 
for  rural  nursing,  but  will  also  influence  the  establishment  of 
courses  in  public  health  work  and  social  service  in  hospital 
training  scliools  wlierc  such  courses  properly  belong.  Women 
who  anticipate  rural  nursing  will  eventually  look  for  their 
training  to  schools  qualified  to  prepare  tlicm  to  meet  the  re- 
quirements of  the  Red  Cross  for  this  work. 

The  superintendent  began  at  once  to  make  a  survey  of  all 
the  nursing  associations  and  (>ducational  institutions  of  the 
country  to  ascertain  where  suitable  supplementary  training 
and  experience  in  visiting  nursing  and  related  work  might 
be  obtained. 

This  survey  showed  that,  of  all  visiting  nurse  associations  in 
the  United  States  employing  ihroo  or  more  nurses  (there  were 
'The  Jird  Cms!?  Bulletin.  January.  1913. 


1218  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

then  about  forty  associations  of  that  size),  training  centers 
where  nurses  could  obtain  preparation  in  public  health  nursing 
as  deemed  necessary  by  the  Red  Cross  for  rural  work  were 
few  and  far  between.  Only  about  six  visiting  nurse  associa- 
tions offered  a  so-called  course,  and  in  most  of  those  there  was 
little  class  instruction. 

Circulars  of  information  were  prepared  and  widely  dis- 
tributed, giving  the  scope  and  aims  of  the  venture,  and  the 
organized  nursing  profession  was  directly  appealed  to.  Miss 
Clement  wrote : 

The  Red  Cross  is  dependent  largely  upon  hospital  training 
school  superintendents  to  induce  the  right  kind  of  women  to 
enter  the  rural  nursing  field.  Presidents  of  alumnse  asso- 
ciations, officers  of  state,  county  and  local  nursing  associa- 
tions, nurses'  clubs  and  registries,  and  the  members  of  Eed 
Cross  committees  are  in  a  position  to  lend  their  influence  to 
aid  the  Red  Cross  in  its  endeavor  to  build  up  its  Rural  Xurs- 
ing  Service.  It  is  important  also  that  they  do  so  if  it  is  to 
succeed  in  fulfilling  the  purpose  for  which  it  has  been 
organized. 

The  call  for  public  health  workers  must  be  sounded  in 
every  hospital  training  school,  among  nursing  organizations, 
and  educational  institutions,  and  much  remains  to  be  accom- 
plished in  providing  special  training  for  these  workers,  oppor- 
tunities for  which  are  far  too  inadequate.  .  .  . 

The  Red  Cross  will  meet  the  expense  of  organization  and 
general  supervision.  In  order  to  maintain  a  imiform  stand- 
ard of  nursing,  all  Red  Cross  rural  nurses  will  be  under  the 
general  direction  and  supervision  of  the  superintendent.  .  .  . 

For  rural  communities  already  alive  to  the  advantages  of 
visiting  nursing  which  are  looking  for  a  nurse,  for  those  which 
realize  these  advantages  but  need  advice  as  to  ways  and  means 
of  support  of  a  nurse,  and  for  those  regions  where  it  will 
doubtless  appear  necessary  to  demonstrate  more  fully  the  need 
of  one.  the  Red  Cross  Rural  Xursing  Service  stands  ready  to 
furnish  all  possible  assistance.^ 

At  the  end  of  the  trial  year  (1913)  the  name  "Rural  Nursing 
Service"  was  changed  to  "The  Town  and  Country  Nursing 
Service"  for  reasons  to  be  specified  presently.  The  sub- 
committee on  nursing  then  became  the  Town  and  Country 
Nursing  Committee,  and  was  enlarged  to  allow  representation 

''Red    Cross   Magazine,    July,    1913. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1219 

tipon  it  to  the  three  national  nursing  associations,  whose  scope 
and  titles  have  been  mentioned  in  a  former  chapter. 

To  the  sub-committee  as  originally  formed  there  were  now 
added  Miss  Krueger  (American  Nurses'  Association),  Miss 
Nutting  (National  League  of  Nursing  Education),  and  Miss 
Crandall  (National  Organization  for  Public  Health  Nursing). 
Thus  complete  coordination  of  these  societies  was  brought 
about,  as  was  essential  for  the  solution  of  such  pressing  ques- 
tions as  the  establishment  of  new  training  centers  and  the  ad- 
justment of  relations  with  public  health  organizations  and 
related  bodies.  Finally  several  valued  members  were  added 
to  the  committee  from  the  laity.     The  complete  list  follows: 

Town  and  Country  Nursing  Committee : 

Mrs.  Whitelaw  Reid,  chairman  Prof.  Thomas  N.  Carver 

Jane  A.  Delano,  vice-chairman  Matliild  Krueger 

Mabel  T.  Boardman  Edna  Foley 

Lillian  D.  Wald  Mrs.  Larz  Anderson 

Mrs.  William  K.  Draper  Mrs,  Willard  Straight 

Annie  W.  Goodrich  John  !M.  Glenn 

M.  Adelaide  Nutting  Wickliffe  Rose 

Ella  P.  Crandall  Dr.  Winford  Smith 
Dr.  J.  W.  Schereschewsky,  P.H.S, 

To  consider  the  conditions  of  affiliation  with  local  organiza- 
tions, with  power  to  act,  there  was  a  committee  consisting  of: 

Miss  Boardman,  chairman  Miss  Delano 

Miss  Wald  Miss  Goodrich 

Finally,  there  was  the  Committee  on  Education : 

Miss  Goodrich,  chairman  Miss  Clement 

Mrs.  Draper  Miss  Wald 

Miss  Crandall 

The  cooperation  thus  arrived  at  was  of  great  significance, 
for  the  steady  and  unbroken  growth  of  nursing  organization 
had  made  American  nurses  a  real  power.  Tt  will  be  recalled 
that  at  the  convention  of  11)11,  the  Associated  Ahnnua^  had 
broadened  into  the  American  Nurses'  Association,  in  1!)12  the 
SnjK'rintondent's  Society  had  reorganizf^d  on  ampler  lines  to 
become  the  National  League  of  Nursing  Education,  and  within 
its  membership  and  that  of  the  American  Nurs(M'  Association 


1220  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

there  had  been  formed  the  new  and  potential  National  Organi- 
zation for  Public  Health  Nursing,  with  Miss  Wald  and  Miss 
Crandall  as  its  first  president  and  secretary.  This  new  body 
necessarily  included  many  members  of  the  laity,  and  because 
of  its  own  vital  energy  and  the  demands  of  the  times,  promised 
to  have  a  future  of  wide  scope,  while  the  League  of  Nursing 
Education  now  took"  the  key  position  of  being  the  one  united 
force  responsible  for  guiding  the  adequate  training  of  the 
nurse  in  manifold  new  lines.  The  delicate  questions  of  coordi- 
nation opening  before  them  were  dealt  with  by  Miss  Wald  in 
a  letter  to  Mrs.  Whitelaw  Reid : 

December  2,  1913. 

We  are  in  the  position  of  which  we  have  dreamed  for  years, 
of  promoting  and  actually  establishing  nursing  for  the  people 
throughout  the  country.  I  presume  all  of  us  are  too  experi- 
enced in  the  organization  of  great  movements  not  to  expect 
to  make  some  mistakes,  but  I  have  the  hope  that  this  great 
movement  for  hitherto  neglected  people  will  be  phenomenally 
free  in  this  respect.  I  am  tremendously  interested  in  the  two 
organizations  recently  established,  this  one  and  the  National 
Organization  for  Public  Health  Nursing.  Each  has,  in  my 
judgment,  a  distinctive  place  and  should  interlock  without 
overlapping.  But  there  seems  to  have  arisen  some  question 
of  the  latter  and  since  the  same  people  are  interested  in  both 
organizations,  that  would  appear  to  be  avoidable.  May  I 
suggest  that  at  the  meeting  in  Washington,  so  far  as  possible, 
the  scope  of  each  may  be  definitely  outlined. 

In  my  judgment,  the  National  Organization  for  Public 
Health  Nursing  should  maintain  the  purposes  of  its  consti- 
tution. It  is  in  some  measure  a  mutual  benefit  society, 
wherein  nurses  and  individuals  and  organizations  that  pro- 
mote the  work  of  nurses  may  meet  together  for  combined 
effort.  The  methods  whereby  their  efforts  may  lead  to  mutual 
benefit  are  written  into  the  constitution.  .  .  . 

It  is  my  hope  that  the  supervision  and  the  central  control 
of  the  l^ed  Cross  society  will  be  so  obviously  advantageous 
that  gradually  every  rural  and  small  community  nurse  will 
be  enrolled  under  its  organization,. 

I  believe  that  it  would  be  practical  and  statesmanlike  for 
our  committee  of  the  Ped  Cross  to  limit  its  work  during  its 
constructive  period  to  the  first  object  that  it  has  set  out  to 
accomplish,  namely,  the  promotion  of  interest  in  country 
nursing,  and  the  establishment  and  supervision  of  nurses  iu 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1221 

country  communities  and  small  towns.  The  difference  be- 
tween the  two  societies,  as  1  see  it,  is  that  the  one  is  for  edu- 
cation and  mutual  benefit,  a  union  of  workers  and  those  inter- 
ested in  their  work,  and  the  other  administrative  and  super- 
visory. In  my  judgment  it  would  seem  that  our  Ked  Cross 
Committee  ought  not  to  establish  educational  centers,  but 
that  it  should  send  nurses  who  are  to  be' enrolled  in  Ked  Cross 
work  to  the  educational  centers  provided  by  other  organiza- 
tions. It  ought  to  be  the  business  of  Teachers  College  and 
the  National  Organization  for  Public  Health  Nursing  to  pro- 
mote these  educational  centers  in  the  interest  of  public  health 
nursing  throughout  the  country.  Should  these  agencies  fail 
to  provide  proper  educational  facilities  for  the  Eed  Cross 
nurses,  our  society  may  eventually  be  obliged  to  organize  such, 
but  it  seems  to  me  that  we  are  dissipating  some  of  our  strength 
by  assuming  functions  which  as  yet  we  are  not  in  a  position 
to  carry  out  efficiently. 

(Signed)     Lillian  D.  Wald. 

The  relationship  between  the  National  Organization  for 
Public  Health  Xursing  and  the  Town  and  Covuitry  Service 
was  defined  at  a  committee  meeting  in  March,  1914,  in  the 
following  statement : 

The  National  Organization  for  Public  Health  Nursing  is  a 
general  body,  including  in  its  membership  persons  engaged  in 
all  forms  of  public  health  nursing.  It  is  concerned  with  de- 
veloping standards  of  ethics  and  technique,  maintaining  a 
central  bureau  of  information  and  issuing  regular  and  occa- 
sional publications.  ...  On  the  other  hand  the  Red  Cross 
has  undertaken  a  specialized  piece  of  work,  namely,  the  or- 
ganization and  administration  of  visiting  nursing  in  towns 
and  country  districts,  its  efforts  being  directed  toward  the 
establishment  of  a  personnel  of  visiting  nurses  especially 
qualified  for  this  work.  To  this  end  it  assists  in  the  organiza- 
tion of  local  nursing  associations  and  on  the  basis  of  affilia- 
tion assigns  l^ed  Cross  visiting  nurses  to  local  organizations 
wishing  to  employ  a  Ped  Cross  visiting  nurse.  The  Ped 
Cross  Town  and  Country  Nursing  Service  represents  an  effort 
to  standardize  visiting  nursing  in  tlie  towns  and  rural  dis- 
tricts and  to  correlate  the  work  of  isolated  nurses  and  nursing 
organizations  under  a  central  body  as  a  means  of  strengthen- 
ing to  the  fullest  possible  degree  their  powers  to  meet  most 
adequately  the  health  needs  of  their  communities.  Bv  mutual 
agreement,  the  promotion  of  interest  and  advice  on  all  visit- 
ing nursing  questions  in  small  towns  and  rural  comnninities 


1222  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

is  deflected  as  far  as  possible  by  the  National  Organization 
for  Public  Health  Nursing  to  the  Red  Cross.  .  .  .  The  Na- 
tional Organization  for  Public  Health  Nursing  does  not 
maintain  a  nursing  personnel  as  does  the  Red  Cross,  nor  does 
it  assume  responsibility  in  the  supervision  of  the  work  of 
visiting  nurses.  ...  By  reciprocal  representation,  it  is  made 
possible  for  either  organization  to  hold  intimate  knowledge 
of  the  other's  activities,  and  for  the  two  to  work  together 
consistently  to  develop  and  maintain  standards  of  visiting 
nursing  technique  to  the  ultimate  benefit  of  both  the  nursing 
profession  and  the  public  at  large. 

The  energy  with  which  Miss  Clement  and  her  small  staff 
worked  in  those  first  months  may  be  judged  by  lines  taken  from 
the  brief  records  of  May,  1913 : 

Nearly  seven  hundred  letters  enclosing  bulletins  on  rural 
nursing  have  been  sent  to  superintendents  of  all  hospitals  in 
the  United  States  of  fifty  beds  and  over,  asking  them  to  inter- 
est pupils  in  rural  nursing. 

A  request  has  been  sent  to  one  hospital  in  every  large  city 
asking  for  addresses  of  local  registries,  and  by  this  means  one 
hundred  and  thirty-six  nurses'  clubs  and  registries  have  been 
informed  upon  the  work. 

Circulars  have  been  sent  to  over  four  hundred  Red  Cross 
nurses  enrolled  since  1912,  to  one  hundred  and  sixty-seven 
members  of  state  committees,  and  to  the  chairman  of  local 
committees,  with  the  request  to  interest  nurses. 

About  four  thousand,  five  hundred  circulars  all  told  have 
been  distributed. 

Several  articles  on  rural  nursing  have  been  published  in 
the  nursing  journals  and  in  one  a  course  of  instruction  in 
visiting  nursing  has  been  advertised.^ 

The  records  of  January  1,  1914,  show  the  following-  figures 
and  give  the  action  of  committees  on  points  coming  before 
them: 

No.  of  associations  affiliated 14 

Applications  from  nurses  received 120 

No.  of  nur.^es  appointed IG 

Applications   rejected    2G 

Preparatory  courses  arranged  for  nurses 15 

"  Minutes    of    To\'n    and    Corintrv    Xursing    Sprvicp    Conimittop,    Mav    5, 
1013. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1223 

Courses  completed 8 

Courses  discontinued  before  completion 2 

Nurses  still  in  training,  Jan.  1,  1914 5 

Applications  pending   10 

Eligible  for  appointment   (not  including  those  ap- 
pointed )     19 

Eligible  for  preparatory  courses 27 

Scholarships  granted 3 

Amount  of  money  expended  in  scholarships.  .$350.00 

Loans  made  to  nurses 4 

Amount  of  money  loaned 199.00 

Supervisory  visits    5 

By  that  time  the  question  of  affiliation  with  State  boards 
of  health  had  come  up  twice.  It  was  talked  over  at  the 
January  meeting  of  the  Town  and  Country  N^ursing  Com- 
mittee (1914)  and  it  was  agreed  that  the  demands  which 
would  inevitably  come  through  such  extensive  affiliation  could 
not  yet  be  met.  The  Committee  on  Education  then  framed 
the  following  resolution : 

This  committee  recommends  that  the  Town  and  Country 
Xursing  Service  concentrate  its  effort  for  the  present  within 
a  comparatively  small  area,  ratlicr  than  to  undertake  work  in 
widely  scattered  districts,  where  proper  supervision  and  de- 
velopment are  practically  impossible. 

On  ^farch  2,  1014,  increased  scope  was  given  to  the  Com- 
mittee on  Education  by  enlarging  its  functions  to  include 
questions  of  (1)  Organization,  (2)  Administration,  (3) 
Affiliation.  The  committee  thereupon  handed  in  on  ^^larch 
9,  1914,  these  recommendations: 

1.  That  for  the  present,  women  of  high  school  education  be 
given  ])refercnce,  and  that  two  years  of  high  school  be  re- 
quired. 

2.  That  as  soon  as  possible,  full  high  school  education  be 
made  a  prerequisite. 

3.  That  for  the  present  every  candidate  be  obliged  to  take  at 
least  four  months'  training,  except  in  cases  of  exceptional 
women,  who  might  be  required  to  take  only  theory,  allow- 
ing their  former  experience  to  serve  as  equivalent  for  field 
work  included  in  such  course. 


1224  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  end  of  1914  showed  figures  and  statistics  of  a  work  as 
yet  only  in  its  incipiency.  Alone,  these  figures  express  little, 
but  are  striking  in  comparison  with  later  statistics  and  are 
valuable  as  showing  the  very  beginnings,  always  the  records 
most  easily  lost  in  historical  files: 

December  8,  1914 

Loans                                                                      No.  Amoujit 

Loans  granted  previous  to  December  1,  1913     3  $    199.00 

Loans  granted  Dec.  1,  1913,  to  Dec.  1,  1914  13  1,900.00 

Total   $2,099.00 

Scholarsliips 

Scholarships  granted  previous  to  Dec.  1,  1913     3     $    350.00 

Scholarships  granted  Dec.  1,  1913,  to  Dec.  1, 

1914    1  200.00 

Total   $    550.00 

Exhibit 

Eequests  for  exhibit 10 

Granted 6 

Nurses 

Total  number  of  nurses  appointed  Dec.  1,  1913  13 

Js'urses  appointed  Dec.  1,  1913,  to  Dec.  1,  1914  33 

Total  appointments  since  organizations  of 
service 46 

Appointed  nurses  receiving  preparation  under 
direction  of  Eed  Cross 7 

The  exliibit  referred  to  in  this  report  was  the  first  one  pre- 
pared for  use  by  the  Town  and  Country  Xursing  Service,  and 
after  being  shown  at  the  International  Dry-Farming  Congress 
in  Tulsa,  Oklahoma,  it  was  taken  to  the  nurses'  convention 
at  St.  Louis.  It  was  intended  for  use  at  conventions  and  in 
small  communities  that  were  considering  public  health  nursing, 
as  it  portrayed  in  a  simple  way,  by  cliarts  and  photographs, 
the  daily  work  of  the  lied  Cross  visiting  inirse. 

A  special  exhibit  on  Town  and  Country  Xursing  Service 
was  next  prepared  for  the  World's  Fair  in  San  Francisco 
(1915).  For  til  is  a  certificate  and  bronze  medal  were  awarded. 
Another  form  of  educational  work  of  that  year  was  the  travel- 
ing library  put  into  circulation  on  August  3,  1914.  Four 
months  after  its  foundation  it  had  fiftv-five  books  with  an  aver- 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1225 

age  daily  circulation  of  fourteen.  It  grew  in  usefulness  and 
in  dimensions  until  early  in  April,  1020,  when  it  was  discon- 
tinued by  reason  of  the  very  extensive  and  thorough  plans  of 
the  National  Organization  for  Public  Health  Nursing  for  pro- 
viding special  sources  of  reference  in  at  least  one  public  library 
in  every  state. 

The  committee  work  of  1914  was  full  of  planning  and 
preparation ;  the  results  of  much  of  this  will  be  met  in  detail 
in  subsequent  pages. 

The  pressing  need  for  more  centers  which  would  offer  courses 
in  preparation  for  the  Town  and  Country  Nursing  Service  was 
continually  dealt  with,  and  a  great  part  of  the  labor  of  those 
early  months  consisted  in  correspondence  with  schools  and 
training  leaders  all  over  the  country.  Several  visiting  nurse 
associations  were  opening  their  fields  of  work  for  practical 
use,  but  it  was  essential  that  theory,  properly  presented,  should 
be  combined  with  the  practical  work.  How  this  problem  was 
met  will  be  told  presently. 

For  the  help  and  interest  of  affiliated  groups  as  well  as  for 
communication  between  the  nurses,  the  first  leaflet,  called  ''The 
Red  Cross  Visiting  Nurse,"  was  issued  on  April  12,  1915. 
"In  order"  [it  said  editorially]  "that  members  of  the  Town 
and  Country  Nursing  Service  as  well  as  affiliated  organizations 
may  become  acquainted  ...  to  keep  the  nurse  and  affiliated 
organizations  informed  .  .  .  every  member  .  .  .  and  every 
affiliated  organization  is  invited  to  become  a  contributing 
Editor  .  .  ."  It  was  issued  •  several  times  in  multigraphed 
form,  and  in  September,  1915,  it  expanded  into  a  printed 
leaflet,  published  at  the  discretion  of  the  superintendent,  not 
at  fixed  periods.  This  little  bulletin  was  presently  named 
"The  Town  and  Country  Nursing  Service"  and  appeared  at 
intervals  until  December,  1918,  when  it  was  discontinued. 
The  National  Rod  Cross  and  the  various  Divisions  had  mean- 
while adopted  a  similar  form  for  their  Bulletins.  In  January, 
1920,  the  service  began  publishing  a  department  in  "The 
Public  Healtli  Nurse!"  organ  of  the  N.  O.  P.  11.  N.,  under 
the  title  "Red  Cross  Public  Health  Nursing." 

By  1914  tlie  organizations  affiliating  with  Red  Cross  Rural 
Nursing  were  of  a  varied  nature — Red  Cross  Chapters,  wom- 
en's clubs,  health  and  w(>lfare  societies.  Associated  Charities, 
visiting  nurse  associations  and  corp(u-ations,  while  their 
locations  brouaht  the  Red  Cross  Town  and  Countrv  nurse  into 


1226  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Alabama,  Arizona,  Connecticut,  Illinois,  Kentucky,  Maryland, 
Massachusetts,  Michigan,  New  Jersey,  New  York,  Ohio,  Penn- 
sylvania, South  Carolina,  Virginia,  West  Virginia  and  Wis- 
consin, thirty-eight  in  all,  the  first  nurse  having  received  her 
appointment  in  July,  1913,  to  an  Ohio  village,  Cuyahoga  Falls. 
The  second  one  went  to  Warrenton,  Virginia. 

The  human  side,  which,  after  organization  has  been  per- 
fected is  ever  the  all-important  side  of  the  work,  may  be  best 
shown  in  the  graphic  reports,  narratives  and  appeals  of  the 
nurses  engaged  in  the  service.  For  a  comprehensive  impres- 
sion of  the  chief  events  as  they  occurred  in  the  early  years 
the  following  material  has  been  selected  from  the  reports  made 
by  Miss  Clement  to  her  committee: 

.  ,  .  The  effort  to  begin  rural  nursing  in  Laurel,  Mary- 
land, first  brought  up  the  question  of  Eed  Cross  cooperation 
with  the  Metropolitan  Life  Insurance  Company.  This  cor- 
poration had  on  the  suggestion  of  Miss  Wald  already  devel- 
oped an  extensive  visiting  nurse  service  for  its  industrial 
policy  holders.  An  agreement  was  finally  concluded  with  it 
by  the  Eed  Cross  in  May,  1913,  of  which  the  most  essential 
provision  was  this : 

"The  Eed  Cross  is  prepared  to  make  an  arrangement 
with  the  Metropolitan  Life  Insurance  Company  in  providing 
nursing  care  for  its  industrial  policy  holders  through  the  Eed 
Cross  Eural  Nursing  Service,  this  arrangement  to  include  the 
official  endorsement  by  the  Metropolitan  Life  Insurance  Com- 
pany of  regulations  for  rural  nurses  authorized  by  the  Eed 
Cross." 

The  Eussell  Sage  Foundation,  through  its  Southern  Higli- 
lands  Department,  was  instrumental  in  bringing  about  co- 
operation with  the  Eed  Cross  in  the  southern  mountains,  and 
early  in  1913  before  any  affiliations  with  the  new  Service  were 
made,  the  superintendent  of  nurses  under  the  auspices  of 
that  department  visited  five  counties  in  the  Kentucky  moun- 
tains, stopping  at  the  various  denominational  schools  and 
learning  of  opportunities  for  introducing  Eed  Cross  nursing. 

The  Eural  Organization  Service  of  the  Department  of 
Agriculture  cooperated  with  the  Eed  Cross  in  1914.  It  was 
among  the  early  organizations  to  appreciate  the  part  public 
health  nursing  was  to  play  in  the  development  of  rural  life, 
and  in  its  local  demonstration  work  a  group  was  organized  in 
Chilton  County,  Alabama,  to  have  charge  of  a  county  nursing 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING     1227 

system,  the  first  in  the  state.  The  committee,  constituting  as 
it  did  one  of  the  very  earliest  examples  of  cooperation  be- 
tween public  and  private  interests,  is  worthy  of  special  note. 
The  lied  Cross  nurse  appointed  in  March,  1914,  was  respon- 
sible to  a  county  health  committee  on  which  served  the 
county  health  otlicer,  the  county  superintendent  of  schools, 
the  county  agent  of  the  Farmers'  Union  and  a  representative 
of  a  leading  woman's  club.  Expenses  were  met  by  an  appro- 
priation of  $500  from  the  county  board,  $500  from  the 
school  board,  and  $500  from  private  sources. 

...  In  Alabama  there  are  "beats," — territorial  divisions 
which  include  several  school  districts.  A  county  improvement 
association  with  branches  in  each  beat,  under  a  "beat  man- 
ager," has  been  organized,  each  beat  subdivided  into  school 
districts  where  a  superintendent  is  head  of  a  small  group.    .   .   . 

Industrial  nursing  early  came  within  the  scope  of  the  Town 
and  Country  Nursing  Service.  While  a  number  of  the  nurses 
worked  in  manufacturing  towns  or  villages  they  were  not 
invariably  emi)loyed  by  an  industrial  concern. 

The  Xew  Jersey  Zinc  Company  as  early  as  April,  1914, 
sought  Red  Cross  affiliation.  This  company  for  many  years 
has  carried  on  welfare  work  successfully  and  when  its  work 
extended,  a  Red  Cross  nurse  was  assigned  to  Palmerton, 
Pennsylvania.  Franklin,  Xew  Jersey,  where  the  smelter  of 
this  com])any  was  located,  employed  a  Red  Cross  nurse  in 
June  of  tlie  same  year  and  a  nurse  was  sent  to  its  mining 
section  in  (Jilman,  Colorado,  in  1917. 

In  1913,  through  the  generosity  of  a  member  of  the  Com- 
mittee of  the  Rural  Xursing  Service,  a  nurse  was  appointed 
to  organize  a  nursing  association  in  Hazard,  a  rapidly  growing 
railroad  town  in  the  Kentucky  mountains.  This  first  effort 
did  not  stimulate  local  support  as  was  anticipated,  but  when 
the  work  was  started  again  in  May,  1914,  the  town  contributed 
toward  the  nurse's  salary  and  the  work  continued  for  a  year, 
during  which  time  a  valuable  demonstration  was  made  as  to 
what  put)li('  health  nursing  may  mean  to  this  and  otiier  moun- 
tain sections.  Tn  six  months'  time  the  nurse  examined  all 
the  school  children,  and  found  in  one  small  village  that  seven 
per  cent  of  the  children  had  trachoma.  .  .  .  Tiirough  her 
efforts  the  state  law  excluding  such  cases  from  the  schools 
became  for  the  first  time  effective  in  that  part  of  the  state. 

The  Bureau  of  Rural  Sanitation  of  the  Virginia  State 
Board    of    Ilealtli,    administering    funds    of    the    Rockefeller 


1228  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Foundation,  employed  a  Red  Cross  nurse  to  work  in  the 
Eagged  Mountain  section  of  the  Virginia  mountains.  The 
physicians  who  had  made  the  initial  survey  and  administered 
treatment  for  hookworm  disease  had  left,  and  it  was  the  plan 
to  put  nurses  in  the  field  for  follow-up  work,  teaching  prac- 
tical sanitation  from  home  to  home  and  working  under  the 
county  health  officer  in  giving  further  treatment  for  hook- 
worm. This  was  a  new  departure  in  public  health  nursing 
and  a  promising  one,  but  the  funds  were  withdrawn  by  the 
Rockefeller  Commission  for  other  purposes,  and  after  several 
successful  months  this  work  was  discontinued. 

In  a  South  Carolina  community  a  unique  phase  of  the  work 
of  one  of  the  Red  Cross  visiting  nurses  has  resulted  from  her 
appointment,  amongst  various  other  duties,  as  sanitary  in- 
spector of  washerwomen.  Since  last  March,  such  workers  have 
been  required  by  law  to  hold  permits.  Over  seven  hundred 
have  applied  for  permits,  and  the  living  and  working  condi- 
tions of  over  half  of  them  have  already  been  investigated,  and 
permits  granted  by  the  nurse. 

The  first  appointment  west  of  the  Mississippi  was  made 
in  October,  191-i,  to  a  typical  mining  community  in  Arizona. 
This  represents  a  pioneer  work,  for  the  nurse  was  the  first  in 
the  state  who  had  had  special  training  in  public  health  nurs- 
ing. To  the  credit  of  the  group  responsible  for  this  work  in 
Jerome,  it  may  be  said  that  in  order  to  obtain  a  nurse  thus 
qualified  they  volunteered  to  pay  her  traveling  expenses  across 
the  continent.  Success  in  developing  her  school  nursing  and 
general  community  service  played  an  important  part  in  the 
extension  of  public  health  nursing  in  Arizona  as  was  fre- 
quently attested  by  the  State  board  of  health  and  State 
medical  authorities. 

The  Red  Cross  visiting  nurse  in  Wisconsin  is  developing 
school  work  particularly,  inspecting  children  in  public  and 
parochial  schools.  After  examining  several  hundred  children 
she  found  that  many  had  spinal  curvature.  This  condition 
was  reported  to  the  school  authorities,  who  will  remedy  the 
faulty  seating  and  desk  arrangements.  The  defective  eyesiglit 
and  hearing,  throat  troubles,  skin  and  teeth  conditions 
brought  to  light  give  convincing  evidence  of  the  need  of  close 
supervision  of  the  physical  well-being  of  children.  Wherever 
school  nurses  are  employed  communities  are  pretty  generally 
aroused  to  this  fact.  Teachers,  and  parents  appreciative  of 
results,  are  usuallv  m.ost  grateful  for  the  attention  given  the 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1229 

children  by  the  nurse.  She  has  also  been  asked  to  give  talks 
on  hy<i^iene  in  the  continuation  schools  and  at  tiie  teaeiicrs' 
training  sciiool  in  lier  conununity,  graduates  of  which  will 
soon  be  going  out  into  the  rural  schools  of  Wisconsin. 

The  State  Tuberculosis  Committee  has  been  active  here 
[Fulton,  Kentucky).  Such  associations  have  always  empha- 
sized tiie  importance  of  the  visiting  nurse.  Indeed,  it  was 
the  Tuberculosis  Associations  that  first  brought  the  visiting 
nurse  to  the  forefront  and  recognized  her  teaching  powers. 

The  first  county  school  nursing  in  ^lichigan  started  in 
March,  1915,  under  the  Kent  County  Board  of  Supervisors 
and  the  nursing  in  an  adjacent  county  became  affiliated  in 
December  of  that  year.  Kent  County  was  the  first  in  the 
country  to  ap[)ly  the  idea  of  health  leagues  for  school  chil- 
dren on  a  county  basis  and  among  its  several  pioneer  efforts  a 
dental  traveling  clinic  for  county  schools  was  instituted. 

The  three  county  nurses  in  ^lichigan  are  employed  by 
Boards  of  Supervisors,  affiliated  with  the  Eed  Cross.  The 
area  in  these  several  counties  ranges  from  forty  to  nine  hun- 
dred square  miles.  Two  of  the  nurses  are  known  as  county 
school  nurses,  having  supervision  of  eight  thousand  to  twelve 
thousand  cliildrcn.  While  most  of  the  time  of  the  other 
county  nurses  is  devoted  to  school  work,  anti-tuberculosis  and 
infant  welfare  nursing,  and  sometimes  bedside  nursing,  are 
included. 

The  two  nurses  appointed  to  DeKalb  County,  Illinois,  by 
the  Eed  Cross  (1915)  were  the  first  county  nurses  in  that 
state. 

The  Consolidated  Coal  Company,  through  its  Welfare  De- 
partment, contracted  IJed  Cross  affiliation  (191G)  and  the 
first  nurse  was  appointed  in  Jenkins,  Kentucky. 

The  Anti-Tul)erculosis  Committee  of  Creenville,  ^lissis- 
sippi,  was  the  first  grou])  in  that  state  to  seek  Eed  Cross  atfilia- 
tion,  while  the  first  Kcd  Cross  nurse  to  be  actually  assigned 
to  duty  was  under  the  PVderation  of  Women's  Clubs  in  .fack- 
son.  Through  develojuuent  of  the  work  in  these  centers  the 
State  tul)erculosis  authorities  wrote  to  the  Eed  Cross  in  re- 
gard   to    coiipcration    in    (level()])iiig    ]iublii'    licalth    nursing 


1230  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

throughout  the  state.  Circulars  issued  by  this  association 
advocated  the  employment  of  Red  Cross  nurses  and  of  a  state 
nurse  who  also  would  be  of  the  Red  Cross  staff. 


North  Dakota  made  rapid  advance  in  its  development  of 
county  nursing.  The  Red  Cross  nurse  appointed  to  LaMoure 
County  (October,  1916)  was  a  pioneer  and  her  work  stimu- 
lated others  as  a  letter  written  by  her  (July,  1917)  indicates. 
She  said :  "I  am  indeed  pleased  over  the  prospect  of  a  nurse 
in  Stutsman  County.  That  is  our  neighboring  county  to  the 
north.  ...  I  have  just  had  a  letter  from  the  superintendent 
of  schools  of  Dicky  County,  our  neighbor  to  the  south.  In 
Sargent  County,  east  of  Dicky,  they  are  circulating  their 
petition  for  a  Red  Cross  nurse.  .  .  .  Barnes  County  is  em- 
ploying a  domestic  science  teacher.  They  promised  that  if 
our  nurse  was  a  success  they  would  get  one  too." 

Appointment  of  nurses  for  county  work  is  a  practice  rapidly 
spreading.  Wisconsin  has  its  State  law  authorizing  counties 
to  employ  nurses  for  combined  school  nursing  and  anti-tuber- 
culosis work,  while  a  number  of  other  states  are  about  to  enact 
such  laws.  To  be  a  county  school  nurse  means,  usually,  that 
one  must  be  a  tuberculosis  and  infant  welfare  nurse,  an  at- 
tendance officer,  a  sanitary  inspector,  a  teacher  of  hygiene, 
family  adviser  and  more  or  less  of  a  general  visiting  nurse, 
as  well,  for  the  various  school  districts  within  the  area. 

Dental  clinics  have  been  established  by  several  affiliated 
organizations,  and  one  rural  community  has  started  school 
lunches,  which  have  met  with  much  favor.  Xursing  in  the 
schools  is  generally  introduced  voluntarily  on  the  part  of  the 
nursing  association.  Boards  of  education  soon  appreciate  its 
value,  and  the  number  of  appropriations  from  school  boards 
made  to  nursing  organizations  for  services  of  the  nurse  in 
the  schools  is  increasing  from  day  to  day. 

Owing  to  the  risk  of  contracting  typhoid  fever  in  country 
districts,  where  it  is  much  more  prevalent  than  in  cities,  and 
in  order  to  safeguard  rural  nurses  from  this  disease,  the 
Committee  on  Town  and  County  Xursing  Service  now  (1914) 
requires  that  candidates  submit  a  certificate  of  immunity 
from  typhoid  before  appointments  are  granted.  A  certificate 
of  immunity  from  smallpox  and  a  health  certificate  are  also 
required. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING  1231 

Infant  welfare  work  is  a  prominent  feature  in  several  of 
the  communities,  where  mothers'  conferences  are  held  regu- 
larly. Prenatal  visiting,  making  periodical  visits  to  new 
mothers  and  babies,  teaching  in  the  home  in  regard  to  the  care 
and  feeding  of  infants,  discouraging  the  employment  of  un- 
trained nudwives,  all  are  activities  which  claim  the  attention 
of  the  Ked  Cross  visiting  nurse.  In  a  southern  mountain 
community  one  of  the  nurses  has  organized  mothers"  helpers' 
classes,  similar  to  those  carried  on  in  some  of  our  large  cities. 
She  is  also  giving  weekly  lectures  on  health  to])ics  in  the 
schoolhouse  of  over  five  villages,  to  which  young  and  old  are 
welcome.  Nurses  are  sending  articles  regarding  their  work 
to  their  county  or  local  newspapers,  while  a  number  have  re- 
sponded to  calls  to  speak  at  meeting?  of  parent-teachers'  asso- 
ciations, church  societies,  women's  clubs  and  country  life 
conferences. 

!Miss  Florence  Besley  has  been  with  the  Radcliffe  Chautau- 
qua, representing  the  Red  Cross.  This  plan  of  including  such 
representation  was  an.  innovation,  but  has  proved  so  success- 
ful that  the  Chautauqua  Company  has  asked  the  Red  Cross 
(191G-191T)  to  appoint  nurses  for  several  circuits. 

Miss  Kuhn,  in  the  mountains  of  Kentucky,  has  originated 
an  idea  new  to  ])ublic  health  nursing  (IDKi).  She  has  been 
holding  a  health  clinic  at  a  Sunday  school  in  her  tounty.  It 
has  been  so  successful  that  she  expects  to  start  another  in 
another  section. 


Baby  welfare  stations  were  nndertaken  in  several  places  by 
Red  Cross  nurses.  Palmerton,  Pennsylvania,  and  Fraidvlin, 
New  Jers(\v,  were  the  first  among  Ilcd  Cross  atHliations  to 
start  permanent  baby  welfare  stations,  as  they  are  known  in 
cities. 

The  second  traveling  exhibit  was  arranged  during  tlic  year 
1015  and  many  requests  to  Red  Cross  Headcpiartei's  testitied 
to  its  usefulness.  The  BuUetin  (September  l-'i,  lOlT))  gives 
this  description  of  it: 

The  e.\hil)it  consists  of  thirteen  frames,  dimensions  two  by 
two  and  a  half  feet  each,  which  tell  l)y  means  of  ])ictures  and 
legends  of  the  activities  of  the  visiting  nurse  in  rural  connnu- 
nities  and  small  towns. 


1232  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Frames  one,  two  and  tliree  picture  the  nurse  preparing  for 
her  daily  rounds  and  at  work  in  the  homes  caring  for  the  sick ; 
four,  five  and  six  show  the  nurse  at  work  in  the  school;  seven 
and  eight  are  devoted  to  infant  welfare  work ;  nine  to  sani- 
tary inspection ;  ten  and  eleven  to  tuberculosis  work ;  twelve 
and  thirteen  to  club  and  class  work  as  it  is  frequently  organ- 
ized by  the  nurse. 

The  first  lantern  slide  exhibit  was  prepared  in  1914  and 
circulated  Avidely  for  two  years  with  excellent  results.  It  had 
a  set  of  about  one  hundred  views.  The  later  striking  amplifica- 
tion of  education  throi;gh  the  eve  in  the  elaborate  moving  pic- 
ture department  of  the  lied  Cross  Xursing  Service  was  initi- 
ated by  a  two-reel  film  illustrating  its  work,  which  was  used 
by  the  Government  at  the  San  Francisco  Exposition  (1915) 
up  to  December  of  that  year.  Duplicates  were  made  and  used 
over  the  country  by  the  Red  Cross.  This  was  one  of  the  first 
moving  pictures  for  furthering  health  nursing  propaganda.  By 
1920,  the  Bureaii  of  Motion  Pictures  of  the  Red  Cross  had 
three  distinct  films  of  the  Nursing  Department,  namely: 
''Winning  Her  Way,"  "In  Florence  Nightingale's  Footsteps" 
and  ''Every  Woman's  Problem." 

At  the  end  of  this  brief  outline  of  the  early  years  of  the 
service,  it  is  appropriate  to  emphasize  the  part  of  the  Red 
Cross  in  strengthening  and  multiplying  public  health  nursing 
centers.  ^Miss  Clement's  article,  ''Five  Years  in  Retrospect" 
(October  31,  1917,  ended  the  iive-year  period),  brings  out  in- 
cidentally this  great  service  of  the  health  organizations  of  1912, 
but  few  were  concerned  with  rural  communities.  In  training 
schools  and  among  nurses  themselves  there  was  little  realiza- 
tion of  country  health  problems,  nor,  indeed,  had  the  hospitals 
yet  felt  keenly  the  obligation  to  send  out  women  equipped  to 
carry  on  the  teachings  of  health  preservation. 

The  visiting  nurse  associations  of  the  large  cities  had  been 
the  first  to  realize  that  more  training  was  needed  to  cope  suc- 
cessfully with  the  health  problems  of  the  home  and  industry, 
as  they  were  also  the  first  to  endeavor,  to  the  best  of  their 
ability,  to  provide  o])portunities  for  such  further  training. 

Miss  Clement  wrote  of  the  Red  Cross  inlluence: 

It  was  at  a  time  when  pul»lie  health  nursing  was  new  alike 
to  the  ]iursing  profession,  to  those  rcsjjonsihle  for  the  training 
of  nurses  and  to  rural  connnunities  uenerallv.  that  the  Town 


FROM  RURAL  IX:)  PUBLIC  HEALTH  NURSING    1233 

and  Country  Nursing  Service  was  organized.  Adopting  as  its 
premise  that  training  or  exj)erience  in  public  health  nursing 
was  necessary  for  rural  health  work,  the  greatest  ell'ort  during 
the  past  live  years  has  been  directed  toward  the  supply  of 
adequately  })rej)ared  nurses.  With  almost  no  propaganda 
among  comnninities,  the  number  of  requests  for  nurses  com- 
ing to  the  Ked  Cross  iias  always  exceeded  the  supply.  Numer- 
ous organizations,  national  and  local,  have  been  actively  dis- 
closing the  ])revalence  of  sickness  and  disease  in  rural  dis- 
tricts and  the  possibility  of  better  living  conditions  through 
the  teachings  of  health  nurses.  With  one  or  two  exceptions, 
however,  none  until  lately  have  concerned  themselves  with 
increasing  the  supply  of  nurses  to  fill  the  demand  thus  cre- 
ated, which  is  quite  another  problem  and  a  far  more  dilli- 
cult  one. 

To  what  extent  the  Red  Cross  has  been  instrumental  in 
stimulating  a  desire  among  nurses  for  rural  work,  would  be 
hard  to  tell.  Every  possible  opportunity  to  reach  nurson 
through  the  training  schools,  through  nurses'  organizations 
and  at  nurses'  meetings,  has  been  utilized.  Thousaiuls  of 
pamphlets  dealing  with  rural  nursing  have  been  distributed 
among  the  affiliated  communities.  ^lany  of  the  Town  and 
Country  nurses  have  written  papers  or  spoken  before  groups 
of  nurses.  Figures  showing  how  many  nurses  have  entered 
post-graduate  training  in  public  health  nursing  subsequent 
to  correspondence  with  the  Town  and  Country  Nursing  Ser- 
vice during  the  past  five  years  would  indicate  most  concretely, 
perha])s,  the  results  of  this  endeavor.  Covering  this  ])eriod 
there  have  been  one  hundred  and  seventeen  applicants  to 
the  Town  and  Country  Nursing  Service  wiio  have  entered 
courses  in  public  health  nursing,  thirty-four  of  them  taking 
an  eight  months'  course.  Since  December  1,  IDKi,  twenty- 
nine  applicants  have  entered  courses,  thirteen  for  an  eiglit 
months'  term.  The  total  number  represents  an  increase  of 
ten  over  last  year. 

Primarily  tlirough  the  influence  of  the  national  societies 
of  nurses,  a  change  in  the  hospital  training  school  curriculum 
is  gradually  taking  place  in  many  cities." 

Tlio  response  made  to  the  pamphlets  and  letters  lioro  spoken 
of  included  many  retpu^sts  for  ''alfiliation"  from  small  cities 
which,  though  not  strictly  ''rural",  wished  to  he  included  with- 
in the  scope  of  the  sei-vicc.  It  was  in  order  that  such  towns 
might  be  consistently  included  that  the  lunne  '■Jiural  Nursing" 

""Five  Years  in  llctrospect":    Annual  Pa'port  of  tlic  T.  and  C.  N.  S..  lUlT. 


1234  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  changed  to  "Town  and  Country  Nursing  Service"  within 
the  first  experimental  year.  By  this  change  the  original  pur- 
pose and  policy  of  the  Rural  Nursing  Service  remained  un- 
changed, but  with  broadened  scope,  to  include  affiliations  with 
nursing  organizations  in  cities  that  were  carrying  on  country 
or  rural  nursing  work.  At  first  the  limits  of  a  "Town"  were 
not  defined,  but  in  March,  1915,  it  was  agreed  that  a  popula- 
tion of  25,000  should  be  regarded  as  the  maximum  sized  town 
with  which  affiliation  be  undertaken,  and  that  the  service 
should  aim  to  reach  the  strictly  rural  communities  first.-^" 

This  limitation  remained  in  force  until  1018. 

At  the  end  of  the  five  first  years  Miss  Clement  resigned  her 
position  of  superintendent  of  the  service,  having  built  up  her 
work  strongly  and  well,  from  its  tentative  inception.  Her 
resignation,  reluctantly  accepted,  was  deUiyed  for  some  months 
by  the  committee.  Of  the  essential  quality  of  her  influence 
and  spirit,  Mary  S.  Gardner  wrote: 

Because  the  war  brouglit  about  such  unprecedented  devel- 
opment of  all  American  public  health  nursing  work  and  be- 
cause the  new  fields  of  action  so  frequently  appealed  to  the 
dramatic  sense,  students  of  the  public  health  nursing  move- 
ment sometimes  fail  to  give  sufficient  acknowledgment  to 
those  pre-war  efforts  which  alone  made  possible  the  later 
expansion. 

During  Miss  Clement's  directorship  of  the  Town  and 
Country  Nursing  Bureau,  all  local  matters  were  dealt  with 
directly  from  Washington,  decentralization  not  having  at  that 
time  simplified  the  difficult  problems  of  administration.  To 
deal  wisely  with  the  details  of  a  hundred  varied  situations  in 
as  many  parts  of  the  irnited  States,  demands  unusual  powers 
of  understanding.  Every  word  of  Miss  Clement's  filed  corre- 
spondence breathes  not  only  a  spirit  of  intense  personal  inter- 
est, and  that  sympathetic  understanding  of  widely  diverse 
local  conditions  leading  to  wise  decisions,  but  also  a  love  of 
the  work  which  made  it  for  her  a  true  vocation.  Her  successor 
feels  that  the  subsequent  success  of  this  bureau  of  the  Kcd 
Cross  was  in  large  measure  due  to  ^liss  Clement's  quiet  and 
unobtrusive  preliminary  work.  In  any  estimate  of  the  final 
achievement  of  the  Public  Health  Nursing  Bureau  of  the 
American  Red  Cross,  ]\Iiss  Clement's  pioneer  contribution 
should  be  recognized  to  the  full  degree  as  important  and 
valuable. 

"Minutes,  March   18,   1015. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1235 

Fannie  F.  Clement  was  born  in  Boston  and  inherited  the 
staunch  and  conscientious  virtues  of  the  pioneer  New  Eng- 
lander.  She  was  a  Smith  Collej^e  woman  (chiss  of  1003)  ;  a 
graduate  of  the  Boston  City  Hospital  School  for  Nurses  and  of 
the  Boston  Lying-in  Hospital ;  then  after  three  years  of  private 
and  district  nursing  she  spent  the  year  1910  in  the  Social 
Service  Department  of  the  Boston  Dispensary,  and  had  also  a 
course  at  the  School  for  Social  Workers  in  Boston.  She  en- 
rolled in  the  Ked  Cross  Nursing  Service  on  April  10,  1910. 
During  the  war  she  was  head  of  the  Smith  College  Unit.  Her 
reports  and  articles  form  a  complete  history  of  the  Rural  and 
Town  and  Country  Nursing  Service  during  her  direction  of  it. 

The  rest  of  this  chai)ter  will  go  back,  in  point  of  time,  to 
take  up  the  special  features  of  the  work  as  they  developed,  in 
sufficient  detail  for  students  and  serious  readers,  who  may 
desire  to  follow  each  topic  through  to  the  date  of  reorganization. 

In  the  small  booklet  of  printed  "Regulations"  adopted  by 
the  Executive  Committee  of  the  Red  Cross,  December  30, 
1012,  the  rules  and  requirements  for  nurses  desirous  of  entering 
the  Rural  Nursing  Service  were  given.  Their  essential  para- 
graphs were  these : 

The  Rod  Cross  Xursing  Service  includes  a  section  on  rural 
nursing,  established  to  provide  visiting  nurses  for  rural 
connnunities. 

A  two  years'  course  of  training  received  in  a  general  hos- 
pital with  a  daily  average  of  at  least  iil'ty  ])atients  during  the 
applicant's  training  is  required.  Subsequent  hospital  experi- 
ence, or  a  ]iost-gra(luate  course,  may  be  judged  as  an  equiva- 
lent where  there  is  deficiency  of  previous  training.  Graduates 
of  state  liospitals  for  the  insane  are  eligible  if  their  experience 
inc]u(h's  nine  inontlis'  training  in  a  general  hospital  either 
during  their  course  of  training  or  subsequent  thereto. 

An  applicant  nuist  be  a  member  of  an  organization  aflfili- 
ated  with  the  American  Nurses'  Association,  and  must  have 
the  otlicial  endorsement  of  this  organization  and  of  the  train- 
ing sch()<il  from  whicli  she  graduated. 

in  states  where  rei^ist ration  is  provided  for  by  law,  rural 
nurses  must  he  reiristered. 

Training  or  experience  in  visiting  nursing  or  some  other 
form  of  social  service  is  re(iuired. 

Exceptions  to  th(>  alxAc  cpialifications  may  be  made  with 
the  approval  of  the  committee  in  charge. 


1236  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  four  months'  course  with  selected  visiting  nursing  asso- 
ciations is  arranged  by  the  Red  Cross  for  nurses  who  have  not 
had  this  preliminary  training.  Where  possible,  one  month  of 
this  period  will  be  spent  with  a  visiting  nursing  association 
in  the  country. 

These  requirements  had  been  agreed  upon  at  a  meeting  of 
the  Committee  on  Rural  Nursing  Service,  held  on  December  10, 
1912.  One  year  later  (December  9,  1913)  they  were  reissued 
with  the  added  proviso,  moved  by  !Miss  Delano  and  voted  affir- 
matively by  the  committee,  that  enrollment  with  the  Red  Cross 
Xursing  Service  should  be  made  one  of  the  requirements  for 
appointment  to  the  Rural,  by  that  time  renamed  the  Town  and 
Country,  Xursing  Service. 

A  number  of  exceptions  to  the  regulations  for  general  enroll- 
ment were  then  found  to  be  necessary  for  the  admission  of 
nurses  to  the  Town  and  Country  Nursing  Service.  Such  were 
allowed  as  to  the  age  limit,  uniform,  and  other  details 

In  1914  some  stiffening  of  the  requirements  was  agreed 
upon.  To  the  general  hospital  regulation  it  was  now  stipulated, 
as  already  specified  in  t^he  regulations  for  enrollment,  that  such 
training  must  have  included  the  care  of  men.  The  applicants' 
school  record  was  taken  up  for  discussion,  and  the  subcommittee 
on  education  recommended  (October  18,  1914)  that  two  years 
of  high  school  or  its  equivalent  be  required  for  appointment  to 
the  Town  and  Country  Nursing  Service  until  October,  1916, 
after  which  a  high  school  diploma  or  an  equivalent  to  a  full 
high  school  course,  be  required.  ^^ 

The  standard  thus  set  seemed  feasible  in  view  of  the  aca- 
demic ratings  of  the  thirty-five  nurses  in  active  service, 
namely : 

Common  school  8 

High  school,  one  year  3 

High  school,  two  years  2 

High  school,  graduate  7   (generally  3  yr.  course) 

High  school,  equivalent  3 

In "doubt  8 

College,  two  years  2 

College,  graduate  1 

Having  these  figures  and  the  unanimous  recommendation  in 
favor  of  high  school   i-e(|U!re]iiciit  of  the  supervising  nurses  of 
"Minutes  T.   &   C.   X.   S.:    Dec.   8.   1914. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1237 

the  Metropolitan  Life  Insurance  Company,  with  which  the 
service  was  cooperating,  the  Committee  on  Education  voted 
unanimously  to  establish  this  standard  as  recommended,  and 
at  a  meeting  of  the  whole  committee  (March  18,  1915)  the  step 
was  endorsed,  one  vote  only  being  cast  in  the  negative.  At  the 
same  meeting  the  committee  discussed  the  possibility  that  the 
special  training  might  come  to  be  included  in  the  training 
school  period,  and  with  this  in  mind  it  was  moved  by  !Mrs. 
Draper  and  seconded  by  ^liss  Wald  that  the  following  resolu- 
tion be  sent  to  the  Committee  on  Education  of  the  League  of 
Nursing  Education : 

Inasmuch  as  tlie  Town  and  Country  Xursing  Service  can- 
not meet  the  increasing  demands  of  comnmnities  for  nurses, 
the  committee  calls  to  tlie  attention  of  the  National  League 
of  Xursing  Education  the  advisability  of  including  in  the 
training  school  curriculum  a  s])ecial  course  fitting  the  nurses 
for  this  public  health  service,  the  Ked  Cross  recognizing  that 
even  to  require  a  minimum  of  four  months  postgraduate 
work  is  asking  a  great  deal  of  the  nurse  after  a  regular  three 
years'  course.^- 

In  the  meantime,  while  waiting  and  hoping  for  the  training 
schools  for  nurses  to  act  on  the  resolution,  though  the  regulation 
for  four  months  special  postgraduate  training  still  obtained, 
the  committee  I'ccomnieuded  that  student  nurses  be  encouraged 
to  take  the  more  thorough  preparation  offered  in  the  several 
eight  months  courses  then  developing.  This  policy  was  fol- 
lowed, even  though  its  adoption  by  reducing  the  number  of 
training  centers  to  which  applicants  for  the  service  could  be 
referred,  made  more  difficult  the  work  at  H(>adquarters  in  try- 
ing to  meet  the  demands  upon  it.  In  lOlH,  with  the  pressure 
of  war  problems  then  arising,  the  decision  regarding  high 
school  was  reconsidered,  and  temporarily  discontinued  as  shown 
in  the  following  rcccu-d : 

Of  the  sixty-nine  nurses  m  the  sorvieo.  twelve  have  had  a 
grammar  S(h()(d  education  only,  twcnfy-three  one  year  hiirh 
school  or  less  tluin  two.  twenty-one  have  had  fwo  or  three 
years  of  high  school  in  advance  of  grammar  sclinol.  and  thir- 
teen liave  had  four  vears'  high  school  or  more.  It  was  move(l 
by  ^liss  Crandall  and  seconded  hy  Airs.  Draper  that  the  high 
"Ariiuitcs  T.  c^  C.  \.  S.:   ^farch   IS.  1015. 


1238  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

school  requirement  be  suspended,  but  that  the  question  come 
up  for  action  a  year  hence.    This  was  voted.^' 

The  leaflet  of  information  for  applicants,  published 
March  21,  1917,  announced  the  final  action  on  the  high  school 
requirement : 

A  minimum  of  two  years'  high  school  education  or  its 

equivalent  is  required.  Study  and  experience  subsequent  to 

schooling  will  be  taken  into  consideration  when  determining 
an  equivalent.^* 

In  the  same  leaflet,  candidates  for  the  Town  and  Country 
Xursing  Service  were  required  to  have  "attended  schools  of 
nursing  which  included  in  their  courses  both  theory  and  prac- 
tice in  obstetrics  and  the  care  of  children."  This,  as  all  nurses 
know,  meant  post-graduate  training  for  many,  as  it  was  then 
by  no  means  universal,  even  in  general  hospitals,  to  find  these 
two  branches  provided.  This  new  requirement  of  the  Red 
Cross  undoubtedly  stimulated  greatly  that  process  of  "affilia- 
tion" between  hospital  nursing  schools  which  was  designed  to 
afford  every  pupil  training  in  these  and  other  important  spe- 
cialties. Another  requirement  of  a  different  kind  met  with  in 
1917  was  this: 

A  knowledge  of  driving  or  riding  horses,  and  more  fre- 
quently the  use  of  an  automobile  is  necessary. 

In  1918  attention  was  drawn  to  the  personal  equation: 

The  fact  that  a  nurse  meets  the  educational  qualifica- 
tions and  the  professional  requirements  as  well,  is  not  suffi- 
cient to  secure  lier  acceptance  and  assignment  by  the  Bureau 
of  Public  Health  Xursing.  Personality  and  the  ability  to 
manage  difficult  situations  and  to  carry  responsibilities  will 
also  be  considered. 

Regulations  of  1917  and  1918  said: 

Certain  visiting  nurse  associations  and  educational  institu- 
tions accept  as  students  for  a  four  or  eight  months'  course 
nurses  who  wish  to  prepare  for  the  Town  and  Country  Nurs- 
ing Service,  and  who,  though  otherwise  eligible  have  not  had 

"Minutes  T.  &  C.  N.  S.:   December   12,   1916. 
"A.  R.  C.  150,  March,  1917. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1239 

training  or  experience  in  public  health  nursing.  It  is  ex- 
pected that  their  preparation  will  include  several  weeks  with 
a  rural  nurse  in  order  that  they  may  come  in  direct  contact 
with  rural  social  problems  before  assuming  responsibility  in 
work  of  their  own. 

The  requirements  of  1920  for  general  enrollment  were  these: 

Nursing  Education. 

The  applicant  must  be  a  graduate  of  a  school  for  nurses 
giving  at  least  a  two-years'  course  of  training  in  a  general 
hospital  which  includes  the  care  of  men  and  has  a  daily  aver- 
age of  at  least  fifty  patients  during  the  applicant's  training 
period.  Graduates  of  hospitals  for  the  insane  are  not  eligible 
for  enrollment  unless  their  experience  includes  at  least  nine 
months'  training  in  a  general  hospital,  either  during  their 
course  of  training  or  subsequent  thereto.  Subsequent  post- 
graduate training  or  hospital  experience  which  supplements 
deficiencies  of  training  may  be  accepted  as  an  equivalent  by 
the  National  Committee  upon  recommendation  of  a  Local 
Committee  on  Red  Cross  Nursing  Service. 

Registration. 

In  states  where  registration  is  provided  for  by  law,  the 
nurse  applying  for  enrollment  in  the  Red  Cross  must  be 
registered. 

Age  Limit. 

Applicants  must  be  at  least  twenty-one  and  not  over  forty- 
five  years  of  age.  Exceptions  to  this  requirement  may  be  made 
by  the  Red  Cross  for  those  enrolling  for  public  health  nurs- 
ing and  other  special  Red  Cross  service. 

Physical  Examination. 

A  physical  examination  certificate  must  be  filed  with  the 
enrollment  application.  Immunization  against  typhoid,  para- 
typhoid and  smallpox  is  also  required  when  an  applicant  is 
enrolling  for  services  of  a  nature  which  renders  such  pre- 
cautionary measures  desirable.  Blank  forms  will  be  supplied 
for  this  purpose  and  the  jihysical  examination  and  immuniza- 
tion treatment  will  be  given  without  expense  to  nurses  by  a 
physician  designated  or  provided  by  tlie  Nursing  Service. 

Enrollment  for  public  health  nursing  carried  these  require- 
ments (1020)  : 


1240  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Applicants  must  have  had  at  least  two  years'  high  school 
education  or  its  equivalent  and  must  have  attended  schools  of 
nursing  which  include  in  their  courses  both  theory  and  prac- 
tice in  obstetrics  and  the  care  of  children.  Special  training 
or  experience  in  public  health  nursing  may  be  accepted  by 
the  Red  Cross  to  supplement  deficiencies  in  hospital  training. 
In  addition,  applicants  must  have  had  not  less  than  eight 
months'  experience  on  the  staff  of  a  recognized  public  health 
nursing  association  under  a  supervising  nurse,  or  not  less 
than  a  four  months'  course  in  public  health  nursing  in  a 
school  acceptable  to  the  Red  Cross  Bureau  of  Public  Health 
Nursing.  Exceptions  to  these  requirements  should  be  taken 
up  with  the  Division  Director  of  Public  Health  Nursing  and 
such  applications  will  be  considered  on  their  merits.  The  fact 
that  a  nurse  meets  the  educational  qualifications  and  the  pro- 
fessional requirements  as  Avell  is  not  sufficient  to  secure  her 
acceptance  and  assignment  by  the  Bureau  of  Public  Health 
Nursing.  Personality  and  the  ability  to  manage  difficult 
situations  and  to  carry  responsibilities  will  also  be  considered. 

While  the  minimum  requirement  of  the  Red  Cross  for  pre- 
paratory training  is  a  four  months'  course,  including  both 
theoretical  and  practical  work,  experience  in  the  past  few 
years  has  demonstrated  the  advantages  of  nurses  having  even 
longer  preparation  for  public  health  nursing  in  the  smaller 
communities,  where  the  responsibilities  devolving  upon  the 
nurse  working  alone  are  considerable.  There  is,  in  addition, 
a  great  demand  for  nurses  who  have  had  a  more  thorough 
preparation.  The  four  months'  course  may  be  supplemented 
by  theoretical  work,  such  as  given  in  the  six  weeks'  summer 
course  at  Teachers  College,  Columbia  University,  New  York 
City,  and  by  other  special  courses  offered  by  this  and  other 
educational  institutions. 

In  addition  to  academic  training,  eight  months'  courses, 
including  experience  in  school  nursing,  pre-natal  and  infant 
welfare  work,  tul)erculosis  and  industrial  nursing,  and  other 
branches  of  pu1)lic  Iiealth  nursing  may  be  obtained  in  Bos- 
ton, New  York,  Cleveland,  and  other  sections  of  the  country. 
There  are  a  number  of  universities  or  schools  offering  post- 
graduate courses  in  public  health  nursing  which  are  accept- 
able to  the  Red  Cross. ^^ 

A  later  and  briefer  statement  shows  that  the  hope  of  having 
public  health  training  included  in  the  regular  hospital  had  not 
been  realized.  Tt  is,  in  fact,  often  not  practicable,  and  still 
oftcncr  even  impossible. 

"A.  R.  C.  703,  Revised,  Jiilv  15,  1920. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1241 

Public  health  nursing  is  a  highly  developed  form  of  nurs- 
ing, preparation  for  which  is  not  included  ordinarily  in  the 
training  school  curriculum.  It  is  necessary,  therefore,  for 
the  nurse  who  wishes  to  be  successful  in  this  iield  to  undertake 
a  postgraduate  course  or  to  secure  her  training  through  super- 
vised experience  under  the  direction  of  a  public  health  nurse 
instructor.^^ 

During  the  winter  of  1912  and  1913  letters  of  inquiry  were 
tent  bv  Miss  Clement  to  forty  Visiting  Nurse  Associations  to 
learn  what  course  of  post-graduate  instruction  might  be  oifered 
by  them,  and  what  possibility  of  cooperation  there  might  be 
in  the  special  training  of  rural  nurses,  lieplics  were  received 
from  twenty-six,  and  arrangements  were  made  by  the  Red 
Cross  with  several,  next  to  be  mentioned,  whereby  applicants 
who  had  not  yet  had  suitable  experience  and  who  in  other  re- 
spects were  qualified,  should  receive  a  short  course  in  public 
health  nursing.  None  of  these  associations  charged  tuition. 
Three  of  them  gave  a  salary  during  the  special  training.  Out- 
lines of  the  available  courses  were  typed  by  the  Red  Cross  for 
distribution,  and  their  important  details  are  given  below.  Many 
minor  points  covering  uniform,  expenses,  etc.,  have  been  omit- 
ted as  unessential. 

The  Instructive  District  Nursing  Association,  Boston.^' 

In  response  to  the  increasing  demand  of  the  public  for 
nurses  qualified  for  positions  in  public  hoaltli  work  this  asso- 
ciation oll'ors  to  nurses  of  recognized  hospitals  a  post-graduate 
course  of  four  months  in  public  health  nursing.  This  course 
is  designed  to  give  a  basis  for  any  field  or  social  work  where 
nurses  are  in  demand.  Tiie  variety  of  field  work,  lecture?  and 
class  discussion,  shows  the  relation  of  nursing  to  other  social 
activities.  Field  work  consists  in  nursing  the  patients  under 
the  care  of  the  Instructive  District  Xursing  Association,  in 
preventive  work  for  babies,  in  work  with  the  Boston  Asso- 
ciated Charities,  and  in  tiio  observation  of  the  work  of  several 
Boston  charities.  Three  courses  deal  with  the  following  sub- 
jects for  which  reading  is  required: 

I.  History,  principles  and  administration  of  public  health 
nursing. 

This  includes  tlie  origin  of  district  nursing,  its  purposes, 
j)rinciples,  and  methods,  records  and  record  kcc])ing,  organiza- 
"A.  R.  C.  71.').   Kcvisod.   .\iijrnst    1.    l!t-20. 

"This  association  liad  hocii  tlie  lirst  to  otfcr  puHt-uradiiatc  traijiing  in 
I)uiiiic    licnlll'    luiisin;:.      It    had    taken    tliis    >.tc|)    in    llMiti. 


1242  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tion,  administration  and  reports;  the  development  of  school 
nursing,  preventive  work  for  babies,  tuberculosis  nursing, 
welfare  work  in  shops  and  factories,  hospital  social  service 
and  rural  nursing.  Opportunity  is  given  to  observe  these 
various  branches  of  nursing. 

II.  Medical  and  social  relations  of  disease. 

What  can  be  done  towards  prevention  as  well  as  treatment 
of  infant  mortality,  tuberculosis,  alcoholism,  venereal  disease, 
neurasthenia  and  occupational  diseases.  Proper  nutrition  of 
families  is  considered. 

III.  Elements  of  sociology  and  social  progress. 

a.  Introduction  to  the  social  field  with  special  reference  to 
the  life  of  the  industrial  city  family,  to  get  a  sympathetic  un- 
derstanding of  their  lives,  their  health,  education,  recreation, 
labor,  politics,  religion,  ethics,  and  ideals. 

b.  Social  progress  as  to  health,  education,  recreation,  etc., 
considering  what  other  agencies  are  doing  and  how  nurses  can 
best  cooperate  with  them. 

Henry  Street  Settlement,  ]^ew  York  City. 

The  Henry  Street  Settlement  offers  a  three  months'  course 
in  public  health  nursing.  .  .  .  Each  nurse  is  assigned  to  one 
of  the  regular  Settlement  districts,  for  which  she  becomes 
directly  responsible.  She  is  expected  to  assume  the  nursing  of 
the  patients  in  her  district  with  the  same  care  and  enthusiasm 
that  would  be  shown  if  she  were  to  remain  permanently.  In 
her  district  or  field  work,  she  is  under  the  careful  guidance 
and  instruction  of  her  head  nurse  and  supervisor. 

Class  instruction  is  given  once  a  week.  A  talk  upon  a  given 
subject  on  one  week  is  followed  on  the  next  by  a  visit  of  in- 
spection to  some  institution,  this  visit  being  intended  to  illus- 
trate the  talk. 

Tlie  following  outlines  represent  one  of  the  courses  cover- 
ing three  months. 

Lesson    I.     Observation.     Inspection  of  Ellis  Island. 

Lesson  II.  Talk,  Public  Health  Nursing  in  New  York 
City. 

Lesson  III.  Talk.  Babies'  Welfare  Associations.  After 
the  lecture,  class  visits  the  Settlement  l\[ilk  Koom. 

Lesson  IV.  Talk.  Social  Service  Bureau  of  Mt.  Sinai 
Hospital. 

Lesson  Y.  Stafl'  ^Eeeting.  (a)  Welcome,  by  I>illian  D. 
Wald.  (b)  Organization  of  the  Public  Health  Xursiiuj  As- 
sociation in  the  United  States,  Ella  P.  Crandall,  secretary. 


JHOM  RURAL  TO  PUBLIC  HEALTH  NURSING    124,3 

Lesson  VI.    The  Public  School  Nurse. 

Lesson  VII.  Observation.  School  nursing  in  one  of  the 
Public  Schools. 

Lesson  VIII,  Symposium  on  Settlements  by  members  of 
the  staff  living  in  various  Settlements  in  the  city. 

Lesson  IX.  Staff  Meeting.  Talk :  New  York's  Milk  Sup- 
ply.    (Lantern  Illustrations.) 

Lesson  X.  Observation,  (a)  79th  St.  Branch  of  the  Henry 
Street  Settlement;   (b)   East  Side  House  Settlemeni;. 

Lesson  XI.  Talk,  (a)  Institutions  for  the  care  of  tuber- 
culosis patients;  (b)  Convalescent  care. 

Lesson  XII.  Observations.  The  Rest;  Grand  View  on  the 
Hudson  (Convalescent  Home  of  the  Settlement). 

Visiting  Nurse  Association,  Chicago,  Illinois. 

The  Chicago  Visiting  Nurse  Association  gives  a  three 
months'  course,  covering  the  various  branches  of  public 
health  nursing.  Personal  attention  is  given  by  the  super- 
visor. Weekly  meetings  are  held  at  the  office  and  daily  meet- 
ings at  the  sub-stations. 

Detroit  Visiting  Nurse  Association,  Detroit,  Michigan. 

The  District  Association  provides  a  course  of  three  months, 
giving  the  advantage  of  observation  in  the  several  districts 
with  various  types  of  populations,  in  five  dispensaries  where 
Association  nurses  serve,  in  the  baby  welfare  field,  in  tuber- 
culosis work  including  an  open  air  school,  one  county  and  two 
city  sanatoria  and  in  the  summer  home  for  mothers  and 
children  at  Bay  Court.  Through  the  Board  of  Health  nurses 
get  in  touch  with  the  work  of  the  school  nurses. 

Practical  teaching  in  the  homes  will  be  given  chiefly  by 
the  senior  nurse.  Nurses  are  expected  to  do  general  nursing, 
giving  half  time  to  field  work. 

Eichmond  Instructive  Visiting  Nurse  Association,  Richmond, 
Virginia. 

The  Richmond  Association  provides  a  three  months'  course 
or  longer  with  field  work  under  supervision  of  the  Associa- 
tion. Experience  will  be  given  with  the  staff  of  nurses  doing 
instructive  work  in  the  infant  mortality  and  tuberculosis 
field,  also  experience  with  the  medical  and  sanitary  inspec- 
tors of  the  citv. 


124-4.  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

District  Nursing  Association,  Buffalo,  New  York. 

A  six  months'  course  for  graduate  nurses  is  provided  by 
the  District  Nursing  Association  of  Buffalo,  New  York,  giv- 
ing the  first  months'  training  in  office  experience,  followed  b}' 
practical  field  work  under  a  supervisor  for  four  months, 
changing  districts  and  nationalities,  A  three  months'  course 
is  also  given.  Through  cooperation  with  the  Board  of  Health 
experience  with  the  school  nurses  and  tuberculosis  nurses  is 
provided.  The  baby  welfare  nurses  are  under  the  Nursing 
Association,  and  experience  in  this  field  will  be  included  in  a 
course.  Nurses  will  be  given  opportunity  to  attend  weekly 
conferences  by  the  Associated  Charities. 

Weekly  lectures  are  given  on  such  subjects  as  the  follow- 
ing: Friendly  Visiting;  Principles  of  Organized  Charity; 
County  Poor  Department;  Children's  Aid  and  Care;  Health 
Department;  School  Nursing  and  Child  Hygiene,  Children's 
Court ;  Truant  School ;  Probation  System ;  Crippled  Chil- 
dren's Guild;  Settlement  Work;  District  Nursing  and  Social 
Service  Work. 

Visiting  Nurses'   Settlement,  Orange,  New  Jersey. 

This  association  provides  a  three  months'  course  to  in- 
clude lectures  on  social  and  nursing  work,  classes  in  cooking 
and  general  instruction  in  visiting  nnrsing.  In  classes  for  the 
baby  clinic  instruction  is  given  by  a  physician. 

District  Nursing  Association,  Concord,  New  Hampshire. 

The  association  provides  a  three  months'  course.  Experi- 
ence is  provided  in  connection  with  courses  taken  in  Chicago, 
111..  Concord,  New  Hampshire,  and  Eichmond,  Virginia.  It 
is  the  intention  of  the  Ped  Cross  to  provide  at  least  one 
month's  experience  in  rural  nursing  for  all  nurses  who  have 
completed  a  three  months'  course  with  a  city  organization. 
Experience  in  rural  work  will  be  provided  by  the  District 
Nursing  Association  of  Northern  Westchester  County,  New 
York,  and  the  Nursing  Association  in  Ilagerstown,  Maryland. 

As  other  associations  will  be  utilized  by  the  Ped  Cross  as 
training  centers  for  its  rural  nurses,  the  foregoing  outline  is 
subject  to  additions  at  any  time.  It  is  hoped  that  at  least 
one  association  in  every  state  may  become  a  training  center 
for  Ped  Cross  nurses  in  city  and  country. 

Those    schedul(>s    have    been    repeated    in    detail    because   as 
pioneer   efforts   of   great    sincerity   and   altruism   they   deserve 


FROM  UUllxVL  TO  PUBLIC  HEALTH  NURSING     1245 

recognition,  and  also  bocauso  historically  tlioy  will  sorvc  to 
measure  progress.  Even  a  few  years  after  their  origin,  the 
broadening  and  enriching  of  their  teaching  work  was  marked, 
in  the  ease  of  those  associations  that  continued  to  teach.  The 
Henrv  Street  Settlement,  for  example,  in  afiiliation  with  Teach- 
ers College,  gi'ew  to  the  stature  of  an  eminent  educational 
center.  None  would  now,  at  time  of  writing,  use  the  term 
"course"  in  connection  with  their  carefully  planned  field  work 
and  instruction,  but  however  they  may  expand  no  finer  spirit  of 
service  can  they  show  than  that  of  their  early  and  eager  service. 
As  other  opportunities  w-ere  opened  some  of  the  pioneers  felt 
relieved  of  responsibility. 

Soon  after  these  schedules  had  been  published  twenty-four 
nurses  had  been  assigned ;  twelve  to  Henry  Street  Settlement, 
New  York ;  five  to  the  Ilichmond  Association,  five  to  Boston, 
and  one  to  Chicago. 

This  type  of  preparation  through  apprenticeships  continued 
for  several  years  (1!)12-1015),  gradually  giving  way  to 
"courses''  of  a  more  genuinely  educational  character  given  by 
universities  and  colleges. 

Not  content  with  simply  recommending  the  existing  special 
courses  to  its  applicants,  the  Committee  on  Education,  at  an 
early  moment,  had  gone  thoroughly  into  the  subject  of  prepar- 
ing its  own  minimum  standardized  schedules  of  post-graduate 
work  for  the  help  of  training  centers.  As  early  as  1914  requests 
had  come  from  several  colleges  in  the  South  and  West  for 
outlines  of  courses  for  Rural  Nurses,  and  tentative  sugges- 
tions had  been  submitted  in  reply.  The  demand  for  schedules 
for  suitable  courses  grew  to  be  insistent,  and  this  at  a  time 
when  it  was  difficult  even  for  the  leaders  in  nursing  education 
to  formulate  the  mininuim  requirements  of  post-graduate  study 
to  fit  nurses  for  this  new  and  rapidly  developing  field  of  service. 
The  field  itself  seemed  daily  to  disclose  broader  horizons,  reach- 
ing far  beyond  those  that  the  ordinary  training  of  nurses  had 
equipped  them  to  meet.  To  crowd  specialized  instruction  into 
a  four  months'  post-gTaduate  course  soon  proved  unsatisfactory 
to  the  centers  trying  this  method,  as  well  as  a  severe  tax  upon 
the  student,  and  yet  while  the  Town  and  Country  Nursing 
Service  felt  early  and  keenly  the  need  for  d(>tinite  courses  as 
the  only  sure  foundation  for  the  proper  develojuiient  of  its 
work,  its  recoinineiulations  were,  of  course,  subject  to  the  de- 
cision of  educators.      I'herefore,  while  tentative  outlines  wcvo 


1246  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

sent  out  by  the  Red  Cross  previous  to  1915,  it  was  not  until 
March  of  that  year  that  it  definitely  sanctioned  an  outline,  and 
that  was  for  an  eight  months'  course  only. 

The  early  outlines,  always  tentative,  were  agreed  upon  by 
the  Committee  on  Nursing,  in  two  forms :  one,  the  minimum 
for  a  four  months'  course ;  the  second,  for  an  eight  months' 
course. ^^  They  were  sent,  always  with  emphasis  laid  upon  the 
longer  one,  to  the  various  groups  of  institutions  which  subse- 
quently established  training  centers.  An  active  correspondence 
was  conducted  from  Headquarters  on  the  proposed  courses,  and 
a  general  propaganda  was  carried  on,  including  personal  visits 
to  a  number  of  cities.  The  propaganda  was  of  considerable 
magnitude,  and  it  may  be  justly  held  that  the  influence  of  the 
Red  Cross  in  thus  promoting  opportunities  for  advanced  train- 
ing in  public  health  work  was  very  gTcat  and  constituted  the 
first  efforts  at  standardizing  such  courses.  Miss  Clement  said 
of  that  period: 

The  education  of  the  rural  nurse  was  of  such  vital  impor- 
tance in  the  early  days  of  the  service,  that  our  struggle  to 
locate  opportunities  for  obtaining  it  never  ceased.  Our  out- 
line of  the  four  months'  course  was  prepared  at  the  time  when 
we  first  began  to  insist  that  a  "course"  must  include  academic 
training  and  not  experience  alone.  The  proposal  of  a  training 
center  to  be  established  by  the  Red  Cross  itself,  came  up  be- 
fore the  committees  on  Town  and  Conntry  Nursing  Service, 
but  it  was  generally  agreed  that  teaching  was  the  duty  of 
strictly  educational  institutions  and  should  be  left  to  them. 

The  outlines  of  those  earliest  tentative  schedules  drawn  up 
by  the  Committee  on  Education  are  here  given: 

The  minimum  training  period  in  preparation  for  Red  Cross 
visiting  nursing  is  four  months,  a])proxi]nately  eighteen 
weeks.  It  should  include  class  instruction,  lectures  and  visits 
for  observation,  together  with  practical  work  in  connection 
with  well  organized  public  health  nursing  agencies  in  city  and 
country. 

The  academic  work  of  a  four  or  eight  mouths'  course  given 
in  counection  with  a  uuiversity  or  other  educatioual  institu- 
tion must  be  in  charge  of  a  teacher  nurse  well  grounded  in  the 
principles  and  technique  of  public  health  nursing.  This  part 
of  the  course,  consisting  of  class  instruction  and  lectures, 
should  occupy  five  or  six  hours  weekly.  Additional  time 
should  be  allowed  for  visits  of  observation. 
"  Annual   Meeting,   Committee  on  Xursing,   December,    1913. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    124-7 

Four  ^Months'  Course 

L  Public  health  nursiiif;  (three  hours  weekly)  to  he  given 
by  nurse.  History,  development,  principles,  equipment, 
technique,  nursing  care,  surgical  nursing,  medical  nursing, 
nursing  of  chronics,  nursing  of  children,  nursing  of  infants, 
maternities,  insurance  and  industrial  nursing,  emergencies, 
free  medical  service,  relief  and  cooperation,  fees,  gifts  and 
other  related  subjects,  household  hygiene  and  dietaries, 
clerical  work. 

II.  Hygiene  and   Sanitation.      (Two  hours  weekly.) 

A  general  survey  of  priiuipal  health  problems  of  a  modern 
municipality  and  rural  district. 

The  fundamental  ]trinciplcs  of  sanitary  science,  their  ap- 
plication to  water  supply  and  milk  supply  and  to  the  disposal 
of  sewage  and  garbage. 

Air  supply,  problems  of  tenement  and  factory  sanitation, 
functions  and  methods  of  boards  of  health. 

The  use  of  vital  statistics  as  an  index  of  health  conditions. 

III.  Practical  Sociology   (one  hour  weekly). 

This  course  should  be  designed  to  suggest,  with  such  class 
discussion  as  the  limited  time  permits,  the  important  and 
significant  phases  of  the  social  treatment  of  families  and  indi- 
viduals. It  shoidd  include  the  making  of  an  investigation, 
keeping  of  records,  recognition  of  the  normal  standard  of 
living,  enforcement  of  ordinary  family  and  social  obligations, 
utilization  of  one's  experience  with  individuals  and  families 
in  distress  as  a  contribution  to  movements  for  prevention  and 
social  protection,  and  other  common  elements  in  these  various 
kinds  of  social  work.  Pcading  and  special  topics  for  study 
might  be  included. 

Field  Instruction.  .  .  . 

The  field  nursing  in  its  various  branches  must  be  under 
close  supervision  of  experienced  visiting  nurses.  It  is  im- 
perative that  general  visiting  nursing,  school  nursing,  tuber- 
culosis and  infant  welfare  work  should  be  well  organized  in 
the  city  where  the  course  is  offered.  During  the  course  stu- 
dent nurses  should  be  given  opportunity  to  learn  of  board  of 
health  activities,  what  public  institutions  exist  for  relief,  and 
the  laws  relating  to  health,  education  and  employment  of 
men.  women  and  children.  They  -"hould  attend  Associated 
Charities  conferences,  where  the  relief  work  is  well  organized 
and  learn  of  the  office  routine,  methods  of  family  treatment. 
record  kee])ing  and  use  of  the  contidential  cxcliaiiire.  If  a 
well-organ i zed  social  service  department  of  a  hospital  is 
available,  the  nurses  should  visit  and  learn  of  it<  procedure. 


1248  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Visits  for  observation  to  various  other  social  agencies  might' be 
inchided. 

Of  the  fifteen  weeks'  work  spent  in  the  city,  eleven  might 
be  given  to  general  visiting  nursing  of  surgical,  medical,  ma- 
ternity and  infectious  cases,  special  attention  being  given  to 
asepsis,  use  of  household  utensils,  disposal  of  used  dressings, 
ventilation,  care  of  room,  diet,  medication,  provision  for  care 
between  nurses'  visits,  disinfection,  sick  room  comforts,  baths, 
provision  for  care  of  family  during  illness  of  a  parent,  isola- 
tion and  quarantine  precaution,  treatment  of  family  problems, 
cooperation  with  other  agencies,  special  branches,  two  weeks 
in  the  schools,  one  week  in  tuberculosis  and  contagious  nurs- 
ing, and  one  in  infant  welfare  work.  Record  keeping  in  the 
various  branches  of  public  health  nursing  should  be  a  subject 
of  special  study.  If  experience  in  these  branches  is  included 
in  the  general  work  of  a  visiting  nurse  association,  corre- 
sponding allowance  should  be  made  in  the  amount  of  time 
devoted  for  special  work  in  each  branch. 

The  last  three  weeks  should  be  spent  in  a  rural  community, 
if  possible  where  school  nursing  is  carried  on,  and  where  the 
nurse  has  developed  classes  or  clubs  for  young  persons,  or- 
ganized mothers'  conferences  or  has  been  instrumental  in  de- 
veloping other  forms  of  social  work.  It  would  be  well  for  the 
nurse  to  attend  a  meeting  of  the  local  visiting  nurse  associa- 
tion and  to  have  explained  to  her  the  form  of  organization, 
duties  of  committee  and  methods  of  financing  the  work,  that 
she  might  understand  the  problems  from  that  side. 

Eight  Months'  Course 

I.  Public  health  nursing  (see  I  under  four  months' 
course) — "^J^hree  hours  weekly. 

II.  Nutrition — Two  hours  weekly. 

A  non-technical  study  of  the  functions  and  nutritive  values 
of  foods,  the  feeding  of  families  and  larger  groups  with  par- 
ticular reference  to  nutritive  requirements  and  the  cost  of 
food  in  relation  to  the  family  budget. 

III.  Elements  of  psychology  and  their  application  to  nurs- 
ing problems— Two  liours  weekly. 

IV.  Preventive  Medicine — Two  hours  weekly. 

^Methods  of  application  by  nurses  of  modern  scientific  medi- 
cal knowledge  in  the  prevention  of  disease;  the  causes  of  in- 
fant mortality,  tuberculosis  and  the  more  prevalent  communi- 
cable diseases;  alcoholism,  feeble-mindedness,  insanity,  etc., 
and  available  measures  for  prevention  and  methods  of  care. 

V.  Hygiene  and  Sanitation — Two  hours  weekly.  (See 
n  under  "Four  months'  course."') 


IKOM  RURAL  TO  PUBLIC  HEALTH  NURSING    1249 

VI.  Modern  Social  Problems — Two  hours  weekly. 

An  introduction  to  the  study  of  modern  social  problems 
and  their  relations.    Such  topics  as  the  following: 

Adjustments  made  necessary  by  changes  affecting  the  fam- 
ily, property  and  freedom  of  contract ;  the  demands  for  better 
protection  of  personal  rights  in  contrast  to  property  rights, 
emphasized  by  the  growth  of  the  democratic  movement;  the 
tendency  toward  direct  action  in  the  affairs  of  government; 
the  control  of  industrial  conditions  in  the  interest  of  the  com- 
mon welfare;  the  adjustment  of  the  educational  system  to 
modern  needs;  the  public;  health  movement  in  its  relation  to 
other  social  ])roblems;  the  movement  through  labor  organiza- 
tions and  other  voluntary  associations,  or  through  social  legis- 
lation and  social  insurance,  to  raise  and  maintain  the  stand- 
ard of  living;  finally  the  emphasis  upon  cooperation  in  con- 
trast to  individualism. 

VIT.  Practical  Sociolog}' — One  hour  weekly.  (See  III  un- 
der "Four  Months'  Course.") 

VIII.  Pural  Sociology — One  hour  weekly. 

In  j\rarcli,   1915,  the  schedule  given  above  was  revised  in 
certain  details  as  follows.     The  new  material  only  is  shown : 

III.  A  Study  of  Mental  Processes  Involved  in  the  Work  of 
a  Xurse  with  Individuals  and  Communities — Two  hours 
weekly.      (Compare   III.  Elements  of  Psychology.) 

This  course  will  include  definitions  and  class  exercises  illus- 
trating certain  connnon  mental  processes.  These  will  be  con- 
sidered in  their  connection  with  tho  bedside  and  educational 
work  of  a  nurse  and  application  made  with  reference  to  her 
aiiproach  to  individuals,  families,  classes  and  other  group 
meetings,  as  well  as  to  the  entire  community.  Foreign  and 
native  populations  in  their  old  and  new  environments  will  be 
studied  with  reference  to  customs,  superstitions  and  other 
racial  characteristics.  Practice  in  construction  of  lesson  plans 
and  jiresentation  of  subject  material  will  be  required.  Con- 
crete plans  for  community  service  will  be  developed. 

VII.  Practical  Sociolog}'  (slightly  modified) — One  hour 
weekly. 

This  cdurse  should  be  designed  to  suggest,  with  such  class 
discussions  as  the  limited  time  permits,  the  important  and 
significant  ])liases  of  the  so{Mal  treatnuMit  of  families  and  indi- 
viduals. It  slionld  include  the  making  of  an  investigation,  the 
kee])ing  of  records,  the  recognition  of  the  normal  standard  of 
living,  the  enforcement  of  ordinary  family  and  social  obli- 


1250  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

gations  and  other  elements  of  social  work.  Reading  and 
special  topics  for  study  might  be  included. 

VITI.  Rural  Sociology  (new) — One  hour  weekly. 

This  course  is  descriptive  and  sociological  in  character  with 
a  purpose  of  directing  students  into  practical  forms  of  ser- 
vice. It  includes  lectures,  recitations  and  a  limited  number  of 
special  papers  presented  by  members  of  the  class.  The  ma- 
terial used  is  the  Country  Life  Bibliography  on  the  topics, 
Church,  School,  Public  Health,  Good  Roads,  Cooperation, 
etc.  A  study  is  made  of  the  history  of  rural  society,  its  ex- 
tent, the  rural  population,  size,  composition,  sources,  regional 
populations;  the  rural  community,  types  and  organization, 
peculiar  communities  and  peoples,  contrasting  types,  as  the 
individualist  and  the  highly  socialized  communities,  princi- 
ples of  social  service,  methods  and  results,  specific  problems 
such  as  poverty,  rural  health,  rural  education,  the  country 
church,  cooperative  organization  and  the  method  and  princi- 
ple of  rural  survey  for  finding  the  basis  of  country  social 
service. 

To  this  suggested  outline,  several  training  centers  having  by 
that  time  been  opened,  as  we  shall  see  later,  the  Committee  on 
Nursing  added: 

Your  committee  expects  to  present  for  your  consideration 
during  the  current  year  a  resolution  to  the  effect  that  only 
training  centers  offering  eight  months'  courses  shall  be  ac- 
cepted as  giving  satisfactory  preparation  for  Red  Cross  Town 
and  Country  Nursing  Service ;  that  a  suggestive  outline  for  an 
eight  months'  course  as  herewith  presented  be  endorsed  and 
your  Superintendent  be  authorized  to  use  it. 

No  sooner  had  the  needs  of  the  Rural  Service  become  evi- 
dent than  Miss  Nutting,  at  the  head  of  the  Department  of 
Nursing  and  Health  at  Teachers  College,  Columbia  University, 
took  action  to  meet  them. 

A  special  four  months'  course  was  established  there  in  the 
winter  of  1913-1014.  The  practical  instruction  was  worked 
out  in  cooperation  with  the  Henry  Street  Settlement  and  the 
District  Nursing  Association  of  Westchester  County,  New 
York. 

Two  months  were  spent  in  the  Settlement,  in  visiting  nursing 
in  the  homes ;  one  in  the  Division  of  Child  Hygiene  and  Con- 
tagious Diseases  of  the  New  York  Board  of  Health  ;  one  with 
the  public  school  nurses  and  in  the  Tuberculosis  Service  and 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING     1251 

Milk  Stations,  and  ono  in  the  rural  nursing  work.  Instruction 
by  means  of  lectures,  conferences  and  excursions  was  given 
twice  weekly  by  Teachers  College,  as  grouped  under  the  three 
heads:  1,  Public  Health  Nursing;  2,  Rural  Life  Problems;  3, 
The  Application  of  Preventive  Medicine  in  Nursing. 

Teachers  College,  said  Miss  Clement,  was  thus  the  first 
educational  institution  in  the  country  to  offer  a  course  by 
whicli  graduate  nurses  coukl  receive  academic  instruction  in 
rural  problems  in  coiniection  with  a  short  course  in  public 
health  nursing. 

The  Boston  Visiting  Nurse  Association  (formerly  the  In- 
structive District  Nursing  Association  of  Boston),  followed 
next  to  Teachers  College  in  framing  a  course  meeting  the  spe- 
cial needs  of  the  Red  Cross  Town  and  Country  Nursing  Ser- 
vice. It  gave  its  practical  teaching  in  a  ''model  district"  under 
a  competent  supervisor.  Two  months  spent  in  this  way  were 
followed  by  two  in  preventive  work  with  mothers  and  babies, 
and  the  field  work  of  the  Associated  Charities,  under  the  guid- 
ance of  the  respective  secretaries  of  those  associations.  Special 
provision  was  made  for  actual  service  in  rural  communities, 
and  special  classes  and  reading  on  rural  problems  provided. 
The  lectures  and  class  work  covered : 

1.  History,  principles,  and  administration  of  public  health 
nursing; 

2.  Medico-social  relations  of  diseases ; 

3.  Elements  of  sociology  and  social  progress. 

Excursions  were  arranged  weekly  to  institutions  and  char- 
itable agencies  in  l>ost()n.  Opportunities  were  given  for  obser- 
vation of  industrial  welfare  work,  public  school  nursing  and 
tuberculosis  nursing  and  prevention. 

Similar  steps  were  taken  in  a  number  of  other  localities  so 
that  the  Red  Cross  Report  covering  the  year  ending  Novem- 
ber 30,  11)  1(),  said: 

Four  and  eight  months'  courses  have  been  opened  this  year 
in  Cincinnati.  Columbus  and  Chicago.  Tlie  estal)lislunent  of 
such  courses  closely  concerns  the  dcvelopiiicut  of  the  Town 
and  Country  Nursing  Service.  ...  St.  Louis.  Baltimore  and 
Iowa  City  are  anionic  centers  now  organizing  general  courses 
in  public  healtli   nursing.     ^lilwaukee  bas  a  tbree  months' 


1252  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

course  and  several  cities,  among  them  Pittsburgh  and  Detroit, 
are  offering  lecture  courses  for  nurses  on  public  health  topics. 
Seventeen  nurses  have  entered  upon  courses  this  year.  The 
increased  number  of  nurses  desiring  to  qualify  for  Red  Cross 
service  in  the  eight  months'  courses  in  preference  to  the 
shorter  periods  of  training,  is  a  particularly  encouraging'  fea- 
ture in  the  development  of  rural  nursing.  Ten  nurses  now 
taking  eight  months'  postgraduate  courses  in  Boston,  New 
York,  Philadelphia  and  Chicago,  will  be  available  for  appoint- 
ment in  June. 

The  results  of  improved  opportunity  were  shown  in  the 
following  record : 

Out  of  sixty-six  nurses  in  service  in  1916,  thirty-three  had 
had  special  courses  including  academic  training,  fourteen 
having  had  eight  months'  courses.  Of  the  total  number  of 
thirty-three,  fourteen  were  prepared  at  Teachers  College  in 
conjunction  with  Henry  Street  Settlement,  four  months' 
course ;  two  were  prepared  at  Teachers  College,  eight  months' 
course ;  eight  were  prepared  at  Phipps  Institute,  eight  months' 
course;  three  were  prepared  at  Boston  Instructive  District 
Association  in  conjunction  with  Boston  School  for  Social 
Work,  eight  months'  course;  four  were  prepared  at  Boston 
Instructive  District  Nursing  Association,  four  months' 
course;  one  at  New  York  School  for  Social  Work,  eight 
months'  course ;  and  one  at  the  Chicago  A^isiting  Nurse  Asso- 
ciation, four  months'  course. 

Two  of  these  taking  the  Summer  Course,  four  and  eight 
months'  course,  and  seventeen  the  four  and  six  months'  course 
given  in  conjunction  with  Henry  Street  Settlement. 

Covering  about  this  same  period,  twenty-two  candidates 
for  the  Town  and  Country  Nursing  Service  entered  the  Bos- 
ton Instructive  District  Nursing  Association  courses  given 
in  conjunction  with  other  local  agencies.  Of  these  five  took 
the  eight  months'  and  seventeen  the  four  months'  course. 

A  year  later  Columbia  University  took  another  advanced 
step  by  preparing  Teachers  College  to  give  special  public  health 
instruction  to  undergraduate  nurses  during  their  hospital 
training. 

While  it  was  true  that  public  health  nursing  in  general 
was  becoming  more  and  more  seriously  developed,  yet  the  con- 
crete specialty  of  rural  work  was  not  always  thoroughly  dealt 
with.     On  this  point  Aliss  Clement  wrote : 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING     1253 

With  one  or  two  exceptions  the  courses  in  public  health 
nursing  do  not  include  study  or  experience  in  rural  health 
and  sanitation  or  practical  experience  in  rural  nursing. 
There  is  need  for  such  a  course  for  while  knowledge  of  city 
conditions  serves  as  a  good  foundation  for  rural  work,  some 
knowledge  of  rural  sociology  and  familiarity  with  country 
life  will  forestall  lessons  otherwise  to  he  learned  hy  sad  ex- 
perience. Any  one  of  the  present  schools  of  public  health 
nursing,  were  financial  assistance  from  the  IJed  Cross  forth- 
coming, might  willingly  provide  for  specialization  in  rural 
nursing. 

In  1919,  of  thirteen  educational  institutions  giving  public 
health  nursing  courses,  two  were  recorded  as  giving  eight 
months',  four  giving  four  months',  and  two  nine  months'.  The 
others  gave  summer  or  evening  courses. 

With  the  development  of  the  Educational  Committee  of  the 
National  Organization  for  Public  Health  Nursing  (1917-1918) 
it  was  no  longer  neccssarv  for  the  Red  Cross  to  give  time  and 
labor  toward  stimulating  the  establishment  of  courses  in  public 
health  nursing,  or  advising  upon  the  form  and  contents  of  their 
curricula.  For  then  a  new  committee  of  the  N.  O.  P.  H.  X.  took 
over  these  responsibilities,  and  employed  an  educational  secre- 
tary to  carry  on  its  work,  ^fuch  of  the  time  of  this  secretary 
was  given  to  field  work,  visits  to  schools  already  conducting 
or  preparing  to  open  public  health  nursing  courses.  The 
Committee  nuide  a  study  of  existing  centers  with  the  aim  of 
arriving  at  a  satisfactory  basis,  and  presently  announced  a 
minimum  standard  based  largely  on  the  previous  models  set 
up  by  the  Kcd  Cross  Town  and  Country  Xursing  Service.  It 
then  gradually  compiled  a  list  of  schools  which  maintained  this 
standard  and  which  it  endorsed.  In  1918  the  Town  and 
Country  Xursing  Service  definitely  placed  the  responsibility 
of  endorsement  upon  the  Xational  Organization  for  Public 
Health  Xursing.  i^y  July,  1921,  tlu^'c  were  t('n  public  health 
nursing  courses  fully  endorsed  by  the  Educational  Committee 
of  the  Xational  Organization  for  Public  Health  Xursing  and 
nine  tentativ(>ly  endorsed,  meaning  that  full  (Mulnrsemciit  was 
to  be  given  when  certain  (jualitications  had  been  met.  All  of 
these  courses  were  us(>d  by  the  Red  (^ross  for  the  training  of 
public  health  nurses  who  had  been  grant(>d  scholarships. 

The  public  lu^alth  nursing  courses  wer(>  established  on  a 
sound  educational   basis.      In  most  cases  they  were  a  j^art  of 


1251  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  curriculum  of  a  leading  university  and  in  a  few  they  were 
developed  within  a  school  for  social  service  or  social  economy. 
Lectures  and  instruction  of  a  high  order  in  the  theory  of  public 
health  nursing  were  thus  assured. 

The  length  of  the  courses  was  usually  one  academic  year, 
with  the  possibility  of  further  specialized  or  advanced  study. 
A  course  of  four  months  was  also  offered  for  nurses  unable  to 
take  the  longer  one. 

The  work  of  the  courses  was  divided  about  evenly  into 
theory,  obtained  in  the  university  or  school,  and  field  work, 
where  the  theory  was  applied.  To  this  end,  practice  fields  were 
developed  or  existing  facilities  utilized  to  provide  supervised 
experience  in  the  different  forms  of  public  health  nursing. 
Thus  for  four  months  of  study  and  class  room  instruction  in 
the  principles  of  public  health  nursing,  medical  inspection  and 
school  nursing,  nutrition,  communicable  disease  control,  sani- 
tary science,  educational  and  industrial  hygiene,  educational 
psychology  and  sociology  and  principles  of  modern  social  work, 
the  student  spent  the  full  four  months  in  the  field  putting  into 
practice  what  the  course  had  taught  her.  Perhaps  the  greater 
part  of  the  time  would  be  spent  on  the  staff  of  a  good  visiting 
nurse  association  which  offered  experience  in  the  care  of  all 
kinds  of  illness  in  the  home  and  in  teaching  the  principles  of 
healthful  living,  home  hygiene  and  sanitation.  Some  time 
would  be  spent  on  the  staff"  or  at  least  in  observing  the  work  of 
the  school  nurses ;  with  the  board  of  health  nursing  staff, 
observing  methods  of  communicable  disease  control  and  other 
activities.  A  definite  period  of  actual  family  ease  work  would 
be  aft'orded  with  a  charity  organization  society  so  that  the  nurse 
might  become  accustomed  to  treating  the  family  as  a  unit  and 
also  might  gain  an  insight  into  social  problems  and  their  solu- 
tion. Experience  in  methods  of  infant  and  child  welfare,  nu- 
trition, care  of  dclin(iucnts,  dependents  and  other  special  classes 
was  included  either  through  participation  or  observation.  Some 
courses  provided  also  a  rural  field  where  conditions  peculiar  to 
country  life  might  be  met. 

This  incomplete  list  serves  to  show  how  public  health  nurs- 
ing education  had  progressed  since  the  short  time  when  the 
pioneer  district  mirsing  associations  provided  the  only  means 
for  public  health  nursing  training. 

The  process  of  eil'ecting  a  working  union  with  local  groups 
prepared  to  assist  in  taking  up  rural  work  preceded  and  gave 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1255 

rise  to  the  present  organization  of  the  Town  and  Country 
Nursing  Service  as  perfected  in  its  central  and  related  associa- 
tions, and  therefore  logically  comes  next  in  our  text. 

As  already  pointed  out,  there  were  few  Red  Cross  Chapters 
before  the  World  War,  nor  did  these  occupy  themselves  espe- 
cially with  questions  of  health.  It  was,  therefore,  to  groups  of 
a  different  character  that  the  Rural  Nursing  Committee  first 
turned. 

To  reach  and  inform  such  groups  a  pamphlet  was  issued 
(1913)  giving  a  statement  of  the  aims  of  the  Rural  Nursing 
Service  and  offering  suggestions  on  how  to  organize  a  local 
nursing  association.  Local  groups  were  asked  to  w^ite  to  Head- 
quarters, and  upon  request  suitable  b^'-laws  for  their  needs 
and  an  outline  of  suggested  duties  would  be  forwarded  to  them, 
A  year  later  (1914)  a  revised  pamphlet  called  ''American  Red 
Cross  Town  and  Country  Nursing  Service,  General  Outline, 
Form  No.  2"  contained  full  information  on  every  point.  From 
those  first  leaflets  only  the  earliest  and  later  sections  historically 
interesting  will  be  quoted,  in  order  that  changes  may  be  traced 
and  the  general  continuity  on  main  lines  made  clear. 

It  is  the  purpose  of  the  Eed  Cross,  through  its  To^vn  and 
Country  Nursing  Service,  to  further  the  establishment  of 
local  nursing  associations  in  order  that  the  services  of  the 
visiting  nurse  may  be  brought  within  reach  of  small  towns  and 
country  districts  of  the  United  States,  and  through  afTiliation 
witli  local  organizations  to  assist  them  in  promoting  the  inter- 
ests of  public  health  nursing.  In  accordance  with  this  pur- 
pose the  Hed  Cross  endeavors : 

1.  To  assist  local  groups  iu  the  organization  and  adminis- 
tration of  nursing  associations  within  its  scope  when  called 
upon  to  do  so. 

2.  To  develop  a  personnel  of  eflficient  visiting  nurses  well 
equipped  by  trainiufj  and  exjierience  for  visiting  nursing  in 
the  smaller  connnunities,  such  nurses  to  be  employed  by  local 
organizations  atliliated  witb  the  Town  and  Country  Nursing 
Service. 

.3.  To  assist  atliliated  or<ranizatioiis  in  maintaining  approved 
standards  of  public  health  nursing,  and  in  various  ways  to 
help  the  iiurses  meet  the  health  needs  of  their  connnunities 
more  adecpiately. 

I'he  acceptanc(>  of  a  few  regulations  on  the  ]iart  of  local 
organizatioiis  constitutes  afliliation  with  iho  Town  and  Coun- 
try Nursing  Service.    These  conditions  have  been  adopted  for 


1256  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  purpose  of  establishing  some  degree  of  uniformity  in  the 
administration  of  visiting  nursing.  They  consist  of  standard 
regulations  deemed  essential  by  the  Eed  Cross  to  conserve  the 
best  interests  of  local  nursing  associations  and  the  community 
at  large.  All  other  regulations  or  recommendations  contained 
in  this  "Outline"  are  suggested,  not  prescribed. 

1.  An  affiliated  organization  shall  regularly  employ  such 
visiting  nurses  as  fulfill  the  requirements  of  the  Eed  Cross 
and  are  appointed  to  its  Town  and  Country  Xursing  Service. 

(Although  the  assignment  and  dismissal  of  these  visiting 
nurses  is  made  by  the  Red  Cross,  whether  they  retain  their 
position  or  not  depends  upon  the  recommendation  of  the 
affiliated  organization  by  which  they  are  employed,  and  to 
which  they  are  directly  responsible.) 

2.  Temporary  or  substitute  visiting  nurses  employed  by  an 
affiliated  organization  shall  be  approved  by  the  Red  Cross. 

3.  At  least  six  months'  salary  shall  be  assured  before  a 
visiting  nurse  is  assigned  to  duty  by  the  Eed  Cross. 

4.  When  on  duty  Eed  Cross  visiting  nurses  shall  wear  the 
uniform  and  pendant  of  the  Town  and  Country  Nursing 
Service. 

5.  The  constitution,  by-laws,  rules  and  regulations  that  con- 
cern the  visiting  nursing  of  affiliated  organizations  shall  be 
approved  by  the  Eed  Cross  (and  before  adoption  any  subse- 
quent alterations  or  timendments  thereto). 

6.  The  designation  "in  affiliation  with  the  American  Eed 
Cross  Town  and  Country  Xursing  Service"  shall  always  follow 
titles  of  an  affiliated  organization  when  appearing  on  publi- 
cations, record  blanks,  etc. 

7.  For  each  year's  service  a  Eed  Cross  visiting  nurse  shall 
be  entitled  to  one  month's  vacation  with  pay,  during  which 
time  a  substitute  nurse  sliall  be  employed.  (The  Eed  Cross 
will  endeavor  to  supply  substitutes.) 

8.  In  order  to  guarantee  maintenance  of  nursing  standards, 
the  work  of  Eed  Cross  visiting  nurses  shall  at  all  times  be 
subject  to  inspection  by  the  Eed  Cross. 

9.  The  nursing  of  patients  by  Eed  Cross  visiting  nurses 
shall  always  be  carried  on  under  the  direction  of  a  physician. 

10.  When  two  or  more  visiting  nurses  are  employed  in  one 
community  by  an  affiliated  organization,  one  shall  be  desig- 
nated by  the  Eed  Cross  as  liead  nurse  or  superintendent.  In 
such  instances  it  is  so  advised  that  provision  be  made  for  the 
nurses  to  live  together,  exceptions  to  which  custom  shall  be 
approved  by  the  Eed  Cross. 

11.  Eed  Cross  visiting  nurses  shall  keep  careful  records  of 
their  patients  on  report  cards  provided  or  approved  by  the 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1257 

Eed  Cross,  and  an  attiliated  organization  sliall  sul)niit  to  the 
Red  Cross  duplicates  of  the  niontlily  reports  made  by  the 
nurse  or  report  sheets  for  this  puipose. 

12.  Eed  Cross  visiting  nurses  shail  not  attend  infectious 
diseases  unless  due  provision  can  be  made  for  the  care  of  other 
patients.  (They  give  instruction  in  nursing  and  every  possi- 
ble assistance  to  families  in  which  such  cases  occur.) 

!;>.  lied  Cross  visiting  nurses  shall  not  act  as  midwives 
when  medical  attendance  is  available. 

14.  A\'herevor  an  aHiliated  organization  assumes  the  re- 
sponsibility of  nursing  care  of  industrial  policy-holders  for 
the  Metropolitan  Life  Insurance  Company,  the  montlily  re- 
ports of  such  visits  sent  to  the  office  of  the  company  in  ac- 
cordance Mith  an  arrangement  previously  effected,  shall  be 
acconi])anied  by  bills  for  the  amount  to  be  paid  by  the  com- 
pany to  the  Ked  Cross  for  the  ser\ice  rendered,  the  full 
amount  of  said  bills  to  be  remitted  by  the  Eed  Cross  to  the 
Affiliate<l  organization. 

15.  An  annual  report  of  the  work  of  an  affiliated  nursing 
organization  made  to  the  Eed  Cross  on  special  forms  fur- 
nished for  this  purpose  shall  be  submitted  in  January  of  each 
year. 

16.  An  affiliated  organization  shall  agree  to  employ  a  Eed 
Cross  visiting  nurse  for  a  period  of  not  less  than  a  year,  and 
to  notify  the  Eed  Cross  in  writing  of  any  intention  thereafter 
to  withdraw  from  affiliation  one  month  before  it  may  be 
discontinued.  This  agreement  is  made  with  th'e  understand- 
ing that  should  the  Eed  Cross  deem  it  advisable  to  discontinue 
affiliation  it  will  do  so  by  giving  a  month's  notice  of  its  inten- 
tion to  the  affiliated  organization. 

In  1014  l)nt  two  changes  were  made  in  the  '^Conditions  of 
Affiliation."  namely: 

2.  If  at  any  time  an  affiliated  organization  desires  a  change 
of  nurses  at  least  one  month's  notice  thereof  shall  be  given 
to  the  Eed  Cross  and  the  nurse  employed. 

And  this  proviso  was  added  : 

(Conditions  (^f  Affiliation  are  snliject  to  amendment  by  the 
Eed  Cross  as  further  experience  may  indicate.) 

The   second   article   of  '"Conditions  of  Affiliation"'    of   1013 
was  amplified  (  1014)  to  read: 


1258  HISTORY  OF  AMERICAN  RED  CROSS  NURSIXG 

When  temporary  nursing  assistance  is  necessary,  affiliated 
organizations  will  engage  a  nurse  who  is  a  graduate  of  a 
hospital  training  school  giving  at  least  two  years  of  general 
medical,  surgical  and  obstetrical  training  in  a  hospital  having 
a  minimum  daily  average  of  fifty  patients.  An  effort  will 
always  be  made  by  the  Eed  Cross  to  supply  qualified 
substitutes. 

Of  the  advantages  to  local  nursing  associations  of  affiliation 
with  the  Red  Cross,  the  first  circular  said : 

Upon  the  affiliation  of  a  local  nursing  organization  with  the 
Town  and  Country  Nursing  Service,  the  latter  assumes  no 
financial  or  other  local  responsibility,  or  does  it  impose  any 
fee.  On  the  contrary,  certain  benefits  are  extended  to  affili- 
ated organizations,  made  possible  by  a  large  endowment  fund 
to  be  used  by  the  Eed  Cross  for  this  special  purpose. 

1.  A  distinct  advantage  lies  in  the  assurance  that  Eed  Cross 
visiting  nurses  have  met  a  definite  standard  as  to  character 
and  as  to  preparation  for  visiting  nursing. 

2.  The  Eed  Cross  meets  the  expense  of  a  general  super- 
vision of  its  visiting  nurses,  maintained  by  occasional  visits 
of  the  superintendent  of  nurses  and  supervisors,  and  through 
monthly  and  annual  reports  kept  by  the  nurses  and  submitted 
by  local  committees  to  the  Town  and  Country  Nursing  Serv- 
ice. Tliig  supervision  in  no  way  interferes  with  the  responsi- 
bility of  a  nurse  to  the  local  organization  under  which  her 
work  is  conducted.  On  the  other  hand,  through  these  visits, 
it  is  made  possible  for  affiliated  organizations  to  obtain  help- 
ful suggestions  as  to  methods  of  administration  that  have 
proved  of  value  in  other  sections  of  the  country. 

3.  By  various  forms  of  assistance  given  to  its  nurses,  the 
Eed  Cross  can  best  serve  its  affiliated  organizations.  A  travel- 
ing library  is  maintained  for  their  use,  including  standard 
works  on  economic  and  social  problems. 

4.  In  most  rural  sections  nurses  are  cut  off  from  helpful 
association  with  others  doing  similar  work.  Both  they  and 
their  committees  often  realize  that  they  are  handicapped  by 
this  isolation,  whereas  identification  with  an  extensively  or- 
ganized public  health  agency,  as  the  Town  and  Country 
Nursing  Service,  would  give  them  an  added  stimulus  toward 
the  establishment  and  maintenance  of  high  standards  of  visit- 
ing nursing.   .  .  . 

7.  The  Eed  Cross  supplies  affiliated  organizations,  without 
charge,  with  record  cards,  receipt  books,  l)edside  notes,  aud 
monthly  report  sheets  used  in  connection  with  the  local  work 


FROM  RURAL  TO  PUBLIC  HEALTH   NURSING     1259 

of  the  nurse.  These  cards  are  adapted  to  the  use  of  small 
communities.  A  set  of  forms  to  l)e  used  in  school  work  has 
been  prepared,  and  may  be  purciiased  In*  aniiiated  organiza- 
tions. Atliliated  or^'anizations  are  not  required  to  use  the 
Red  Cross  forms  where  they  have  preference  for  otliers. 

8.  A  supply  of  visiting  nurses'  bags  and  equipment  is  kept 
on  hand  by  the  Red  Cross  in  Wasliington.  They  may  be 
purchased  by  alliliated  organizations. 

For  the  ^lidanco  of  affiliated  societies  these  rules  for  the 
nursing  service  were  sent  out : 

1.  Appointment  to  the  Rural  Nursing  Service  will  be  for  a 
period  of  one  year,  and  reappointment  may  be  made  for  each 
year  subsequent  thereto.  A  nurse  may  leave  during  the  first 
three  montlis  in  the  service,  but  after  that  time  she  is  ex- 
pected to  remain  throughout  the  year,  except  in  case  of  serious 
illness,  or  when  tiie  local  committee  recommends  otherwise. 

2.  A  rural  nurse  will  be  given  a  certificate  of  appointment 
and  furnished  with  a  Red  Cross  pendant  bearing  her  appoint- 
ment number.  The  latter  is  to  be  worn  only  when  she  is  in 
regulation  uniform  of  a  Red  Cross  rural  nurse,  which  she 
should  wear  while  on  duty.  The  pendant  remains  the  prop- 
erty of  the  I?cd  Cross  and  must  be  returned  when  her  con- 
nection with  the  society  has  ceased. 

3.  Rural  nurses  will  receive  thirty  days'  vacation  annually 
with  j)ay  and  this  vacation  is  to  be  devoted  to  rest. 

4.  It  is  not  expected  that  under  ordinary  circumstances 
nurses  will  1)0  called  upon  for  night  duty,  but  in  case  of 
emergency  where  tliis  is  necessary  provision  should  be  made 
for  tlie  care  of  their  jiatients  during  the  day.  Patients  will 
l)e  visited  on  holidays  and  Sundays  when  special  or  innnediate 
attention  is  required.  P>xcept  in  emergencies  the  nurse  is 
expected  to  make  visits  at  night  only  at  the  request  of  a 
physician. 

5.  It  is  advisable  that  calls  for  a  nurse  be  accepted  from 
all  sources  in  (-onununitics  where  tliis  ])lan  is  ])racticable.  but 
it  sliould  be  generally  understood  tliat  the  nursing  of  patients 
is  always  conducted  under  the  direction  of  a  medical  prac- 
titioner. 

().  A  nurse  is  expected  to  obtain  the  consent  of  her  com- 
mittee before  answering  the  call  of  a  ])hysician  outside  her 
district  and  this  should  only  be  given  when  the  nurse's  other 
cases  ])erniit. 

7.  Nurses  are  ex})ected  to  pay  for  aprons,  uniforms,  liats 
and  coats  of  tlie  ])attern  prescriljed  for  Red  Cross  rural  nurses. 


1260  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

8.  Xurses  are  not  allowed  to  attend  infectious  diseases 
unless  due  provision  can  be  made  for  the  care  of  the  other 
patients.  They  may  give  instruction  in  nursing  and  every 
possible  assistance  to  families  in  which  such  cases  occur. 

9.  They  should  not  act  as  midwives  when  medical  aid  is 
available,  nor  under  ordinary  circumstances  be  expected  to 
attend  normal  deliveries.  They  may  answer  calls  to  patients 
reported  any  time  after  confinement. 

10.  Where  two  or  more  nurses  are  employed  in  a  com- 
munity, one  will  be  designated  head  nurse. 

11.  Xurses  should  not  accept  personal  presents  of  money 
from  patients  or  friends  of  patients, 

12.  They  should  not  attempt  to  influence  the  religious  or 
political  opinion  of  patients,  to  influence  patients  in  the 
choice  of  a  physician,  or  prescribe  for  patients  or  dispense 
drugs  except  under  directions  of  a  physician. 

13.  Nurses  are  not  allowed  to  solicit  in  any  way  for  com- 
mercial interests  with  which  the  Ked  Cross  through  local 
organizations  cooperate  in  the  care  of  the  sick. 

14.  Giving  of  material  relief  is  outside  the  sphere  of  the 
visiting  nurse,  and  cases  requiring  such  aid  should  be  reported 
to  the  committee  or  directly  to  an  agency  in  the  community 
whose  province  it  is  to  provide  for  such  needs.  The  nurse, 
however,  should  be  provided  with  means  for  relieving  emer- 
gency need  until  such  time  as  her  committee  or  the  relief 
agencies  can  act.  This  "emergency  fund"  might  also  be 
increased  to  include  extraordinary  expenses  such  as  a  night 
nurse,  or  a  relief  nurse,  or  the  transportation  of  a  patient 
when  necessary. 

15.  Kural  nurses  are  expected  to  keep  careful  records  of 
their  patients  on  report  cards  provided  by  the  Red  Cross  for 
this  purpose, 

16.  To  avoid  leaving  verbal  messages  with  patients  or  their 
friends  when  not  able  to  communicate  directly  with  the 
physician,  the  nurse  should  do  so  in  writing,  and  in  order  to 
protect  both  patient  and  the  nurse  it  is  hoped  that  under 
similar  circumstances  the  physician  will  observe  the  same 
rule. 

17.  Xurses  should  be  held  responsible  for  property  loaned 
by  the  local  board  of  patients,  and  they  should  take  a  receipt 
for  the  same,  seeing  that  it  is  returned  in  good  condition. 

18.  Xurses  are  expected  to  share  in  the  responsibility  of 
local  committees  in  every  way,  to  protect  their  property  and 
practice  economy  in  the  use  of  supplies. 

10.  Xurses  will  be  under  the  general  supervision  of  the 
Eed  Cross,  which  will  be  maintained  by  occasional  visits  of 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1201 

the  superintendent  of  rural  nurses  and  through  tlieir  montlily 
and  annual  reports  submitted  by  local  conimittees.  This 
supervision  will  in  no  way  interfere  with  the  responsibility  or 
the  nurse  to  the  local  board  under  which  her  work  is  con- 
ducted. 

20.  Enrolled  Ked  Cross  nurses  form  the  nursing  reserve  of 
the  Army  and  Xavy.  They  are  called  u])on  for  (hity  only  in 
time  of  war  and  for  emergency  work  during  cahimities  or 
national  disasters.  Enrolled  lied  Cross  nurses  may  be  ap- 
pointed as  rural  nurses,  in  which  case  tiiey  will  not  be  sul;ject 
to  call  for  emergency  work  outside  their  own  community. 

21.  Kural  nurses,  although  primarily  responsible  for  the 
efficient  care  of  patients,  are  expected  to  take  an  active  interest 
in  families,  teaching  by  instruction  and  demonstration  tiie 
principles  of  hygiene  as  applied  to  their  homes  and  surround- 
ings as  well  as  of  person.  They  should  know  the  health  laws 
and  what  opportunities  exist  in  their  community  for  the 
improvement  of  unsanitary  and  other  unfavorable  conditions 
in  which  the  patients  live.  They  should  be  informed  upon 
social  matters  and  avail  themselves  of  educational  advantages 
within  their  reach  to  enable  them  to  meet  more  adequately  the 
needs  of  their  people.  With  the  support  of  an  al^le  and 
enthusiastic  committee,  they  have  unlimited  opportunities  for 
constructive  work  through  the  homes,  interested  individuals, 
private  societies,  country  scliools  and  other  public  institutions. 

The  foregoing  conditions  and  regulations  are  subject  to 
amendment  as  I^ed  Cross  rural  nursing  develops. 

Affiliation  with  societies  organized  on  the  state-wide  plan 
was  a  question  of  frequent  recurrence.  It  had  been  considered 
premature  in  1914.  In  1015  it  still  seemed  so,  but  a  beginning 
was  then  made.      The  BuUetin  of  Xovember  17,  1915,  said: 

It  would  l)e  impracticable  for  the  Ked  Cross  to  contract 
atliliation  with  State  organizations  in  wliich  cases  it  would  he 
im])ossiblc  to  meet  its  ol)ligations  tlK'rel)y  assumed  to  sup])ly 
qualified  visiting  nurses.  Tlie  Red  Cross,  however,  as  far  as 
it  can,  will  appoint  nurses  for  local  work  at  the  instigation  of 
State  organizations  to  communities  where  local  Red  Cross 
athliation  with  the  nursing  organization  or  committee  is 
accomplished. 

An  important  reservation  made  in  191("1  was  u]ion  the  rela- 
tionship with  relief-giving  societies.  It  was  tinally  dccich'd 
that  such  affiliation  should  not  be  cnten-ed  into,  as  it  was  lield 
to   be   inadvisable   to   associate   the    nurses    in   the   public   mind 


1262  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

with  agencies  for  giving  material  relief  or  charitable  aid.  Up 
to  that  time,  affiliation  with  such  bodies  had  not  been  entirely 
ruled  out,  although,  as  the  regulations  show,  emphasis  had  been 
laid  on  the  importance  of  separating  the  nurse's  work  from  that 
of  the  charity  worker.  Such  separation,  however,  for  practical 
purposes,  was  difficult  and  from  the  popular  point  of  view 
impossible,  if  affiliation  actually  existed  between  charitable 
bodies  and  Red  Cross  nurses. 

The  official  record  on  this  point  was: 

The  attitude  among  the  leading  nursing  associations  today 
being  against  material  relief  giving,  the  question  as  to  whether 
or  not  Eed  Cross  affiliation  Avith  Associated  Charities  should 
be  contracted  was  discussed  at  length.  Miss  Wald  moved  that 
the  sense  of  this  committee  he  recorded  as  against  affiliation 
with  organizations  of  relief,  or  those  known  as  relief  giving 
agencies.  Mr.  Bicknell  seconded  the  motion,  which  waj 
carried. ^^ 

On  the  matter  of  financing  visiting  nursing  the  earliest  sug- 
gestions made  to  local  associations  for  their  guidance  were : 

1.  The  chief  item  of  expense  in  rural  nursing  is  the  salary 
of  the  nurse.  The  cost  of  livery  will  be  an  important  item  in 
some  communities.  This  may  be  lessened  by  suggesting  to 
families  requiring  the  services  of  the  nurse  that  tliey  send  a 
conveyance  for  her  when  possible.  The  use  of  a  bicycle  or 
horseback  riding  may  often  be  practicable.  Where  there  is  no 
telephone  in  the  house  where  a  nurse  resides  one  should  be 
provided  where  possible.  A  fully  equip])e(]  bag  for  profes- 
sional use  should  be  loaned  her  by  tlie  local  Board.  It  will  be 
necessary  to  maintain  a  supply  closet  from  whith  articles  may 
be  loaned  or  rented  to  patients.  Xcodle  Work  fiuilds  ami 
other  societies  may  be  expected  to  contribute  some  of  the 
necessary  supplies. 

2.  Various  ways  of  raising  money  are  in  a-Mioral  use. 
"Members  of  the  board  should  improvise  digiiilied  methods 
adaptable  to  local  conditions.  As  many  ])erso  .  •  in  the  com- 
munity as  possible  should  be  urged  to  contribute  toward  the 
Avork,  either  by  an  annual  house-to-iiouse  camass  or  by  send- 
ing out  written  requests.  As  all  persons  without  any  lines  of 
distinction  enjoy  the  benefits  of  impro\ed  conditions  l)rou,<rli' 
about  through  the  nursing  association,  contributions  from 
all   should   be   solicited.      Those   who   can    well    alforrl   larr' 

*•  Minutes:  Town  and  Country  Nursing  Service,  Dec.  12,  1010. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1263 

subscriptions  sliould  be  encouraged  to  make  them,  and  every 
contribution,  no  matter  how  small,  should  be  welcome. 

3.  Fees  collected  from  patients  should  add  considerably  to 
the  income.  It  is  a  generally  accepted  principle  among  lead- 
ing nursing  associations  that  patients  should  pay  for  the 
services  of  the  nurse.  Her  field  of  usefulness  is  greatly 
extended  by  working  as  far  as  possible  on  a  business  basis. 
Many  will  thus  utilize  her  services  who  on  other  terms  would 
resent  the  idea  of  employing  a  "charity  nurse."  Patients  are 
expected  to  pay  for  professional  visits  according  to  their 
means  and  nurses  and  local  committees  should  encourage 
patients  to  do  so.  Where  it  is  practicable  a  nominal  fee 
sliould  be  designated,  regulation  of  which  is  a  matter  for  local 
boards  to  discuss.  If  a  patient  is  unable  to  meet  the  full 
charge,  the  amount  to  be  collected  should  be  left  to  the 
discretion  of  the  nurse.  Sick  persons  who  should  receive 
nursing  care  and  are  unable  to  pay  for  it  should  not  for  this 
reason  be  denied  the  services  of  the  nurse.  Patients  who  are 
able  to  engage  a  private  nurse  are  not  expected  to  utilize  the 
services  of  a  rural  nurse  except  in  cases  of  emergency. 

4.  Sometimes  several  small  villages  which  alone  cannot 
raise  funds  sufficient  to  carry  on  rural  nursing  may  unite  in 
this  work  and  share  the  necessary  expenses. 

5.  Through  cooperation  between  the  Metropolitan  Life 
Insurance  Company  and  the  Red  Cross,  the  nurse's  visits  to 
industrial  policy  holders  will  be  paid  for  by  the  Insurance 
Company,  and  funds  thus  collected  will  be  used  to  increase  the 
income  to  local  nursing  associations. 

f).  Churches,  women's  clubs  and  various  local  societies  will 
often  contribute  toward  the  work.  Boards  of  education, 
health  departments,  local  and  county,  may  appropriate  an 
annual  amount  toward  the  care  of  school  children  or  for 
sanitary  measures  carried  on  by  the  nurse.  Local  nursing 
associations  should  appeal  to  their  county  and  state  tubercu- 
losis societies  and  other  agencies  working  along  public  health 
lines.  Large  organizations  interested  in  special  diseases,  or 
those  interested  in  improving  general  living  conditions,  may 
lend  financial  assistance  to  commimities  within  their  field  of 
activity.  If  only  a  few  months'  salary  is  available,  the  work 
sliould  be  put  under  way.  This  is  the  best  method  of  edu- 
cating a  community  to  the  need  and  usefulness  of  a  visiting 
nurse. 

Certain  minor  changes  in  the  rules  of  afiiliation  were  made 
from  time  to  time.  In  lOlS  a  somewhat  complicated  procedure 
for  payincnt  bv  the  ^letropolitan  Life  Insurance  Company  for 


1264  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

services  to  its  policy  holders  was  simplified  by  authorizing 
affiliated  societies  to  negotiate  matters  of  payment  directly  with 
the  company.  At  some  time  in  the  summer  of  1917  the  pen- 
dant worn  by  the  nurse  was  given  up  and  from  then  on  the 
Ked  Cross  public  health  nurse  wore  the  regular  pin. 

In  1919  the  privilege  of  using  the  Red  Cross  emblem  was 
withdrawn  from  affiliated  organizations,  although  they  might 
continue  to  use  the  words  ''In  affiliation  with  the  Red  Cross 
Bureau  of  Public  Health  Nursing."  This  became  necessary, 
as  the  war  growth  of  chapters  was  so  great  that  every  county 
had  its  Red  Cross  Chapter,  and  where  affiliated  nursing  organi- 
zations also  were  formed,  bearing  the  emblem  and  collecting 
funds  under  its  sanction,  confusion  resulted  and  difficult  situa- 
tions arose. 

Although  the  granting  of  scholarships  and  loans  was  a  very 
important  feature  in  the  early  development  of  the  service,  it 
became  so  much  more  complex  as  related  to  the  later  growth 
that  it  has  seemed  best  to  deal  first  with  the  progress  of  organi- 
zation : 

In  the  initial  work  of  organizing  the  Rural  Nursing  Service 
following  the  preliminaries  of  1910  and  1911,  the  special  com- 
mittee in  charge  of  this,  with  Miss  Boardman  as  first  chairman, 
was  organized  under  the  National  Relief  Board.  This  differen- 
tiated, at  the  outset,  the  nurses  of  the  Rural  Nursing  Service 
from  those  who  had,  from  the  time  of  the  reorganization  of  the 
Red  Cross  (1904),  enrolled  for  war  service  or  emergency  call 
under  the  War  Relief  Board. 

In  1915  the  Committee  on  Town  and  Country  Nursing 
Service  lost  the  immediate  and  personal  association  with  Mrs. 
Whitclaw  Reid  which  it  had  had  from  its  foundation,  for  her 
prolonged  absence  from  the  country  decided  her  to  resign  as 
chairman  of  the  committee.  Her  place  was  filled  by  ^Irs. 
Harriet  Blaine  Beale,  for  many  years  closely  associated  with 
the  Visiting  Nurse  Society  of  the  District  of  Columbia. 

In  the  following  year  Mr.  Ernest  P.  Bieknell,  Miss  Blanche 
E.  Hazard,  Mrs.  William  C.  Osborn,  and  ]\Liss  Ruth  Morgan 
became  members  of  the  committee.  At  the  annual  meeting  of 
the  Central  Committee  in  December,  1916,  the  war  pressure 
making  a  more  coniplete  amalgamation  nec(>ssary,  unification 
was    brought    about.      All    Red    Cross    nursing,    of    whatever 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING     1265 

variety,  was  then  composed  into  one  general  service,^*'  with 
ordered  subdivisions,  as  has  been  described  under  Mobilization. 
Hitherto  there  had  been  no  formal  relation  between  the 
Town  and  Country  Nursing  Service  under  the  National  Relief 
Board,  and  the  Nursing  Service  operating  under  the  War  Relief 
Board.  But  now  (191  (J)  all  Red  Cross  nurses  were  placed  in 
one  "Red  Cross  Nursing  Service,"  of  which  the  component 
parts  were  defined  thus* 

Tlie  term  "Red  Cross  Nursmg  f^ervice"  includes  (a)  the 
National  Committee:  (b)  State  and  Local  Committees  on 
Nursing  Service  and  such  other  committees  as  it  may  deem 
necessary  to  appoint;  (c)  all  enrolled  Red  Cross  nurses,  in- 
cluding members  of  the  Town  and  Country  Nursing  Service ; 
(d)  enrolled  dietitians,  Sisterhoods  and  other  orders,  when 
assigned  to  duty  under  the  Red  Cross;  and  (e)  women  volun- 
teers selected  for  liospital  service  or  other  duties  relating  to 
the  care  of  the  sick. 

All  nurses  employed  by  Chapters,  other  Red  Cross  organi- 
zations, or  aflliliated  societies  authorized  to  use  the  Red  Cross 
insignia,  must  be  enrolled  Red  Cross  nurses  and  subject  to  the 
regulations  of  the  Nursing  Service. 

All  Red  Cross  courses  of  instruction,  except  those  in  First 
Aid  and  Accident  Prevention,  are  under  the  control  of  the 
Red  Cross  Nursing  Service. 

This  National  Committee  was  empowered  to  create  special 
sub-committees.  The  Town  and  Country  Nursing  Service  next 
(1917)  becamo  one  of  the  two  bureaus  operating  under  the 
National  Committee  on  Nursing  Service,  the  other  being  the 
Bureau  of  Nursing  Service.  The  title  of  the  superintendent 
was  altered  to  "Director  of  the  Bureau"  and  certain  changes 
of  policy  for  the  nursing  staff  were  adopted,  which  will  be  dealt 
with  in  a  later  paragraph.  The  position  given  to  organized 
nurses  on  the  National  Committee  was  unique  among  interna- 
tional Red  Cross  societies,  and  emphasized  both  the  recognition 
of  and  the  grave  responsibility  devolving  upon  the  American 
nursing  profession  as  a  self-controlled  body  of  organized 
workers.  In  July,  1017,  a  third  bureau,  that  of  Instruction, 
had  been  organized  in  the  Red  Cn^ss  Nursing  Sci-vice,  but  the 

*"  Tlio  Minutes  of  tlie  Central  Committee,  December  13.   1916,  read: 
'•RESOLVED:    First,  that  the  Committee  on  Town  and  Country  Nursing 
be  hereby   discontinued   and   tliat   tlie   duties   and    functions   with   wliich    it 
was  chartred  be  transferred  to  tlie  National  Committee  on  Xursin<:  Service." 


1266  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

functioning  of  the  Bureau  of  Town  and  Country  Nursing  was 
unaltered. 

In  December,  1915,  when  the  three  governing  boards  of  the 
Red  Cross  were  made  advisory,  the  executive  powers  which  they 
had  formerly  had  were  placed  in  newly  created  Departments. 

The  Department  of  Civilian  Relief  then  functioned  as  had 
the  former  ''National  Relief  Board"  and  the  Town  and  Coun- 
try Nursing  Service  bore  the  same  relation  to  it  as  it  had  borne 
toward  the  older  body.  This  arrangement,  however,  resulting 
as  it  did  in  a  division  of  responsibility  between  the  "Nursing 
Service"  and  the  '^Department  of  Civilian  Relief,"  was  not 
permanent,  and  on  December  7,  1917,  the  Red  Cross  Nursing 
Service  was  made  a  Department,  and  thenceforth  the  Town  and 
Country  Nursing  Service  functioned  as  one  of  its  bureaus. 
The  general  extension  of  branches  and  Division  headquarters 
that  took  place  during  the  war  has  been  outlined  (see  Mobiliza- 
tion), and  the  reorganization  after  the  war  will  be  described 
in  a  final  chapter. 

No  special  form  or  name  was  required  of  local  organizations 
wishing  to  affiliate,  but  simply  that  they  should  have  the  purpose 
of  promoting  rural  visiting  nursing  by  the  help  of  the  Red 
Cross  organization  and  equipment.  However,  when  affiliation 
was  effected  with  a  society  not  primarily  organized  for  com- 
munity nursing,  an  effort  was  always  made  to  have  a  special 
group  created  to  be  directly  responsible  for  this  branch  work : 

It  is  expected  that  in  the  development  of  TJed  Cross  rural 
nursing,  local  committees  will  be  created,  meeting  standards 
of  salary  and  other  regulations  which  are  deemed  necessary  to 
insure  the  best  interests  of  a  community.  The  locality  bene- 
fited by  file  work  of  a  nurse  is  expected  to  meet  the  expenses 
connected  with  it.  Fees  collected  from  patients  are  not 
sufficient  for  this,  as  all  sick  persons  arc  not  able  to  pay  for 
the  services  of  the  nurse.  As  a  rule,  patients  are  expected  to 
pay  for  professional  visits,  according  to  their  means,  but  those 
unable  to  make  any  payments  should  not  go  uncared  for. 
The  responsibility  for  raising  the  necessary  funds  rests  witli 
the  local  committee,  which  also  superintends  tlie  work  of  the 
nurse. 

How  necessary  and  valuable  the  influence  of  the  Red  Cross 
was  and  is  locally  in  maintaining  good  nursing  standards,  is 
well  illustrated  by  the  following  incident.     A  local  association 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1267 

affiliated  in  the  early  days  with  the  Red  Cross  formed  a  secon- 
dary, informal  relation  with  another  local  group  not  connected 
with  the  Red  Cross.  This  second  group  employed  untrained 
women,  whom  it  called  "attendant  nurses."  The  Red  Cross 
then,  through  its  affiliated  associations,  requested  the  secondary 
group  to  use  only  the  term  '^attendant"  and  to  discontinue 
calling  untrained  women  ''attendant  nurses."  It  is  precisely 
by  such  easy  steps  as  the  above  that  local  standards  may  be 
lowered  in  the  absence  of  some  strong,  central,  unifying  body. 
The  early  work  of  the  I^ed  Cross  in  encouraging  local  pioneer 
efforts  was  tireless  and  painstaking.  No  beginning  was  too 
small  to  receive  its  fostering  care.  As  a  result,  it  created  an 
atmosphere  that  stimulated  and  encouraged.  An  advantage  of 
a  strong  central  body  is  found  in  the  inspiration  of  the  feeling 
communicated  to  its  membership,  of  belonging  to  something 
large,  something  luitional.  The  personal  visits,  the  national 
correspondence,  the  definite  standards,  convey  a  sense  of  sup- 
port and  encouragement. 

While  supervisors  soon  come  to  be  a  necessity  in  any  large 
organization,  they  were  also  definitely  useful  in  the  early  work 
as  organizers.  This  was  recognized  from  the  first,  and  in  the 
Report  of  191-3  we  read: 

To  reach  the  most  neglected  communities,  it  is  necessary 
for  an  organization  to  spend  much  time  in  the  field,  and  the 
demand  for  this  work  will  in  future  be  more  adequately  met 
by  the  appointment  of  another  nurse,  whose  salary  will  be  paid 
by  tlie  l?e(l  Cross.  With  this  addition  to  the  staff,  it  will  be 
possible  to  make  regular  and  systematic  visits  of  inspection  to 
affiliated  organizations,  and  more  opportunity  will  be  available 
to  respond  to  many  calls  asking  for  someone  to  present  the 
work  at  various  clubs  and  mass  meetings,  whicli  has  been 
possible  thus  far  only  to  a  limited  degree. 

In  1014  the  Iveport  said: 

]\riss  Abbie  f?ol)erts.  formerly  superintendent  of  the  Msit- 
ing  Xurse  Association  of  Cincinnati,  and  wlio  has  recently 
completed  a  course  in  the  Department  of  Xursing  and  Healtli 
at  Teaclicrs  Colle(re,  Columbia  University,  has  beeen  ajipointcd 
supervisor  of  Red  Cross  visiting  nurses. 

Fifty-one  supervisory  visits  to  affiliated  organizations  have 
be(Mi  niad(^  by  the  superintendent  and  supervisor  during  1!)14, 
and,   with   the   |)ur])()se  of   placing  before  nurses   the  public 


1268  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

health  needs  of  the  smaller  communities,  they  have  presented 
the  work  of  the  Town  and  Country  Nursing  Service  in  seventy- 
five  hospital  training  schools. 

In  1914  the  field  supervising  nurses  of  the  Metropolitan 
Insurance  Company,  four  in  number,  who  were  appointed  to 
the  Town  and  Country  Nursing  Service,  were  requested  by  the 
Red  Cross  to  make  a  special  study  of  the  demands  made  upon 
rural  nurses  and  the  preparation  needed  by  members  of  the 
Town  and  Country  Nursing  Service.  At  an  informal  meeting 
in  St.  Louis,  held  later  that  year  (1914),  these  field  nurses, 
whose  work  took  them  from  coast  to  coast,  met  with  the  Com- 
mittee of  the  Town  and  Country  Nursing  Service  of  the  Red 
Cross  to  discuss  their  findings.  An  arrangement  had  lasted 
for  a  year  (1913-1914)  by  which  these  supervisors,  paid  by 
the  Company,  made  reports  to  the  Red  Cross  of  organizations 
aifiliated  with  the  Rural  Nursing  Service.  In  the  matter  of  a 
uniform  standard  the  Red  Cross  visiting  nurses  were  under  the 
general  supervision  of  the  superintendent  or  her  supervisors. 
But  in  matters  relating  to  their  local  work  their  responsibility 
to  the  local  group  was  complete. 

In  1915  the  supervisory  visits  numbered  sixty-seven  with 
eighteen  more  for  organizing  work.  In  1916,  sixty-nine,  with 
many  additional  meetings  with  committees  and  public  officials, 
and  to  address  organizations  and  mass  meetings. 

The  Annual  Report  of  the  service  for  1917  said: 

A  second  supervising  nurse  was  employed  for  several 
months  early  in  the  year.  This  has  made  more  visits  to 
communities  possible  than  during  1916.  One  hundred  and 
eight  supervisory  visits  and  fifteen  visits  of  organization  were 
made.  To  do  justice  to  a  most  important  function  of  the 
Town  and  Country  Nursing  Service,  additional  supervisors 
are  needed.  ^Many  affiliated  organizations  are  seeking  more 
frequent  supervisory  visits  than  the  present  limited  number 
permits. 

To  help  the  local  applicants  it  was  agreed  that  members  of 
the  Town  and  Country  Nursing  Service  Committee  should, 
whenever  possi])le,  act  as  advisors  and  organizers  in  their  own 
environments,  and  the  superintendent  recommended  that 
annual  conferences  for  Red  Cross  visiting  nurses  and  affili- 
ated local  groups  be  arranged  for  yearly  at  the  time  of  the 
annual  Ked  Cross  meetin^r  in  Washinciton, 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1269 

To  assist  ill  tlio  formation  of  local  units  the  Red  Cross 
Nursing  Service  prepared  and  distributed  leaflets  of  advice  on 
how  to  organize.  The  earliest  form  of  this  advice  was  included 
in  the  first  pamphlet  issued  by  the  Service  in  1013. 


In  any  work  the  initial  efforts  have  a  special  interest, 
and  are,  moreover,  too  easily  lost  sight  of,  and  so  it  is  befitting 
to  record  the  affiliations  of  1913  and  1914  that  they  may  not 
be  forgotten. 


Location 


Name  of  Organization 


Date  of 
Affiliation 


Cuyahoga  Falls,  Ohio 
Warrenton,  Va. 
Hot  Springs,  Va. 

Bloomfield,  N.  J. 


Winchoater,  Va. 
East  Islip,  N.  Y. 

Clarksburg,  W.  Va. 
Laurel,  Md. 

Spartanburg,  S.  C. 


Dorset,  Vermont 
Gloucester,  Mass. 

Greenwood,   Va. 

Purchase,  N.  Y. 
Manchester,   Mass. 


Greenville,  S.  C. 

Cohaaset,  Mass. 
Chilton  County,  Ala. 

Pahnerton,  Pa. 


\'isiting  Nurse  Association  July      1,   191,3 

District  Nurse  Association  "         " 

Hot  Springs  Valley  Nursing  As-  "         " 

sociation 

League      for      Friendly      Service      Aug.      1, 
(Community    Nursing    Service 
taken  over  by  R.  C.  Chapter) 

District       Nurses'       Association  "         " 

(Community  Nursing  Service) 

Visiting  Nurse  Committee  of  R.  "         " 

C.  Cliapter   (Community  Nurs- 
ing Service) 

Women's  Civic  Club  (Community       Sept.     1, 
Nursing  Service) 

Visiting       Nursing       Committee  "       15, 

(Temporary  Community  Nurs- 
ing) 

Spartanburg       Health        League  "     .  30, 

(Community     nursing     service 
cotton   mills) 

Dorset  Nursing  Association  Nov.      1, 

Gloucester   District   Nursing  As-  "         8, 

sociation.  Inc. 

Greenwood  Visiting  Nurse  Asso-  "       21, 

ciation 

Purchase  Nursing  Association  Dec.     1.3, 

Manchester  Visiting  Nurse  Com-  "       23, 

mittee    of    the    \V(mien's    Club 
(Community  Nursing  Service) 

Children's    Charity    Circle,    later       Feb.       1,   1914 
known  as  Public  Health  Nurs- 
ing Association 

District    Nursing    Committee    of  "         6,  .    " 

the  Social   Service   League 

Cliilton    County   Health   Commit-       Mar.    24,      " 
tee     (Primarily    health    educa- 
tional    work     with     3     county 
schools) 

Visiting     Nurse     Committee     of       Apr.    16,      " 
New   .Tersev   Zinc   Co. 


1270  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 


Location 


Name  of  Organization 


Date  of 
Affiliation 


Hazard,  Ky. 
Albemarle  County,  Va. 

Franklin,  N.  J. 

Canaan,   Conn. 
Chippewa  Falls,  Wis. 
Cambridge,  Md. 
Grosse  Pointe,  Mich. 

Alorgantown,  W.  Va. 

ilt.  Carmel,  111. 
Bridgeton,  N.  J. 

Jerome,  Arizona 
Litchfield,  Conn. 
Fulton,  Ky. 


Perry    County   Nursing   Associa-       May      4,      " 

tion   (Mining  section  of  moun- 
tain and  general  work) 
Community   Work   of   Bureau   of       June     1,      " 

Rural    Sanitation,    Va.     State 

Board  of  Health    (Educational 

Health  Service) 
Visiting     Nurse     Committee     of  "       13,      " 

New   Jersey   Zinc  Co.    (Indus- 
trial   Nursing    on    Community 

basis) 
North     Canaan     Visiting    Nurse      Aug.      1,      " 

Association 
Associated  Charities  (Community  "        5,      " 

Nursing  Service) 
Cambridge  Visiting  Nurse  Asso-       Sept.   12,      " 

ciation 
Mutual  Aid  Society  and  Neigh-      Oct.       1,      " 

borhood       Club       (Community 

Nursing  Service) 
Child  Welfare  Committee  of  As-  "         "       " 

sociated  Charities    (taken  over 

by    Morgantown    Chapter,    A. 

R.   C,  Nov.    1,   1919) 
Women's       Club        (Community  "         7,      " 

Nursing    Service) 
City  Nurse  Committee  of  Bridge-  "         8       " 

ton  Civic  Club   (taken  over  by 

Cumberland  County  Chapter — 

Community    Nursing    Service) 
Visiting  Nurse  Association    (Re-  "      21,      " 

opened  under  Board  of  Health) 
Litchfield  District  Nursing  Asso-       Nov.    20,      " 

ciation 
R.     C.    Public     Health     Nursing       Dec.      3,      " 

Service     ( formerly    known    as 

City      Health      and      Welfare 

League  until  Nov.  18,  1918) 


If  space  permitted,  credit  should  be  given  in  the  case  of 
ever}'  association  listed  above  to  some  one  or  more  specially 
devoted  women  to  whose  ability  and  influence  success  was 
largely  due.  It  would  be  a  fitting  tribute  to  them  to  mention 
special  phases  of  their  work,  but  one  which  would  require 
anotlier  volume. 

So  wroto  the  first  superintendent  of  the  service,  and  she  added : 

Then,  too,  if  anyone  connected  with  the  Town  and  Country 
Xursing  Service  deserves  sjiecial  mention,  it  is  that  grouj)  of 
niirses  who  labored  with  such  faithfulness  and  courage  in 
countrv  districts  from  the  beginning. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1271 

They  were  superior  women,  the  heart  and  soul  of  the 
public  health  nursing,  and  after  all  k  said  the  greatest  benefit 
of  affiliation  resulted  from  their  attraction  to  the  Ked  Cross 
and  the  appointment  of  women  of  their  type. 

Before  the  outbreak  of  the  World  War  the  organization  of  the 
Red  Cross  by  Chapters  was  but  slightly  developed.  Those  that 
were  strongest  were  in  large  cities  where  the  rural  nursing  idea 
was  not  felt,  and  as  a  rule  the  Chapters  did  not  then  take  up 
activities  along  lines  of  health  conservation.  It  was  only  after 
the  entrance  of  the  L^nited  States  into  the  war  that  rural  sec- 
tions generally  organized  into  Chapters,  and  not  until  after 
the  armistice  did  these  Chapters  turn  to  the  activity  of  the 
public  health  service. 

The  influence  of  the  war  on  both  general  organization  and 
the  Town  and  Country  Nursing  Service  was  profound.  As  to 
the  nursing  service,  a  completely  new  policy  was  formulated, 
and  in  organization  generally  new  forms  developed.  The  nurs- 
ing staff  will  be  considered  first. 

It  is  to  be  remembered,  at  this  point,  that  while  any  regularly 
enrolled  Red  Cross  nurse  with  additional  requirements  for 
public  health  nursing  might  enter  the  Town  and  Country 
Nursing  Service,  and  many  did,  not  all  Town  and  Country 
nurses  were  necessarily  "enrolled."  For  them  enrollment  for 
war  service  had  not  at  first  been  required,  and  in  place  of  the 
Red  Cross  badge  of  the  enrolled  nurse  the  To^\^l  and  Country 
Nursing  Service  staff  wore  a  pendant,  but  under  the  excitement 
of  the  war  menace  a  new  situation  arose,  partly  brought  about 
by  the  inclination  of  nurses  to  volunteer  for  the  war;  partly 
from  the  desire  on  the  part  of  the  leaders  in  Public  Health 
Nursing  to  keep  their  forces  intact  in  this  country.  The  situa- 
tion offered  these  alternatives:  Either  the  Public  Health 
Nurse  was  to  be  put  in  a  separate  group,  of  which  the  members 
should  be  given  credit  for  military  service,  or  all  nurses  should 
be  allowed  to  decide  freely  whether  to  take  active  service  under 
the  War  Department,  or  home  service  in  their  own  country.  A 
combination  of  these  alternatives  eventually  brought  about  a 
kind  of  classification  enrollment  for  the  Red  Cross,  In  1U17 
Miss  Clement  wrote : 

When  the  two  Services  were  brought  together  under  the 
one  administration,  definite  provision  was  made  liy  the  Na- 
tional Coniniittee  on  Hed  Cross  Xursincr  Service  regularly  to 


1272  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

enroll  nurses  who  were  available  for  the  Town  and  Country 
Nursing  Service  solely.  Thus  all  nurses  assigned  to  duty 
under  this  Service  are  now  enrolled  Red  Cross  nurses.  They 
are  enrolled  as  any  other  Red  Cross  nurse  by  the  National 
Committee  on  Nursing  Service,  but  with  the  understanding 
that  response  to  a  call  for  war  service  is  not  compulsory,  or 
any  other  Red  Cross  duty  outside  the  community  to  which 
they  already  are  assigned  under  the  Town  and  Country 
Nursing  Service. 

The  Bulletin  of  April  15,  1917,  said: 

While  one  of  the  most  important  duties  of  the  Red  Cross  is 
to  maintain  at  all  times  an  adequate  enrollment  of  nurses 
for  service  in  the  event  of  war,  the  rapid  development  of 
various  peace  activities  under  the  Nursing  Service  has  made 
it  desirable  to  enroll  nurses  with  special  qualifications  who 
might  be  available  for  war  duty. 

Certain  exceptions  to  the  usual  requirements  for  enroll- 
ment will  therefore  be  made,  as  in  the  case  of  nurses  selected 
for  committee  work,  those  willing  to  act  as  Instructors  of 
Red  Cross  classes,  and  candidates  for  public  health  nursing 
under  the  Town  and  Country  Nursing  Service. 

Many  inquiries  regarding  the  calling  out  of  enrolled  Red 
Cross  nurses  in  the  Town  and  Country  Nursing  Service  for 
war  relief  work  have  been  received  of  late,  both  from  nurses 
and  their  nursing  organization.  There  being  over  eight 
thousand  enrolled  Red  Cross  nurses,  those  assigned  to  duty 
under  the  Town  and  Country  Nursing  Service  will  not  be 
called  out  by  the  Red  Cross  for  war  service.  Although  the 
latter  would  not  be  debarred  from  volunteering  for  war  ser- 
vice, the  Red  Cross  considers  the  public  health  work  in  which 
they  are  at  present  engaged  as  most  important,  and  only  if 
urgent  needs  of  this  country  require  it  would  the  Red  Cross 
consider  calling  them  for  other  duty. 

The  following  letter  from  Miss  Delano  to  the  nurses  belongs 
to  this  period : 

April  2 G,  1918. 

In  these  days  of  unprecedented  demand  upon  the  nursing 
profession,  decision  as  to  tlie  relative  usefulness  of  individual 
efFort  is  often  a  matter  of  great  difficulty.  The  call  for  nurses 
for  military  service  both  here  and  abroad  must  rightly  and  of 
necessity  draw  heavily  upon  the  nursing  resources  of  tlie 
country,  but  we  feel  that  the  public  health  nurse  is  also  an 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1273 

important  factor  in  the  preservation  of  national  health.  It  is 
therefore  the  policy  of  the  Hed  Cross  to  leave  undisturbed  as 
long  as  possible  the  nurses  of  its  Town  and  Country  Xursing 
Service. 

Should  a  change  of  this  policy  (which  now  seems  unlikely) 
ever  become  necessary  you  will  be  personally  notified.  Mean- 
while, I  hope  you  will  continue  at  your  present  work  with  the 
assurance  that  the  Red  Cross  fully  appreciates  its  importance 
and  value  to  the  country. 

We  are  planning  to  supply  an  insignia  to  be  worn  on  the 
arm  by  all  Ked  Cross  nurses  who  at  our  request  are  remaining 
at  their  present  post  of  duty. 

Very  sincerely  yours, 

(signed)    Jane  A.  Delano,  Director, 

Department  of  Nursing. 

This  attitude  of  tho  Red  Cross,  strongly  supported  by  public 
health  bodies  generally,  was  quickly  justified  by  events,  for 
while  on  the  one  hand  war  demands  broke  through  the  routine 
of  peace,  on  the  other,  the  calls  for  nurses  for  health  conserva- 
tion were  immensely  increased,  and  the  nurses  who  stood  at 
their  posts  in  this  field  were  classified  as  the  Special  Service 
Group.  This  group  has  already  been  described  with  sufficient 
detail.  In  the  Bulletin  of  October,  1918,  Mary  S.  Gardner 
wrote : 

Soon  after  the  declaration  of  war  the  National  Committee 
on  Ked  Cross  Nursing  Service  provided  for  an  enrollment  of 
pui)lic  health  nurses  to  be  held  available  for  public  health  work 
under  the  lied  Cross  either  in  this  country  or  abroad.  Later 
it  seemed  necessary  to  safeguard  the  training  of  our  ])upil 
nurses  and  the  maintenance  of  our  national  health  by  creating 
a  special  group  for  all  nurses  holding  important  positions  in 
training  schools  or  in  public  health  nursing.  This  group  was 
called  the  Special  Service  Group.  As  soon  as  this  ])lan  was 
completed  ^liss  Delano  sent  you  a  letter  to  tell  you  that  the 
Ked  Cross  recognizes  the  important  part  you  are  ))laying  in 
the  protection  of  the  health  of  the  nation  and  asks  all  of  you 
to  remain  at  your  posts  as  members  of  this  Special  Service 
Group. 

To  many  public  health  nurses  the  decision  to  stand  by  an 
important  piece  of  home  work  has  been  a  (lilUcult  one.  It  is 
not  easy  in  such  times  as  these  to  pursue  a  safe  and  ingloriou> 
way,  even  though  the  sign-posts  be  very  })lainly  marked  "patli 
of  dutv." 


1274  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  public  health  group,  however,  is  not  a  large  one,  if  all 
the  nursing  resources  in  the  country  are  taken  into  account. 
It  would  seem,  therefore,  wise  that  though  all  nurses  should 
enroll  in  the  Eed  Cross,  those  trained  or  experienced  in  public 
health  work  should  for  the  present  at  least  use  that  training 
and  experience  where  it  will  be  most  effective,  namely,  in  doing 
the  work  for  which  they  alone  are  prepared  and  which  so 
sadly  needs  them. 

A  further  extension  of  the  service  resulted  from  the  need 
of  special  health  protection  in  the  military  cantonments  at 
home.     Miss  Gardner  wrote: 

We  had  been  at  wslt  but  a  short  time,  when  the  Red  Cross 
added  a  new  activity  to  its  countless  forms  of  helpfulness  and 
one  involving  public  health  nurses.  Zones  were  formed  by  the 
United  States  Public  Health  Service  around  the  big  canton- 
ments and  in  these  zones  public  health  nurses  were  placed 
working  under  the  medical  director.  For  this  service  experi- 
enced nurses  are  needed.  At  first,  part  of  the  nurses  were 
Eed  Cross  nurses,  and  on  the  Red  Cross  payroll,  part  were 
engaged  and  paid  by  the  United  States  Public  Health  Service. 
It  has  been  decided  that  all  the  zone  nurses  should  be  enrolled 
Red  Cross  nurses,  thus  setting  a  single  standard  for  all,  and 
that  on  the  recommendation  of  the  Red  Cross  all  chief  nurses 
should  enter  the  United  States  Public  Health  Service. 

When  this  zone  work  carried  on  by  the  Red  Cross  in  co- 
operation with  United  States  Public  Health  Service  eventually 
found  its  way  into  the  Town  and  Country  Xursing  Service  it 
seemed  only  out  of  place  because  the  name  of  the  bureau  was 
not  sufficiently  inclusive  to  be  descriptive  of  such  an  activity. 
It  was  therefore  decided  to  change  the  Bureau's  name  to  the 
Bureau  of  Public  Health  Nursing.^^ 

The  change  in  name  and  scope  of  the  service  went  into  effect 
on  May  18,  1918.  Miss  Gardner  had  then  succeeded  Miss 
Clement  for  a  temporary  period  only,  with  Miss  Fox  as  asso- 
ciate director.  Both  were  exceptionally  well  fitted  to  direct 
the  enlarging  service. 

Mary  Sewcll  Gardner  was  a  Connecticut  woman,  of  a  repre- 
sentative Xew  England  family.  One  of  her  ancestors  on  the 
maternal  side  had  been  president  of  the  first  Provincial  Con- 
gress of  Xew  Hampshire  and  later  a  signer  of  the  Declaration 
of  Independence.      On  the  paternal  side  her  family  had   in- 

-' Bulletin  No.  3,  Vol.  4,  October,   1918. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING     1275 

eluded  many  lawyers  and  judges  and  her  father  served  on  the 
Supreme  Bench  of  Massachusetts.  jMiss  Gardner's  early  edu- 
cation had  been  entrusted  to  tutors  and  later  she  attended  a 
girls'  school  in  Farmington,  Connecticut,  then  traveled  exten- 
sively abroad.  She  was  given  the  position  of  superintendent  of 
the  Providence  (Rhode  Island)  District  Nursing  Association 
immediately  after  her  graduation  from  the  Newport  Hospital. 
To  enable  her  to  help  in  the  development  of  the  Red  Cross 
Town  and  Country  Nursing  Service  the  trustees  of  the  Provi- 
dence Association  generously  gave  her  leave  of  absence  for 
that  purpose.  ^liss  Gardner  was  recognized  throughout  the 
country  as  an  authority  on  all  phases  of  public  health  work, 
and  she  had  had  unusual  experience  in  rural  nursing  while 
extending  visiting  nursing  throughout  Rhode  Island.  She  was 
the  second  president  of  the  National  Organization  for  Public 
Health  Nursing  and  a  permanent  member  of  its  board.  She 
wrote  ''Public  Health  Nursing,"  the  first  book  on  that  subject 
and  a  standard  one.  In  1918  Brown  University  gave  her  its 
M.  A.  as  a  "pioneer  in  making  the  care  of  the  sick  an  honored 
profession  ...  a  gentlewoman  whose  writings  and  example 
have  brought  us  healing  of  the  body  and  inspiration  of  the 
spirit." 

Very  charming,  feminine  and  attractive  with  a  rich  sense 
of  humor  and  a  balanced  mind,  so  upright  that  she  commanded 
general  confidence,  Miss  Gardner  threw  all  her  gifts  into  the 
Red  Cross  work,  but  in  the  midst  of  her  administration  she 
was  dispatched  on  a  special  mission  to  Italy  to  organize  public 
health  nursing  there,  and  then  after  the  war  she  returned  to 
her  position  in  Rhode  Island. 

Elizabeth  Gordon  Fox  then  became  the  director  of  the 
Bureau.  Born  in  ^Milwaukee,  she  took  honors  at  the  University 
of  Wisconsin  (Phi  Beta  Kappa)  and  graduated  with  distinction 
from  the  Johns  Hopkins  Hospital.  She  served  on  the  staff  of 
the  Chicago  Visiting  Nurse  Association  for  four  years,  then 
became  superintendent  of  the  Visiting  Nurse  Association  of 
Dayton,  Ohio,  and  from  there  went  to  a  similar  position  in  the 
city  of  Washington,  where  she  also  served  as  president  of  the 
Board  of  Nurse  Examiners.  She  had  been  enrolled  in  the  Red 
Cross  Nursing  Service  since  1913.  In  1921  she  was  chosen  as 
vice-president  of  the  National  Organization  for  Public  Health 
Nursing,  and  upon  the  resignation  of  Edna  Foley,  then  presi- 
dent,, succeeded  liej*  and  was  elected  as  president  to  a  second 


1276  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

term  of  office  in  1922.  Her  largest  achievement  after  becoming 
director  of  the  Red  Cross  work  was  in  knitting  np  the  relations 
between  the  Red  Cross  national  organization  and  its  branches 
and  State  health  boards.  This  important  stage  of  progress 
will  be  described  in  the  next  chapter.  Forceful,  direct  and 
unaffected,  a  keen  and  analytical  thinker  and  a  remarkable 
organizer.  Miss  Fox  held  her  bureau  in  strong  hands. 

At  first  the  war  worked  injuriously  upon  the  service.  Miss 
Fox  wrote : 

The  Town  and  Country  Nursing  Service  experienced  a 
check  in  its  growth  during  the  war  brought  about  by  the 
transfer  of  national  and  local  attention  from  peace  activities 
to  war  work,  and  by  the  serious  shortage  both  in  qualified 
public  health  nurses  and  in  candidates  for  post-graduate  prep- 
aration occasioned  by  the  withdrawal  of  many  thousands  of 
nurses  for  military  service. 

The  secondary  effect  of  the  war  and  its  accompanying  calam- 
ity, the  epidemic  of  influenza,  was  to  heighten  the  interest  of 
Red  Cross  Chapters  and  the  general  public  in  health  and 
nursing  matters. 

The  first  financing  of  a  Rural  Nursing  Service  was  made 
possible,  as  has  been  told,  by  the  gifts  of  j\Ir.  Jacob  Schiff  and 
Mrs.  Whitelaw  Reid.  But  not  all  could  be  used  for  loans  and 
scholarships,  as  the  general  administration  of  the  Service  had 
to  be  covered  as  well.  In  1912  $1000  was  set  aside  for  loans, 
a  maximum  of  $250  being  agreed  upon  for  one  loan,  and  seven 
scholarships  were  announced,  three  of  $200  each  and  four  of 
$100  each.  Previous  to  December  1,  1913,  three  scholarships 
were  granted  and  three  loans  made.  Between  that  date  and 
December  1,  1914,  one  scholarship  and  thirteen  loans  were 
granted. 

In  1915  ^Ir.  and  ^Irs.  Schiff  gave  $5,000  more  to  be  used 
expressly  for  the  Loan  Fund  and  the  Scholarship  Fund  was 
thereafter  abolished  for  a  time.  Between  December  1,  1914, 
and  December  1,  1915,  eleven  loans  were  granted.  By  Decem- 
ber 1,  191G,  eight  more  had  been  made. 

At  the  annual  meeting  of  that  year  it  was  agreed  that,  as 
nurses  were  taking  the  eight  months'  course  in  larger  numbers, 
the  maximum  loan  should  be  increased  from  $250  to  $.'300  and, 
in  special  cases,  to  $400. 

It  was  never  contemplated  that  the  Red  Cross  would  entirely 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1277 

support  the  cost  of  a  local  rural  nursing  service.  Its  policy  was 
against  this  practice?  from  the  very  start  even  though  appeals 
for  financial  aid  were  numerous  and  although  lack  of  local 
funds  became  a  frequent  cause  for  the  discontinuance  of  affilia- 
tions one  after  another.  It  was  not  long,  however,  before  the 
financial  helplessness  of  certain  communities  became  appeal- 
ingly  clear: 

Before  the  end  of  the  first  year  of  the  service,  and  before 
any  outside  effort  to  meet  particular  financial  appeals  was 
contemplated,  a  member  of  the  Committee  on  the  Town  and 
Country  Nursing  Service  had  volunteered  to  meet  the  ex- 
penses of  placing  a  nurse  in  the  Kentucky  mountains.  Con- 
tributions from  private  sources  for  particular  communities 
were  later  administered  by  the  Red  Cross  in  a  number  of 
instances,  primarily  to  encourage  the  introduction  of  visiting 
nurses  in  the  Southern  Higlilands.  These  donations  were 
used  to  pay  the  salaries  of  nurses  temporarily  in  whole  or  in 
part  with  the  idea  always  in  mind  that  the  work  would 
eventually  be  supported  locally. 

In  1914  the  possibility  of  creating  a  sustaining  fund  was 
discussed.     The  records  say  (December  8,  1914)  : 

The  desirability  of  the  Red  Cross  establishing  a  fund 
whereby  the  salary  of  nurses  might  be  supplemented  who 
were  to  be  employed  in  sections  of  the  country  that  could  not 
at  present  provide  the  salary  of  a  Red  Cross  visiting  nurse  in 
full,  was  favorably  considered.  ]Miss  Delano  offered  to  supple- 
ment tbe  salary  of  a  nurse  to  be  sent  to  the  mountains  of 
North  Carolina  under  the  Presbyterian  Board  for  one  year. 

The  report  of  December,  1915,  returned  to  this  theme,  dwell- 
ing especially  on  the  needs  of  the  mountain  regions: 

In  many  mountain  communities  local  financial  resources 
are  sucli  that  the  salary  of  the  nurse  cannot  be  raised  either 
by  private  subscription  or  public  appropriation.  The  church 
mission  boards  and  educational  organizations  which  have  been 
active  in  the  mountain  country  for  years  have  included  visit- 
ing nursing  in  their  activities  in  twelve  or  thirteen  instances, 
but  there  are  three  million  persons  living  in  tlie  Southern 
Highlands. 

The  Town  and  Country  Nursing  Service  was  organized  to 
help  just  sucli  coninninities  as  this  section  represents,  and  yet 
they  cannot  procure  Red  Cross  vi.'-iting  nurses  unless  some 


1278  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

provision  can  be  made  to  aid  them  financially.  Three  Red 
Cross  visiting  nurses  have  been  appointed  to  mountain  com- 
munities, one  in  each  of  the  States  of  Virginia,  Kentucky  and 
North  Carolina.  One  was  employed  by  a  visiting  nurse  asso- 
ciation supported  by  private  subscription  from  the  mountain 
people  and  summer  visitors,  one  by  a  denominational  mission 
board,  and  one  by  local  funds  supplemented  by  outside  indi- 
viduals. 

Within  the  past  few  months  inquiries  have  been  received 
from  several  mountain  schools  asking  if  the  Red  Cross  could 
aid  in  financing  the  work  of  a  visiting  nurse.  A  broad  field 
for  rural  nursing  lies  open  in  this  section  and  study  of  its 
resources  reveals  the  fact  that  unless  some  provision  is  made 
by  the  Eed  Cross  or  other  organization  whereby  such  com- 
munities may  be  aided  financially,  there  is  little  prospect  of 
nurses  who  have  met  the  standards  of  hospital  training  and 
post-graduate  preparation  in  public  health  nursing  required 
by  the  Red  Cross  being  employed  in  this  part  of  the  country. 

The  meeting  of  the  committee  (March  18,  1915)  had  taken 
steps  to  meet  this  need.  The  Department  of  Agriculture 
under  the  Smith-Lever  Act  had  aided  numerous  rural  locali- 
ties throughout  the  country  by  contributing  toward  the  sup- 
port of  county  agents.  There  was  a  close  connection  between 
the  work  of  these  agents  and  health  work  being  done  by  the 
county  nurse.  One  middle  western  state  had  even  written  to 
the  Red  Cross  to  ask  if  nurses  could  be  supplied  to  fill  county 
.agents'  positions  with  the  aid  of  State  and  Federal  support. 
Other  instances  were  .kjiown  too  where  Federal  money  was 
being  used  for  local  educational  health  work  by  nurses.  Thus 
the  idea  of  direct  financial  aid  from  the  Federal  Department 
of  Agriculture  in  tiie  extension  of  rural  nursing  was  not 
entirely  novel  wlien  the  committee  appointed  its  chairman, 
Mrs.  Beale,  and  Miss  Lathrop,  head  of  the  Children's  Bureau, 
a  committee  to  interview  Secretary  Houston  upon  this 
subject.  The  interview  took  place,  however,  with  negative 
results. 

Within  a  short  time,  however,  public  support  by  contribu- 
tions to  local  funds  had  grown  rapidly  along  lines  indicated 
as  the  original  plan  of  the  Red  Cross. ^^ 

A  committee  report   (November  30,   1916)   said: 

In  twenty-seven  communities  public  funds  are  now  paid 
toward  the  support  of  the  work.    There  is  little  uniformity  in 
the  amounts  of  appropriations,  ranging  as  thej  do  all  the  way 
■"Pvcport  by  ^Fiss  Cloment.  Dpc,  J9J5.. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1279 

from  $200  to  $300  annually,  the  amount  received  by  six  com- 
munities, to  $1200  and  over  received  by  six  other  communities. 
The  entire  salary  is  paid  in  six  communities  from  public 
funds. 

By  1917  gifts  from  individuals  and  from  Rod  Cross  Chapters 
had  bo<iriin  to  swell  the  funds  for  nursing  education.  In  that 
year  the  Chapters  of  New  York  County,  Boston  ^letro- 
politan,  Chicago  and  Cincinnati  each  gave  $500,  and  Mr. 
Harvey  Gibson  and  Mrs.  William  Draper  each  gave  $500, 
making  $3000.  In  the  autumn  scholarships  for  visiting  nurses 
were  again  announced.  IMore  than  one  hundred  direct  in- 
quiries came  from  nurses,  giving  clear  evidence  of  the  value 
of  the  scholarship  plan.  Nine  scholarships  of  $250  each,  for 
eight  months'  courses,  were  distributed,  and  the  Superinten- 
dent's report  said: 

It  is  to  be  hoped  that  a  permanent  scholarship  fund  may  be 
provided  by  tlie  Red  Cross  whereby  an  eight  months'  course 
will  be  brought  within  reach  of  many  nurses,  otherwise  unable 
to  obtain  it. 

During  the  formation  of  plans  for  the  rapid  extension  of 
public  health  nursing  under  the  Chapters  immediately  after 
the  Armistice  in  1018,  the  need  for  increasing  greatly  the  num- 
ber of  nurses  prepared  for  public  health  nursing  stood  out 
clearly.  The  earlier  scholarship  fund  of  $3000  was  nearly 
exhausted.  The  opportunity  to  secure  many  recruits  for  public 
health  iiursin<>  from  among  the  thousands  of  nurses  returning 
from  war  service  seemed  good,  providing  some  means  were 
available  to  help  them  pay  the  cost  of  preparation. 

Just  before  sailing  for  Europe  (January  1,  1010)  !Mis3 
Delano  presented  a  recpiest  to  the  general  manager  that  the 
War  (\)un('il  of  the  Red  Cross  appropriate  $50,000  for  a  schol- 
arship and  loan  fund  for  nurses  needing  instnu'tion  in  public 
health  nursing  before  being  available  for  assignment  to  duty 
under  the  Red  Cross: 

In  the  development  of  our  Rod  Cross  public  health  pro- 
gram. 1  do  not  feel  that  it  will  be  necessary  to  ask  for  any 
large  expenditure  of  funds  for  administrative  progress.  The 
organization  which  we  now  have  ought  to  be  sulVicieiit.  It 
will,   however,   be  necessary,   in   my  opinion,  to   have   funds 


1280  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

available  for  other  phases  of  the  work,  the  most  important  of 
which  are  as  follows : 

1.  A  loan  or  scholarship  for  nurses  who  need  instruction  in 
public  health  nursing  before  being  available  for  assignment 
to  duty  under  the  Eed  Cross.  May  I  recommend  that  $50,000 
or  so  much  of  this  fund  as  may  be  necessary  be  set  aside  as  a 
loan  or  scholarship  fund  for  the  coming  year. 

2.  A  fund  available  for  the  maintenance  of  a  public 
health  nurse  during  a  period  of  demonstration  in  rural  or 
mountain  districts  which  are  unfamiliar  with  the  value  of 
such  a  service.  The  communities  most  in  need  of  public 
health  work  are  often  absolutely  ignorant  of  the  advantages 
to  be  gained,  and,  while  perhaps  entirely  able  to  support  a 
nurse,  can  be  convinced  of  their  needs  only  by  an  actual 
demonstration  of  at  least  a  few  months.  Time  and  again  we 
have  found  in  the  development  of  our  Town  and  Country 
Xursing  Service  that  communities  were  entirely  able  and 
willing  to  support  a  public  health  nurse  after  such  actual 
proof. 

In  contrast  to  communities  of  this  character,  remote  and 
scattered  settlements  may  never  be  able  to  provide  the  entire 
salary  of  a  public  health  nurse.  For  such  communities  the 
Eed  Cross  might  be  justified  in  supplementing  the  salary 
which  such  a  community  might  l)e  able  to  pay  by  an  amount 
sufficient  to  secure  the  services  of  a  graduate  nurse. 

I  have  no  doubt  that  the  Eed  Cross  Chapters  can  be  inter- 
ested in  assuming  the  responsibility  for  the  salary  of  nurses 
during  this  period  of  demonstration,  and  I  believe  that  every 
effort  should  be  made  to  secure  the  funds  locally,  if  possible, 
but  there  should  also.  I  believe,  be  a  fund  at  Headquarters 
which  could  be  used  in  an  emergency  until  other  arrange- 
ments could  be  made. 

3.  A  fund  for  the  establishment  of  a  teaching  center  where 
nurses  can  receive  definite  instruction  and  experience  in  the 
management  of  a  rural  community.  For  several  years  I  have 
hoped  for  the  establishment  of  such  a  center  in  a  typical 
rural  community — preferably  a  county  with  a  small  city  or 
village  as  headquarters.  Such  an  organization  could  no  doubt 
be  established  in  cooperation  with  the  community,  but  it 
would  scarcely  seem  fair  to  ask  a  county  to  meet  the  entire 
expense,  as  this  project  would  be  conducted  as  a  trying-out 
place  and  instruction  center  for  nurses  who  would  be  employed 
in  other  communities. 

4.  A  fund  for  the  extension  of  Eed  Cross  courses  of 
instruction  to  include  all  the  women  of  the  country,  especially 
those  who  are  living  in  remote  and  rural  districts.     Our  plan 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1281 

of  instruction  in  Home  Hygiene  and  Care  of  the  Sick  and  in 
Home  Dietetics  has  so  far  been  avaihible  only  for  women 
living  in  large  cities  or  where  graduate  nurses  and  dietitians 
are  easily  available  to  give  the  instruction.  It  has  not  been 
possible  to  extend  the  work  to  isolated  conimunities  where  the 
need  is  far  greater  than  in  the  cities  and  larger  towns.  These 
courses  of  instruction — especially  in  rural  communities — 
might  often  give  us  the  opportunity  to  conviiu-e  the  com- 
munity of  the  necessity  of  establishing  a  public  health  nurs- 
ing service,  and  wouid  be  our  easiest  and  most  natural  point 
of  approach.  These  courses  would  secure  for  the  nurse  serving 
such  a  community  the  intelligent  cooperation  of  the  women 
and  would  greatly  facilitate  and  increase  the  usefulness  of  her 
work.  I  believe  that  some  plan  should  be  worked  out  to 
provide  instruction  for  all  classes  of  women,  regardless  of 
their  ability  to  pay  for  such  instruction.  Funds  for  this 
purpose  should,  I  believe,  be  secured  through  the  Chapters, 
but  may  1  recommend  that  a  letter  be  sent  to  the  Chapters, 
authorizing  them  to  use  Chapter  funds  for  the  extension  of 
our  educational  program.  I  submit  in  connection  with  this  a 
recommendation  adopted  at  a  recent  meeting  of  the  Division 
Directors  of  Xursing.^^ 

On  December  81,  1918,  the  War  Council  authorized  an 
appropriation  of  $80,000  as  a  Scholarship  and  Loan  Fund 
for  nurses  needing  instruction  in  public  health  nursing.  Later 
it  was  decided  to  allot  $25,000  for  scholarships  and  $5,000 
for  loans.  ^^ 

This  fund  was  appropriated  for  the  exclusive  use  of  nurses 
preparing  to  do  public  health  nursing  under  the  Ked  Cross, 
since  its  purpose  was  to  make  possible  the  plan  for  the  expan- 
sion of  such  work. 

In  February,  1919,  a  group  of  representatives  of  the  iSTational 
Organization  for  Public  llealth  Xursing,  headed  by  Miss 
Wald,  conferred  with  Ur.  Farrand,  the  chairman  of  the 
Central  Committee,  for  the  purpose  of  asking  the  American 
Red  CVoss  to  make  an  additional  appropriation  f<n'  scholar- 
ships which  would  not  be  restricted  to  nurses  promising  to  enter 
Red  (^ross  service,  but  would  be  available  also  to  nurses  pre- 
paring for  public  health  nursing  under  other  auspices.  This 
project  was  statiMl  in  a  letter  to  J)r.  Farrand  from  Miss  Wald, 
Febnuirv  14,  191  !>,  as  follows: 

"^  Letter   from   Miss   Delano  to   Mr.  Scott,  Docoinbor   14.   1018. 
"Xotter  Ironi  ^Jiss  Noycs  to  Mr.  Scott,  January  S,   1!)19. 


1282  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Just  prior  to  the  entrance  of  the  United  States  into  the 
war  there  were  estimated  to  he  about  six  thousand  public 
health  nurses,  and  the  demand  was  already  greatly  in  excess 
of  the  supply.  While  the  war  increased  this  demand  and 
created  an  enormously  increased  need  for  such  nurses,  the 
supply  became  even  less,  and  with  the  coming  of  peace  this 
momentum,  already  great,  has  become  overwhelming. 

Municipal,  county  and  state  departments  of  health,  public 
schools,  child  saving  agencies,  industrial  establishments,  visit- 
ing nurse  associations  and  other  public  and  private  agencies 
are  unable  to  develop  their  public  health  plans  because  of 
inability  to  secure  a  sufficient  nursing  personnel,  and  are 
making  demands  for  nurses,  which  cannot  be  filled  except  in 
very  small  measure. 

The  introduction  of  two  federal  bills,  one  by  the  Children's 
Bureau  of  the  Department  of  Labor  and  the  other  by  the 
United  States  Public  Health  Service,  both  projecting  plans 
which  will  demand  many  hundreds  of  public  health  nurses, 
also  emphasize  the  need. 

The  Bureau  of  Public  Health  Nursing  of  the  Red  Cross 
proposes  to  develop  rural  and  small  town  public  health  nurs- 
ing and  will  need  several  hundred  nurses  for  this  purpose. 
The  appropriation  of  $30,000  made  by  the  Red  Cross  for  the 
preparation  of  public  health  nurses  for  the  service  of  this 
bureau  will  provide  from  seventy-five  to  one  hundred  nurses. 
The  Chapters,  through  Chapter  scholarships,  it  is  expected, 
will  provide  possibly  one  or  two  hundred  more.  The  rest  of 
the  nurses  needed  by  the  bureau  must  be  secured  through 
other  means.  While  the  work  the  Bureau  of  Public  Health 
Nursing  expects  to  do  will  meet  a  great  need,  it  can  care  for 
only  a  small  part  of  the  whole  field.  Therefore,  there  is  a 
great  need  for  an  added  appropriation  of  $150,000  to  prepare 
several  hundred  nurses  for  public  health  work  outside  of  the 
Red  Cross. 

With  a  fund  of  $150,000,  $300  scholarships  could  be  given 
to  five  hundred  nurses  for  a  four  months'  course  in  public 
health  nursing.  However,  as  there  is  a  special  and  immediate 
need  for  executives  and  teachers,  it  is  the  feeling  of  those 
primarily  interested  in  public  health  nursiiig  education  that  a 
more  desirable  distribution  would  be  to  offer  scholarships  of 
$000  for  an  eight  months'  course  to  125  nurses  especially 
adapted  by  preparation,  experience  and  temperament  for  the 
larger  executive  and  ediicational  positions.  The  remaining 
fund  of  $75,000  would  then  be  available  as  $300  scholarships 
for  250  nurses  for  a  four  months'  course. 

There  are  at  present  thirteen  centers  scattered  throughout 


FROM  RURAL  TO  PUBLIC  HEALTH   NURSING     1283 

the  country  already  organized  and  conducting  such  courses, 
which  couhl  admit  and  most  satisfactorily  train  these  nurses 
for  public  health  work. 

Such  a  group  of  l??5  women  especially  equipped  for  rural, 
town  and  city  work  requiring  executive  and  teaching  ability, 
combined  with  social  knowledge  and  vision,  while  not  com- 
pletely meeting  the  constantly  increasing  need,  would  serve 
as  a  tremendous  impetus  to  public  health  nursing  throughout 
the  whole  country. 

The  Ked  Cross  nurse  appeals  strongly  to  the  heart  of  the 
American  public,  and  the  ])ublic  woukl  unquestionably  ap- 
prove the  expenditure  of  Eed  Cross  money  in  any  plan  to 
bring  help  to  Ked  Cross  nurses  in  the  difficult  period  of 
readjustment,  especially  when  such  help  might  be  given  her 
as  a  recognition  of  her  tine  service  and  as  an  expression  of  the 
conviction  of  the  American  Ked  Cross  that  the  country  still 
needs  her  in  a  valuable  public  service  here. 

Public  health  nursing  cannot  continue  to  meet  the  greatly 
stimulated  demand  without  a  scholarship  fund  sufficiently 
large  to  show  appreciable  results.  It  is  more  fitting  and  less 
confusing  to  have  such  a  fund  come  from  one  source,  not 
several  sources. 

Such  a  Eed  Cross  scholarship  fund  might  well  be  admin- 
istered by  the  special  committee  of  the  Eed  Cross,  now  in 
existence,  which  has  in  its  membership  representatives  of  the 
three  national  nursing  associations,  and  which  is  now  acting 
in  an  advisory  cajiacity  to  the  Ked  Cross  Bureau  of  Informa- 
tion for  returning  nurses. 

(signed)  Lillian  T).  Wald, 
Honorary  President  of  the  National  Organization  for  Public 
Health    Xursing   for   the   Otlicers   and   Members  of  the 
Advisory  Council. 

On  February  27,  11)10,  the  War  Council  acting  upon  this 
petition,  authorized  the  appropriation  of  seventy-five  thousand 
dollars  ($75, 000)  as  an  additional  Scholarship  Fund  for  nurses 
needing  instruction  in  public  health  nursing  but  not  lUH'cssarily 
promising  to  serve  in  the  Red  Cross  Public  Health  Xursing 
Service. 

This  made  a  total  of  $100,000  for  scliolarships  and  $:).0()0 
for  loans  authorized  on  December  .'U,  1!»1S,  and  February  27, 
1!)1!>.  The  general  terms  under  which  this  fund  was  to  bo 
administered  were  stated  in  a  letter  to  ]\Iiss  Wald  from  the 
general  manager  as  follows: 


1284  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

1.  These  scholarships  are  open  to  TJed  Cross  nurses  or  those 
eligible  for  enrollment  on  the  recommendation  of  the  Division 
Directors  of  Public  Health  Nursing  and  the  Joint  Committee 
representing  the  tliree  national  organizations  of  nursing 
through  their  representation  at  the  Red  Cross  Bureau  of 
Information,  These  recommendations  are  subject  to  the 
approval  of  the  director  of  Public  Health  Nursing  Bureau 
and  the  director  of  the  Department  of  Nursing  at  National 
Headquarters. 

2.  While  the  appropriation  is  mainly  intended  for  those 
who  are  being  released  from  military  service,  other  nurses  who 
meet  the  general  requirements  are  also  eligible. 

3.  While  the  War  Council  stipulated  the  purpose  for  which 
this  fund  should  be  used,  they  did  not  wish  to  establish  hard 
and  fast  regulations,  but  preferred  to  leave  the  matter  of 
spending  it  subject  to  alterations  within  the  discretion  of  the 
general  manager  and  the  director  of  the  Department  of 
Nursing. 

4.  In  addition  to  the  scholarship  fund  of  $110,000 
($25,000  of  which  was  appropriated  for  preparation  of  nurses 
for  service  under  the  Bureau  of  Public  Health  Nursing  of  the 
Eed  Cross)  there  is  a  loan  fund  available  of  $5,000.  The 
maximum  loan  shall  be  $350.  Recommendations  for  loans 
from  this  fund  are  received  through  the  same  channels  as 
indicated  above  for  scholarships.  It  is  definitely  understood 
that  loans  should  be  awarded  by  the  Department  of  Nursing 
for  the  purpose  of  educating  nurses  for  Public  Health  Nursing 
under  the  Red  Cross  Bureau  of  Public  Health  Nursing.^^ 

The  specific  conditions  governing  the  distribution  of  scholar- 
ships and  loans  were  set  forth  in  a  memorandum  of  instruc- 
tions, July  15,  1919,  as  follows: 

There  are  now  two  scholarship  funds  available  for  Red 
Cross  nurses  who  contemplate  preparing  themselves  for  public 
health  nursing  by  taking  post-graduate  courses.  Scholar- 
ships from  the  first  of  these  funds  are  known  as  "restricted 
scholarships,"  meaning  that  they  are  restricted  to  nurses  who 
are  pledged  to  serve  in  the  Red  Cross  Public  Health  Nursing 
Service  for  one  year. 

There  are  three  types  of  scholarships  awarded  from  this 
fund.  ''J'hese  scholarships  are  awarded  for  post-graduate 
courses  of  eight  months',  four  months'  and  six  weeks'  dura- 
tion.   The  maximum  scholarship  for  the  eight  months'  course 

''Letter  from  Mr.  :\f()nr()o  to  ^fiss  Wiild,   February  20,   191fl.     See  Di- 
visions  of   File   Records,    Natioiiiil   Headquarters   American    Red    Cross. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1285 

is  $()00;  for  the  four  months'  course  $300;  and  for  the  six 
weeks'  course  $75.  The  scholarship  carrying  tlie  maximum  of 
$75  is  designed  only  for  nurses  who  have  had  a  considerable 
amount  of  {)ublic  health  nursing  experience  under  super- 
vision and  who  feel  the  need  of  additional  theoretical  prepa- 
ration before  undertaking  independent  work.  This  scholar- 
ship is  to  enable  them  to  take  the  six  weeks'  summer  course  in 
theory.  There  are  two  or  three  such  courses  which  are 
approved  by  the  Department  of  Nursing.  Xurses  who  have 
had  very  little  experience  or  experience  of  doubtful  value 
should  take  one  of  the  longer  courses. 

Scholarships  may  be  awarded  to  nurses  who  have  had  no 
experience  in  public  health  nursing,  who  have  had  a  limited 
or  considerable  amount  of  public  health  nursing  experience 
without  supervision  or  who  have  had  considerable  experience 
under  supervision  and  give  promise  of  further  development. 
It  is  not  thought  wise  to  grant  scholarships  to  nurses  who  have 
had  considerable  experience  in  public  health  nursing  under 
supervision,  but  who  have  shown  no  e\idence  of  ability  to 
work  witliout  supervision.  Candidates  should  meet  the  train- 
ing school  requirements  necessary  for  enrollment  in  the  Red 
Cross.  Preference  should  be  given  to  high  school  graduates 
or  those  who  can  show  a  substantial  equivalent.  Registration 
should  be  required  in  accordance  with  the  ruling  of  the  Red 
Cross. 

In  states  where  registration  is  provided  for  by  law  the  nurse 
applying  for  enrollment  in  the  lied  Cross  must  be  registered : 

Preference  should  be  given  to  nurses  who  are  enrolled  or 
who  are  eligible  for  enrollment  and  will  become  enrolled, 
although  exceptions  may  be  made  where  deemed  necessary. 
In  general,  scholarships  will  be  awarded  to  nurses  between 
the  ages  of  twenty-three  and  forty  years.  Exceptions  may  be 
made  where  candidates  possess  unusual  ability.  The  candi- 
date shall  present  a  doctor's  certificate  of  her  physical  con- 
dition. 

]\Iuch  more  than  good  education  and  good  physique  is 
required  to  make  a  good  public  health  nurse.  The  candidate 
must  possess  good  judgment,  self-reliance,  the  ability  to  work 
in  harmony  with  all  kinds  of  people,  good  nature  and  common 
sense.  In  order  to  be  certain  of  this  a  request  for  information 
should  l)e  sent  to  the  superintendent  of  her  training  school, 
two  or  more  recent  employers,  and  possibly  a  school  teacher 
who  had  known  her  for  some  years.  Where  the  candidate  has 
been  engaged  in  private  duty  this  request  should  be  sent  to  at 


1286  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

least  two  people  who  have  known  her  intimately,  in  addition 
to  the  superintendent  of  her  training  school.  If  the  candidate 
has  been  engaged  in  war  service.  National  Headquarters  will 
secure  her  efficiency  record. 

In  February,  1919,  the  director  of  the  Department  of 
Nursing  received  the  following  letter  from  Dr.  Taliaferro 
Clark,  of  the  United  States  Public  Health  Service,  chief  of 
the  Bureau  of  Sanitary  Service  of  the  Red  Cross: 

I  am  in  receipt  of  communication  from  the  Surgeon  General 
of  the  U.  S.  Public  Health  Service  under  date  of  January  25, 
1919,  in  which  he  states  that  the  service  desires  to  inaugurate 
a  system  of  social  service  and  follow-up  work  as  a  part  of  its 
program  for  the  prevention  and  control  of  venereal  diseases 
so  that  infected  persons  may  be  kept  under  observation  with 
strict  supervision  of  their  homes  and  places  of  employment 
until  they  have  been  cured. 

The  services  of  qualified  public  health  nurses  who  have 
had  additional  training  in  social  service  work  are  required  to 
do  this  important  public  health  work  effectively.  After  a 
canvass  of  the  field  the  Surgeon  General  advises  that  no 
registered  public  health  nurses  having  special  qualifications 
for  follow-up  work  in  connection  with  venereal  disease  control 
work  are  available  at  the  present  time,  although  the  Public 
Health  Service  is  prepared  to  give  immediate  employment  to 
ten  nurses  qualified  for  this  particular  form  of  public  health 
work  and  to  continue  the  employment  of  such  nurses  in 
increasing  number  for  an  indefinite  period  of  time  provided 
the  appropriations  asked  of  Congress  for  this  purpose  are 
granted.  Furthermore,  it  is  the  plan  of  the  Service  to  transfer 
this  special  form  of  activity  to  State  and  Local  Boards  of 
Health  as  rapidly  as  this  can  be  arranged,  thereby  creating  an 
increased  demand  for  nurses  with  the  special  qualifications 
mentioned. 

The  Surgeon  General  states  that  so  far  as  it  is  known  to 
him  no  funds  are  available  for  this  purpose  from  any  source 
and  recommends  that,  if  such  request  be  consistent  with  the 
Eed  Cross  program  for  public  nursing  and  not  at  variance 
with  the  Rq(\  Cross  program  for  post-war  work,  tbe  sum  of 
$6,000  be  appropriated  to  l)e  expended  in  the  training  of  not 
less  than  ten  public  health  nurses  for  a  period  of  four  months 
each  at  tlie  .Tohns  Hopkins  Hospital.  Baltimore,  ^Maryland. 

In  view  of  the  wide  prevalence  of  venereal  infections  in  the 
general  population  niu^  tbo  potential  danger  of  tbese  infections 
to  national  efficiency,  the  desirability  of  adopting  all  fruitful 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1287 

measures  for  their  control  and  the  lack  of  public  health 
nurses  with  the  special  training  desired  by  the  Public  Health 
Service  available  for  duty  in  connection  with  its  program  for 
the  control  of  these  diseases,  I  wish  to  recommend  that  the 
War  Council  be  requested  to  appropriate  the  sum  of  $G,000  to 
be  expended  by  the  director  of  the  Bureau  of  Public  Health 
Nursing  for  the  training  of  not  less  than  ten  public  health 
nurses  in  accordance  with  the  plan  proposed  by  the  United 
States  Public  Health  Service. 

In  response  to  this  letter  the  Department  of  iNTursing  made 
recommendations  to  Mr.  Munroe  which  were  approved  by  him, 
and  certain  funds  were  appropriated  for  the  cooperation  seught 
by  the  United  States  Public  Health  Service. 

With  the  exhaustion  of  the  first  large  scholarship  and  loan 
fund  the  need  for  another  such  fund  stood  out  sharply  as 
stated  in  a  memorandum  sent  by  the  director  of  the  Depart- 
ment of  Nursing  to  the  Central  Committee  in  December,  1919, 
as  follows: 

After  careful  consideration  and  conference  with  the  Division 
directors  of  the  Departments  of  Nursing  and  the  director  of 
Public  Health  Nursing  at  National  Headquarters,  it  seemed 
highly  desirable  to  present  a  request  for  an  additional  appro- 
priation for  scholarships  and  loan  funds  to  the  Executive 
Committee. 

At  the  meeting  of  the  National  Committee  on  Red  Cross 
Nursing  Service  on  December  9,  1919,  the  matter  was  pre- 
sented for  their  consideration  and  it  was  a  unanimous  vote 
that  the  request  be  prepared.  The  recommendations  for  this 
appropriation  are  based  upon  the  following  arguments : 

1.  The  Division  directors  of  Public  Health  Nursing  have 
estimated  that  they  can  readily  use  sixteen  hundred  public 
health  nurses  and  will  acutely  need  at  least  one  thousand 
public  health  nurses  during  the  coming  six  months.  From 
present  resources  there  is  very  little  possibility  of  meeting 
even  a  small  part  of  this  personnel. 

2.  It  will  be  necessary,  therefore,  to  look  to  the  graduates 
of  courses  in  public  health  nursing  to  fill  this  need.  The 
courses  can  admit  during  the  next  six  months  somewhere 
between  450  and  oOO  students.  There  are  undoubtedly  as 
many  more  nurses  who  are  ready  for  post-graduate  course^;, 
but  the  large  majority  will  be  unable  to  do  so  unless  they  are 
given  lil)eral  financial  assistance.  The  high  cost  of  living 
continues  to  make  it  practically  impossible  f -r  them  to  forego 


1288  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  salary  and  in  addition  meet  the  cost  of  a  course  from  their 
own  resources. 

3.  Chapter  scholarships  will  undoubtedly  be  available  in 
considerable  number,  but  they  can  by  no  means  be  relied  upon 
to  meet  the  whole  need  and  they  are  limited  to  a  comparatively 
small  group  of  nurses  who  are  in  a  position  to  return  to  the 
Chapter  which  grants  the  scholarship.  There  will  be  many 
occasions  when  the  Division  directors  would  like  to  grant 
scholarships  to  nurses  but  will  not  find  the  Chapter  scholar- 
ships suitable.  There  are  also  Divisions  where  Chapter  schol- 
arships will  be  scarce. 

4.  The  original  scholarship  fund  of  $100,000  is  exhausted. 
The  results  achieved  from  it  would  seem  to  justify  us  in 
seeking  another  such  fund.  It  helped  materially  in  meeting 
the  need;  by  this  means,  247  nurses  have  already  been  pre- 
pared for  this  branch  of  work ;  it  greatly  increased  the  popular 
appreciation  of  the  need  of  adequate  preparation  for  public 
health  nursing ;  and  it  undoubtedly  stimulated  the  opening  of 
several  new  courses. 


Following  the  granting  of  this  appropriation  new  instruc- 
tions were  issued  governing  its  disbursements  indicating  certain 
changes  in  policy  from  that  governing  the  distribution  of  the 
first  fund : 

A  second  national  fund  of  $100,000  is  now  available  for 
Eed  Cross  nurses  who  contemplate  preparing  themselves  for 
public  health  nursing  by  taking  a  post-graduate  course.  This 
fund  is  divided  into  two  sums,  $00,000  being  for  scholarships 
and  $40,000  for  loans.  Xo  part  of  this  fund  is  "restricted" 
and  no  recipients  will  be  required  to  serve  in  the  IJed  Cross 
Public  Health  Nursing  Service  although  all  recipients  must 
promise  to  engage  in  public  health  nursing  for  one  year. 

In  addition  a  special  loan  fund  of  $10,000  has  been  appro- 
priated to  be  distributed  among  the  Divisions  for  the  purpose 
of  defraying  traveling  and  other  incidental  expenses  incurred 
by  nurses  taking  the  post-graduate  courses  in  public  health 
nursing.  Where  such  loans  are  considered  necessary  in  addi- 
tion to  a  National  or  Chapter  scholarship  or  loan,  they  may  be 
made  from  this  fund  by  the  Division  Department  of  Nursing 
direct  to  the  nurse. 

It  is  desired  that  oidy  those  candidates  shall  be  recom- 
mended for  scholarships  who  are  well  educated,  academically 
and  professionally,  and  whose  records  show  more  than  ordi- 
nary ability  and  personality. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1289 

Furthermore,  it  has  been  deemed  unwise  to  set  any  stated 
amount  either  for  the  scholarships  or  the  loans.  In  making 
announcement  of  this  second  fund  no  amounts  will  be  speci- 
fied and  no  maximum  and  minimum  stated.  Funds  are  avail- 
able for  partial  scholarships  supplemented  by  loans  to  be 
added  to  the  nurses'  own  resources,  the  amounts  to  be  deter- 
mined individually  for  each  candidate.  It  is  desired  that  in 
the  future  the  majority  of  candidates  shall  receive  smaller 
scholarships  than  in  the  past  and  that  deficiencies  shall  be  met 
by  loans.  Scholarships  covering  the  entire  cost  of  the  course, 
no  part  being  in  the  form  of  a  loan,  shall  be  granted  hereafter 
only  under  exceptional  circumstances. 

Scholarships  and  loans  from  the  national  fund  may  be 
awarded  for  one  or  both  semesters  of  a  post-graduate  course  of 
eight  months;  for  a  post-graduate  course  of  four  months  or 
for  one  of  six  weeks.  The  scholarship  or  loan  for  the  six 
weeks'  summer  course  should  be  granted  only  to  nurses  who 
have  had  a  considerable  amount  of  public  health  experience 
under  supervision  and  who  feel  the  need  of  additional  theo- 
retical preparation  before  undertaking  independent  work. 
Nurses  who  have  had  experience  of  less  than  six  months,  or 
without  supervision,  or  of  doubtful  value,  should  take  one  of 
the  longer  courses. 

It  should  be  explained  to  applicants  that  scholarships  and 
loans  are  not  awarded  to  nurses  who  are  able  to  meet  the 
expenses  of  a  course  themselves.  Candidates  should  apply  for 
the  minimum  amount  whicli  will  enable  them  to  meet  the  cost 
of  the  course.  Nurses  who  can  take  the  course  with  the 
assistance  of  a  loan  shall  be  granted  a  loan  rather  than  a 
scholarship  and  where  possible  partial  scholarships,  supple- 
mented by  loans,  should  be  encouraged. ^"^ 

With  the  decentralization  of  the  Bureau  of  Public  Health 
Nursing  earlier  methods  of  administration  became  obsolete 
and  a  different  system  was  set  up.  New  instructions  were 
issued  to  the  Chapters,  whose  great  increase  in  numbers  has 
been  mentioned.     Sections  relating  to  finance  are  quoted  below: 

15.  Wliere  no  Puljlic  Health  Nursing  Service  exists  or 
none  is  immediately  projected  it  is  very  desirable  that  a 
Chapter  establish  such  a  service  and  Chapter  funds  may  be 
used  for  this  purpos*^.  However,  it  will  be  preferable  in  many 
cases  not  to  use  Chapter  funds  wholly,  ])ut  to  enlist  the  sup- 
port of  the  community  i)y  seeking  the  money  needed  from 

"Instructions  for  Divisions,  March  15,  1920,  from  general  manager. 


1290  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

sources  such  as  municipal  or  county  funds,  private  contribu- 
tiouB,  or  special  campaigns. 

18.  Where  a  nursing  service  is  being  conducted  by  a  mu- 
nicipality or  county  at  public  expense,  but  is  affiliated  with  the 
Eed  Cross  Bureau  of  Public  Health  Nursing,  the  Chapter 
should  be  permitted  to  contribute  money  from  Chapter  funds 
to  cover  certain  necessary  expenditures  not  provided  by  law  to 
be  paid  from  public  funds.  The  Chapter,  however,  should  not 
take  over  the  entire  financial  responsibility  for  a  nursing 
service  which  is  now  being  conducted  by  the  city  or  county 
and  supported  by  public  funds. 

20.  The  desirability  of  establishing  a  Chapter  public  health 
nursing  service  having  been  decided  upon,  the  Chapter  should 
adopt  in  advance  some  plan  for  financing  it.  The  financing  of 
the  public  health  nursing  service  shall  be  done  by  the  Chapter 
Committee  on  Xursing  Activities,  subject  to  and  with  the 
advice  of  the  Chapter  Executive  Committee. 

21.  It  will  be  well  to  have  available  at  the  time  of  starting 
the  service  an  amount  sufficient  to  finance  it  for  a  period  of  at 
least  three  months. 

22.  The  various  items  of  expense  which  may  be  expected 
are: 

The  salary  of  the  public  health  nurse  or  nurses. 

The  salary  of  a  possible  substitute  for  either  the  period  of 
a  nurse's  vacation  or  illness. 

The  rent  of  an  office  for  the  nursing  service,  where  neces- 
sary. 

The  purchase  or  rental  of  a  conveyance. 

Street  car  or  train  fare. 

The  cost  of  a  telephone  in  the  nurse's  home. 

The  cost  of  loan  closet  supplies.^" 

The  cost  of  the  nurse's  bag  with  equipment. 


With  the  promulgation  of  the  above  reorganization  plans  the 
final  policy  of  the  Red  Cross  was  thus  stated : 

The  Red  Cross  would  prefer  to  have  communities  organize 
and  finance  their  own  public  health  nursing  service,  when 
possible,  under  the  supervision  of  tlie  state  autliorities. 

Where  the  community  is  unable  or  not  ready  to  bear  the 
entire  burden  of  financing  a  public  health  nursing  service,  the 
"In  cflFect  March  1,  1919. 


FROM  RURAL  TO  PUBLIC  HEALTH  NURSING    1291 

Red  Cross  will  undertake  to  organize  the  service,  and  finance 
it,  with  the  aid  of  tlie  community,  or  from  its  own  funds,  until 
such  time  as  the  State  or  Municipality  will  take  over  the 
direction  and  supervision  of  the  service. 

It  was  well  known  that  when  the  Red  Cross  launched  its 
Rural  Xursing  Service  large  sections  of  the  country  had  no 
visiting  nurses. 

In  loot),  in  seventeen  states  of  the  Union,  only  seven  visiting 
nurses  were  reported,  or  one  to  every  230,000  square  miles. 
Throughout  Great  Britain  and  Ireland  in  1900  there  was  one 
Queen's  Xurse  to  every  seventy-two  square  miles.  On  the 
basis  of  population  there  was  (1000)  an  average  of  one  nurse 
to  614,03-1  persons  in  the  seventeen  states  under  consideration, 
while  in  Great  Britain  and  Ireland  there  was  one  nurse  to 
every  27,246  persons. 

The  sixteen  Red  Cross  nurses  appointed  in  1013  were  a 
veritable  grain  of  mustard  seed.  Nearly  twelve  months  later 
the  variety  of  groups  employing  Red  Cross  visiting  nurses 
included : 

Health  Committees  and  Social  Welfare 9 

Health  Committees 3 

Social  Welfare  Organizations 4 

Associated   Charities    2 

Visiting  Xurse  Associations 11 

Women's  Civic  Clubs 3 

Red  Cross  Chapters 2 

Corporations 2 

Miscellaneous   1 

One  year  more,  and  the  demand  far  outran  the  supply.  In 
that  year  21  new  affiliations  were  accomplished,  but  8  old  ones 
were  discontinued  for  lack  of  funds.  By  1017,  85  affiliated 
associations  were  employing  07  nurses  in  small  towns  and 
rural  communities.  In  that  year  it  was  estimated  that  all  the 
nurses  save  one  were  at  work  in  communities  numbering  from 
5U0  to  10,000  people,  the  early  limit  of  5000  inhabitants  per 
town  having  gradually  risen  to  25,000.  Nineteen  fields  of 
work  had  populations  running  from  1000  to  5000:  thirteen 
other  fields  varied  between"  5000  to  10,000.  The  visit- 
ing areas  ranged  fro;n  two  square  miles  in  the  smallest  field 
of  500  persons  to  from  two  to  eight  S(|uar(>  miles  in  those  having 


1292  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

1000  to  5000  persons,  and  from  one  to  seven  square  miles  in 
those  having  populations  between  5000  to  10,000.  By 
February  1,  1917,  there  were  sixty-one  communities  where 
Red  Cross  visiting  nurses  were  stationed.  Twenty-two  states 
entered  into  this  list,  New  Jersey  and  Michigan  each  having 
eight,  Massachusetts  seven,  Kentucky  and  Pennsylvania  each 
five,  California,  Arizona,  North  Dakota,  Missouri,  Ohio  and 
Iowa  each  one.  During  the  previous  year  (1916)  the  cases 
having  received  nursing  care  numbered  10,286 ;  the  total  num- 
ber of  visits  made  were  112,836.  These  visits  fell,  approxi- 
mately, into  classes  as  follows: 

Public  school  visits,  eight  per  cent;  infant  welfare,  seven 
per  cent ;  prenatal  care,  two  per  cent ;  tuberculosis  cases,  three 
per  cent;  visits  of  sanitary  inspection,  four  per  cent;  nursing 
care,  forty-seven  per  cent ;  while  business  and  unclassified  calls 
completed  the  list. 

In  other  words,  bedside  nursing  came  first  with  47  per  cent 
of  visits  made.  Instructive  visits  came  next,  with  17  per  cent, 
business  calls,  with  13  per  cent ;  social  service  calls,  with  11  per 
cent,  and  unclassified,  10  to  12  per  cent.  Inquiries  from  com- 
munities eager  to  learn  of  visiting  nursing  or  to  establish  it  now 
increased  by  nearly  100  per  cent,  while  applications  from 
nurses  also  increased.  The  status  of  public  health  nursing 
generally  after  the  Armistice  is  described  in  the  next  chapter, 
and  the  statistical  chart  there  shown  gives  a  complete  picture 
of  the  statistical  side  of  oux"  material. 


CHAPTER  XV 

RED  CROSS   PUBLIC    HEALTH    XIRSIXG    AFTER   THE   "WAJl 

A  MONTH  after  the  Armistice  the  general  manager 
(Frederick  ^Iiinroe)  wrote  to  the  Division  managers  the 
following:  ''With  the  declaration  of  peace  the  further 
development  of  our  public  health  nursing  and  of  our  courses 
in  Home  Hygiene  and  Care  of  the  Sick  and  Home  Dietetics, 
which  have  been  temporarily  interrupted  hy  the  more  insistent 
needs  of  the  war,  will  now  be  among  the  foremost  activities  of 
the  Red  Cross."  '"It  is  planned,"  he  wrote,  ''that  each  chapter 
will  have  a  Committee  on  Xursing  Activities  through  which 
all  matters  relating  to  this  work  may  function,"  and  stated  that 
one  of  the  activities  to  be  assumed  by  this  committee  would 
be  "to  develop  and  aid  the  organization  of  public  health  nursing 
over  the  entire  territory  of  the  Chapter."  Thus  the  first  official 
step  was  taken  toward  the  initiation  of  the  expanded  public 
health  nursing  program  of  the  Red  Cross  after  the  war. 

The  reasons  given  by  the  Bureau  of  Public  Health  Xursing 
in  recommending  this  expansion  were  set  forth  as  follows: 

Public  health  nursing,  like  many  social  developments  of 
recent  years,  had  its  origin  in  the  large  city,  spreading  slowly 
from  one  city  to  another  and  from  city  to  town,  but  not  ex- 
panding to  any  extent  at  first  to  small  towns,  villages  and  the 
open  country.  Only  in  the  years  immediately  preceding  the 
war  had  there  begun  to  be  an  active  appreciation  of  the  need 
of  extending  the  advantages  of  public  health  nursing  heyond 
the  larger  centers.  The  attention  of  many  students  and 
leaders  of  American  affairs  shifted  its  focus  to  the  study  of 
the  development  of  country  life.  They  were  quick  to  dis- 
cover that  among  other  elements  of  neglect  one  of  the  most 
serious  was  tiie  lack  of  provision  for  the  preservation  of  health 
and  care  of  the  sick.  At  the  same  time  national  and  state 
agencies,  both  public  and  private,  concerned  witli  health  prob- 
lems, were  also  discovering  these  gaps  in  tlieir  system  for 
maintaining  high  standards  of  health  and  were  giving  much 
thought  to  ways  and  means  of  lilling  them.     State  tuhercu- 

1293 


1294  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

losis  associations  in  many  states,  and  state  departments  of 
health  in  a  few,  began  to  extend  public  health  nursing  to  the 
people  in  the  smaller  towns  and  the  country,  and  were  making 
fair  headway.  And  then  the  war  came  and  a  large  part  of  the 
trained  personnel  necessary  for  the  execution  of  these  plans 
was  drawn  into  war  work,  thereby  seriously  crippling  their 
fulfillment  for  the  time  being.  At  the  same  time  the  need 
for  extending  health  machinery  and  increasing  the  number  of 
health  workers  all  over  the  country  was  greatly  accentuated 
by  Avar  conditions,  and  so  soon  as  possible  emergency  plans  to 
fill  these  needs  were  set  going. 

For  five  years  before  the  war  the  Eed  Cross  also  was  en- 
gaged in  promoting  rural  nursing  through  its  Town  and 
Country  Nursing  Service.  Having  for  the  most  part  a  quite 
uncultivated  field  in  which  to  labor,  this  service  progressed 
but  slowly.  Though  the  number  of  services  under  its  direc- 
tion never  exceeded  one  hundred  at  any  one  time  and  the  work 
consequently  never  reached  impressive  proportions,  its  influ- 
ence was  much  in  excess  of  its  size  and  it  played  a  valuable 
part  in  the  early  days  of  rural  nursing.  During  the  war  a 
number  of  new  activities  came  under  its  direction.  Since  the 
old  title,  the  Town  and  Country  Nursing  Service,  did  not  fit 
these  new  phases  of  work,  it  was  changed  to  the  more  appro- 
priate one  of  the  Bureau  of  Public  Health  Nursing. 

Out  of  the  experience  of  the  war  and  of  the  country  during 
the  war  grew  certain  great  primary  lessons  of  more  universal 
and  convincing  value  than  could  perhaps  have  been  taught  by 
all  the  educational  work  of  all  the  health  agencies  together 
before  the  war.  Jt  is  unnecessary  here  to  recite  these  lessons, 
since  they  are  known  to  all.  As  the  result  of  them  at  the 
close  of  the  war  there  existed  throughout  the  country  a  lively 
awareness  of  the  present  inadequate  distribution  of  public 
health  nursing,  an  acute  consciousness  of  the  universal  need 
for  it  and  a  widespread  demand  for  public  health  nurses. 

A  year  after  the  armistice,  we  found  in  taking  stock  of  the 
situation  that  there  were  two  states,  Ohio  and  Wisconsin,  in 
which  there  Avas  a  mandatory  law  compelling  every  county  to 
have  a  public  health  nurse  (in  Wisconsin  the  law  provides  the 
alternative  of  a  public  health  instructor)  ;  that  in  sixteen 
states  there  were  permissive  laws  enabling  the  counties  to  use 
county  funds  for  public  health  nursing,  if  tbey  choose  so  to 
do;  that  in  fifteen  states  there  were  state  supervising  nurses 
employed  by  the  state  department  of  healtli  as  directors  of 
bureaus,  divisions  or  sid)-divisions  of  public  health  nursing, 
whose  functions  were  to  promote  ])ui)li('  health  nursing  in  the 
counties  and  to  get  county  officials,  county  funds  and  county 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1295 

interest  back  of  a  public  program  for  public  liealth  nursing. 
According  to  Miss  Yssabella  Waters'  figures  there  were  four 
states,  Massachusetts,  Connecticut,  Khode  Island  and  New 
York,  in  which  there  was  one  public  health  nurse  to  every 
four  or  five  thousand  people.  Dr.  C.  E.  A.  Winslow  says  the 
ideal  is  one  to  every  two  thousand.  From  the  high  standard 
of  these  states  the  ratio  decreased  rapidly,  the  lowest  being 
one  public  health  nurse  to  one  hundred  and  eighty  thousand 
people  in  IMississippi.  Wyoming  had  only  two  public  health 
nurses;  Nevada,  three;  Utah,  outside  of  Salt  Lake  City,  none. 
So  rapidly  in  the  last  few  months,  however,  has  rural  nursing 
progressed  that  no  doubt  these  figures  are  already  out  of  date. 

At  the  same  time  the  country  was  covered  with  "ready- 
made"  groups  of  workers  in  Red  Cross  chapters.  These  work- 
ers were  disciplined  by  continuous  and  exacting  war  duties; 
they  had  learned  to  get  together  for  a  common  purpose ;  they 
had  shared  in  the  responsibilities  of  the  nurse  and  had  felt  the 
exhilaration  of  serving  others  in  a  big  cause.  Their  war 
duties  were  drawing  to  a  close,  but  for  many  of  them  the 
spirit  of  service  remained  and  could  be  put  to  use  in  com- 
munity activities. 

With  this  machinery  and  this  spirit  ready  at  hand  and  a 
great  need  existing  throughout  the  rural  parts  of  our  country 
for  public  health  nursing,  the  Red  Cross  was  in  a  position  to 
make  a  great  contribution  to  the  welfare  of  the  people  of  the 
nation  by  setting  the  chapters  to  work  to  promote  this  activity 
in  territories  which  otherwise  might  not  be  able  to  introduce 
it  for  some  time  to  come.  In  so  doing  the  Red  Cross  would 
simply  bo  extending  its  traditional  duties  of  saving  life,  miti- 
gating suffering,  preventing  unnecessary  disease  and  fortify- 
ing physical  stamina.^ 

The  Red  Cross  was  convinced  that  the  Chapters  in  niral  and 
semi-rural  comnmnities  would  find  an  excellent  opportunity  to 
perform  a  service  of  great  value  through  the  establishment  of 
public  health  niirsing  since  there  were  many  counties,  towns 
and  villages  having  no  such  service,  where  the  need  was  great 
and  where  the  installation  of  such  a  service  bv  the  chapter 
would  be  warmly  welcomed.  It  was  planned,  therefore,  to  en- 
courage Chapters  in  such  localities  to  develop  a  public  health 
nursing  service. 

The  scope  of  the  Town  and  Country  8ervice  had  been  limited 
to  towns  having  a   population   less  than   25,000   and   to  rural 

^  Fehniary,  1920.  issue  of  tlio  Puhlic  Health  Xursc:    "The  development  of 
the   Ked   Cross   Public   lleulth    Niirsiiifr   Service." 


1296  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

communities.  In  the  spring  of  1918  the  National  Committee 
on  Red  Cross  Nursing  Service  removed  this  limitation  and  set 
no  restriction  in  its  place  on  the  basis  of  population.  It  was 
henceforth  permissible  to  establish  a  nursing  service  in  com- 
munities of  any  size  when  so  desired.  The  Red  Cross  did  not 
propose,  however,  to  enter  communities  where  the  work  was 
well  established  and  the  people  well  informed  in  public  health 
nursing  principles  and  procedures.  Such  communities  were 
already  meeting  the  situation  in  this  field  and  were  not  in 
need  of  assistance  and  supervision.  The  concern  of  the  Red 
Cross  was  for  those  communities  in  which  public  health  nursing 
was  just  being  established,  where  the  people  had  yet  to  learn 
how  to  develop  and  manage  this  new  undertaking,  where  advice 
and  trained  supervision  were  needed,  or  where  the  backing 
secured  by  being  a  part  of  the  Red  Cross  service  was  a  source 
of  moral  support  and  strength. 

It  was  recognized  that  public  health  nursing  was  a  public 
function  which  depended  for  its  success  on  its  understanding 
and  willing  acceptance  by  the  people  of  the  community.  For 
this  reason,  it  was  agreed  that  it  would  be  much  more  sound 
and  permanent  in  character  and  wider  in  scope  if  it  were  built 
slowly  and  if  the  general  public  had  a  share  in  the  local  re- 
sponsibility for  and  management  of  this  fundamentally  public 
enterprise.  As  public  health  nursing  was  considered  to  be  a 
community  service,  it  was  to  be  developed  in  harmony  and 
cooperation  with  other  community  activities.  Furthermore, 
as  any  local  accomplishment  formed  an  organic  part  of  the 
work  of  the  state,  it  was  agreed  fliat  the  Chapter  should  plan 
its  service  in  line  with  the  state  program  for  public  health 
nursing  and  should  always  be  responsive  to  suggestions  from 
the  state.  The  Red  Cross  was  to  be  considered  an  educational 
agency,  not  necessarily  the  permanent  directing  agency,  and 
assumption  of  financial  responsibility  by  the  municipal  or 
state  authorities  was  to  be  welcomed. 

Moreover,  as  reported  later:  "In  working  out  the  plans  for 
the  conduct  of  this  work,  consideration  was  immediately  given 
to  the  fact  that  the  Red  Cross  was  not  alone  in  the  field ;  that 
many  other  agencies,  national,  state  and  local,  public  and  pri- 
vate, were  engaged  in  promoting  some  one  or  mcu'c  branches 
of  public  health  nursing;  and  that  much  good  work  was  already 
under  way.  These  agencies  were  attacking  the  need  from  vari- 
ous angles,  none  of  tlicni  with  complete  programs  or  with  any 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1297 

immediate  expectation  of  meeting  the  whole  need.  There 
seemed  to  be  no  probability  that  all  of  them  working  together 
would  be  able  to  meet  more  than  part  of  the  great  need  of  rural 
communities  for  some  time  to  come.  The  Red  Cross  merely 
proposed  to  supplement  the  work  of  these  agencies  by  bringing 
assistance  to  rural  people  until  governmental  agencies  could 
more  nearly  take  care  of  them."  ^ 

When  this  general  plan  had  been  accepted  by  the  Central 
Committee  of  the  Red  Cross,  instructions  were  issued  which 
set  forth  the  following  policy : 

Chapter  nursing  activities  shall  always  be  conducted  with 
the  thought  that  in  so  far  as  they  alfect  the  public  health  they 
constitute  one  phase  of  a  very  broad  public  problem.  With 
this  thought  in  mind  the  chapter  nursing  activities  shall  be 
carried  on  in  a  manner  that  will  assure  cooperation  with 
medical  or  social  welfare  work  existing  or  to  be  introduced  in 
the  community.  It  is  equally  important  that  the  spirit  in 
which  the  work  is  conducted  shall  be  one  that  will  enlist  the 
interest  and  aid  of  the  entire  community.  With  that  end  in 
view  the  activities  shall  be  developed  as  a  public  service  and 
not  as  a  charity  and  the  personnel  conducting  such  activities 
shall  make  an  especial  effort  to  popularize  them.  It  is  not 
proposed  to  initiate  public  health  nursing  activities  in  com- 
munities where  agencies  exist  for  this  purpose,  unless  to  co- 
operate with  or  aid  the  estaldished  agencies.  The  American 
Red  Cross  seeks  only  to  develop  the  public  interest  in  public 
health  nursing  activities.  It  does  not  seek  to  retain  permanent 
supervision  of  these  activities  and  will  welcome  state  or 
municipal  assumption  of  supervision  and  control  of  all  public 
health  nursing  services.  Tlie  Red  Cross  proposes  to  initiate 
public  health  nursing  services  only  in  localities  where  there 
are  no  existing  agencies  for  that  purpose  and  where  none  is 
immediately  projected  by  any  other  state  or  national  organi- 
zation. The  b'ed  Cross  also  desires  to  cooperate  with  other 
organizations  already  in  the  field  and  to  render  the  fullest 
measure  of  such  cooperative  service.  It  does  not  seek  to 
supplant  or  compete  with  any  existing  service  or  organization, 
or  to  initiate  any  ])rograni  which  will  conflict  with  the  plans 
of  other  organizations.  The  l?ed  Cross  rather  seeks  to  aid 
other  agencies  with  the  ultimate  purpose  of  securing  the 
wisest  })ossible  development  of  the  public  health  nursing  serv- 
ice through  the  properly  constituted  State  and  local  organiza- 

'"The  Red  Cross  I'uhlic  TIcalth  Xursitifx  Service.  A  History  and  Fore- 
cast."    Jicd  Cruiss  Hullitin,  January  20,  1920. 


1298  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tions.  Because  of  its  extensive  Chapter  organization,  the  Eed 
Cross  feels  that  it  is  able  to  promote  the  establishment  of 
these  activities  in  territories  which  otherwise  might  not  be  able 
to  introduce  such  a  service  for  some  time  to  come.  By  this 
development  the  Red  Cross  may  make  a  distinct  contribution 
to  the  progress  of  public  health  nursing  throughout  the 
country.^ 

Participation  in  and  the  organization  of  public  health  nurs- 
ing by  the  American  Red  Cross  was  described  as  follows : 

The  American  Eed  Cross  is  anxious  to  promote  this  work  in 
small  towns  and  in  the  country,  but  would  prefer  to  have 
communities  [public  authority]  organize  and  finance  their 
own  public  health  nursing  service,  where  possible,  under  the 
supervision  of  the  State  authorities.  Where  the  community 
[public  authority]  is  unal)le,  or  not  ready  to  bear  the  entire 
burden  of  financing  a  public  health  nursing  service,  the  Eed 
Cross  may  undertake  to  organize  tlie  service  and  finance  it, 
with  the  aid  of  the  community  or  from  its  own  funds,  until 
such  time  as  the  state  or  municipality  will  take  over  the 
direction  and  support  of  the  service. 

The  ways  in  which  the  Red  Cross  may  proceed  in  develop- 
ing public  health  nursing  may  roughly  be  classified  under  four 
headings : 

(a)  It  has  authorized  its  Chapters  to  develop  public  health 
nursing  services  and  to  use  Chapter  funds  for  tliis 
purpose.  The  work  may  therefore  be  started  by  the 
Eed  Cross  Chapter. 

(b)  Where  one  or  more  other  local  agencies,  public  or  pri- 
vate, are  desirous  of  combining  in  a  joint  nursing 
service  and  are  ready  to  sliare  in  its  cost,  the  Chapter 
may  participate  and  contribute  its  share  of  the  funds  if 
it  is  proportionately  represented  on  the  committee  in 
charge  of  the  service  and  if  its  standards  of  personnel 
and  work  are  maintained. 

(c)  Occasionally  an  organization  which  is  conducting  a 
local  public  health  nursing  service  desires  the  assistance 
of  the  Eed  Cross  in  securing  a  nurse  and  its  advice  and 
help  in  regard  to  and  supervision  of  the  nursing  service. 
It  may  secure  this  continuous  and  systematic  assistance 
by  affiliating  with  the  Eed  Cross  Public  Health  Nurs- 
ing Service.     In  so  doing  it  must  agree  to  maintain 

'  "The   Organization    and    Administration    of    a    Public   Health    Nursing 
Service.     Instruction  for  Chapters,"  March  1,  1919. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1299 

certain  standards  of  sorvico  set  forth  in  the  .  .  . 
statement  caUcd  the  "Aftiliation  Af(reement"  and  must 
sign  this  statement  as  an  evidence  of  its  intention  to 
ohserve  these  conditions, 
(d)  Where  there  is  an  existing  organization  conducting  a 
puhli(!  liealth  nursing  service  which  might  greatly  ex- 
tend the  development  of  its  work  through  the  financial 
assistance  of  a  Chapter,  the  Chapter  may  contrihute  a 
sum  suilicient  to  aid  in  this  development.  No  dona- 
tions from  Chapter  funds  in  excess  of  one-tenth  of  the 
yearly  expense  of  conducting  the  puhlic  health  nursing 
service  may  he  made,  however,  excejit  under  special 
circumstances  and  with  special  permission  from  the 
Division.* 

The  old  Town  and  Country  Xursing  Service  had  consisted 
largely,  as  set  forth  in  the  preceding  section,  of  a  series  of 
aliiliations  with  local  organizations,  quite  independent  of  the 
Jvcd  Ooss  Chapter,  such  as  women's  clubs,  Visiting  Xurse 
Associations,  Civic  Leagues,  town  and  school  boards  and 
similar  groups.  While  the  plan  was  now  changed  to  extend 
the  service  hereafter  throngh  the  chapters,  the  old  method  of 
creating  athliations  with  local  organizations  outside  of  the 
chapter  was  not  abandoned,  althongh  limited  by  the  new-  policy 
that  such  affiliations  should  not  be  made  in  states  having  a  well 
developed  system  of  State  supervision  of  nursing  nnder  the 
State  department  of  health.  It  was  felt  that  the  State  super- 
vising nnrse  was  prepared  to  give  the  necessary  direction,  as- 
sistance and  supervision  to  independent  public  health  nursing 
organizations  and  that  conse(piently  any  affiliations  which  the 
Red  Cross  might  form  with  them  would  only  result  in  needless 
duplication. 

As  stated  in  the  first  paragraph  of  this  chapter,  all  nursing 
activities  conducted  by  the  (^hapter  including  public  health 
nursing  werc^  to  be  administered  by  a  Committee  on  Nursing 
Activities.  I'lie  method  of  appointing  this  committee  and  sug- 
gestions concerning  its  membership  were  set  forth  in  the  in- 
structions to  chapters  as  follows : 

The  mem])ers  of  this  committee  shall  he  appointed  by.  and 
continue  in  office  during  the  ])lcasurc  of.  tlie  Chapter  I-accu- 
tivc  Coiumittce.   Th(^  ai)i)()iiitnioiits  to  the  Cha]itcr  Cdininittoe 

*  Tnforniiit  ion  for  Communities  Conccniinjr  tlio  TumI  Cross  Public  Health 
Xursin"   Service, 


1300  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

on  Xursing  Activities  shall  be  approved  by  the  Division 
Director  of  Nursing  before  they  are  confirmed.  The  commit- 
tee should  consist  of  as  many  workers  as,  in  the  judgment  of 
the  Chapter,  may  be  necessary  to  carry  on  the  work  effectively 
and  should  include  both  men  and  women.  It  will  usually  be 
found  desirable  to  limit  the  committee  to  fifteen  members  and 
there  should  not  be  less  than  five  members. 

The  chairman  of  the  committee  shall  be  appointed  by  the 
chapter  p]xecutive  Committee  and  should  be  a  person  having  a 
positive  interest  in  all  the  activities  under  the  jurisdiction  of 
the  committee.  A  vice-chairman  should  also  be  appointed  to 
carry  on  the  work  of  the  committee  in  the  absence  of  the 
chairman. 

The  chapter  Committee  on  Nursing  Activities  should  in- 
clude among  its  members  one  or  more  representatives  of  each 
of  the  following : 

(a)  The  Board  of  Health. 

(b)  The  Board  of  Education  (or  representative  teacher). 

(c)  The  ]\Iedical  Association. 

(d)  The  Chamber  of  Commerce  or  Board  of  Trade. 

(e)  The  Clergy. 

(f )  Such  other  active  local  organizations  as  the  Civic  Club, 
Woman's  Club,  etc. 

(g)  The  Chapter  Home  Service  Section.  It  may  be  of 
advantage  also  to  have  a  representative  of  the  Com- 
mittee on  Nursing  Activities  on  the  Home  Service 
Committee,  and  it  is  suggested  that  this  be  arranged 
for  when  practical)le. 

(h)  The  Local  Committee  of  the  Bed  Cross  Nursing  Ser- 
vice, where  convenient ;  or,  if  not,  then  a  representative 
Eed  Cross  nurse  qualified  as  a  general  representative  of 
the  Bed  Cross  Nursing  Service  should  be  appointed 
with  the  approval  of  the  Division  Director  of  Nursing. 

(i)    Other  local  public  health  iiursing  agencies,  if  any. 

(j)    Chapter  School  Committee. 

(k)  United  States  Department  of  Agriculture  (usually  a 
Home  Demonstration  agent)."' 

Certain  regulations  were  made  concerning  the  nurse's  ser- 
vice to  the  Chapter.  Tlie  first  three  months  were  to  be  consid- 
ered probationary  and  a  month's  vacation  with  pay  allowed  an- 
nually. It  was  recommended  that  after  six  months'  service 
one  half  the  trav(ding  oxpc^nsos  incurred  by  a  nurse  in  reporting 

'^  "Tlio  Dovplopmcnt  and  Administration  of  Chapter  Nursing  Activities; 
Instruction   for   Chapters/'   March    1,    1919. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1301 

for  duty  be  refunded.  One  half  day  a  week,  exclusive  of  Sun- 
days and  holidays,  was  assigned  for  rest  and  recreation  and 
sick  leave  with  pay  arranged  for.  if  night  duty  were  necessary 
in  emergencies,  the  nurse  was  to  have  sutHcient  rest  the  follow- 
ing day.  Private  practice  by  the  nurse  was  absolutely  for- 
bidden. 

In  addition,  definite  instructions  were  issued  concerning 
certain  aspects  of  the  work,  such  as  the  professional  relation- 
ship of  the  nurse  to  the  medical  profession,  the  inadvisability 
of  material  relief  given  by  the  nurse  and  the  placing  of  the 
work  on  a  business  rather  than  on  a  charity  basis,  allowance 
being  made,  however,  for  those  unable  to  pay  the  full  cost  of 
the  nurse's  visit  and  for  the  maintenance  of  a  free  service  for 
Army  and  Xavy  men  and  their  families  and  for  disabled  ex- 
service  men. 

In  regard  to  appointments  the  instructions  read : 

The  public  health  nurses  must  be  appointed  to  the  Chapter 
by  the  Bureau  of  Public  Health  Nursing  at  Ked  Cross  Division 
headquarters.  .  .  . 

Xurses  desiring  to  serve  as  Tied  Cross  public  health  nurses 
must  meet  all  the  requirements  of  the  Ped  Cross  Bureau  of 
Public  Health  Xursiug  and  must  be  enrolled  Ked  Cross  nurses 
or  must  make  application  for  enrollment.  .  .  . 

Requirements  for  appointment  in  the  Red  Cross  Public 
Health  Xursing  Service  were  defined  as  follows : 

A  graduate  nurse  who  has  had  no  experience  or  training  in 
public  health  nursing  cannot  conduct  a  public  health  nursing 
service  satisfactorily.  The  varied  responsibilities  demand  a 
person  who  is  an  organizer,  teacher  aiul  demonstrator  as  well 
as  a  nurse  and  one  who  is  familiar  with  public  health  problems 
and  procedures.  These  qualifications  and  this  knowledge  are 
only  secured  by  experience  under  direction  or  by  special 
training. 

Public  health  nursing  is  a  highly  developed  form  of  nurs- 
ing, ])re])aration  for  winch  is  not  iiuhided  ordinarily  in  the 
training  school  curriculum.  It  is  necessary,  therefore,  for  the 
nurse  who  wishes  to  be  successful  in  this  lield  to  undertake  a 
post-graduate  course  or  to  secure  lier  1  raining  thi'ougli  super- 
vised exiierience  mufer  the  direction  of  a  puMie  health  nurse 
instructor. 

Professional  requirements  for  tlie  Bed  Cross  i)uhlic  health 
nurst^  ;u'(>  eliuihilitv  for  enrollment  in  1  he  I'cd  Ci'oss  Xur'^in<jc 


1302  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Service  and  a  four  or  eight  months'  course  in  public  health 
nursing,  either  post-graduate  or  taken  during  training,  or  its 
equivalent  in  supervised  practical  work. 

In  addition,  such  personal  qualifications  as  good  health, 
education,  public  spirit,  ability  to  manage  difficult  situations 
and  to  carry  responsibility,  must  be  considered.  In  many 
services  a  nurse  is  granted  two  weeks'  sick  leave  with  salary-, 
though  a  more  generous  arrangement  may  be  made  where  the 
nurse  has  become  of  proved  value  and  where  the  illness  has 
been  contracted  through  the  performance  of  her  duties. 

Under  ordinary  circumstances,  nurses  should  not  be  called 
for  night  duty,  but  in  case  of  emergency,  when  this  is  done, 
the  chapter  should  provide  for  the  care  of  her  patients  during 
the  day.  The  chapter  should  forbid  any  attempts  made  by  the 
nurse  to  practice  privately  after  hours.° 

The  instructions  also  included  recommendations  that  an 
office,  telephone,  loan  closet,  filing  cabinet,  nursing  equipment 
and  suitable  transportation  be  provided  and  that  an  accurate 
and  adequate  record  system  be  maintained.  No  salary  could 
be  prescribed  and  only  a  general  guide  was  attempted  and 
issued.'^ 

As  was  reported  later: 

The  old  Town  and  Country  Nursing  Service  was  managed 
entirely  from  Headquarters,  as  it  had  its  beginning  long  be- 
fore the  Red  Cross  decentralized.  But  with  this  greatly  en- 
larged program  it  was  necessary  immediately  to  set  up  a 
Bureau  of  Public  Health  Nursing  in  each  of  the  thirteen  Red 
Cross  Divisions  and  to  secure  public  health  nurse  directors  for 
these  bureaus.^ 

The  staff  of  the  Bureau  of  Public  Health  Nursing  at 
National  Headquarters  included  the  director,  Elizabeth  G.  Fox, 
and  an  assistant,  Charlotte  E.  VanDuzer,  a  public  health  nurse 
of  wide  experience  as  city  visiting  nurse,  rural  county  school 
nurse  and  as  medical  social  service  worker  at  Bellevue  Hos- 
pital, New  York  City.  As  school  nurse  she  organized  scluxd 
nursing  in  Watcrtown,  New  York,  and  later  in  Kent  County, 
]\Iichigan,  under  the  Town  and  Country  Nursing  Service  of 
the  Red  Cross,  did  an  outstanding  piece  of  work  which  is  still 
a  model  to  be  followed  by  rural  school  nurses. 

""Tlic  Development  aiul  Administration  of  Cliapter  Nursing  Activities." 
'Hid. 

*  "Tlie  Red  Cross  Public  llealtli   Xursinu   Service.     A  History  and   Fore- 
east,"  Red  Cross  Bulletin,  Janiiarv  20,  1920. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1303 

In  January,  1920,  Katharine  W.  Holmes,  whose  work  in 
Europe  has  been  described,  was  added.  Steps  were  immediately 
taken  to  appoint  public  health  nurses  as  directors  to  organize 
and  operate  the  newly  created  Bureaus  of  Public  Health  Nurs- 
ing in  the  Divisions. 

In  several  of  the  Divisions,  the  already  appointed  director 
of  the  Department  of  Nursing  v/as  a  public  health  nurse  and 
was  therefore  appointed  director  of  the  Bureau  of  Public 
Health  Nursing  also.  These  were  Elizabeth  Ross,  later  suc- 
ceeded by  Bernicc  Billings;  Jane  Van  de  Vrede;  V.  Lota 
Lorimer,  succeeded  by  Grace  Bentley  and  later  by  I.  Malinde 
Havey ;  jVlinnie  Ahrens,  and  Eva  Anderson.  Grace  Harring- 
ton and  Ethel  Binder,  the  first  appointed  in  May  of  1920  and 
the  second  in  July,  1920,  to  fill  vacancies  in  the  Northwestern 
and  Southwestern  Divisions  respectively,  were  also  appointed 
as  directors  of  Nursing  and  Public  Health  Nursing,  Three 
nurses,  Mary  K.  Nelson,  Nellie  F.  Oxley,  and  Olive  Chapman, 
who  were  appointed  Directors  of  Public  Health  Nursing  in 
the  New  England,  Potomac  and  ]\rountain  Divisions  respec- 
tively, later  became  Directors  of  Nursing  as  well.  Most  of 
these  nurses  have  been  spoken  of  earlier  in  the  history. 

Four  nurses,  Anna  A.  Ewing,  ]\Iadeline  Oldfield,  Mrs.  Ethel 
S.  Parsons  and  ^Irs.  Grace  Engblad,  all  of  whom  had  served 
as  chief  nurses  in  the  extra  cantonment  zones  during  the  war, 
were  appointed  dir(>ctors  of  Bureaus  of  Public  Health  Nursing 
in  four  of  the  Divisions.  Having  had  several  years'  experience 
of  public  health  nursing  in  the  east,  west  and  south  and  a  post- 
graduate course  at  1'eachers  College,  Anna  A.  Ewing  was 
appointed  to  the  Atlantic  Division  and  filled  the  position  with 
painstaking  zeal  until  the  Atlantic  Division  was  merged  in 
the  Washington  Division  in  June,  1922.  ^Madeline  Oldfield, 
who  had  had  ten  years'  experience  in  public  health  nursing 
largely  in  or  around  New  York  City,  was  appointed  to  the 
Potomac  Division  and  was  later  succeeded  by  Nellie  F.  Oxley. 
^Irs.  Grace  Engblad,  an  English  woman,  trained  and  with  years 
of  experience  in  this  country,  undertook  the  work  in  the  Gulf 
Division,  wli(>re  she  served  until  her  health  made  a  change 
necessary.     Sli(>  was  succeeded  by  Mary  ]v.  Nelson. 

]\Irs.  Ethel  S.  Parsons,  a  graduate  of  the  public  health  nurs- 
ing course  at  ^(^acliers  College  and  with  several  years  of  execu- 
tive public  health  nursing  experience  in  Texas,  became  Director 
of  Public  Health  Nursinii'  in  the  S(^utlnvestern  Division.  After 


1304  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

a  year  of  service  she  resigned  to  become  Director  of  Public 
Health  Nursing  in  the  Texas  State  Board  of  Health  and  was 
succeeded  by  Anna  L.  Stanley. 

One  of  the  leading  school  nurses  in  the  country,  Miss  Stanley 
could  not  long  be  satisfied  in  a  general  executive  position  and 
in  July  of  1920  gave  up  the  Division  directorship  to  become 
special  supervisor  of  school  nursing  for  the  Red  Cross,  in  which 
position  she  did  much  to  work  out  a  standard  school  nursing 
technique  for  Red  Cross  nurses.  She  was  succeeded  by  Ethel 
Pinder. 

Two  years'  experience  in  industrial  nursing  gave  Mrs. 
Florence  Downing,  who  was  appointed  director  in  the  Penn- 
sylvania-Delaware Division,  an  added  advantage  in  handling 
the  public  health  nursing  problems  in  Pennsylvania,  a  state  of 
many  industries. 

Coming  from  the  East  originally  but  with  ten  years  of  public 
health  nursing  experience  on  the  Pacific  Coast,  Emma  Grit- 
tinger,  as  director  of  the  Bureau  of  Public  Health  Nursing 
in  the  Northwestern  Division,  was  no  "outsider."  Leaving 
for  the  East  in  February,  1920,  to  take  up  public  health  nursing 
work  at  Teachers  College,  she  was  succeeded  by  Grace  Har- 
rington. 

Also  with  an  eastern  training,  but  a  western  exxperience, 
Mary  L.  Cole  was  taken  over  from  the  super intendency  of 
the  Visiting  Nurse  Association  of  Santa  Barbara,  California, 
to  become  Director  of  Public  Health  Nursing  in  the  Pacific 
Division  and  later  director  of  the  Nursing  Service  as  well. 

Each  Division  Bureau  was  a  part  of  the  Division  Depart- 
ment of  Nursing.  It  remained  the  function  of  the  National 
Bureau  to  determine  general  policies  and  plans,  set  uniform 
standards,  outline  uniform  administrative  procedures,  make 
contact  and  work  out  agreements  with  other  national  agencies 
and  to  guide  and  help  the  Division  Bureaus.  It  became  the 
function  of  the  Division  Bureaus  as  projections  of  the  National 
Bureau  to  interest  the  Chapters  in  and  to  help  them  to  organize 
and  administer  public  health  nursing  services,  to  secure  for 
them  trained  public  health  nurses  and  to  guide  and  assist  them 
by  visits  of  the  Division  staft'  to  the  Chapters  and  of  Chapter 
officials  and  workers  to  the  Division  office,  by  regional  and 
state  meetinas,  through  correspondence  and  a  system  of  monthly 
reports  and  by  other  nietliods.  The  Division  ]^ui'eau  was  re- 
sponsible for  the  niaintenanee  in  the  Chapters  of  standards  of 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1305 

nursing  work  and  personnel  set  by  the  American  Red  Cross 
as  previously  described. 

The  operating  unit  was  the  Chapter,  which  was  usually  coun- 
trywide, or  the  affiliated  organization.  The  planning,  direction 
and  execution  of  the  work  was  left  entirely  to  these  local  units 
with  national  standards  for  their  guidance  and  with  the  super- 
vision described  alwve,  which  always  had  as  its  primary  con- 
sideration the  peculiar  needs  and  possibilities  of  the  individual 
Chapter.  The  line  of  communication  was  from  Chapter  to 
Division  and  from  Division  to  National  Headquarters.  The 
latter  did  not  negotiate  directly  with  the  Chapters. 

In  ^larch,  1!)1J),  soon  after  the  work  was  decentralized,  the 
general  manager  issued  two  sets  of  instructions  to  be  dis- 
tributed by  the  Division  managers  to  the  Chapters.  These 
were  called  **The  Development  and  Administration  of  Chapter 
Nursing  Activities"  and  "The  Organization  and  Administra- 
tion of  a  Public  Health  Nursing  Service"  and  were  designated 
as  "A-700"  and  ''A-TOl."  ]\Iany  extracts  from  these  Instruc- 
tions have  been  given  in  the  preceding  pages.  Two  pamphlets 
called  "Information  for  Communities  Concerning  the  Ked 
Cross  Public  Health  Nursing  Service"  and  "Information  for 
Nurses  Concerning  the  Red  Cross  Public  Health  Nursing 
Service"  were  issued  by  the  bureau,  as  was  also  a  popular  pam- 
phlet for  propaganda  purposes  called  "Have  you  a  Community 
Nurse  V 

The  typical  methods  used  by  the  Divisions  to  introduce  pub- 
lic health  nursing  to  the  Chapters  were  described  by  one  of 
the  Division  directors  of  Public  Health  Nursing  as  follows: 

The  progress  of  the  work  in  the  chapters  may  be  indicated 
through  the  followiii;^  methods  which  have  been  ])ursued.  The 
work  had  its  first  introduction  tlirough  the  medium  of  a  cir- 
cuhir  letter  from  the  Division  Manager  to  all  Chapters,  an- 
nouncing the  ])lan  and  sending  a  copy  of  ATOO  and  ATOl. 

Tlie  next  step  was  to  make  the  general  field  rejirescntatives 
thoroughly  familiar  with  the  {)lans  and  ])urposes  of  the  Bu- 
reau. In  their  general  development  (if  Chapter  activities  they 
included  the  giving  of  information  concerning  public  health 
nursing  as  a  possible  activity  of  the  Chapter.  The  tliird  step 
was  to  acquaint  all  hosjutals  and  training  sciiools  for  nurses 
with  the  phin  for  jirovidiii','-  IJed  Cross  sch(ilar>hi|)s  whicli 
made  training  in  public  health  nursiiiL;-  available.  This  infor- 
mation  was  also  sent   to  all    Local  Coinniittees  on   lie(l  Cross 


1306  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Xursiiig  Service  and  to  all  Home  Service  secretaries.  In  addi- 
tion, the  Department  of  Publicity  pjave  full  information  re- 
garding the  Red  Cross  plans  for  public  health  nursing  to  the 
publicity  chairmen  of  the  different  Chapters  and  also  to  press 
officials.  The  Division  publication,  "IJed  Cross  Briefs,"  also 
carried  regular  articles  on  the  subject  and  in  order  to  make 
this  information  available  to  nurses  about  to  be  graduated, 
every  hospital  in  the  accredited  class  was  asked  to  furnish  a 
list  of  the  senior  nurses  in  their  training  schools  and  these 
nurses  were  put  on  the  regular  mailing  list  for  "Briefs,"  thus 
giving  them  each  week  current  information  regarding  the 
progress  of  the  work  of  the  bureau  and  other  information 
w^hich  might  be  of  value  to  these  prospective  nurses  in  plan- 
ning their  work  after  graduation. 

Efforts  were  made  by  the  Division  Directors  to  visit  in  person 
or  to  send  a  nurse  assistant  to  visit  as  many  of  the  Chapters 
as  possible  both  to  introduce  the  work  and  to  help  the  Chapters 
which  were  interested  to  take  the  right  stops  toward  its  organi- 
zation.    Some  of  them  commented  as  follows : 

Only  those  Chapters  were  visited  by  us  who  requested  us  to 
do  so,  saying  they  were  interested  or  could  Ije  interested. 

Every  Chapter  and  most  of  the  larger  branches  in  the  Divi- 
sion have  been  visited  by  tlie  Division  Director  of  Nursing 
and  the  health  ])rogram  presented. 

The  Division  Director  made  personal  visits  to  Chapters, 
hchl  coiiforeuces,  spoke  to  groups  of  nurses,  Chapter  execu- 
tives, liigh  school  ])u])ils,  physicians,  boards  of  health,  and  to 
various  other  groups  of  people. 

While  this  w^as  going  on  in  the  Divisions,  miich  publicity 
was  being  given  the  public  health  nursing  program  by  the  Red 
Cross  in  n(;wspapers,  popular  magazines,  nursing  journals,  tho 
Bed  Cross  Magazine  and  from  the  platform. 

The  response  from  the  Chapters  to  th(!  suggestion  that  they 
might  engage  in  public  health  nursing  was  so  immediate  that 
the  Division  directors  were  soon  overwhelmed  by  its  volume. 

As  an  immediate  corollary,  it  was  reported,  they  had  to  find 
public  health  nurses  to  fill  the  positions  which  immcdiatelv 
began  to  spring  up,  or  to  interest  other  nurses  in  securing  the 
necessary  preparation  to  fill  these  pr)sitions. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1307 

The  second  proposition  was  much  harder  than  the  first.  Hun- 
dreds of  Chapters  received  with  great  interest  and  zest  the 
information  that  under  certain  conditions  they  might  engage 
in  puhlic  health  nursing  and  were  eager  to  get  under  way  at 
once.  Their  demands  speedily  outran  the  supply,  and  the 
Division  directors  had  to  turn  from  stimulation  to  restraint. 

They  described  the  methods  used  to  reach  and  interest  nurses 
as  follows: 

Interviews  and  correspondence  with  nurses  in  Division 
offices;  addresses  to  nurses  at  State  and  local  organization 
meetings  and  to  pupils  in  training  schools;  circularization  of 
nurses  and  superinteiulents  of  training  schools;  distribution 
of  the  booklet  "Information  for  Xurses"  and  Division  bulle- 
tins to  senior  classes  of  training  schools;  personal  talks  to 
nurses  who  were  to  take  state  registration  examinations ;  in- 
fluencing Cbapters  to  interest  senior  nurses  in  training  schools 
by  inviting  them  to  social  functions  at  which  public  health 
nursing  was  ])resented ;  advertisements  and  write-ups  in  news- 
papers, magazines  and  The  Puhlic  Health  Nurse  and  the 
American  Journal  of  Nurying.^ 

They  ascribed  their  inability  to  keep  up  with  the  demand  to 
a  variety  of  causes,  the  most  common  being :  the  lack  of  properly 
qualified  public  health  nurses ;  the  lack  of  convenient  post-grad- 
uate schools  and  their  overcrowded  condition ;  the  inability  of 
numy  nurses  to  take  post-graduate  training  because  of  insuffi- 
cient (education  or  lack  of  funds;  the  difficulty  in  getting  nurses 
to  undertake  rural  work,  and  the  scarcity  of  accredited  training 
schools  in  several  states. 

In  June,  1020,  the  national  director  of  Public  Health 
Xursing  reported : 

During  the  year  nearly  SOO  nurses  have  been  added  to  our 
field  staff  and  20  per  cent  of  tlie  cha])ters  have  been  enabled  to 
launcli  a  public  health  luirsing  service,  a  truly  remarkable 
achievenieiit.  The  securing  of  so  large  an  additional  per- 
sonnel in  so  short  a  time  was  due  ]irincipally  to  three  things: 

1.  The  return  of  tliousands  of  nurses  from  overseas,  many 
of  them  witli  a  new  interest  in  ])ublic  health  nursing.  While 
bundre(ls  of  these  came  into  our  service,  huiulreds  also  went 
into  ]iuhlic  JK^alth  iiursinLT  und(M'  other  ausjuces.  thus  greatly 
incrcasinLT  the  total  nuniher  of  work(>rs  in  this  field. 

°  ■■'i'lic   I'fd    Cross   I'lililic    llcnllli    Nursing   Service.    A    History  and   Fore- 
cast,"   h'xl   Crn.K.K    HuUrlii).    .lanuarv   -iC.,    1920. 


1308  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

2.  The  active  campaign  carried  on  by  the  Divisions  in  all 
nursing  centers,  such  as  training  schools  and  state  and  local 
nursing  associations,  and  the  broadcast  advertising  given  rural 
nursing.  The  Eed  Cross  has  made  rural  nursing  popular 
among  nurses.  Formerly  interest  was  largely  directed  toward 
city  work,  and  only  a  few  nurses  had  caught  the  vision  of  the 
great  opportunities  awaiting  them  outside  the  large  centers. 
To-day  rural  nursing  occupies  the  limelight,  and  nurses  by 
the  hundreds  are  flocking  into  it.  They  have  had  their  imagi- 
nation fired  by  the  infinite  possibilities  for  original,  effective 
and  very  human  service  in  the  smaller  towns  and  the  country. 

3.  During  the  past  year  278  scholarships  and  69  loans  have 
been  awarded  from  the  National  Fund  of  the  Red  Cross  to 
graduate  nurses  to  enable  them  to  secure  public  health  nursing 
training  at  one  of  the  accredited  schools  or  universities  giving 
a  public  health  nursing  course.  The  Chapters  also  have  shown 
great  interest  in  assisting  nurses  to  become  fully  prepared  for 
their  public  health  nursing  work,  and  have  given  approxi- 
mately 2G-\:  scholarships  for  this  purpose.  The  Metropolitan 
Chapter  of  Boston  alone  has  furnished  60  scholarships  to 
graduate  nurses,  leaving  them  free  to  take  up  their  public 
health  work  in  whatever  part  of  the  country  they  desire.  [This 
was  also  true  for  other  Chapters.] 

Both  the  National  IJed  Cro*  and  the  large  city  Chapters 
have  been  most  generous  too  in  aiding  schools  and  universities 
giving  a  public  health  nursing  course  to  perfect  either  their 
theoretical  or  practical  work.  Peabody  College  has  been  helped 
to  carry  on  its  course  through  a  large  subsidy  from  the  Eed 
Cross  and  at  the  University  of  Louisville,  Kentucky,  the  salary 
of  a  director  for  the  course  is  contributed  by  the  Red  Cross. 
...  A  practice  field  is  being  provided  for  the  course  at  the 
University  of  California,  and  the  Richmond  School  of  Social 
Service  and  Simmons  College,  Boston,  have  been  aided  with 
appropriations.  The  ]\Iinncapolis  Chapter  is  financing  the 
practice  field  in  Hennepin  County  for  the  course  in  pul)lic 
healtli  nursing  given  by  the  University  of  IMinnesota.  The 
St.  Louis  Chapter  is  contributing  not  only  the  entire  cost  of 
the  practice  field  for  the  public  health  nursing  course  given 
by  the  ^lissouri  School  of  Social  Economy,  but  the  salary  of 
the  director  of  the  course  and  three  supervisors  as  well.  The 
New  York  County  Chapter  has  made  a  large  appropriation 
toward  the  preparation  of  public  health  nurses  at  the  Henry 
Street  Settlement,  Xew  York  City.'° 

^'' Tho  University  (if  Micliipan  and  the  Sclinol  for  Sdcial  Service  at 
Philadelphia  were  given  financial  assistance  later  bv  the  National  Red 
Crosis. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1309 

Because  of  tlie  tremendous  demand  for  nurses  trained  espe- 
cially for  public  health  nursin<,%  because  of  the  popularizing 
of  rural  nursing  which  demands  special  preparation,  and 
because  of  the  much  needed  assistance  rendered  hundreds  of 
nurses  through  Ked  Cross  scholarships,  there  has  been  a 
remarkable  boom  in  all  the  schools  giving  courses  in  public 
health  nursing.  Formal  training  in  public  health  nursing 
through  definite  educational  channels  has  been  given  tremen- 
dous impetus,  and  nurses  generally  are  becoming  convinced  of 
the  need  for  such  training  before  undertaking  public  health 
nursing.  Attendance  at  the  various  schools  for  public  health 
nursing  iiu-reased  during  the  school  year  1919-20  from  100  to 
1000  per  cent.  Three  new  courses  were  opened  and  there  are 
definite  prospects  of  three  more  being  opened  in  the  fall  of 
1920. 

At  the  conference  of  the  staff  of  the  Department  of  Xiirsing 
at  National  Headquarters  in  the  fall  of  1910,  it  was  estimated 
that  the  Divisions  would  need  over  1000  public  health  nurses 
in  the  uext  year.  The  great  question  was  how  to  secure  them. 
The  number  of  nurses  returning  from  overseas  service  who 
had  had  training  in  public  health  nursing  and  whom  it  was 
hoped  to  recruit  for  chapter  service  was  far  too  few.  The 
scholarship  fund  of  $100,000.00  was  a  great  help  toward  ob- 
taining a  trained  personnel,  but  meant  delay  while  the  nurses 
were  receiving  their  public  health  nursing  training.  In  the 
meantime  the  Chapters  were  clamoring  for  public  health  nurses. 

In  the  discussion  at  the  conference,  the  directors  spoke 
again  and  again  of  the  eagerness  of  the  Chapters  to  help  their 
communities  through  establishing  a  public  health  nursing  ser- 
vice and  the  pitv  of  losing  the  opportunity.  Various  methods 
of  adding  to  the  supply  of  public  health  nurses  without  seri- 
ously lowering  the  standard  established  by  the  Red  Cross  were 
discussed:  the  sending  of  nurses  to  a  good  visiting  luirse  asso- 
ciation for  a  few  months'  experience  and  then  placing  them  in 
a  Chapter  service  with  the  understanding  that  tluMr  theoretical 
training  should  bo  gotten  at  the  first  ()p])ortunity  ;  or  the  placing 
id"  carefully  sch^cted  nurses  who  had  had  teaching  expcricmce 
but  no  public  health  nursing  experience  in  positions  under  con- 
tinuous supervision  for  a  few  weeks  with  freipicnt  follow  up 
visits  so  that  they  might  learn  while  gaining  experience  in  the 
tield  and  delay  the  taking  of  the  course  until  the  opportunity 
arose. 


1310  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

It  was  the  growing  sentiment  of  the  conference,  however, 
that  a  four  months'  public  health  nursing  course  was  little 
enough  training  to  require  and  Miss  Gardner  crystallized  this 
feeling  in  words  which  met  with  overwhelming  agreement : 

Before  we  put  in  inexperienced  nurses  why  couldn't  we 
frankly  say  that  we  haven't  the  goods  to  deliver?  This  is  not  a 
proposition  that  we  can  go  at  by  leaps  and  bounds.  It  is  slow 
moving.  We  are  going  to  lose  a  certain  amount  of  enthusiasm, 
but  we  can  afford  to.  We  should  educate  the  Chapters  more 
and  stimulate  them  less.  Let  us  frankly  say  Ave  cannot  meet 
the  demands  with  trained  people  all  at  once  and  must  wait 
until  we  can,  rather  than  resort  to  all  sorts  of  makeshifts. 

In  view  of  the  stand  taken  by  the  directors  that  the  Red 
Cross  should  not  attempt  to  meet  the  needs  of  the  Chapters  with 
unprepared  nurses,  another  way  of  securing  a  few  experienced 
public  health  nurses  was  brought  up  for  discussion.  It  was 
suggested  that  Visiting  Xursc  Associations  should  be  looked 
upon  as  recruiting  and  training  centers  for  public  health  nurses, 
giving  them,  through  actual  experience  on  the  staff  under  super- 
vision, sufficient  preparation  for  independent  work  in  the  coun- 
try. Ways  of  accomplishing  this  without  making  it  difficult 
for  the  already  overburdened  Visiting  Nurse  Associations  were 
discussed.  The  conclusion  seemed  to  be  that  two  methods 
might  be  followed.  The  first,  suggested  by  Miss  Gardner,  was 
to  send  nurses  from  a  given  locality  to  a  Visiting  Nurse  Associa- 
tion to  become  a  member  of  its  staff  for  a  sufficient  period  to 
gain  necessary  experience,  probably  not  less  than  eight  months, 
and  then  to  return  to  the  community  from  which  she  came,  to 
take  an  independent  position.  The  Visiting  Nurse  Association 
would  probably  be  able  to  take  such  a  nurse  on  the  usual  salary 
basis.  The  second,  that  already  in  vogue,  was  for  the  Division 
directors  to  make  personal  or  written  re(piests  to  specific  Visit- 
ing Nurse  Associations  for  candidates  to  fill  specific  vacancies, 
since  the  nurses  with  the  Visiting  Nurse  Associations  were  more 
likely  to  be  interested  in  a  concrete  offering  of  a  definite  posi- 
tion than  in  a  general  appeal  for  interest.  Directors  in  Divi- 
sions far  removed  from  the  larger  Visiting  Nurse  Associations 
might,  by  this  nu'thod,  interest  soni(^  of  the  nurses  on  such 
staffs  to  come  to  their  Divisions  to  definite  positions. 

The  Division  directors  concluded  by  unanimously  recom- 
mending the  continuance  of  a  national   fund  for  scholarships 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1311 

and  loans  to  prepare  nurses  for  public  health  nursing  in  the 
regular  post-graduate  courses. 

Several  months  later  the  problem  of  meeting  the  needs  of 
the  Chapters  for  public  health  nurses  having  continued  acute, 
the  subject  of  some  temporary  measure  to  meet  the  need  was 
again  considered.  A  plan  was  laid  before  the  Divisions  for 
the  employment  of  nurses  not  fully  (pialified  because  of  a  lack 
of  sufficient  training  or  experience  in  public  health  mirsing. 
It  was  proposed  that  these  nurses  should  be  appointed  as  substi- 
tutes, be  given  two  months'  preliminary  preparation  on  the 
staif  of  a  recognized  public  health  nursing  organization  under 
supervision  and  then  be  placed  in  Chapters  under  much  closer 
sup(n'vision  than  that  given  the  regular  staff. 

Jt  was  further  proposed  that  these  substitutes  should  carry 
on  a  })r()cess  of  self-education  through  prescribed  reading  and 
be  encouraged  to  complete  their  preparation  as  soon  as  possible 
through  taking  a  full  standard  course,  or  at  least  a  summer 
course  of  six  weeks. 

This  plan  was  decided  upon  with  much  reluctance  and  appre- 
hension, because  it  was  feared  that  nurses  with  so  inadequate 
a  preparation  would  not  be  able  to  meet  the  many  responsi- 
bilities of  a  public  health  nurse,  since  those  with  far  better 
j)reparation  were  finding  that  their  knowledge  was  scarcely 
equal  to  their  tasks  and  that  they  had  to  draw  on  every  resource 
to  handle  the  problems  daily  confronting  them. 

It  was  a  pleasant  surprise  therefore  to  discover  that  the 
chapters  on  the  whole  had  so  far  progressed  in  understanding 
the  range  and  importance  of  public  health  nursing  that  they 
were  not  willing  to  accept  this  opportunity  to  launch  a  service 
without  further  delay,  but  preferred  to  wait  for  a  fully  quali- 
fied ])ublic  health  luirse.  In  the  words  of  one  state  supervisor's 
report : 

Here  1  found  the  Committee  on  Xursing  Activities  composed 
of  seven  men  and  two  women,  and  the  most  wide-awake  com- 
mittee we  have.  They  were  well  organized,  seeking  informa- 
tion, studying  the  ])roiM)sition  from  all  an<rles  and  willing  to 
wait  until  a  very  competent  nurse  can  be  located. 

Xurses  were  no  more  interest(>d  in  this  substitute  plan  than 
were  Chapters,  and  it  was  not  possible  to  iiml  many  willing  to 
undertake  it.  In  an  Annual  Report  the  national  dirt'ctor  of 
Tublic   Health    .Xursinu'  stated: 


1312  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  plan  for  the  use  of  substitutes  has  not  met  with  much 
enthusiasm  so  far.  The  five  Divisions  which  are  able  to  fill 
their  positions  have  no  need  of  it.  In  many  states  the  State 
standard  has  now  been  elevated  and  a  return  to  a  more  ele- 
mentary form  of  training  would  not  be  acceptable  to  the 
state,  as  in  California,  for  instance.  A  very  practical  obstacle 
has  been  that  the  Chapters  themselves,  and  even  many  public 
officials,  are  not  willing  to  start  their  nursing  service  with  a 
nurse  who  is  not  sufficiently  trained  to  do  a  big  constructive 
piece  of  work.  They  demur  when  it  is  suggested  that  they 
accept  a  substitute  and  frequently  say  they  would  rather  wait 
until  a  fully  equipped  public  health  nurse  can  be  had.  Every 
division  reports  this  same  response.  Substitutes  are  not  going 
to  be  popular.  Furthermore,  the  nurses  themselves  have 
passed  the  stage  of  makeshifts  and  are  daily  becoming  more 
impressed  with  the  need  for  further  preparation.  Few  nurses 
of  the  right  sort  are  willing  to  accept  the  status  and  prepara- 
tion of  substitutes.  Nevertheless,  the  plan  will  be  tried  in 
perhaps  a  half  dozen  states  where  the  need  is  pressing  and  the 
supply  small. ^^ 

As  a  result  the  plan  soon  fell  into  disuse  and  was  abandoned. 
Not  more  than  thirty  substitute  nurses  were  employed. 

It  must  not  be  construed,  however,  that  all  the  Chapters  were 
so  enlightened  that  they  recognized  the  value  of  employing  only 
a  qualified  public  health  nurse.  Every  now  and  then  the  Divi- 
sion directors  found  that  some  Chapter  had  employed  a  local 
nurse  with  no  training  or  experience  in  public  health  nursing 
without  consultation  with  the  Division.  In  the  course  of  time, 
however,  it  frequently  turned  out  that  the  Chapter  regretted 
its  action  and  later  came  to  the  Division  seeking  a  nurse  w'ith 
adequate  preparation.  It  also  happened  even  more  frequently 
that  the  nurse  engaged  by  a  Chapter  without  any  public  health 
nursing  experience  or  training  soon  discovered  that  she  was 
beyond  her  depth  and  voluntarily  decided  to  seek  further  train- 
ing. This  tendency  was  mentioned  in  several  of  the  monthly 
reports : 

One  of  the  healthy  signs  of  growth  is  that  the  nurses  who 
have  gone  on  duty  without  sufficient  training  have  in  every 
instance  recognized  their  need  and  have  api)lied  for  assistance 
in  planning  fur  post-graduate  courses. 

In  the  Lake  Division  no  less  than  four  nurses  insufficiently 
prepared   and    placed   by   Cliapters  without   due  consultation 
"Annual    Report,  July    1,   1!)1!)  to  June  30,   1920. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1313 

with  Division  headquarters  have  themselves  now  felt  the  in- 
adequacy of  their  own  training  and  are  seeking  to  supplement 
it  by  a  course  in  public  health  nursing. 

On  the  whole,  the  effect  of  Red  Cross  public  health  nursing 
has  been  to  elevate  the  standard.  Some  of  the  State  depart- 
ment of  healtli  men  still  say  quite  openly  that  they  think  the 
Red  Cross  is  demanding  too  high  a  standard,  but  many  of 
tliem  are  coming  to  feel  that  we  have  been  wise  in  maintaining 
a  high  standard  and  a  good  many  people  in  the  Chapters  are 
beginning  to  realize  the  necessity  of  demanding  nurses  with 
better  preparation. 

There  is  much  more  definite  recognition  of  the  need  for 
special  training  for  public  health  nurses  among  all  groups 
employing  such  nurses.  Appreciation  of  the  necessity  of 
special  training  is  constantly  increasing  among  the  nurses 
themselves  with  the  sudden  prominence  given  to  public  health 
nursing. 

We  feel  that  our  program  has  had  a  stimulating  effect  and 
aroused  tiie  interest  not  only  of  the  nurses  but  of  county 
boards  of  supervisors.  In  a  recent  conference  with  a  member 
of  a  board  of  supervisors  we  were  told  that  the  board  realized 
the  need  for  qualified  women  and  was  especially  anxious  to 
have  the  supervision  of  the  Red  Cross.  Chapters  who  have 
put  on  unqualified  nurses  without  the  knowledge  of  the 
Division  ofiico  have  almost  invariably  come  to  realize  that  the 
nurse  is  not  able  to  carry  the  program  and  have  asked  us  to 
assist  them  to  secure  proper  preparation  for  the  nurse.  When 
sucli  nurses  liavc  resigned  and  the  Chapters  have  asked  for 
another  nurse  they  have  stated  they  would  prefer  to  wait 
indefinitely  in  order  to  have  a  qualified  public  health  nurse. 

It  must  be  confessed  that  now  and  then  one  of  those  iinqnali- 
fiod  nurses  did  surprisingly  well,  coml)ining  valuable  experi- 
ence in  other  nursing  fields  with  personality  and  good  sense. 
One  State  director  reported  the  work  of  a  nurse  with  no  public 
health  nursing  training: 

"Miss deserves  special  mention.    Tlie  toclmique  of 

her  work  seems  ideal,  and  h(^r  acconiplislinients  have  been 
niar\cl<)us.  In  no  district  has  been  found  better  coiipcrat idU 
from  doctors  and  nursins,^  conimittecs.     Tliis   is  due  almost 


1314  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

entirely  to  the  personality  of  the  nurse.  Her  marked  success 
and  the  failure  of  some  of  the  young  graduates  of  the  four 
months'  public  health  courses  gives  rise  to  the  question  as  to 
whether  an  older  nurse  with  experience  as  a  hospital  execu- 
tive, even  without  public  health  training,  is  not  preferable. 
As  the  State  is  now  districted,  the  district  supervisor  is  able  to 
give  close  supervision  to  all  nurses,  and  certainly  in  this  one 
instance  the  experiment  has  been  successful.  In  almost  every 
instance  do  we  find  that  the  older  women  are  doing  better 
work  than  younger  nurses. 

With  the  rapid  growth  in  the  number  of  public  health  nursing 
services  the  necessity  arose  for  securing  assistance  by  building 
up  a  field  staff,  each  department  in  the  Red  Cross  having  its  own 
specialists  in  the  field.  Before  decentralization  eight  Division 
Directors  of  Public  Health  Nursing  had  been  appointed  who 
in  turn  had  appointed  fifteen  assistants  and  field  supervisors. 
As  even  this  expansion  was  inadequate  the  national  director 
in  the  summer  of  1919  sent  this  memorandum  to  the  general 
manager  recommending  that  the  staff  be  doubled : 

The  American  Red  Cross  in  undertaking  the  promotion  of 
rural  public  health  nursing  throughout  the  country  has  taken 
upon  itself  the  responsibility  for  a  very  far-reaching  and  im- 
portant public  activity.  This  undertaking  will  be  either  a 
widespread,  superficial,  comparatively  unproductive  and  poor 
piece  of  work,  or  else  it  will  be  an  intelligent,  thorough- 
going, permanently  productive  enterprise. 

With  almost  no  exceptions  the  Chapter  people  know  very 
little  about  public  health  administration  in  general  and  in 
particular  of  the  activities  carried  on  under  the  name  of 
public  health  nursing  or  community  nursing.  The  suggestion 
that  they  should  undertake  to  develop  public  healtli  activities 
within  their  jurisdiction  usually  is  a  new  idea  to  them. 

Tliere  is  very  definite  and  immediate  need  for  the  enlarge- 
ment of  the  Division  staffs.  In  response  to  our  stimulation 
many  of  them  are  conceiving  original  ])lans  for  carrying  on 
public  health  nursing,  which  very  frequently  are  not  sound 
nor  well  adajited  to  local  needs.  Inasmuch  as  they  have  little 
knowledge  of  the  scope,  functions,  principles  and  management 
of  public  health  nursing,  it  is  quite  natural  that  their  plans 
frequently  should  be  unwise  and  imperfect. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1315 

Tlie  overwlu'lming  (lemand  for  public;  health  nurses  has 
made  it  iiecest;ary  for  us  to  appoint  to  independent  and  re- 
sponsible positions  many  nurses  who  are  young  in  years,  lack- 
ing both  in  general  experience  in  the  world  and  special  experi- 
ence in  public  health  nursing.  We  are  requiring  only  a 
minimum  of  preparation. 

For  all  of  these  reasons  it  is  absolutely  essential  to  the 
success  of  our  work  that  there  should  be  very  close  contact 
between  the  Chapters  and  the  Divisions;  that  there  should  be 
personal  visitation  at  frequent  intervals;  and  that  guidance 
and  assistance  should  be  at  ail  times  available  to  the  Chapters 
without  undue  delay.  This  necessitates  adequate  and  well- 
trained  staffs  at  Division  headquarters  permitting  constant 
field  supervision.  It  seems  essential  that  there  sliould  be  pro- 
vision on  the  staffs  of  the  Division  Bureaus  of  Public  llealtii 
Nursing  for  at  least  one  public  health  nurse  for  each  state  to 
act  as  field  organizer  and  supervisor. 

By  fall,  that  is  six  months  after  decentralization  was  com- 
pleted, the  Division  and  field  staff  numbered  42.  In  this  same 
time  the  number  of  local  nurses  had  grown  from  99  on  ]\[arch  1, 
1919,  to  .310  October  1  of  the  same  year.  A  paragraph  in  the 
Annual  Report  for  the  fiscal  year  ending  June  30,  1921,  reads 
as  follows : 

In  addition  to  the  Division  Director  of  Xursing  local  Red 
Cross  nurses  are  receiving  lielp  and  supervision  from  fifty-five 
supervising  nurses,  whicli  is  an  average  of  twenty-four  local 
nurses  to  one  sui)ervisor.  Of  these  fifty-five  supervising 
nurses,  thirty-seven  are  employed  wholly  by  the  Ked  Cross  and 
eighteen  are  shared  with  the  State  department  of  health  or 
the  State  Tuberculosis  Association  or  both.  It  is  our  hope 
that  our  supervisory  staff  can  be  increased  sufficiently  to  give 
more  assistance  to  tlie  young  nurses  who  are  taking  up  their 
first  ])iece  of  executive  work.  All  of  us  need  help  and  advice 
and  inspiration,  but  especially  when  we  are  starting  out  alone 
into  a  new  field,  and  it  is  a  serious  obligation  on  the  part  of 
the  Red  Cross  to  give  full  measure  of  support  and  assistance  to 
these  young  pioneers  in  our  service. 

At  the  nuM'ting  of  the  Xational  and  Division  staffs  of  the  De- 
partment (if  Xursing  at  Xational  lleadcpiarters  in  the  fall  of 
1911>,  referred  to  previously,  a  discussion  of  the  need  of  the 
chapter  nurse  for  assistance  hrought  out  many  interesting 
points  of  view  and  suggestions.      Several    felt   that   the   nurses 


1316  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

needed  much  help  in  the  first  few  months  of  their  service  and 
should  be  visited  frequently.  Others  thought  that  a  super- 
vising or  organizing  nurse  should  go  with  the  newly  appointed 
nurse  to  her  new  territory  and  assist  and  guide  her  in  making 
her  contacts.  Still  others  felt  that  organizing  nurses  should 
go  into  a  county,  before  the  coming  of  the  Chapter  nurse  to 
prepare  the  ground  for  her  reception  and  insure  the  right  work- 
ing relations  between  the  nurse,  the  committee  and  the  com- 
munity. 

The  concensus  of  opinion  in  regard  to  supervision  was  that 
it  should  be  primarily  for  the  purpose  of  consultation  and 
encouragement ;  frequency  and  length  of  visits  depended 
largely  upon  the  nurse ;  the  nurse  should  if  possible  be  given  a 
chance  to  spend  a  few  days  at  the  Division  office  before  taking 
up  her  work  with  the  Chapter  in  order  that  she  might  learn 
something  of  her  Chapter  and  of  general  Eed  Cross  organization 
and  procedures.  It  was  felt  that  if  a  nurse  was  well  prepared 
for  her  work  she  should  be  given  the  chance  to  make  her  own 
contacts  and  to  develop  her  own  initiative. 

It  was  also  suggested  that  the  nurses  would  learn  much 
from  each  other  and  from  the  Division  staff  if  they  could  come 
together  occasionally  in  state  meetings  or  in  smaller  meetings 
of  those  in  a  group  of  counties.  This  plan  was  followed  with 
good  results  in  a  number  of  Divisions.  ]\[eetings  were  arranged 
of  Chapter  nurses  from  perhaps  eight  or  ten  adjacent  counties 
at  the  most  central  point.  Often  the  nurses  drove  to  these  meet- 
ings on  a  Saturday.  They  were  usually  the  guests  of  the  Chap- 
ter of  the  county  in  which  they  were  entertained.  The  Division 
director  or  a  field  supervisor  usually  met  with  them  and  many 
practical  problems  were  discussed.  Another  way  of  comparing 
experiences  and  passing  on  ideas,  of  forwarding  helpful  sug- 
gestions and  of  keeping  the  nurses  in  touch  with  what  was 
going  on  in  the  Red  Cross  was  thnuigh  the  issuing  of  periodical 
Division  bulletins  to  the  nurses.  The  bulletin^  were  informal, 
newsy,  personal  documents,  not  pretending  to  be  dignified  lit- 
erary achievements  but  partaking  more  of  the  character  of  a 
family  letter.  This  method  proved  so  popular,  stinuilating 
and  helpful  that  it  became  the  regular  practice  in  nearly  all  of 
the  Divisions. 

A  large  volume  of  correspondence  passed  between  the  nurses 
or  menilx'rs  of  their  committee  and  the  Division  office.  Through 
;li;'    receipt    of    tlie    nnrs(\s'    monthly    statistical    and    narrative; 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1317 

reports  the  Division  directors  were  able  to  keep  in  pretty  close 
touch  with  the  work  of  the  nurses  and  with  their  problems  and 
to  offer  many  suggestions. 

In  many  Chapters  where  a  public  health  nurse  was  employed 
there  was  already  a  Home  Service  secretary  in  charge  of  the 
social  work  of  the  Chapter.  It  happened  occasionally  that  a 
difficulty  arose  in  determining  what  should  be  the  division  of 
work  between  these  two.  As  a  guide  to  a  solution  of  this  diffi- 
culty, Miss  ]\fargaret  Byington  of  the  National  Department  of 
Civilian  Relief  and  later  director  of  Field  Service  prepared  in 
collalx)ration  with  ^liss  Fox  a  statement  which  defined  the  re- 
spective functions  of  both  nurse  and  social  worker  so  that  there 
should  be  no  duplication  but  rather  a  dovetailing  of  each  other's 
activities  to  insure  a  unified  piece  of  family  health  and  social 
work.  Matters  of  health  were  thus  the  responsibility  of  the 
nurse,  and  social  and  economic  problems  that  of  the  social 
worker,  both  being  alike  responsible  to  the  Chapter  Executive 
Committee  and  neither  undertaking  to  direct  the  work  of  the 
other. 

A  better  understanding  also  grew  out  of  State  and  Division 
conferences  attended  by  Home  Service  secretaries  and  public 
health  nurses.    A  report  of  one  such  conference  stated : 

Tennessee  was  well  represented  at  the  conference  held  the 
lat^t  week  in  August  at  Division  headquarters  for  Home  Service 
secretaries  and  nurses.  This  conference  was  particularly  nec- 
essary and  proved  to  be  most  valuable  in  making  it  clear 
to  secretary  and  nurse  just  what  their  respective  duties  were 
and  how  they  were  related  very  closely  to  each  other.  It  also 
gave  a  vision  of  what  cordial  team  work  could  accomplish,  as 
the  reports  from  communities  where  Home  Service  secretary 
and  nurse  were  working  together  were  a  real  inspiration.  I 
am  quite  sure  that  each  Home  Service  secretary  and  nurse 
who  was  working  alone  went  away  with  a  desire  to  so  organize 
their  connnunity  that  a  co-worker  would  he  einjiloyed. 

The  tendency  on  the  part  of  the  Chapt(n*s  to  use  the  Homo 
Service  secretary  as  executive  scn-retary  led  occasionally  to  dis- 
cord which  required  a  visit  from  the  supervising  nurse  or  field 
representative  to  adjust.  Since  expcricMice  had  proven  the 
wisdom  of  keeping  the  line  of  responsibility  from  the  nurse  to 
Nursing  Activities  Comiiiittce  and  from  the  Nursing  Activities 
Committee   to   the    Kxecutive   ('onnnittee   it   was   not   necessary 


1318  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  the  executive  secretary  to  assume  any  responsibility  for  the 
nursing  service  other  than  that  of  helping  to  coordinate  its 
undertakings  with  other  activities  of  the  Chapter. 

The  instruction  that  public  health  nurses  should  not  engage 
in  relief  giving  was  found  to  be  too  rigid  to  be  followed  at  all 
times  in  Chapters  having  no  Home  Service  worker  and  com- 
munities having  no  social  worker.  In  svich  localities,  in  order 
to  accomplish  her  primary  purpose  of  alleviating  and  pre- 
venting disease,  the  nurse  was  confronted  in  many  homes  with 
the  necessity  of  first  removing  the  social  or  economic  difficulty 
which  was  causing  the  ill  health.  The  safest  and  wisest  pro- 
cedure seemed  to  be  for  the  nurse  to  report  her  problem  to  her 
Executive  Committee  and  to  place  the  responsibility  for  action 
with  it.  In  such  situations  as  these  the  Division  was  prepared 
to  give  attention  to  each  individual  family  problem  and  to 
advise  the  Chapter  Executive  Committee. 

A  matter  of  important  concern  to  the  Red  Cross  was  its 
initiation  into  State  departments  of  health  and  other  State 
agencies,  such  as  the  State  Tuberculosis  Association,  from  a 
standpoint  of  cooperation  and  the  maintaining  and  upholding  of 
the  authority  of  the  State  department  and  the  good  work  of  all 
while  developing  public  health  nursing  in  the  Chapters  as  a 
part  of  the  Chapter  organization  and  program.  The  Red  Cross 
believed  that  the  State  departments  of  health  should  have  the 
moral  if  not  the  legal  authority  and  responsibility  for  outlining 
a  State-wide,  general  program  for  the  development  of  public 
health  nursing  throughout  the  State,  and  for  establishing  and 
maintaining  at  least  a  minimum  standard  of  personnel  and 
service.  It  believed  that  the  programs  of  public  and  private 
local  organizations  should  fit  in  as  far  as  possible  to  the  general 
program  for  the  State  as  a  whole  and  should  be  under  the  gen- 
eral oversight  of  the  State  in  regard  to  standards  of  personnel 
and  practice.  The  Red  Cross  also  believed  that  the  State  would 
have  no  reason  nor  desire  to  interfere  with  the  internal  organi- 
zation and  administration  of  local  private  agencies  or  their  rela- 
tion to  their  central  bodies,  as  long  as  the  State  standard  was 
maintained  as  a  minimum  and  as  long  as  the  activities  of  the 
private  agencies  did  not  conflict  with  the  general  plan  outlined 
by  the  State. 

There  was  at  first  in  several  states  an  attitude  on  the  part 
of  some  of  the  State  departments  of  health  of  doubt  and  even 
disapproval   of  the   Red   (^ross  purposes   in   expanding  public 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1319 

health  nursing  through  its  Chapters.  This  was  due  largely  to 
the  fact  that  it  was  a  slow  and  difficult  task  to  bring  about 
working  agreements,  owing  to  the  rapidity  with  which  the  work 
expanded,  the  diversity  of  conditions  in  each  State,  and  the 
differences  in  program  and  development  of  the  various  State 
departments  of  health.  Thus  in  order  that  there  might  be  some 
generally  accepted  principles  of  cooperation,  representatives 
of  the  Executive  Committee  of  the  Conference  of  State  and 
Provincial  Health  Authorities,  the  l^ational  Tuberculosis  As- 
sociation and  the  American  Red  Cross  carried  on  a  series  of 
consultations.  These  resulted  in  December,  1919,  in  a  mutually 
accepted  statement  of  principles  as  follows : 

I.  In  undertaking  to  develop  public  health  nursing  the 
Red  Cross  does  not  seek  to  supplant  or  compete  with  State 
and  local  departments  of  health  or  other  organizations, — 
national,  state  or  local,  public  or  private,  engaged  in  the 
same  work.  Jt  seeks  rather  to  supplement  their  activities 
by  assisting  legitimate  public  healtli  nursing  agencies 
and  by  establishing  itself  or  working  with  other  agencies 
to  establish  community  nursing  services.  It  plans  to 
interest  its  Chapters  throughout  the  country  in  public 
health  nursing  with  this  purpose  and  policy  in  view. 

II.  The  Red  Cross  believes  that  in  time  public  health  nurs- 
ing should  and  will  become  a  public  service  conducted  by 
the  State,  county  or  municipality,  through  their  official 
health  agencies.  Red  Cross  Division  officers  will  seek 
consultation  with  the  State  health  authorities  in  each 
state  where  this  has  not  already  been  done,  for  the  pur- 
pose of  learning  what  plans  the  State  Department  of 
Health  may  have  for  developing  public  health  nursing, 
and  of  determining  in  what  way  the  Red  Cross  may  co- 
operate and  make  Red  Cross  plans  for  the  development  of 
this  work  by  its  Chapters  throughout  the  state  conform 
to  the  plans  of  the  State  department  of  health.  In  tliis 
undertaking  the  Red  Cross  will  have  as  its  ohjeet  the 
ultimate  assumption  by  the  State,  counties  and  luiuiic- 
ipalities  of  public  liealth  services  initiated  by  its  C]ia]>ters. 

III.  Following  this  principle  the  Red  Cross  will  encourage 
the  creation  of  a  Bureau,  Division  or  Sub-Division  of 
Public  Health  Nursing  within  the  State  department  of 
health,  wliich  should  assume  such  supervision  of  public 
health  nursing  as  may  be  assigned  to  it  by  the  (.liief 
health  executive  otbccr  of  the  Slate. 


1320  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

IV.  (a)  Looking  towards  the  establishment  of  a  bureau, 
division  or  sub-division,  a  State  supervising  nurse  might 
be  appointed  to  serve  the  State  department  of  health, 
who  would  study  the  public  health  nursing  needs  of  the 
State,  would  work  out  a  plan  to  cover  them,  assume  super- 
vision of  local  services,  as  indicated  in  paragraph  III,  and 
correlate  so  far  as  possible  the  nursing  activities  of  other 
agencies  within  the  state  such  as  the  Red  Cross  and  the 
State  Tuberculosis  Association. 

(b)  In  states  where  these  two  agencies  are  working  ex- 
tensively it  is  suggested  that  the  State  supervising  nurse 
should  have  assistant  supervising  nurses,  one  in  charge 
of  the  nursing  activities  of  the  Red  Cross  and  one  in 
charge  of  these  activities  for  the  State  Tuberculosis 
Association.  These  two  agencies  would  provide  the  sal- 
aries for  the  assistants  in  charge  of  their  respective 
activities.  The  assistants  would  be  responsible  both  to 
their  respective  agencies  and  to  the  State  supervising 
nurse  and  would  submit  their  plans  to  her  for  adjustment 
and  endorsement. 

V.  In  each  State  a  Committee  on  Coordination  of  Public 
Health  Nursing  Services  might  be  created  representing 
the  State  Department  of  Health,  the  Red  Cross,  the  State 
Tuberculosis  Association  and  other  appropriate  agencies 
to  advise  with  the  State  Department  of  Health  at  fre- 
quent intervals  concerning  the  best  alignment  and  co- 
operation of  the  various  nursing  activities. 

VI.  Where  State  supervising  nurses,  assistant  supervising 
nurses  and  other  public  health  nurses  attached  to  the 
State  health  organization  and  supported  by  funds  con- 
tributed jointly  by  the  State  health  organization  and 
other  agencies  or  are  contributed  wholly  by  such  agencies, 
appointment  should  be  made  by  the  State  health  execu- 
tive with  the  approval  of  the  participating  agencies.  Such 
appointment  should  not  be  in  conflict  with  existing  laws 
of  the  state.  Public  health  nurses  supported  wholly  by 
funds  contributed  by  the  American  Red  Cross  or  other 
extra-governmental  agencies  should  be  free  from  Civil 
Service  restrictions. 

VII.  Where  the  State  Department  of  Health  is  unable  to  pro- 
vide the  salary  for  a  state  nurse  and  where  some  mutually 
satisfactory  plan  of  cooperation  (such  as  that  outlined 
above)  has  been  agreed  upon  by  the  State  Department  of 
Health,  the  Red  Cross  and  State  Tuberculosis  Associa- 
tion, the  salary  might  be  paid  in  part  or  in  whole  t)y  any 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1321 

or  all  of  these  and  other  agencies.  This  should  he  a  tem- 
porary measure,  the  State  to  assume  the  salary  as  soon  as 
possible  and  the  nurse  regardless  of  the  source  of  her. 
salary  should  be  state  supervising  nurse  for  the  State 
Department  of  Health. 

Vin.  Where  the  Eed  Cross  pays  in  whole  or  in  part  for  any 
nursing  service,  I?ed  Cross  standards  of  appointment  of 
nurse  and  service  should  be  observed. 

IX.        Public  health  nursing  as  carried  on  by  the  Red  Cross 
may  cover  any  of  the  following  activities: 
Prenatal  or  infant  welfare  work, 
Maternity  service. 
School  nursing, 
Control  of  communicable  diseases,  including  tubercu 

losis  and  venereal  diseases, 
Industrial  nursing, 
IVfental  Hygiene  nursing, 
Care  of  the  sick  on  the  visit  basis. 

Which  one  or  ones  of  these  branches  is  to  be  undertaken  by 
the  Pcd  Cross  Chapter  in  any  given  community  would  be 
determined  by  tlie  need,  by  the  adequacy  of  any  existing 
services,  by  the  practical  factors  of  territory  to  be  covered  and 
population  to  be  served  and  by  the  plan  adopted  by  the  Red 
Cross  after  consultation  with  the  State  Department  of  Health 
for  the  development  of  public  health  nursing  by  the  Eed  Cross 
in  that  state. 

While  this  statement  was  in  process  of  preparation  there 
ose  a  need  for  a  supplementary  statement  to  cover  tlie  prin- 
ciples to  be  followed  in  states  where  there  was  no  State  bureau 
of  public  health  nursing  and  no  State  nurse,  but  where  both 
the  Red  Cross  and  the  State  Tuberculosis  Association  were 
engaged  in  promoting  public  health  nursing.  The  gist  of  the 
plan  which  was  suggested  to  meet  this  situation  was  contained 
in  the  iirst  two  paragraphs  of  a  supplementary  statement 
drawn  up  by  the  Red  Cross  and  Xational  TubcrcTilosis 
Association : 

I.  It  is  higlily  desirable  tliat  a  public  health  nurse  should 
be  appointed  by  the  State  health  ollicer  upon  joint  recom- 
mendation of  the  Red  Cross  and  the  State  Tuberculosis 
Association  to  liave  charge  of  ])ublic  JKnilth  nursing  witliin 
the  state.  Tier  (wpenses  might  be  sban'(l  by  tbe  State  De- 
partment of  Healtli,  the  K'ed  Cross  ami  the  Tul)crculo.-is 


1322  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Association,  or  by  the  latter  two,  until  such  time  as  the 
State  Department  of  Health  is  able  to  assume  part  or  all 
of  her  salary. 

II.  This  State  Director  of  Public  Health  Xursing  shall  be 
made  the  official  representative  of  the  Division  Bureau  of 
Public  Health  Nursing  of  the  Ped  Cross,  and  of  the  State 
Tuberculosis  Association,  and  shall  be  charged  with  the 
responsibility  for  the  development  of  their  public  health 
nursing  activities  in  conformity  with  the  plan  of  organiza- 
tion, methods  of  procedure  and  standards  of  each. 
Through  the  State  health  officer  she  shall  be  responsible 
to  the  State  Tuberculosis  Association  for  its  part  of  her 
work  and  shall  be  responsible  to  the  Division  Director  of 
Public  Health  Xursing  for  nursing  activities  in  which  the 
Ped  Cross  Chapters  participate. 

The  principles  set  forth  in  those  two  statements  were  fol- 
lowed in  the  working  plans  that  were  subsequently  agreed  upon 
in  a  number  of  states.  The  efforts  made  to  work  out  co<)per- 
ative  plans  in  the  various  states  were  described  in  these  words : 

The  formulation  of  working  arrangements  in  the  states, 
however,  on  the  basis  of  these  principles  has  been  a  slow  and 
difficult  task.  Xo  two  State  agreements  have  been  just  alike. 
In  22  states  a  definite  written  agreement  has  been  made  with 
the  State  Department  of  Health.  In  7  more,  an  agreement 
W'ill  soon  be  in  written  form.  In  6  states,  there  is  a  definite 
understanding  but  no  formal  agreement,  and  in  13,  the  final 
plan  of  cooperation  has  not  yet  been  determined,  in  a  few  of 
which  we  have  been  unal)le  to  reach  any  common  ground.  In 
these  few,  however,  we  are  slowly  overcoming  antagonism  and 
approaching  the  day  when  peaceful  cooperation  will  be 
possible. 

The  majority  of  these  efforts  at  cooperation  are  working 
out  very  well.  There  are  at  present  11  states  in  which  the 
State  wholly  finances  its  State  program  of  public  health  nurs- 
ing. In  these  states  the  Ped  Cross  has  done  one  of  three 
things: 

1.  It  has  made  tlie  State  nurse,  already  appointed  ])y  the 
State  Department  of  Health,  the  official  representative  of  the 
Ped  Cross  Department  of  Nursing  as  well. 

2.  It  has  su)~>plied  an  assistant  State  nurse  in  charge  of 
Ped  Cross  luirsing. 

3.  It  has  maintained  its  own  State  nurse,  who  works  in 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1323 

close  consultation  and  cooperation  with  the  State  Department 
of  Health,  though  independent  of  it. 

In  7  more  states  the  State  pays  the  larger  part  of  the  State 
nursing  budget,  the  l?ed  Cross  contributing  the  remainder 
under  a  cooperative  arrangement  similar  to  one  or  the  other 
of  the  first  two  plans  given  above.  In  7  states  in  which  there 
has  been  no  State  nursing  service,  the  Red  Cross  is  developing 
such  a  service  unTIer  the  auspices  of  the  State  health  officer  but 
at  Ked  Cross  expense.  In  7  states  the  State  nursing  budget 
is  fmanced  jointly  by  the  State,  the  Tuberculosis  Association 
and  the  Red  Cross.  In  the  remaining  states  the  Red  Cross  is 
working  independently  in  anticipation  of  joining  hands  with 
the  State  within  tlie  next  few  months. 

Our  efforts  have  been  directed  primarily  toward  finding  a 
method  of  cooperation  with  the  State  departments  of  health, 
and  secondarily,  wherever  possible,  of  including  coo})eratioii 
with  the  State  Tuberculosis  Association  at  the  same  time.  In 
15  states  this  joint  agreement  has  been  effected.  In  several 
states  we  are  working  amicably  by  the  side  of  the  State 
Tuberculosis  Association,  although  there  is  no  formal  agree- 
ment. In  some  states  its  program  does  not  include  the  organi- 
zation of  local  public  health  nursing  service.  At  present  the 
Red  Cross  is  responsible  for  the  salaries  of  approximately  oU 
State  and  assistant  State  supervising  nurses. 

The  activity  of  the  Red  Cross  in  organizing  town  and  county 
public  health  nursing  services,  in  developing  supervision  on  a 
State  basis,  and  in  providing  or  contributing  toward  the  pro- 
vision of  the  personnel  for  State  bureaus  of  pul)lic  health 
nursing  has  done  much  toward  advancing  State  public  health 
nursing  programs.  State  bureaus  wholly  or  partially  main- 
tained by  State  funds  have  been  created  in  more  than  a  dozen 
states  during  the  past  year.  Legislation  will  be  pushed  in  a 
number  of  states  to  provide  public  fuiuls  for  State  bureaus  of 
nursing  now  financed  by  private  contribution,  or  to  increase 
the  State  budget  already  provided  for  this  purpose.  The 
character  and  standards  of  State  work  have  also  ])een  notice- 
ably improved  and  elevated.  The  superior  quality  and  bt'ttcr 
results  of  work  done  according  to  higli  standards  has  been  so 
convincing  that  many  public  officials,  who  at  first  thouglit  our 
standards  were  too  higli.  are  now  saying  publicly  that  a  nurs,' 
without  special  training  or  experience  in  public  health  nursing 
rarely  accomplishes  any  constructive  work.^^ 

In  the  course  of  time,  as  the  Chapters  continued  to  undertake 
public   health   nursing   services    and   as   these   services   became 
'-■Annual    Report.  .Inly    1.   1019.  to  -Juno  ;?0,   1920. 


1324  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

more  closely  integrated  with  the  other  activities  of  the  Chapter, 
the  need  became  clearer  for  maintaining  a  close  connection 
between  Chapter  pnblic  health  nursing  and  the  whole  Red  Cross 
organization  as  directed  and  supervised  from  the  Division.  It 
did  not  seem  appropriate  or  desirable  to  require  the  State  or 
assistant  State  supervising  nurse  of  the  State  Department  of 
Health  to  give  as  much  of  her  time,  energy  and  thought  to  Red 
Cross  matters  as  was  necessary  to  maintain  the  necessary  in- 
ternal relationship  between  the  Chapter  public  health  nursing 
services  and  other  Chapter  work,  and  to  take  part  in  the  general 
administrative  obligations  of  the  Red  Cross  under  the  direction 
of  the  Division  Staff  Council  (the  need  for  which  will  be 
explained  later  in  this  chapter). 

In  order  to  accomplish  these  Red  Cross  objects  and  at  the 
same  time  to  adhere  to  the  principles  agreed  upon  with  the 
Executive  Committee  of  the  Conference  of  State  Health 
Authorities,  it  was  necessary  merely  for  the  Division  to  arrange 
to  assign  a  member  of  the  Division  nursing  staff  to  act  as  an 
assistant  supervising  nurse  in  states  in  which  the  State  De- 
partment of  Health  had  a  State  nurse,  with  the  understanding 
that  this  nurse  in  her  capacity  as  assistant  would  have  complete 
charge  in  all  matters  of  internal  organization  of  the  Red  Cross 
public  health  nursing  services  in  the  state  under  the  guidance 
of  the  Division. 

To  the  end  that  this  procedure  might  have  the  understanding 
and  approval  of  the  State  health  authorities  the  Executive 
Committee  of  the  Conference  of  State  Health  Authorities  was 
invited  to  meet  with  the  Red  Cross  national  officials  and  Divi- 
sion managers  at  Washington  on  April  20,  1921.  The  report 
of  this  meeting  was  as  follows: 

In  response  to  the  request  of  ^Ir.  Persons  (vice  chairman), 
Miss  Fox  put  before  the  meeting  the  problems  with  reference 
to  the  public  health  nursing  services  now  being  carried  on  by 
the  Chapters  of  the  American  lied  Cross  in  accordance  with 
agreements  made  by  the  Eed  Cross  witli  the  various  State 
healtli  authorities. 

These  problems  are: 

1.  The  intense  demand  for  puljlic  liealth  nurses  has  forced 
the  placement  in  Cha])ters  of  nurses  wlio  are  inexperienced  and 
inadequately  trained  in  community  organization,  in  the  use  of 
volunteer  assistants  and  in  the  stimulation  of  general  Chapter 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1325 

(levelopniont.  Tt  is  not  so  much  a  question  of  addinf^  work  to 
the  well  recognized  forms  of  pui)li(!  iiealth  nursing  as  it  is  the 
adaptation  and  correlation  of  the  nurses'  service  to  other  as- 
pects of  the  Chapter's  program  in  the  local  community.  Chap- 
ters find  it  impossible  to  have  their  nursing  service  divorced 
from  their  Junior  Hed  Cross  work,  their  Home  Service  and 
several  of  the  other  recognized  Red  Cross  activities. 

2.  Under  the  present  form  of  agreement  with  the  health 
authorities  in  several  states,  in  accordance  with  which  the 
nurse  who  supervises  the  Red  Cross  nurses  is  the  State  super- 
vising nurse,  it  has  been  found  that  she  cannot  give  sutficient 
time  and  attention  to  the  peculiar  phases  of  Red  Cross  public 
health  nursing  to  meet  the  needs  of  the  nurses  employed  hy 
Chapters,  to  detect  weaknesses  in  Chapter  machinery,  to  de- 
velop other  kinds  of  Chapter  service  and  to  organize  com- 
munity interest. 

^Miss  Fox  pointed  out  how  the  newer  forms  of  agreement 
and  understanding  which  have  been  worked  out  in  the  State  of 
^lichigan,  where  there  are  more  than  (55  Wed  Cross  nurses,  are 
proving  satisfactory  and  effective  in  solving  the  problems  of 
the  Red  Cross.  Dr.  Olin  (Commissioner  of  Health  for  ^liclii- 
gan)  and  ]\riss  Ahrens  (Director  of  Nursing  in  the  Central 
Division)  explained  in  detail  the  present  arrangements. 

Both  the  State  supervising  nurse  and  the  Eed  Cross  super- 
vising nurse  were  appointed  npon  the  joint  approval  of  the 
State  health  commissioner  and  of  the  Division  office  of  the 
Red  Cross. 

Each  time  before  the  Red  Cross  supervisor  goes  into  the 
field  she  consults  with  the  State  supervisor  of  nursing  about 
the  local  situation  of  each  place  which  she  plans  to  visit.  In 
this  way  the  local  Red  Cross  nurse  receives  a  direct  message 
as  to  State  jdans  and  is  kej)t  closely  in  touch  with  the  State 
bureau  of  nursing.  The  State  report  forms  arc  used  by  tlie 
Red  Cross  nurses  and  duplicate  reports  arc  filed  with  the  State 
hureaus.  The  Red  Cross  nurses  wnto  directly  to  tlie  State 
Dej)artmcnt  of  Health  on  all  ollicial  lu^alth  matters.  They 
write  to  tlie  Division  ollice  on  toclmical  nursing  questions  and 
on  matters  relating  to  Ciia])ter  l)usiness. 

It  was  the  general  ojiinion,  expressed  hy  Dr.  Crumbine 
(State  health  otlicer  of  Kansas)  and  other  State  health  offi- 
cers, that  tlie  public  health  ]irogram  of  the  American  Red 
Cross  has  been  well  articulated  with  the  State  nursing  pro- 
grams and  that,  with  the  exception  of  an  occasional  mis- 
understanding due  to  the  blunder  of  soint>  individual,  there 
was  less  troul»le  in  corr(>lating  those  activiti(»s  than  there  was 
in   keeping  alive  the  interest   of  the  conimunity  and    in   jiro- 


1326  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

moting  the  idea  of  rural  public  health  nursing.  Dr.  Crumbine 
was  convinced  that  the  necessity  for  keeping  Ked  Cross  Chap- 
ter activities  entirely  under  the  Red  Cross,  if  Chapter  interest 
is  to  be  maintained,  had  been  taken  too  lightly.  ]t  was  also 
generally  agreed  that  it  is  to  the  interest  of  the  State  to  have 
Red  Cross  Chapters  attain  permanency,  stability  and  con- 
tinuity. These,  better  than  the  official  agencies,  can  educate 
communities  to  want  public  health  nursing  and  to  appreciate 
standards  in  nursing.  Eventually  all  the  Red  Cross  nurses 
should  be  taken  over  by  public  local  health  authorities,  but  it 
is  anticipated  that  it  will  require  a  long  time  to  bring  this 
about  in  some  communities.  The  Red  Cross  must,  therefore, 
pursue  a  policy  that  will  both  raise  its  nursing  standards  and 
insure  Chapter  understanding  and  support. 

In  reply  to  a  question  from  Dr.  Williams  (State  health 
officer  of  Virginia)  Mr.  Persons  assured  the  health  officers 
that  new  forms  of  cooperation  in  the  various  states  would  be 
effected  only  as  both  the  Red  Cross  and  the  State  health 
authorities  had  reached  a  full  and  complete  agreement.  The 
Red  Cross  is  not  approaching  this  situation  with  preconceived 
ideas  to  be  rigidly  applied  in  all  situations.  .  .  . 

There  was  general  agreement  that  better  mutual  under- 
standing would  be  achieved  if  the  Division  managers  and  the 
State  health  officers  met  more  frequently  in  friendly,  informal 
visits,  when  things  are  running  smoothly,  and  not,  as  now, 
when,  usually,  contacts  are  limited  to  the  occasions  on  which 
there  is  some  question  at  issue. 

Because  of  the  partial  identity  of  goals  and  problems,  even 
though  there  was  distinct  divergence  of  method  and  approach, 
the  need  arose  for  an  understanding  between  the  Red  Cross 
Public  Health  Nursing,  the  National  Tuberculosis  Association 
and  the  National  Organization  for  Public  Health  Nursing. 
The  successful  accomplishment  of  this  understanding  was  re- 
ported as  follows : 

Last  December  the  National  Organization  for  Public 
Health  Xursing,  tlie  National  Tuberculosis  Association  and 
the  Red  (Voss  came  together  to  discuss  their  respective  nursing 
programs  for  tlie  pur])ose  of  deciding  upon  a  division  of  labor, 
methods  of  cooperation  and  chainiels  of  consultation.  As  a 
result,  the  functions  of  each  in  the  fiebl  of  nursing  were 
defined,  measures  for  the  use  of  each  other's  facilities  were 
adopted,  the  undertaking  of  certain  projects  jointly  was  de- 
termined upon  and  a  permanent  conference  committee  ap- 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1327 

pointed.  This  action  shiit  the  door  on  the  possibility  of 
misunderstanding,  wasteful  duplication  and  divided  interest 
among  public  health  nurses  and  opened  up  great  opportunities 
for  joint  effort,  intelligent  team  work  and  united  support. 

The  agreement  follows: 
Foreword : 

The  Red  Cross  and  the  Xational  Tuberculosis  Association, 
through  their  Division  and  State  organizations,  being  the 
organizations  probably  administering  tlie  largest  numl>er  of 
public  liealth  nursing  services,  and  the  Xational  Organization 
for  Public  Health  Nursing,  as  the  voluntary  body  representing 
all  types  of  public  health  nursing,  necessarily  have  many 
interests  and  problems  in  common.  Therefore,  they  seek  to 
supplement  each  other  by  utilizing  the  facilities  of  each  in 
common  as  far  as  possible  and  by  joining  forces  in  under- 
takings in  which  it  is  advantageous  to  do  so.  To  accomplish 
this  it  is  necessary  that  the  functions  of  each  organization  and 
the  lines  of  cooperation  be  clearly  defined  and  future  lines  of 
cooperation  be,  so  far  as  possible,  anticipated.  These  three 
organizations,  through  their  accredited  representatives  in  con- 
ference assembled  in  Washington,  D.  C,  December  5th,  1919, 
hereby  define  wliat  each  organization  considers  to  be  its  func- 
tions in  the  field  of  public  health  nursing,  and  enter  into  an 
agreement  as  to  methods  of  performing  its  functions  by  means 
of  coordination  and  cooperation.  .  .  . 

Ways  and  Means  of  Cooperation. 
I.     Educational 

1.    Courses 

The  Red  Cross  and  the  Xational  Tuberculosis 
Association  look  to  tiie  Xational  Organization  for 
I'ublic  Health  Xursing  to  take  the  lead  in  matters 
pertaining  to  the  education  of  pul)lic  health  nurses. 
Before  granting  either  financial  subsidy  or  scholar- 
ships to  a  post-graduate  course  for  public  health 
nurses  the  ]?ed  Cross  will  require  that  the  course  be 
endorsed  by  the  Xational  Organizaticui  for  Pulilic 
Health  XuTsing.  The  Xational  Tuberculosis  Asso- 
ciation will  make  tlie  same  requirement,  l)ut  will 
insistently  urge  through  its  representative  on  the 
I'Mucational  Committee  of  the  Xational  Organization 
for  Public  Health  Xursing  that  such  courses  male 
jirovision   for  a  suitable  proportion  of  teaching  of 


1328  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tuberculosis  and  is  ready  to  cooperate  in  establishing 
standards  of  teaching  for  tuberculosis  nursing  based 
upon  the  judgment  of  the  leaders  in  this  field,  medi- 
cal nursing  and  sociological.  It  further  urges  simi- 
lar consideration  for  the  advice  of  other  specialized 
health  organizations. 

2.  Forum 

The  Educational  Committee  of  the  National  Or- 
ganization for  Public  Health  Xursing  will  act  as  a 
forum  for  the  discussion  of  all  questions  pertaining 
to  the  education  of  public  health  nurses.  The  direc- 
tor of  the  Red  Cross  Bureau  of  Public  Health  Xurs- 
ing and  the  National  Tuberculosis  Association  Sec- 
retary for  Xursing,  and  possibly  later  representatives 
of  other  national  organizations  interested  in  public 
health  nursing,  will  sit  on  this  committee  as  mem- 
bers. These  organizations  will  undertake  jointly  or 
separately,  but  under  the  general  direction  of  the 
Educational  Committee,  to  prepare  series  of  mono- 
graphs on  practical  methods  of  conducting  various 
public  health  nursing  activities,  and  also  pamphlets 
on  other  special  subjects  as  needed. 

3.  Institutes 

Believing  strongly  in  the  need  for  annual  and 
widely  distributed  institutes  for  public  health  nurses 
of  considerable  experience  or  training,  the  Ped  Cross 
and  the  Xational  Tuberculosis  Association  will  join 
with  the  Xational  Organization  for  Public  Health 
Xursing  in  recommending  that  such  institutes  (to 
cover  two  M'eeks  or  more)  be  organized  and  con- 
ducted by  suital)le  estal)lished  agencies  within  the 
states  with  the  assistance  of  the  Xational  Organiza- 
tion for  Public  Health  Xursing,  in  consultation  with 
these  other  national  bodies.  The  latter  will  offer  the 
assistance  of  their  Division  and  State  staffs  in  con- 
ducting the  institutes  and  will  encourage  their  local 
staffs  to  attend.  These  three  organizations  agree 
that  these  institutes  should  be  general  in  character; 
including  tuberculosis,  child  hygiene,  venereal  dis- 
eases and  other  special  sul)jects.  The  Ped  Cross 
staiids  ready  to  suggest  subjects  and  teachers  in  the 
rural  nursing  field  and  the  Xational  Tuberculosis 
Association  to  furnish  outlines  of  lectures  and  teach- 
ers in  tuberculosis  subjects. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  13^9 

4.  Library 

In  view  of  the  fact  that  the  Xational  Organization 
for  Public  Health  Nursing  has  a  library  department 
"with  an  appropriation  for  adequate  expansion,  and 
has  a  circulating  package  library  operating  through 
44  state  library  centers,  which  has  been  endorsed  by 
the  American  Library  Association,  the  Ked  Cross 
and  the  National  Tuberculosis  Association  will  not 
endeavor  to  develop  duplicate  library  facilities  but 
will  recommend  that  their  field  staffs  make  the 
fullest  possible  use  of  the  facilities  offered  by  the 
National  Organization  for  Public  Health  Nursing. 
The  latter  organization  will  undertake  to  develop  its 
library  resources  to  meet  the  special  needs  of  these 
staffs,  particularly  as  their  work  affects  the  rural 
nurses. 

5.  Magazines 

The  Public  Health  Nurse  has  granted  a  section 
to  the  Eed  Cross  Bureau  of  Public  Health  Nursing 
under  the  editorship  of  the  director  of  the  bureau, 
to  be  devoted  to  the  activities  and  developments  of 
that  bureau. 

The  National  Tuberculosis  Association  does  not  at 
this  time  suggest  a  department  in  the  magazine  de- 
voted exclusively  to  tuberculosis,  but  suggests  that  a 
reasonable  amount  of  space  be  given  to  tlie  considera- 
tion of  tuberculosis  nursing  and  other  phases  of  the 
tuberculosis  movement. 

II.  Recruiting 

The  Eed  Cross  hopes  to  join  with  the  three  na- 
tional nursing  organizations  in  a  program  for  re- 
cruiting student  nurses.  The  National  Tuberculosis 
Association  recognizes  that  this  is  distinctly  a 
function  of  the  nursing  organizations. 

III.  Employment 

Believing  that  there  are  many  advantages  to  be 
secured  through  a  luitional  clearing  house  of  emjiloy- 
ment  whicli  would  also  serve  as  a  directory  of  infor- 
mation, the  National  Organization  for  Public  Health 
Nursing  will  endeavor  to  accomplisb  this  for  ])ublic 
health  nurses  as  a  i)art  of  the  activities  of  the  pro- 
posed joint  nursing  headquarters.  It  is  understood 
that  while  nil  credentials  would  l)e  obtained  by  such 
a  clearing  house,  ])lacements  would  continue  to  be 


1330  HISTORY  OF  AMERICAN  RED  CROSS  NURSINC 

made  through  the  various  existing  agencies.  The 
Eed  Cross,  because  of  its  great  demand  on  the  supply, 
will  appoint  its  own  representative  to  the  executive 
staff  of  the  clearing  house. 

IV.  All  three  organizations  are  free  to  conduct  analytical 

studies  of  various  typical  and  atypical  pieces  of 
machinery  for  the  purpose  of  determining  standard 
methods  of  organization,  practice  and  technique,  but 
will  consult  each  other  in  planning  these  studies  in 
order  to  avoid  duplication  and  to  take  advantage  to 
the  fullest  extent  of  the  facilities  and  fields  each  can 
offer  for  this  purpose. 

V.  Legislation 

The  National  Organization  for  Public  Health 
Nursing  and  the  National  Tuberculosis  Association 
will  seek  to  create  public  opinion  in  favor  of,  and 
assist  in,  the  enactment  of  suitable  public  health 
nursing  legislation,  such  as  the  appropriation  of 
public  funds  for  public  health  nursing  and  the  crea- 
tion of  divisions  of  public  health  nursing  within 
State  departments  of  health.  The  Red  Cross  en- 
dorses this  broad  endeavor  but  prefers  not  to  take 
part  in  efforts  involving  legislation. 

VI.  Machinery  for  Coordination 

1.  Joint  Consultation  Committee 

The  executive  secretary  of  the  National  Organi- 
zation for  Public  Health  Nursing,  the  director  of 
the  Bureau  of  Public  Health  Nursing  of  the  Red 
Cross  and  the  secretary  for  nursing  of  the  National 
Tuberculosis  Association  will  form  a  joint  consulta- 
tion committee.  This  committee  will  meet  fre- 
quently for  conferences  relative  to  problems  and 
projects  confronting  or  contemplated  by  any  one  of 
the  three. 

2.  Exchanges  of  memoranda  regarding  new  pro- 
grams or  clianges  in  policy  before  putting  the  same 
into  action. 

3.  State  Committees  on  Public  IlealtJi  Nursing 
The   Eed   Cross,   the   National    Organization   for 

Public  Health  Nursing  and  National  Tuberculosis 
Association  favor  and  will  endeavor  to  create  State 
committees  on  public  health  nursing  representing 
generally  the  three  organizations  and  the  State  De- 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1331 

partment  of  Health  and  may  include  other   State 
nursing  organizations  and  State  agencies  engaged  in, 
or  responsible  for,  promoting  public  health  nursing 
activities.     Such  a  committee  will  have  no  admin- 
istrative  responsibility  for,  but  will  concern   itself 
with,  the  advancement  of  public  health  nursing  in 
the  State  through  the  stimulation  of  public  opinion, 
through  interpretation  and  advice  and  through  the 
promotion  of  coordination. 
It  is  mutually  understood  that  no  changes  will  be  made  in 
the  procedure  outlined  in  this  agreement  without  the  full  con- 
sideration of  the  three  participating  agencies. 

"While  the  joint  consultation  committee  described  in  the 
paragraph  on  Machinery  for  Coordination  was  not  made  use 
of,  the  methods  of  working  together  described  under  Ways  and 
Means  of  Cooperation  were  carried  out  with  regularity  and 
mutual  satisfaction  and  the  reciprocal  relations  of  the  three 
organizations  were  uninterrupted  and  cordial. 

EEOKGANIZATION 

The  Red  Cross  during  the  war  and  for  two  years  after  the 
Armistice  was  organized  in  departments,  each  one  of  which  had 
its  own  field  staff  for  the  purpose  of  promoting  and  supervising 
its  special  work  in  the  Chapters.  There  soon  developed  a  ten- 
dency, however,  to  concentrate  much  of  the  immediate  guidance 
of  Chapter  work  in  the  hands  of  a  general  field  staff  who  were 
responsible  for  the  organization  and  administration  of  Chapter 
affairs,  but  not  for  the  professional  activities  of  the  Chapters. 
In  July,  1!>20,  a  ''Joint  Memorandum  on  the  Relation  of  State 
Supervising  Nurses  to  Field  Representatives"  was  prepared 
by  the  directors  of  the  Bureau  of  Public  Health  Nursing  and 
Field  Service.     This  read  in  part: 

We  think  it  is  pretty  generally  understood  that  the  new 
plan  of  Division  organization  places  upon  the  general  fieid 
representatives  tiie  responsibility  for  advising  the  Chapter 
concerning  its  organization,  administration,  general  program 
and  apportionment  of  funds.  It  is  their  task  under  tlie 
guidance  of  department  heads  to  develop  in  the  Chapter  a 
coherent,  balanced  and  unified  plan  of  work,  apj)ropriate  to 
the  nc»^(ls  of  the  connnunity  and  m  response  to  the  genuine 
interest  and  wishes  of  the  people.  It  is  their  task  to  see  that 
the  Chapter  ollicials  and  the  connnittecs  are  representative, 


1332  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

well  selected  and  on  the  job;  that  various  committees  work 
together  and  that  their  activities  dovetail;  and,  in  general, 
representing  department  heads,  to  assist  Chapters  to  carry  on 
these  activities  successfully.  The  directors  of  various  depart- 
ments are  responsible  for  seeing  that  the  activities  which  the 
Chapter  undertakes  are  carried  on  according  to  Red  Cross 
standards.  In  the  case  of  the  Public  Health  Nursing  Service, 
the  State  nurse  has  a  special  responsibility  for  the  supervision 
of  the  nursing  service  in  the  Chapter,  including  the  selection 
and  appointment  of  the  nurse,  advice  as  to  the  type  of  nursing 
work  to  be  carried  on  and  its  relationship  to  other  nursing 
service  in  the  county  and  the  supen'ision  of  the  professional 
aspects  of  the  nurses'  work. 

From  this  it  is  evident  that  the  field  representatives  and  the 
department  representatives  must  have  a  genuine  understand- 
ing of  each  other's  work  based  on  constant  consultation  and 
interchange  of  information  and  opinions.  Such  team  work  is 
only  possible  where  the  two  groups  of  workers  meet  for  regular 
and  frequent  conferences. 

Much  of  the  work  of  preparing  the  Chapters  to  undertake 
public  health  nursing  was  delegated  to  these  field  representa- 
tives by  the  Division  Bureaus  of  Public  Health  ^Nursing. 

The  reorganization  of  the  Red  Cross  in  the  spring  of  1921 
brought  about  a  much  closer  relation  between  the  general  field 
staff  and  the  nursing  field  staff.  The  change  in  administration 
was  described  in  The  Public  Health  Nurse,  May,  1921,  in  an 
article  entitled  "Remodeling  the  Red  Cross,"  from  which  the 
following  extract  is  taken : 

In  order  to  meet  the  needs  of  the  Chapters  in  their  local 
expression  of  Red  Cross  service  the  war  organization  of  the 
Red  Cross  has  been  revised.  An  organization  designed  to  do 
a  national  war  task  obviously  was  not  suited  to  the  present 
community  work  of  the  Red  Cross.  .  .  . 

The  result  of  this  change  in  the  needs  of  the  Chapters  has 
been  the  doing  away  with  departments  in  the  national  and 
Divisional  organization  and  the  erection  in  their  place  of 
staff  councils  of  specialists,  meeting  in  consTiltation  with  the 
managers,  concerning  the  problems  of  the  Chapters,  with  the 
resulting  harmonizing  of  tlie  professional  recommendations  of 
each  specialist  into  a  single  unified  scheme  for  the  guidance  of 
the  Chapters. 

This  change  in  organization  wliich  has  just  come  about  in 
the  Division  and  in  the  national  organization  does  not  in  any 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1333 

way  mean  that  the  professional  and  technical  phases  of  the 
work  carried  on  l)y  the  Chapters  will  be  severed  from  profes- 
sional and  technical  standards  of  work  or  from  the  advice 
and  guidance  of  professional  leaders  in  the  division  and  na- 
tional or<^anization.  Professional  stiindards  will  be  observed 
just  as  jealously  in  the  future  as  in  the  past  and  the  means  of 
ujdioldinjf  them  will  be  maintained  and  carefully  guarded. 
In  all  professional  matters  Chapter  nurses  will  be  supervised 
as  heretofore  by  nurses.  The  field  staff  will  include  public 
health  nurse  suj)ervisors  as  formerly  in  order  that  the  local 
public  health  nurses  may  continue  to  follow  and  uphold  the 
best  professional  standards  and  technical  practice  under  the 
guidance  of  supervisors  thoroughly  familiar  by  training  and 
experience  with  such  standards  and  practice. 

The  reorganization  also  changed  somewhat  the  status  of  the 
Bureau  of  Public  Health  Nursing: 

"When  the  elimination  of  departmental  organization  in  the 
Ped  Cross  took  place  on  April  1st,"  the  Annual  Report  of 
1920-21  states,  ''the  Bureau  of  Public  Health  Nursing  became 
the  Public  Health  Nursing  Service,  with  its  director  a  mem- 
ber of  the  National  Staff  Council.  Its  administrative  charac- 
ter was  converted  into  an  advisory  character  and  its  inter- 
relationship to  other  Ped  Cross  activities  became  more  firmly 
established.  While  the  Public  Health  Nursing  Service  has 
equal  standing  and  representation  on  the  National  Staff  Coun- 
cil with  other  services,  there  is  a  closer  relation  to  the 
Nursing  Service  than  to  any  other  because  of  the  almost  in- 
separable connection  between  public  health  nursing  and  nurs- 
ing as  a  whole.  It,  therefore,  continues  to  be  a  ])art  of  the 
Nursing  Service,  although  it  has  direct  representation  on  the 
National  Staff  Council  and  its  director  is  responsible  directly 
to  the  vice-chairman." 


The  inquiry  preceding  the  reorganization  brought  out  the 
fact  that  ir  \vas  necessary  for  the  public  health  nnrs(\  in  those 
(■haptcrs  in  wliicli  she  was  the  only  trained  worker,  to  take  a 
larger  measure  of  responsibility  for  the  atlairs  of  tlie  Chapter 
in  genei'al,  and  in  all  Chapt(>rs  to  relate  \\ov  work  closely  to  the 
other  Cliaptcr  activities.  This  meant  she  must  have  a  more 
intiuiare  knowledge  of  all  phases  of  Red  Cross  work  and  in 
addition  to  her  technical  duties  must  become  something  of  an 
oruanizer  and  leader. 


1334  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

"In  looking  over  the  work  of  our  nurses  during  the  past 
year  or  two,''  the  director  commented  in  her  Annual  Report, 
"we  find  that  though  usually  skilled  technicians  they  are  not 
always  good  organizers.  When  one  stops  to  consider  that 
many  of  them  have  just  completed  their  preparation  for  public 
health  nursing  and  iiave  had  no  executive  experience,  and 
moreover  that  many  of  them  are  city  bred  and  city  trained,  it 
is  not  surprising  that  they  do  not  at  first  show  qualities  of 
leadership  and  organizing  ability.  The  task  which  they  con- 
front is  a  complicated  one  and  difficult  even  for  older  and 
wiser  heads.  We  wish  that  there  were  enough  public  health 
nurses  so  that  we  need  not  place  responsibility  for  the  organi- 
zation of  new  work  on  the  shoulders  of  inexperienced  young 
public  health  nurses.  Their  courage  and  enthusiasm  are 
abundant  and  admirable,  but  their  ability  as  creators,  execu- 
tives and  leaders  is  not  yet  developed.  Often  a  public  health 
nurse  is  the  first  and  only  trained  worker  with  whom  the  Red 
Cross  Chapter  officials  and  the  community  have  ever  had 
dealings.  She  may  be  the  only  person  in  the  whole  county 
trained  in  public  health  work  and  thinking  in  terms  of  broad 
social  endeavor.  Upon  her  shoulders  falls  the  responsibility 
for  making  her  work  a  part  of  the  life  of  the  county,  for 
drawing  the  people  throughout  the  county  into  it  as  individ- 
uals or  organized  groups,  for  developing  ways  of  multiplying 
her  service  through  the  help  of  untrained  volunteers,  for 
making  public  health  nursing  understood,  belie^•ed  in  and 
used  and  its  responsibilities  shared  by  people  throughout  the 
county.  She  also  has  the  responsibility  of  developing  public 
health  nursing  in  harmony  with  the  other  activities  of  the  Red 
Cross  Chapter  and  of  making  it  serve  the  purposes  of  the 
Chapter  to  the  fullest  possible  extent.  Her  task  is  a  big  one 
and  a  most  interesting  one  but  requires  very  definite  qualities 
of  leadership  which  usually  come  only  with  experience. 

The  majority  of  our  Red  Cross  public  health  nurses  are 
recent  graduates  of  public  health  nursing  courses  or  have  not 
been  in  public  health  nursing  work  very  long.  Many  of  them 
are  young  and  unused  to  taking  their  part  in  public  work. 
That  they  need  a  great  deal  of  help  from  their  State  and 
Division  supervisors  is  natural  and  justifiable.  That  many 
of  them  develop  into  real  leaders  in  their  counties  where 
given  enough  help  at  the  beginning  is  being  proven  by  our 
experience. 

The  process  undertaken  late  in  the  year  of  knitting  tlic  field 
staff  together  and  making  it  more  general  and  therefore  more 
useful  in  character  will  help  to  strengthen  the  Chajjter  public 
healtli  nursing  services.     Not  only  will  the   Public   Health 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1335 

Nurses   have   behind   them   the   supervisoiy   nurses   but  the 
general  representatives  of  the  field  staff  as  well.^^ 

Rural  and  small  town  nursing  were  of  such  recent  develop- 
ment that  no  standard  methods  of  procedure  had  been  formu- 
lated and  no  plan  for  a  complete  rural  community  nursing 
service  was  announced.  Because  of  the  widely  varied  condi- 
tions existing  in  different  parts  of  the  country,  no  stereotyped 
plan  could  ever  be  universally  applicable.  A  number  of  ex- 
periments, it  was  felt,  would  have  to  be  conducted  and  their 
results  analyzed  and  measured  before  any  working  models 
could  be  endorsed  as  thoroughly  tested  and  satisfactory. 

In  the  summer  of  1921  Virginia  Gibbes,  who  had  had  sev- 
eral years'  experience  in  the  Red  Cross,  both  in  community 
and  Division  positions,  made  a  study  of  the  Chapter  services 
which  had  been  successful  in  meeting  certain  organization 
problems.  Several  hundred  of  the  Chapter  nurses  also  wrote 
an  account  of  the  methods  used  to  develop  their  work  in  their 
Chapters.  A  pamphlet  based  on  this  material,  which  repre- 
sented the  results  of  widespread  and  varied  experience,  was 
nearing  completion  as  this  book  went  to  press. 

As  approximately  80  per  cent  of  the  Red  Cross  public  health 
nurses  in  rural  districts  were  giving  all  or  part  of  their  time 
to  school  nursing,  for  which  no  recognized  standard  technique 
and  practice  had  been  evolved,  ]Miss  Anna  S.  Stanley,  formerly 
director  of  Public  Health  Xursing  in  the  Southwestern  Divi- 
sion and  an  expert  in  school  nursing  by  reason  of  years  spent 
first  as  school  nurse,  then  as  supervisor  of  scliool  nurses  and 
later  as  teacher  of  school  nursing  in  one  of  the  accredited 
public  health  nursing  courses,  was  asked  to  conduct  a  series 
of  conferences  on  school  nursing  in  six  of  the  Divisions  of  the 
Red  Cross.  As  a  result  of  these  conferences  a  standard  prac- 
tice of  technique  for  school  nursing  was  agreed  upon  and  em- 
bodied in  a  mimeographed  outline  of  school  nursing  procedure. 
This  proved  to  be  of  the  greatest  help  to  nurses  and  met  with 
an  increasing  demand. 

The  effort  to  bring  alxjut  a  closer  articulation  of  tlie  various 
activities  of  tlie  Chapter  was  strengtliened  by  tlie  ten(l(>ncy  to 
do  away  with  the  multiplication  of  Chaptor  committees,  tlins 
concentrating  the  general  management  of  all  its  affairs  in  tlie 
hands  of  the  Executive  Committee.  There  was  frecjuent  difli- 
^■' Annual  Koport,   July   1,    1920   to  June   30,   1921. 


1336  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

culty  in  securing  suitable  personnel  for  the  Executive  Com- 
mittee, the  Home  Service  Section,  the  Committee  on  Nursing 
Activities  and  the  Chapter  School  Committee,  without  using 
the  same  people  for  all  of  them.  The  great  need  for  closest 
cooperation  between  the  various  committees  was  apparent.  In 
many  Chapters  it  was  felt  that  the  various  activities  could  be 
developed  more  intelligently  and  harmoniously  if  the  Chapter 
program  was  conducted  by  the  Executive  Committee,  with  sub- 
committees to  deal  with  the  details  of  different  undertakings. 
The  comment  of  one  director  represented  the  experience  of 
them  all. 

We  are  finding  it  somewhat  difficult  to  secure  sufficient 
number  of  people  willing  to  serve  on  a  Nursing  Committee  as 
outlined  in  A-700  and  A-701,  In  several  Chapters  we  have 
found  it  advisable  to  use  the  Executive  Committee,  adding  to 
it  the  several  people  who  would  be  helpful  and  necessary  to 
carry  on  the  work.  We  believe  this  latter  method  will  be 
generally  used  in  the  smaller  Chapters. 

In  the  light  of  this  general  tendency  to  unify  the  hitherto 
independent  activities  of  the  Chapter,  a  review  of  the  various 
methods  of  engaging  in  public  health  nursing  by  the  Chapters 
was  made. 

The  Red  Cross  had  previously  agreed  that  no  one  activity  of 
the  Chapter  should  bo  operated  independently  of  the  others  and 
that  Chapter  funds  should  only  be  used  for  work  in  the  opera- 
tion of  which  the  Chapter  shared  directly  and  for  which  it 
possessed  an  administrative  responsibility  commensurate  with 
its  financial  responsibility.  As  a  result  it  became  clear  that 
Chapters  thereafter  should  engage  in  public  health  nursing  only 
when  they  could  share  in  its  operation  and  when  they  could 
have  a  connection  with  other  Chapter  work,  such  as  the  service 
for  ex-service  men  and  the  activities  of  the  Junior  Ived  Cross. 
It  was  also  felt  that  since  the  field  staff  was  more  than  ocm- 
pied  with  the  supervision  of  Chapter  public  health  nursing 
services,  affiliations  with  independent  organizations  should  be 
discouraged  except  when  the  public  authorities,  having  taken 
over  a  (^hapter  service,  desired  the  continuance  of  the  assistance 
and  supervision  of  the  Itcd  Cross, 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1337 

TYPES    OF    RED    CROSS    PUBLIC    HEALTH    NURSING 

Red  Cross  public  health  nursing  had  as  its  object  the  saving 
of  life,  the  upbuilding  of  family  health,  and  the  promotion  of 
community  sanitation  and  hygiene.  It  dealt  with  individuals 
and  families  in  its  efforts  to  restore  the  sick  to  health;  to  find 
and  correct  ])hysical  imperfections;  and  to  teach  the  practice 
of  healthful  living  and  establish  hygienic  habits.  It  dealt  with 
the  community  in  its  efforts  to  assist  in  checking  and  eliminat- 
ing communicable  and  preventable  diseases ;  in  discovering  and 
correcting  unsanitary  conditions ;  and  in  educating  the  public 
in  physical  hygiene  and  public  sanitation,  ^o  phase  of  public 
health  nursing  was  omitted,  the  nurses  engaging  in  bedside 
nursing,  prenatal  and  maternity  nursing,  infant  and  child  wel- 
fare and  school  nursing,  tuberculosis  nursing,  communicable 
disease  control  and  health  education  of  many  kinds.  Seldom 
was  a  public  health  nurse  able  to  carry  on  all  of  them.  Usually, 
when  working  alone  in  a  large  territory,  she  confined  herself 
to  one  or  two  activities,  the  choice  being  determined  by  the 
need,  the  desires  of  those  she  served  and  the  possibility  of 
accomplishment. 

The  great  majority  of  the  Red  Cross  Chapter  public  health 
nurses  worked  in  rural  districts  and  most  of  them  had  as  their 
territory  an  entire  county.  In  the  more  highly  organized  sec- 
tions there  were  sometimes  several  health  nurses  working  in 
the  same  county,  each  nurse  having  a  certain  community  within 
the  county  for  her  special  field,  but  in  general  the  nurses  were 
called  u])on  to  cover  a  large  area.  Some  of  the  western  counties 
in  particular  were  no  less  than  enormous,  covering  as  larg(>  a 
territory  as  c(M'tain  of  the  small  eastern  states. 

Idaho  County,  Idaho,  was  one  of  these  vast  counties,  being 
larger  thiui  the  conibincMl  states  ot"  Massachusetts  and  liliode 
Island.     The  Chapter  public  health  nurse  for  this  county  wrote: 

^Fy  baggage  lias  to  be  designed  to  pack  on  the  saddle.  A 
year  ago  1  left  London  the  ])roud  ])ossossor  of  three  jxM't'ect 
traveling  hags,  something  for  (>\'erv  occasion  as  1  thmm'lit.  and 
now  1  am  ci'ossing  tlie  mountains  with  all  mv  immediate 
wants  tieil  to  the  saddle,  in  tho  last  two  weeks  1  have  ridden 
ten  dill'ereiit  horses  and  have  cov(>red  one  hundred  and  iifteen 
miles,  lifty  of  that  Ity  stage.  When  yon  rein(Mnher  that  this 
county  is  twelve  thousand  s(|uare  mihs  in  area,  you  can 
inuiiiine  that  one  needs  to  he  something  of  a  traveler. 


1338  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Red  Cross  public  health  nurse  in  Alaska,  whose  work 
of  health  instruction  took  her  from  place  to  place  often  widely 
separated,  used  whatever  means  of  transportation  were  at  hand. 
At  the  end  of  an  Arctic  winter,  she  wrote : 

I  had  quite  a  trip.  One  place  I  went  by  dog  team  over  a 
hundred  miles,  then  to  another  place  by  train.  There  is  only 
one,  which  runs  to  suit  the  company.  I  was  four  days  coming 
one  hundred  and  thirty  miles,  but  the  scenery  was  sublime. 

This  same  nurse  was  not  deterred  when  trains  and  other 
methods  of  transportation  failed.  Of  her  trip  over  the  broad 
pass  from  Anchorage  to  the  interior,  she  wrote: 

We  (the  nurse  and  two  teachers)  left  Anchorage  July  5th 
and  got  to  Dead  Horse  that  night.  Stayed  all  night  and  left 
next  morning  for  Hurricane  Gulch,  arriving  there  at  two 
P.M.  That  is  the  end  of  the  railway  on  that  side.  From 
there  we  had  to  walk  seventy-two  miles  to  Healy,  the  begin- 
ning of  the  railway  into  the  interior.  We  took  it  slowly  the 
first  day  so  as  to  get  used  to  walking.  The  walking  was  very 
bad  in  some  places,  the  ground  being  wet  and  swampy  and  the 
heat  and  mosquitoes  were  dreadful !  The  third  day  out  one  of 
the  teachers  met  with  an  accident,  so  they  had  to  turn  back 
and  I  continued  my  journey  alone,  but  every  one  along  the 
way  was  so  kind  and  I  got  horseback  and  ''way-on"  rides  for 
about  twenty  miles,  so  I  just  walked  fifty  miles  in  all. 

In  another  of  the  big  counties  of  Idaho,  Lemhi  County,  the 
nurse  reached  her  most  isolated  schools  by  means  of  a  typical 
coach  of  pioneer  days.     She  said : 

We  got  in  a  covered  stage  drawn  by  four  and  six  horses.  If 
you  ever  saw  Buffalo  Bill's  show,  the  "Deadwood"  coach,  you 
see  my  picture.  We  hold  our  breath  as  we  go  up  nine  thou- 
sand feet  straight  up  like  a  ladder  and  then  over  the  moun- 
tain ;  the  road  is  spiral  but  we  go  up  all  the  time ;  ninety  miles 
and  four  days'  trip.  There  are  only  seven  children  in  the 
school,  but  they  are  four  hundred  miles  from  a  hospital  and 
our  visit  is  worth  while. 

Another  pioneer  nursing  service  of  the  Red  Cross  was  that 
which  was  established  among  the  lumber  camps  along  the 
Pemigawasott  River  in  the  Xew  Hampshire  wilderness.  The 
nurse  had  her  headquarters  in  the  little  town  of  Lincoln,  the 
center  of  the  lumbering  operations,   where   she  taught  the 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR   1339 

mothers  Home  Hygiene  and  Care  of  the  Sick.  Her  "district" 
was  the  whole  Pemigawasett  wilderness.  She  assisted  the 
doctor,  accompanying  him  to  the  distant  lumber  camps  often 
into  the  very  heart  of  the  mountains.  Here  she  found  great 
need  of  preventive  work  as  well  as  actual  nursing.  Tiie  men 
were  huddled  together  in  large  numbers  in  almost  unventi- 
lated  bunk  houses.  Many  of  the  men  were  unvaccinated  and 
no  care  was  taken  in  regard  to  communicable  and  other 
diseases.  In  their  work  of  felling  trees  and  getting  them  to 
the  stations  in  the  dead  of  winter,  accident  and  frostbite  were 
common.^* 

A  great  majority  of  our  nurses  being  employed  by  Eed 
Cross  Chapters  whose  jurisdiction  covers  a  whole  county,  are 
engaged  in  county-wide  work.  A  few  are  employed  by  Rod 
Cross  branches  and  their  service  is  limited  to  the  town  in 
which  the  branch  is  located.  The  nurses  engaged  in  town 
work  have  found  it  possible  to  develop  a  fairly  well  rounded 
public  health  nursing  program.  Those  who  are  attempting  to 
cover  a  whole  couiity  without  assistance  have  found  it  mani- 
festly impossible  to  develop  more  than  one  or  two  of  the 
several  phases  of  public  health  nursing.  Usually  the  nurse 
and  the  Chapter  together  have  decided  that  the  best  way  to 
open  a  new  service  is  offered  by  undertaking  school  nursing. 
It  is  obvious  that  if  there  are  from  00  to  90  rural  schools 
scattered  over  a  large  county,  in  all  of  which  the  nurse  wishes 
to  render  some  service,  she  will  not  have  much  time  to  develop 
other  phases  of  public  health  nursing.  There  is  a  danger, 
however,  that  the  people  of  the  county  may  come  to  think  that 
school  nursing  represents  the  whole  of  the  public  health  nurs- 
ing program  when  the  nurse  makes  this  her  primary  work. 
In  order  to  avoid  this  misunderstanding  we  present  tlie  pro- 
gram of  public  health  nursing  in  terms  of  family  health  work 
rather  than  in  terms  of  a  number  of  independent  s])e(ialties. 
We  say  that  we  want  to  help  to  secure  and  maintain  good 
health  among  all  the  families  in  our  county  and  that  our  first 
step  towards  attaining  this  object  will  be  taken  through  tlie 
avenue  of  the  schools.  It  is,  of  course,  our  object  to  build 
eventually  a  complete  and  adequate  county  nursing  service 
providing  all  the  different  forms  of  public  health  nursing, 
including  the  care  of  the  sick.^^ 

Especially  in  the  great  counties  of  the  West,  school  nnrsing 

seemed  to  he  the  most  practical  and  result  producing  prouram. 

^*  Public   llenlth    \ursr,    Fchniary,    1921. 
'•■' Animal   Rfport,  June,   1920,  tu'july.   11)21. 


1340  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

A  typical  winter  day's  work  of  a  school  nurse  was  described 
by  Miss  F.  B.  Palmer,  public  health  nurse  for  Martin  County, 
Minnesota,  and  published  in  the  October,  1920,  issue  of  the 
Public  Health  Nurse. 

I  had  come  to  the  county  for  a  few  weeks  as  a  public  health 
nurse  with  the  hope  of  impressing  upon  the  people  the  need 
of  and  the  benefits  to  be  derived  from  a  continuous  county 
nursing  service. 

It  was  in  December,  when  the  snow  was  many  inches  deep 
and  the  thermometer  below  zero.  The  superintendent  of 
schools,  an  active  and  intelligent  woman  of  fifty-five  years, 
had  mapped  out  the  schools  and  districts  that  were  most 
isolated  and  in  need  of  a  nurse.  We  took  the  4:10  a.m.  train 
to  a  little  town  twenty-five  miles  away.  Here  we  searched  for 
something  that  looked  like  a  hotel.  Finding  it  at  last,  we 
walked  in  and,  seeing  no  one  around,  we  took  possession  of  the 
stove  and  chairs  and  curled  up  and  slept  until  7  a.m.,  when 
the  "proprietor"  came  thumping  down  stairs.  He  was  as 
surprised  to  see  us  as  we  were  glad  to  see  him.  In  a  short 
time  we  had  breakfast — coffee,  bread  without  butter,  and  some 
boiled  meat.  Breakfast  being  over,  we  started  forth  in  an 
auto  for  a  school  ten  miles  north,  but  half  way  there  we  ran  up 
against  so  much  snow  that  we  had  to  dig  our  way  out. 

The  school  wasn't  reached  until  about  10  :30,  but  as  there 
were  only  four  pupils  in  this  school  we  had  plenty  of  time. 
All  the  children  were  from  one  family  and  were  born  in  a 
foreign  land.  They  had  had  nearly  all  of  the  contagious 
diseases  and  were  left  with  some  of  their  complications  and 
were  still  abiding  by  a  few  old  customs.  An  annual  bath  and 
clothes  sewed  on  for  the  winter  was  their  one  law.  One  child 
had  eye  trouble  and  was  deaf,  due  to  poor  care  during  the 
measles.  Another  had  enlarged  tonsils  and  adenoids.  All 
four  had  defective  teeth  and  pediculosis. 

We  decided  to  take  the  children  home  and  explain  their 
condition  to  their  parents.  The  father  was  not  home  and  the 
mother  was  in  bed  with  a  new  bai)y.  While  the  nurse  was 
caring  for  the  mother  and  baby,  the  county  superintendent 
started  on  the  children  and  it  wasn't  long  before  a  great 
change  had  taken  place.  The  superintendent  informed  the 
mother  that  she  would  keep  in  close  touch  with  her  and  help 
her  to  make  healthy  citizens  oTit  of  her  children  and  that  in  the 
spring  slie  would  call  and  take  the  children  to  the  doctor,  and 
when  spring  came  she  did  bring  the  children  in  to  tlie  doctor, 
but  she  had  to  do  it  only  once,  for  the  pareiits  have  been  doing 
it  ever  since. 


ii       J 


An  Aniorican  Kcd  Cross  public  health  nurse  on  her  ro\inds 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1341 

From  this  home  we  drove  our  car  six  miles,  got  out,  hired  a 
team  of  horses  and  buggy  and  slowly  wound  our  way  for  four 
miles  through  the  tall  evergreen  trees.  Only  a  rabbit  or  deer 
jumping  through  the  trees  helped  to  break  the  silence  of  the 
woods.  It  indeed  seemed  like  the  "forest  primeval."  At  the 
end  of  the  narrow  passage  we  reached  a  lake  which  we  crossed 
with  a  little  more  speed.  As  we  drove  up  t<j  the  school,  which 
was  in  the  center  of  a  group  of  small  houses,  every  door  was 
opened  and  interested  people  peered  out.  The  larger  number 
of  them  were  half-breed  Indians.  The  parents  came  up  to  the 
school  to  see  what  was  going  on.  They  saw  the  children  in- 
spected and  listened  to  a  short  talk  on  the  "Health  of  the 
School  Child."  Several  cases  of  trachoma  were  found.  The 
parents  were  told  of  these  and  urged  to  have  every  member  in 
their  family  examined.  A  friendly  old  squaw  asked  us  to 
supper  at  her  house,  and  we  didn't  have  to  be  urged,  as  we 
were  hungry,  having  come  without  lunch.  A  well-cooked 
meal  of  soup,  boiled  potatoes,  rice,  beans  and  venison  was  set 
before  us  and  we  ate  with  a  vengeance. 

Eight  o'clock  found  us  on  our  way  to  a  little  town  eight 
miles  north.  Once  there  it  didn't  take  long  to  warm  up 
around  the  stove  and  then  climb  upstairs  to  our  cots,  which 
looked  pretty  good  but  felt  mighty  cold.  "Well,  to-morrow 
will  find  us  up  early  and  ready  for  another  day  that  is  really 
worth  while,"  said  the  indomitable  superintendent,  "and  if 
each  school  and  each  family  could  have  a  nurse  to  visit  them, 
what  a  liealthy,  happy  place  we  could  have  to  live  in,  and 
wouldn't  I  be  proud  to  have  a  public  health  nurse  in  the  office 
with  me  !    What  a  help  we  would  be  to  each  other  !" 

Frequently  school  nursing  included  the  organization  and 
operation  of  clinics  for  the  correction  of  defects  of  school  chil- 
dren. One  of  the  Chapters  reported  a  clinic  held  in  cooperation 
with  the  local  doctors  for  the  excision  of  adenoids  and  tonsils. 
The  work  of  the  public  health  nurse  had  brought  to  light  the 
need  of  four  hundred  children  for  this  operation.  A  throat 
specialist  was  brought  from  the  city  and  f(u*  an  entire  week  a 
daily  operative  clinic  was  held  with  the  cooperation  of  all  the 
local  doctors,  nurses  and  Chapter  people.  One  hundred  and 
ninety-three  children  were  operatcnl  upon  in  that  one  week 
and  a  valuable  piece  of  corrective  work  accomplished. 

Clinics  of  many  kinds  ^vorv  organized  by  tlu^  Red  Cross 
public  health  nurses  not  (Uily  in  the  larger  towns  and  centers, 
but  in  isolated  rural  districts  wliere  medical  and  dental  attcn- 


1342  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tion  were  most  needed.      One  of  the  Red   Cross  scholarship 
nurses  in  the  Southern  mountains  wrote : 

Our  dental  clinic  held  in  September  was  a  success,  more 
than  seventy-five  people  attended ;  many  came  from  remote 
sections,  miles  away.  One  woman  sixty-eight  years  old  walked 
twelve  miles  across  mountains  to  see  the  "tooth-doctor."  She 
sat  down  in  the  dental  chair  and  in  a  moment  arose  and  said 
"I  want  yer  all  ter  know  I  done  prepared  myself  ter  die  before 
coming  here  en  if  I  never  git  out  a  this  chair  alive  jest  know 
I  wuz  prepared  ter  go."  She  sat  down  and  had  eight  snags 
extracted  (by  painless  extraction)  and  when  the  dentist  had 
finished,  she  "praised  the  Lord  for  tiie  strength"  and  went  out 
and  brought  her  friend  in,  who  had  a  number  of  extractions 
done.  I  asked  the  good  woman  where  she  came  from  and  how 
she  happened  to  come.  She  said  "I  heard  that  bad  teeth  wuz 
bad  fer  tlie  system  and  I  is  been  a  ailin'  fast  lately  en  I 
thought  hit  might  be  my  old  rotten  teeth  a  damagin'  me." 
Her  friend  was  a  widow  with  no  children  and  no  means  of 
support ;  she  was  aged  too.  The  dentist  and  the  Chapter  took 
care  of  her  bill. 

In  many  counties  of  lesser  size,  prenatal  and  infant  hygiene 
activities  were  given  great  emphasis,  and  included  the  conduct 
of  hundreds  of  baby  conferences.  One  of  the  Division  directors 
of  Public  Health  Nursing  reported : 

Summer  seems  to  have  been  the  time  to  sow  the  seed  for 
baby  health  stations  or  clinics.  They  are  springing  up  in  the 
most  unexpected  places,  and  thriving  beyond  the  expectations 
and  hopes  of  those  who  are  responsible.  We  have  twenty-five 
in  active  operation,  with  six  in  process  of  organization.  One 
county  lias  been  practically  covered  this  summer  by  a  travel- 
ing clinic. 

The  supervising  nurse  for  northern  California  wrote: 

The  Mothers'  Educational  Center,  located  in  Red  Cross 
headquarters,  is  the  most  ambitious  attempt  that  has  been 
made  along  these  liiies  by  any  of  our  Chapters,  for  here  we 
have  not  only  two  full  time  nurses,  but  a  paid  medical  man. 
He  is  the  city  physician  aiul  is  on  duty  at  the  Center  two  days 
a  week  from  10  a.m.  until  noon,  and  on  Saturday  at  the  same 
hoiirs  at  a  branch  which  has  been  organized  in  a  kindergarten 
of  a  school,  where  there  is  a  large  attendaiu^e  of  foreigners  of 
many  nationalities.     Ivecords  of  all  first  borns  are  secured 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  134.3 

each  day  and  a  letter  sent  immediately  to  the  parents,  inviting 
tliom  to  make  use  of  the  Health  Center.  This  is  followed  by  a 
monthly  visit  and  letter  throughout  the  entire  first  year;  the 
result  is  shown  in  the  attendance  at  conferences. 

Another  Division  director  wrote : 

Some  of  the  methods  by  which  the  interest  was  gained  (in 
baby  conferences)  in  the  different  communities  were  very 
interesting.  One  nurse  canvassed  the  town  and  put  a  little 
flag  in  the  window  of  each  house  that  claimed  a  baby  under 
two  years  old  as  a  member  of  the  family.  She  secured  the 
cooperation  of  the  physicians  by  speaking  individually  to  them 
of  the  baby  stations  and  asking  them  to  get  together,  and 
decide  among  themselves  what  time  each  one  would  give, 
which  they  did. 

She  offered  a  prize  to  the  high-school  girl  who  made  the 
best  poster  for  the  baby  stations.  One  of  the  newspapers  do- 
nated a  good  quality  of  white  paper  and  the  ])ainting  class  in 
the  high  school  donated  the  paint.  This  resulted  in  active 
interest  among  the  girls,  and  some  very  nice  posters. 

A  little  publicity  in  which  the  townspeople  were  given  a 
chance  to  participate  often  proved  an  auspicious  beginning  for 
a  babv  health  station  . 

Previous  to  the  establishment  of  regular  conferences  a  "Baby 
Campaign"  was  often  held  as  a  preliminarv  measure  to  arouse 
interest.  An  American  Red  Cross  supervising  nurse  sent  the 
following  report : 

The  Parkersburg,  Ya.,  Chapter  of  the  Ped  Cross  arranged 
for  a  Baby  Week  Campaign.  The  publicity  and  preliminary 
work  was  unusually  well  handled  but,  in  their  zeal  to  reach  all, 
too  many  aj)pointmjnts  were  made  for  the  same  hour,  crowd- 
ing us  somewhat. 

The  building  given  to  the  Red  Cross  for  their  activities  was 
made  ready  for  tbe  work.  Being  an  old  residence,  it  would 
have  been  an  admirable  arrangement  if  the  l)abies  had  not 
come  in  such  "droves.''  A  front  room  ujistairs  was  arranged 
with  displays  of  proper  clotliing,  ])ro])er  and  improper  foods 
for  children,  the  usual  posters  aiul  the  like.  A  sup])ly  of 
literature  on  the  health  of  the  child  was  provided  for  distri- 
bution,   ^lore  than  five  tliousand  ])ieces  wore  given  out. 

We  met  with  splendid  cooperation  from  the  doctors  and 
nurses,  in  fact,  so  many  doctors  canie  that  we  fitted  up  two 
rooms  for  the  examinations  and  kept  them  h(>th  busy.     The 


rsu  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Red  Cross  had  employed  one  nurse  full  time  for  the  week  and 
the  various  public  health  nurses  from  the  schools,  Metropoli- 
tan Life  Insurance  Company  and  Ked  Cross,  besides  several 
married  nurses  volunteered  their  services  on  the  various  days. 

It  was  somewhat  hurried  and  crowded  but  with  all  a  real 
success,  I  think.  Four  hundred  and  thirty-six  pre-school  chil- 
dren were  examined  during  the  week  and  Mrs.  Price  wrote  me 
that  since  they  did  not  finish  with  all  who  had  registered,  they 
had  continued  the  clinic  for  two  days  the  following  week. 
Their  public  health  nurse  will  do  the  follow-up  work.  De- 
veloping from  the  campaign  is  their  plan  for  a  demonstration 
in  modifying  milk  in  the  near  future  and  for  baby  clinics  twice 
a  week  tliis  summer. 

The  films  "Birth  Eegistration"  and  "Infant  Clinics"  were 
shown  at  the  various  movie  houses  during  the  week  and  pic- 
tures were  taken  of  a  great  many  of  the  babies.  Slides  will  be 
made  of  these  pictures  and  they  will  he  shown  later  on. 

That  the  nurses  did  much   bedside  nursing  was  shown  in 
many  of  their  reports  as  follows : 

One  day  during  the  influenza  epidemic  I  visited  one  large 
town  in  my  territory  and,  as  I  always  do  on  arriving  in  a 
town,  I  called  on  the  three  doctors  and  obtained  from  them  a 
list  of  people  they  wanted  me  to  visit.  The  people  whom  I 
saw  and  their  circumstances  vary  so  widely  that  I  am  going  to 
enumerate  them. 

The  first  was  not  an  influenza  but  a  maternity  case.  The 
baby  three  days  old  was  wrapped  in  a  Ijlanket  and  placed  at 
the  foot  of  the  mother's  bed.  When  I  entered  the  door  I 
stepped  on  several  pieces  of  coal  which  had  rolled  down  from 
the  pile  of  coal  against  the  wall  on  the  floor  on  one  side.  One 
table,  two  cliairs,  one  cupboard,  a  bed,  an  ironing  board  and 
small  stove  completed  the  furnisbings  of  the  two  rooms  in 
whicli  tliis  young  married  couple  lived  and  brought  tlieir  first 
child  into  tbe  world.  \\'itli  little  to  do  with  outside  of  the 
equi])ment  in  my  nurse's  bag,  I  bathed  the  baby,  demonstrat- 
ing to  tbe  motlier  and  fatbcr  who  were  watching  the  different 
steps  and  impressing  upon  tlicm  tlie  importance  of  beginning 
right  with  their  first  baby  and  feeding  lier  at  reguhir  intervals 
and  Jiot  just  when  the  baby  cried.  After  bathing  and  dressing 
the  baby  I  ga\e  tlie  reguhir  routine  care  to  the  mother,  and 
then  left  with  fliud  brief  repetition  of  important  points  in  the 
care  of  her  baby. 

]\Iy  next  call  was  on  a  ])reniature  baby  two  months  old  ana 
when   I   saw  the  lean-to  which  was  used   for  kitchen,  dining 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1345 

room  and  sitting  room  for  a  family  of  five,  including  the  baby 
which  was  bundled  up  in  old  quilts  behind  a  red-hot  stove, 
I  didn't  wonder  the  doctor  had  sent  me.  When  1  looked  at 
the  baby  I  thought  it  must  have  been  shoveling  coal  along 
with  the  dirty-faced  uncle  who  came  in.  The  baby  was  almost 
the  color  of  a  pickaninny  from  soft  coal  soot,  and  his  little 
shirt  I'm  conii(lent  had  not  been  changed  for  a  Aveek  at  least, 
but  he  was  gaining  even  with  such  treatment  although  still 
very  thin.  1  asked  for  materials  for  a  bath  and  before  the 
indilfercnt  unmarried  mother  and  interested  young  aunt,  and 
skeptical  grandmother  demonstrated  a  bath  and  urged  that  the 
baby  have  one  every  day.  On  seeing  the  baby's  bottle  I  de- 
cided to  suggest  how  it  should  be  cared  for,  which  I  did.  The 
mother  grew  more  interested  in  time  and  promised  to  bathe 
the  baby  regularly,  but  she  will  need  frequent  instruction  and 
encouragement  for  to  all  appearances  she  has  the  mentality  of 
a  child  of  about  ten  years. 

My  last  call  late  in  the  afternoon  was  in  a  home  with  four 
small  children  three  of  whom  were  coming  down  with  the 
measles,  and  one  boy  had  had  measles  and  now  had  pneumonia. 
He  was  irrational  and  had  a  high  temperature  so  the  mother 
quickly  assembled  the  materials  for  a  warm  sponge  ordered 
by  the  doctor  and  while  I  was  giving  the  bath  she  frantically 
finished  making  him  a  new  nightgown  to  be  put  on  after  the 
bath.  I  had  been  there  the  day  before  and  had  advised  that 
the  children  be  put  to  bed  so  of  the  three  prospective  cases  one 
was  in  a  crib  and  the  other  two  crossways  on  a  divan-bed, 
making  the  living  room  resemble  a  hospital.  The  sick  pneu- 
monia boy  was  in  a  room  by  himself  as  directed  with  a  window 
open  and  was  receiving  care  just  as  I  had  demonstrated  the 
day  before.  The  mother  watched  every  movement  I  made 
and  although  she  said  she  knew  nothing  a])Out  caring  for  the 
sick,  she  appeared  to  have  learned  more  in  two  hours  from 
the  looks  of  her  patient  and  bedroom  than  most  people  would 
learn  in  many  days. 

I'll  explain  my  long  silence  by  telling  you  of  my  experi- 
ence during  an  epidemic  of  typhoid  which  broke  out  at  Oil- 
more,  17  miles  from  Salmon  and  10,000  feet  in  the  air.  One 
would  naturally  think  that  altitude  would  jnirify  most  any- 
tliing.  but  we  had  18  cases.  We  lost  only  one.  l)ut  as  we  had 
her  in  our  care  not  more  than  eighteen  liours  you  can  inuigine 
she  was  a  pretty  sick  woman  when  we  got  her. 

Fortunately  this  mining  camp  had  a  little  hos])ital  of  eight 
beds  which  was  very  well  equipped.  Wo  coininaiuUMTod  it  and 
.started  movins:  in   the  worst   cases.      1    took   with   me  from 


1346  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Salmon  a  young  girl,  an  undergraduate  who  had  had  four 
months'  training  in  a  hospital  in  St,  Louis  and  who  was 
most  helpful.  As  soon  as  their  temperatures  were  normal 
the  patients  were  sent  home.  Three  were  kept  all  of  the  time. 
It  was  necessary  to  melt  snow  for  water,  split  wood  and  shovel 
trails.  I  made  regular  visits  to  the  homes,  instructing  the 
people  how  to  take  care  of  themselves  and  of  those  dependent 
upon  them,  so  as  to  prevent  further  cases  developing.  The 
snow  was  between  four  and  five  feet  deep  and  I  was  seventy 
miles  from  a  physician. 

This  last  week  I  was  asked  to  investigate  a  T.  B.  case,  a 
man  living  with  his  four  children  all  in  one  room — living, 
cooking,  eating  and  sleeping  in  the  same  tiny  space.  One  son 
17  had  a  very  suspicious  cough.  A  girl  of  fourteen  did  the 
washing  and  cooking  for  the  family  besides  going  to  school. 
She  washed  the  father's  handkerchiefs,  advised  the  girl  about 
disinfecting  and  the  general  care  of  her  father.  The  Eed 
Cross  has  furnished  a  tent,  and  the  neighbors  have  put  up  the 
frame.  The  happy  man  is  now  in  it,  away  from  the  cooking, 
and  he  feels  so  much  better  in  the  fresh  air.  The  house  has 
been  scrubbed  and  cleaned  generally  and  the  children  are  to 
be  examined  next  week. 


An  average  day's  work  of  a  nurse  in  one  of  the  larger  coun- 
ties was  given  by  one  of  the  Red  Cross  public  health  nurses  in 
a  Minnesota  county: 

A  ride  of  thirty-five  miles  in  a  tin  Lizzie  brought  me  to  my 
destination — a  schoolhouse  of  one  room,  poorly  lighted  and 
dirty,  to  teach  the  first  lesson  of  a  series  of  twelve  two-hour 
lessons  in  Home  Hygiene  and  Care  of  the  Sick.  Twenty 
mothers  of  different  races — Polish,  French,  Irish  and  Ameri- 
can were  assembled. 

A  bed  had  been  installed  with  a  straw  tick,  sheets,  pillow 
cases  and  blankets  borrowed  from  the  pupils.  Each  mother 
was  taught  how  to  make  a  bed,  turn  a  helpless  patient,  change 
draw-sheets,  lift  and  make  comfortable  paralyzed  patients. 
The  position  and  quantity  of  furniture  and  the  temperature 
and  ventilation  of  a  sick  room  were  also  explained.  There 
were  discussions  on  this  lesson  and  preparations  were  made 
for  a  second  meeting  the  following  M^eek. 

Good-bys  were  said  and  I  left  for  another  thirty-five  mile 
ride  over  a  sandy,  rough  road  when  I  was  hailed  by  a  farmer, 
"Be  you  that  county  nurse?"  "Yes."  "Well,  come  and  see 
my  colt,  it's  got  hurt."    Another  drive  of  three  miles  to  find 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1347 

a  beautiful  animal  six  weeks  old  torn  by  wire  on  the  left 
shoulder  straight  across  the  chest  to  the  right  leg.  The  depth 
of  the  wound  was  fully  two  inches,  the  length  over  sixteen. 
The  farmer  had  done  some  veterinary  work  two  days  before, 
but  his  hands,  needle  and  cotton  were  dirty.  Infection  and 
high  fever  had  set  in  and  a  bad  condition  was  the  result. 

A  large  sheet  was  spread  on  the  ground,  the  patient  laid  out 
on  it,  hind  and  forefeet  tied  together  and  flexed,  the  master 
of  the  house  sat  on  its  head,  while  the  young  son  did  likewise 
on  its  flank.  I  sterilized  my  hands  thorouglily  and  proceeded 
to  business  and  for  one  hour  steadily  cleaned  and  removed  in- 
fected tissue,  cut  away  the  old  stitches,  washing  with  hot 
water  and  lysol,  tied  two  arteries  and  poured  tincture  of  iodine 
into  the  wound — the  patient  resting  peaceably  and  quietly  as 
if  it  knew  the  county  nurse  was  doing  her  best  to  help  it.  A 
few  days  later  I  found  the  animal  doing  well  and  the  wound 
healing. 

Another  start  was  made  towards  home  when  a  woman 
emerged  from  the  woods.  "Please  come  and  see  my  twins, 
one  is  dying."  I  found  two  baby  boys,  aged  three  and  one- 
half  months,  weighing  seven  and  one-half  pounds  each,  in  a 
very  serious  condition,  being  fed  every  half  hour  on  con- 
densed milk,  wrapped  up  in  blankets,  lying  on  a  feather  bed 
behind  an  immense  stove.  There  was  no  fresh  air  in  the  room 
and  this  was  August !  There  was  a  history  of  tuberculosis 
in  the  family  and  the  mother  wondered  why  the  children 
didn't  grow !  She  couldn't  see  any  reason  for  it.  With  the 
proper  care  and  with  the  instruction  eagerly  followed  by  the 
mother,  within  a  week  a  marked  improvement  in  babies  and 
mother,  house  and  surroundings,  could  be  seen,  and  all  lived 
happily  ever  after. 

We  have  an  average  enrollment  of  two  hundred  pupils  in 
the  Home  Hygiene  and  Care  of  Sick  classes.  Five  hours' 
daily  teaching,  and  in  addition,  the  weighing  of  various  babies, 
the  changing  of  formulae,  the  removal  of  incipient  tuberculosis 
cases  to  sanitaria,  and  to  make  a  life  a  little  more  interesting 
the  taking  of  a  mental  case  to  a  State  institution  finishes  an 
average  day's  work.^*^ 

The  class  work  in  Homo  Hvgiene  and  Care  of  the  Sick  stimu- 
lated the  demand  for  permanent  public  health  nursing  services. 
One  Division  director  said : 

From  actual  work  in  the  field  we  have  come  to  the  conclu- 
sion that  all  county  public  healtli  work  should  be  prefaced  by 
^"American  .Journal  of  'Surging,  Juno,  1920. 


1348  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

classes  in  Home  Hygiene  and  Care  of  the  Sick.  As  one  of  the 
Red  Cross  chairmen  has  written  in,  "You  will  see  that  the 
nursing  classes  act  as  trumps  in  this  game  of  demonstrating  to 
the  people  the  necessity  of  county-wide  public  health  work." 
In  this  particular  community  the  instruction  work  has  brought 
about  the  demand  for  two  public  health  nurses. 

One  of  the  most  constructive  activities  of  the  public  health 
nurse  which  was  always  attended  with  encouraging  results  was 
nutrition  and  growth  work,  one  aspect  of  which  was  health  and 
growth  classes  and  another  hot  lunch  and  milk  in  the  schools. 
One  Division  director  wrote : 

Many  of  our  nurses  have  started  hot  lunches  in  the  rural 
schools,  and  have  been  able  to  interest  the  mothers  in  devoting 
some  of  their  time  to  preparing  the  lunches :  thereby  relieving 
the  nurse  of  this  extra  responsibility.  Also,  in  some  of  the 
high  schools,  the  older  girls  are  assuming  this  responsibility, 
one  group  preparing  and  serving  the  lunches,  and  anotlier 
putting  the  kitchen  in  order,  under  the  supervision  either  of 
one  of  the  teachers  or  some  member  of  the  Eed  Cross  Xursing 
Activities  Committee. 

Another  Division  director  said : 

A  splendid  cooperative  work  is  being  done  by  Miss  Mayer, 
public  health  nurse  for  Miscogee  County,  and  ]\Iiss  Jessie 
Fortson,  county  demonstration  agent.  ]\Iiss  Fortson  at- 
tended Dr.  Emerson's  lectures  at  the  Division  office  and  has 
returned  to  her  county,  and  is  putting  her  knowledge  into 
practice.  She  goes  with  ^Miss  ]\Iayer  into  the  schools  and 
weiglis  and  measures  the  pupils.  While  ^liss  ]Mayer  is  doing 
physical  inspection  of  the  pupils  ^liss  Fortson  keeps  a  list  of 
each  pupil's  name,  weight,  etc.,  and  checks  up  those  of  normal 
weight.  Then  she  classifies  the  underweight  children  and 
gives  them  special  advice  about  the  selection  of  food  and  how 
to  increase  their  weight.  In  this  way  contact  is  made  with 
the  pupils,  and  much  interest  is  shown  by  them  in  trying  to 
bring  their  weight  up  to  normal.  The  pupils  also  have  ex- 
hibited much  interest  in  the  physical  inspections.  Miss  Mayer 
sends  a  report  sli])  to  the  parents  of  normal  children  as  well  as 
to  the  parents  of  those  needing  correction  of  defects,  as  parents 
not  getting  a  slip  have  been  sending  tlieir  child  Ijack  for  his  or 
her  report  of  inspection.  These  workers  are  really  making 
their  efforts  count  for  somethinnf. 


PUBLIC  HEALTH  NURSING  AFTER  THE  WAR  1349 

That  the  Red  Cross  public  health  nurses  were  called  upon  to 
do  much  teaching  and  organizing  was  evident  from  a  narrative 
report  from  the  supervising  nurse  for  Tennessee : 

On  a  recent  trip  through  Tennessee,  we  found  the  most 
extraordinary  enthusiasm  for  the  public  health  nurse  mani- 
fested by  tlie  chapters  which  have  nurses  employed.  The 
nurses  have  done  excellent  work,  inspecting  school  children, 
giving  nursing  care,  instructing  mothers  in  the  hygiene  of 
pregnancy,  organizing  little  Mothers'  Leagues,  conducting 
health  classes,  opening  health  centers,  infant  welfare  stations 
and  rest  rooms  for  farmers'  wives. 

They  are  conducting  classes  in  Home  Hygiene  and  Home 
Care  of  the  Sick,  and  giving  other  health  instruction  to  pupils 
in  grammar,  high  and  Xormal  schools  and  colleges. 

They  are  giving  nursing  care  and  instruction  in  hygiene  to 
patiejits  ill  with  tuberculosis  and  instructing  families  how  to 
prevent  the  spread  of  tuberculosis  and  other  dangerous  com- 
municable diseases.  In  fact,  their  activities  are  so  many  and 
their  work  so  well  received  that  at  the  Farmers'  Convention  a 
great  deal  of  time  was  given  by  the  Home  Makers'  Section  to 
the  telling  of  the  activities  of  the  nurses  in  the  various 
chapters. 

The  work  of  the  nurses  knew  no  color  line,  l^ot  only  was 
much  bedside  nursing  undertaken  among  the  colored  population, 
but  school  inspection,  special  dental  clinics,  baby  conferences 
and  health  centers  were  established  in  colored  sections.  Mary 
Quinn,  Red  Cross  public  health  nurse  for  Wichita  County, 
Texas,  wrote: 

On  Friday,  we  had  a  health  conference  for  the  colored. 
The  basement  of  the  Baptist  Church  was  fixed  up,  and  Doctor 
Welcli  and  Doctor  ]\reans,  prominent  church  workers  over  in 
the  district,  lined  up  tlie  mothers  and  babies.  There  were 
twenty-two  babies  weighed  and  measured  and  examined.  Talks 
were  given  after  the  examination  and  a  committee  appointed 
to  continut-  witli  the  health  conference  every  month.  The  last 
Thursday  of  the  month  has  been  decided  on.  I  nnist  say  the 
colored  folks  are  very  enthusiastic  over  the  public  health  cen- 
ter work.  There  are  three  cases  who,  I  know,  have  had  ton- 
sillectomies since  the  conference  in  September. 

Scores  of  colored  midwiv(>s  in  the  vSonth,  S(une  of  them  living 
on  islands  which  could  onlv  be  reached  bv  rowboats  on  a  certain 


1350  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

set  of  the  tide,  were  instructed  and  advised  by  public  health 
nurses  of  their  own  race. 

The  nurses  found  excellent  opportunity  for  health  publicity 
in  connection  with  the  State  and  county  fairs,  particularly  in 
the  South  and  West.  Interest  aroused  in  this  way  was  made  the 
basis  for  future  intensive  work.  An  example  of  this  activity 
was  found  in  a  report  from  San  Joaquin  County  Chapter,  Cali- 
fornia : 

The  Public  Health  Xursing  Service  of  San  Joaquin  County 
Chapter  lield  a  very  successful  Children's  Health  Conference, 
in  connection  with  the  County  Fair,  the  week  of  September 
13th-18th.  As  the  fair  committee  had  very  few  permanent 
buildings,  the  conference  was  housed  in  a  tent.  The  space 
allotted  us  was  30  x  50  feet  or  one-half  of  the  tent.  At  first 
glance  it  looked  hopeless,  but  after  a  carpenter  had  erected 
beams  for  dividing  into  smaller  booths,  we  felt  more  hopeful. 
By  the  use  of  sheets  and  mosquito  netting,  we  were  able  to 
arrange  a  dressing  room,  weighing  and  measuring  room,  ex- 
amination room,  booth  for  the  dental  hygiene  department  and 
a  large  space  for  demonstration  and  exhibit  material. 

One  hundred  and  sixty  children,  ranging  in  age  from  six 
weeks  to  six  years,  were  examined  during  the  week.  The  ex- 
aminations were  made  by  physicians  of  Stockton  and  San 
Joaquin  Ceunty,  volunteering  for  three  hours  each.  The  den- 
tal exhibit  from  the  University  of  California  proved  of  great 
interest  to  both  mothers  and  children.  A  Stockton  dentist  was 
in  attendance  each  afternoon.  Demonstrations  on  the  care  of 
the  infant  were  given  each  afternoon,  by  pupil  nurses  from 
the  local  hospitals.  In  the  evening  Bed  Cross  films  were 
shown.  "American  Junior,"  "Winning  her  Way,"  "In  Flor- 
ence Xightingale's  Footsteps,"  "An  Fqual  Chance,"  the  Xa- 
tional  Organization  for  Public  Health  Xursing  film  and  the 
Federal  Children's  Bureau  film,  "Our  Children,"  were  also 
shown. 

A  separate  tent  with  a  cot  and  First-Aid  appliances  was 
provided  and  a  number  of  minor  cases  were  cared  for. 

Although  the  Health  Conference  meant  a  week  of  toil  for 
the  public  health  nurses,  we  feel  that  it  has  been  very  much 
worth  while,  due  to  the  interest  shown  by  mothers  of  children 
of  all  ages  and  also  by  a  great  number  of  prenatal  ca>;cs.  We 
also  feel  that  it  gave  the  people  throughout  the  county  a  better 
understanding  of  the  work  undertaken  by  the  American  Ped 
Cross. 

An  iutorcstin*r  feature  of  the  exhibit  was  a  booth  main- 


PUBLIC  HEALTH  NURSING  AFTER  THE   WAR   1351 

tained  by  the  public  library,  featurinf^  l)ooks  on  child  care, 
and  emphasizing  the  excellent  cooperation  they  give  the  pub- 
lic health  nurses  in  our  work  throughout  the  county. 

The  County  Farm  Bureau  gave  valuable  help  throughout 
the  conference,  and  displayed  in  their  booth  was  an  excellent 
poster  stating  the  cooperation  of  the  Bed  Cross  with  the  Farm 
Bureau  in  giving  the  classes  in  Home  Hygiene  and  Care  of 
the  Sick. 

The  foregoing  examples  written  for  the  most  part  in  the 
nurses'  own  words  gave  some  idea  of  the  scope  of  Red  Cross 
public  health  nursing.  It  was  by  no  means  the  whole  story, 
however,  but  rather  a  glimpse  here  and  there  of  undertakings 
and  accomplishments.  Underlying  every  activity  and  an  in- 
separable part  of  every  public  health  nurse's  program  w^as  the 
constant,  persistent  teaching  of  hygiene  and  health  habits,  better 
care  of  the  sick  and  better  living  through  practice  and  precept, 
through  demonstration,  illustration  and  personal  advice.  The 
following  paragraph  which  plosed  the  annual  report  for  the 
fiscal  year^  1920-21,  epitomized  the  service  rendered  by  the 
Ked  Cross  public  health  nurses : 

All  over  the  country  in  the  most  out-of-the-way  places,  as 
well  as  in  the  thriving  agricultural  centers,  our  nurses  are  at 
work.  In  the  tiny  settlements  in  the  high  Sierras,  among 
Indian  tepees,  in  the  heart  of  the  Appalachians,  on  the  lonely 
islands  off  the  New  England  coast,  on  tlie  wind-swept  plains 
of  Montana,  in  the  villages  along  the  ^Mexican  border,  in  the 
heart  of  the  forest  of  northern  Michigan  and  in  the  mining 
camps  of  Kentucky  and  West  Virginia,  the  chance  to  live,  the 
message  of  health  and  the  good  will  of  the  Bed  Cross  are 
being  carried  by  those  brave,  and  often  lonely  workers,  in  the 
uniform  of  the  nurse  and  of  the  Bed  Cross. 


CHAPTER  XVI 

CLASS  IXSTRUCTIOX   FOR   WOMEN 

THE  system  of  class  instruction  for  women  under  the 
Red  Cross  Kursing  Service,  now  so  extensive  and  so 
carefully  worked  out,  took  its  rise  in  a  suggestion  made 
by  Miss  Boardman  to  the  District  of  Columbia  Branch  in  1908. 
The  January  Bulletin  for  that  year  said : 

The  District  of  Columbia  Branch  at  its  annual  meeting  took 
up  the  subject  of  special  Eed  Cross  courses  in  First  Aid  (for 
men)  and  Home  Nursing  (for  women).  Committees  were 
appointed  to  arrange  for  such  courses. 

In  the  April  following  the  Bulletin  reported: 

Lectures  on  First  Aid  for  men  and  Home  l^ursing  for 
women,  instituted  by  the  District  Red  Cross  Branch,  have 
proved  most  successful.  Especially  the  latter  were  largely  at- 
tended. Inquiries  have  been  received  as  to  arrangements 
being  made  anotlier  year  for  nursing  courses  to  be  provided 
at  small  expense  for  women's  clubs,  etc. 

These  first  classes  in  home  nursing  were  given  in  St.  John's 
Parish  Hall,  Washington,  1).  C.  •  the  First  Aid  lectures,  to  men, 
were  held  in  the  Y.  ^1.  C.  A.  auditorium.  Both  halls  were 
given  without  charge  for  their  use,  but  the  District  Chapter 
paid  the  lecturers  ten  dollars  for  (>acli  class.  The  nurses  who 
conducted  the  classes  for  women  were,  Lily  Kancly  (Connecti- 
cut Training  School)  ;  (ieorgia  Nevins  (Johns  Hopkins)  ;  and 
Mrs.  Charles  Voung  (Kochester  Homeopathic).  They  taught 
largely  by  demonstrations  of  practical   nursing  procedures. 

'I'he  j)reanible  and  schedule  of  this  early  home  nursing  course 
follow,  l^nfortunately  the  precise  authorship  cannot  be  stated ; 
very  probably  the  tliree  nurses  mentioned  collaborated  in  ar- 
ranging the  printed  material. 

1352 


CLASS  INSTRUCTION  FOR  WOMEN  1353 


HOME  NURSING  COURSE   FOR  WOMEN 

There  are  thousands  of  families  in  which  sickness  occurs 
yearly,  when  the  services  of  a  trained  nurse,  either  because  of 
the  question  of  expense  or  for  some  other  reason,  cannot  be 
obtained.  To  provide  a  simple  course  in  Home  Nursing  for 
those  who  will  have  the  care  in  such  cases  of  illness,  the  Ked 
Cross  has  arranged  for  the  following  lectures  to  be  given  and 
demonstrated  by  trained  nurses.  It  is  suggested  tliat  those 
taking  this  course  bring  })aper  and  pencil  or  blank  book  for 
the  j)urpose  of  retaining  notes  of  these  valuable  instructions. 

I.  Hygiene  of  t<ick-room :  Location  of  room.  Ventilation. 
Demonstration  of  bed-making.  Clothing  of  patient.  General 
care  of  patient. 

II.  Dietetics:  Food  in  health.  Preparation  of  food  for  the 
sick,  such  as  beef-tea,  milk,  eggs,  etc.,  with  illustrations. 

III.  TuhercuJosu  icilk  Exhibit:  Mortality.  Modes  of  in- 
fection. Destruction  of  sputum.  Disinfection  of  rooms. 
Open-air  treatment.     Diet  of  consumptives. 

IV.  Contagious  Diseases:  Obligation  to  prevent  spread  of 
infection.  Compliance  with  health  laws.  Protection  of  at- 
tendants. Preparation  of  room.  Disinfection.  Scarlet  fever. 
Diphtheria.  Measles.  Pneumonia.  Typhoid.  Whooping 
cough.  Influenza.  Disinfection  and  fumigation  after  dis- 
ease. 

V.  'Mother  and  Baby:  Care  of  expectant  mother.  Care  of 
new  mother.  Care  of  baby.  Clothing,  feeding  and  habits  of 
baby.    Artificial  feeding.     Diet  of  child  until  six  years  old. 

A'l.  Emergencies:  Medical,  Surgical:  Fainting.  Apoplexy. 
Epilepsy.  Hysteria.  Drowning.  Heat  exhaustion.  Sun- 
stroke. Burns.  Scalds.  Concussion  of  brain.  Foreign 
bodies  in  eye,  ear,  throat,  etc.  Cuts.  Bruises.  Sprains. 
Fractures.     Hemorrhages.     Bandages.     Antiseptics. 

Where  plans  have  been  i)erfected  for  the  delivery  of  tliis 
course,  the  tickets  for  six  lectures  are  $1.00;  or  for  Ked  Cross 
members,  50  cents. 

How  the  example  of  the  District  of  Columhia  inspired  Ixcd 
Cross  members  in  Brooklyn,  and  served  to  bring  Home  Xnrsing 
forward  in  the  discussion  of  local  nursing  associations,  has 
already  been  told.  Still  more  important  was  the  action  of  the 
Society  of  Superintendents  of  Training  Schools  for  Xurscs. 
This  influ(Mitial  body,  at  its  session  in  1008,  directed  its  Stand- 
ing Committee  on  Education  to  prepare  an  outline  of  class 


1354  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

work  in  Home  Nursing  "suitable  for  the  use  of  the  Red  Cross, 
or  any  other  organization  wishing  to  provide  in  a  satisfactory 
manner  for  such  instruction  to  women  in  their  homes."  This 
step  was  taken  on  the  society's  own  initiative.  M.  Adelaide 
Nutting  was  then  chairman  of  the  Education  Committee,  and 
to  assist  her  in  this  special  task,  a  subcommittee  of  five  was 
selected  by  the  society.  They  were  Sister  Amy,  of  the  Boston 
Children's  Hospital ;  Ada  Carr,  of  the  Johns  Hopkins ;  Annie 
Damar,  president  of  the  Associated  Alumnse;  Sara  Cabaniss, 
then  head  of  the  Richmond  Nurses'  Settlement ;  and  Helen 
Scott  Hay,  superintendent  of  the  Illinois  Training  School  for 
Nurses.  Miss  Hay  made  her  first  appearance  in  Red  Cross 
Nursing  history  in  this  committee  work. 

A  year  went  by  with  work  and  correspondence  in  the  Nurs- 
ing Outline,  but  the  pressure  of  the  details  of  early  organiza- 
tion and  expansion  temporarily  hindered  the  Red  Cross  from 
pursuing  systematically  the  class  work  it  had  begun.  A  few 
extracts  from  letters  of  that  time  will  give  a  picture  of  tentative 
effort,  and  of  the  somewhat  sporadic,  yet  encouraging  attempts 
at  teaching. 

To  Miss  Boardman  from  Isabel  Hampton  Robb: 

Cleveland,  Ohio, 
.     .     .  October  4,  1908. 

I  went  up  to  New  York  and  talked  over  our  conversation 
with  the  rest  of  my  committee.  The  Committee  on  Home 
Lectures  is  at  work  on  the  courses  and  will  have  a  course  ready 
to  send  you  between  now  and  January.  If  I  may  suggest, 
would  it  not  be  well  not  to  offer  any  Home  Nursing  courses 
before  January,  1909,  and  to  make  that  generally  known? 
In  the  meantime,  this  course  can  be  prepared,  the  cards 
printed  and  the  various  associations  of  nurses  written  to  in 
each  city  to  secure  suitable  lecturers. 

I  can  take  it  up  here  with  our  local  associations,  or  for  the 
state  society,  if  you  like.  .  .  . 

To  Miss  Boardman  from  M.  Adelaide  Nutting: 

.     .     .  February  18,  1909. 

At  the  meeting  of  the  Superintendent's  Society  last  year  the 
Committee  on  Education  was  asked  to  consider  the  matter  of 
classes  i]i  Home  Nursing,  with  a  view  to  preparing  simple 
outlines  whicli  would  l)e  useful  to  tlie  Eed  Cross  and  other 
societies  desiring  to  carry  on  work  of  this  kind. 


CLASS  INSTRUCTION  FOR  WOMEN  1355 

It  is  the  belief  of  the  committee  that,  inasmuch  as  a  good 
many  diseases  arise  in  the  home  through  if^norance,  it  is  im- 
portant to  begin  the  classes  with  a  short  preliminary  talk  upon 
the  causes  of  disease,  and  the  measures  with  which  the  mother 
or  liomo-maker  should  be  familiar  m  order  to  exercise  proper 
methods  of  prevention.  As  I  understand  from  Mrs.  Kobb  that 
you  may  be  anxious  to  carry  on  some  of  these  classes  this 
winter,  1  am  sending  the  outline,  which  must  be  accepted  as 
preliminary  rather  than  as  a  final  statement  of  the  commit- 
tee's recommendation. 

I  am  sure  that  Mrs.  TJobb  has  discussed  with  you  her  ideas 
which  are  shared  by  the  members  of  the  committee,  as  to  the 
advisability  of  arranging  for  tliese  talks  through  our  nurses' 
association  and  depending  ujjon  them  to  select  from  their  body 
such  trained  nurses  (and  ])robably  other  assistants)  as  are  best 
prepared  to  carry  on  this  teaching.  .  .  . 

To  Miss  i^utting  from  ^liss  Boardman : 

Thank  you  for  your  letter  of  February  18th  with  its  out- 
line for  Home  Nursing  courses.  The  plan  to  have  these 
courses  under  the  nurses'  associations  is  exactly  what  I  should 
like  to  see.  I  hope  a  little  later  in  the  year  to  take  up  this 
matter.  .  .  , 


To  Miss  Boardman  from  Miss  Bichardson : 

.     .     .  California,  January  20,  1909. 

On  Sunday  last  while  addressing  the  Y.  W.  C.  A.  of  this 
city  I  spoke  of  the  advisability  of  organizing  Home  Xursing 
classes  after  the  plan  of  the  St.  John's  Ambulance  Corps. 
The  idea  was  enthusiastically  taken  up  by  that  organization 
and  several  other  societies  have  spoken  to  me  about  it. 

I  brought  the  matter  before  our  meeting  to-day  and  was 
glad  to  learn  that  you  had  begun  this  work  in  Washington 
some  time  ago.  I  would  like,  if  possible,  to  have  the  benetit  of 
your  ex])erience  along  this  line  before  definitely  starting  a 
class;  particularly  regarding  the  character  of  lectures  you  gave 
and  whether  you  had  physicians  or  trained  nurses  to  give  the 
lectures.  1  had  thought  of  having  our  Xurses'  Auxiliary  take 
u])  the  matfer  as  it  would  give  them  something  to  do.  1  sulj- 
mit  herewith  a  synoj)sis  of  what  1  have  planned  to  give  them, 
(signed)      C.  H.  Kichaudson:. 

San  Francisco  Ked  Cross. 


1356  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

To  Miss  Boardman  from  Miss  Pierson: 

.     .     .  New  Jersey. 

Will  you  kindly  send  me  information  of  Eed  Cross  Home 
Nursing  courses?     As  a  similar  course  is  now  given  in  a 
Nurses'  Settlement  in  which  I  am  interested,  it  might  be  de- 
sirable to  incorporate  it  under  the  Red  Cross  auspices, 
(signed)     Margaret  H.  Pierson/ 

Orange,  New  Jersey. 

To  Mr.  McChire  (California)  from  Miss  Boardman: 

.     .     .  April  7,  1909. 

Many  thanks  for  your  notices  in  regard  to  the  meetings  of 
the  Chinese  Detachment  of  the  California  Eed  Cross.  I  think 
it  is  a  most  excellent  idea  to  bring  such  education  in  amongst 
its  people.  I  wonder  if  it  would  be  possible,  in  time,  to  have 
some  simplified  Home  Nursing  courses  for  Chinese  women 
provided?  Most  of  them  must  be  very  ignorant  of  modern 
hygienic  laws,  and  quite  as  ignorant  of  modern  ideas  in  re- 
gard to  the  nursing  of  the  sick. 

(signed)     Mabel  BoARDiiAX, 

The  California  Red  Cross,  then  one  of  the  most  active  of 
the  branches,  having  developed  by  reason  of  the  demands  made 
upon  it  during  the  Spanish-American  War,  had  a  Nurses' 
Auxiliary  which  gave  class  teaching,  not  only  to  home  women 
in  Home  Nursing  but  also  to  women  in  industry.  Its  pioneer 
work  in  that  direction  is  the  earliest  instance  of  the  kind  in 
Red  Cross  annals.     The  Bulletin  (July,  1909)  said  of  it: 

The  Nurses'  Auxiliary,  a  very  valuable  adjunct  of  the  Cali- 
fornia Branch,  has  undertaken  to  start  factory  lectures  and 
demonstrations  at  the  noon  hour  beginning  in  April.  .  .  . 
Several  factories,  laundries  and  dc])artmcnt  stores  are  inter- 
ested in  these  methods,  and  consider  tliem  of  practical  value  to 
working  women.  The  women's  auxiliary  of  the  relief  column 
has  inaugurated  a  series  of  talks  on  Home  Nursing  and  Pre- 
vention of  Disease. 

After  affiliation  had  been  brought  about  in  1909,  ]\riss  Delano 
and  her  committee  at  once  revived  the  project  of  organizing 
Home  Nursing  classes  on  a  national  scale,  as  ]\[rs.  Kobb  had 
'  Miss  Richardson  and  iliss  Pierson  were  nurses. 


CLASS  INSTRUCTION  FOR  WOMEN         1357 

thought  it  possible  to  do.  With  the  exception  of  an  interesting 
letter  written  by  Miss  Delano  to  Mrs.  Draper  suggesting  the 
idea  and  asking  Mrs.  J)raper'g  opinion  (March  15,  1910), 
little  record  was  made  of  preliminary  steps  in  this  direction, 
but  early  in  1011  the  full  plan  was  completed  and  published 
as  follows: 

The  American  Red  Cross  Bulletin 

January,  1911. 

Second  i\.nnual  Keport  of  National  Committee  on  Red  Cross 

Nursing  Service. 

Home  Nursing  and  First  Aid  Instruction  for  Women. 

It  has  been  demonstrated  that  the  instruction  of  men  in 
First  Aid  will  reduce  deaths  and  serious  results  from  injuries 
about  one-half.  Simdar  instruction,  including  Hygiene  and 
Home  Nursing,  is  no  less  important  for  women,  but  has  never 
been  undertaken  on  a  national  scale. 

The  American  Ked  Cross  has  decided  to  organize  such 
classes  and  has  placed  them  under  the  general  direction  of  the 
National  Committee  on  Ked  Cross  Nursing  Service.  We  hope 
for  the  cooperation  of  State  and  Local  Committees  and  all  en- 
rolled Eed  Cross  Nurses.  The  course  of  instruction  will 
include:  ten  lessons  in  First  Aid;  fifteen  lessons  in  Hygiene 
and  Home  Nursing;  fifteen  lessons  in  Dietetics  and  Household 
Economy. 

All  instruction  will  be  very  practical  and  pupils  will,  as  far 
as  possible,  be  required  actually  to  do  everything  described  in 
the  teaching. 

It  must  be  distinctly  understood  that  tlie  instruction  is  only 
intended  to  prepare  women  to  render  emergency  assistance  in 
case  of  accidents,  to  give  more  intelligent  care  to  their  own 
families  under  com])etent  direction  and,  in  exceptional  cases, 
to  assist  in  relief  work  under  the  supervision  of  the  Nursing 
Service  of  the  American  Eed  Cross. 

The  First  Aid  courses  must  be  given  by  a  physician  and 
other  instruction  by  a  Ked  Cross  nurse,  unless  otherwise  au- 
thorized by  the  committee  in  charge. 

Miss  ^Marion  L.  Oliver,  of  Washington,  D.  C,  will  have 
charge  of  the  organization  of  the  classes.  Further  int'orma- 
tidii  may  i)e  obtained  bv  addressing  Honu^  Nursing  and  First 
Aid  Instruction  for  Women,  American  IJed  Cross,  Washing- 
ton, D.  C. 

Th(>  Home  Nursing  classes  wore  then  for  a  time  uppermost 
in  Miss  Delano's  tluuiglits.  ^larv  A.  Clarke,  a  Bellcvue  class- 
inato  who  assisted  her  during  that  [x-riod  wrote: 


1358  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

During  all  the  busy  days  of  1911  Miss  Delano  did  not  for- 
get a  little  pigeon-liole  compartment  of  the  big  steel  filing 
cabinet,  said  drawer  being  marked  "Home  Care  of  the  Sick."' 
Into  this  from  time  to  time  she  tossed  some  little  scrap  from 
her  pen,  or  gleaned  from  the  nursing  magazine,  or  any  other 
source.  She  explained  to  me  that  she  was  collecting  these  for 
a  book  on  Home  Xursing,  that  she  did  not  know  when  she 
would  ever  have  time  to  write  such  a  book,  but  it  was  in  her 
mind  to  do  so,  for  she  candidly  thought  it  was  urgently 
needed,  trained  nurses  being  then,  as  they  always  would  be, 
beyond  the  purse  of  the  great  majority;  and  moreover,  any 
intelligent  woman  was  capable  of  putting  into  practice  the 
principles  of  nursing.  .  .  . 

Some  months  after  this  when  I  was  asked  to  take  charge 
of  the  first  Home  Xursing  class  formed  in  Philadelphia,  com- 
posed of  the  Girls'  Friendly  Society  of  the  Parish  of  St.  John, 
Kensington,  ]\Iiss  Delano  furnished  me  with  chapter  headings 
of  the  book— to  be — as  arranged  by  herself  and  Miss 
Mclsaac,  the  famous  little  book  not  having  yet  reached  the 
stage  of  proof  sheets.  For  two  classes  I  gleaned  my  subject 
material  whence  I  could,  but  for  the  third  I  was  supplied 
with  proof  sheets  which  w^ere  my  pride  until  the  book  was 
published. 

Miss  Mclsaac  had  then  come  to  Washington  as  superintend- 
ent of  the  Army  Xurse  Corps.  She  was  already  a  well-known 
author  of  nursing  text-books  and  her  collaboration  made  pos- 
sible the  speedy  conclusion  of  the  book  Miss  Delano  had  begun. 

The  Red  Cross  Magazine  announced  the  publication  of  this 
text-book  by  saying  in  the  issue  of  October,  1913 : 

So  valuable  and  successful  have  the  Red  Cross  Textbooks 
on  First  Aid  proved  that  tlie  Committee  on  Xursing  Service 
decided  to  provide  an  equally  valuable  text-book  on  Elemen- 
tary Hygiene  and  Home  Care  of  the  Sick. 

This  new  textbook  has  been  prepared  by  two  of  the  best 
known  nurses  in  this  country.  Miss  Jane  A.  Delano,  K.X., 
was  superintendent  of  nurses  at  the  University  of  Pennsyl- 
vania Hospital,  of  the  great  Bellevue  Training  School  in  Xew 
York,  and  of  the  United  States  Army  Xurse  Corps. 

Her  collaborator  in  the  textbook  is  one  of  our  equally 
prominent  and  able  nurses — ]\Iiss  Isabel  ]\lclsaac,  P.X.,  for- 
merly superintendent  of  the  Illinois  Training  School  for 
Xurses  and  at  present  superintendent  of  the  Army  Xurse 
Corps. 


CLASS  INSTRUCTION  FOR  WOMEN         1359 

The  title  page  of  the  textbook  read : 

AMKRICAN'   HED  CROSS  TEXT  BOOK  ON  ELEMENTARY 
HYGIENE    AND    HOME    CARE   OF    THE   SICK 

by 

Jane  A.  Delano,  R.  N.  and 
Isabel  ^Iclsaac,  K.  N. 
Prepared  for  and  indorsed  hy  the 
American  Red  Cross. 

It  was  published  by  P.  Blakiston's  Sons  and  Company,  Phila- 
delphia, and  had  a  preface  written  by  Miss  Boardman,  in  which 
she  said : 

One  of  the  most  significant  facts  in  the  march  of  human 
progress  during  the  last  decade  is  the  great  awakening  of 
public  interest  to  the  questions  of  health.  Work  as  hard  as 
they  might,  neither  the  medical  nor  nursing  profession  could 
alone  accomplish  much  along  sanitary  lines  until  the  people 
in  general  became  aroused  to  the  importance  of  such  mat- 
ters. Knowledge  that  personal  health  depends  largely  upon 
the  liealth  conditions  of  the  community  brings  home  to  each 
individual  _a  serious  personal  interest  and  sense  of  responsi- 
bility. But  in  spite  of  the  strongest  barriers  yet  devised,  dis- 
ease cannot  always  be  kept  out.  To  the  gentle  hands  of 
women  belongs  the  care  of  the  sick  and  every  woman  should 
realize  that  the  time  may  come  when  such  a  care  will  be  hers. 

It  was  hardly  to  be  expected  that  courses  in  elementary 
nursing  procedures  could  be  launched  by  the  Red  Cross  with- 
out considerable  discussion  and  some  opposition.  Especially 
was  this  true  of  graduate  nurses,  who  brought  forward  the 
criticism  that  individuals  completing  the  course  would  prac- 
tice nursing  as  nurses.  So  deep  was  this  feeling  on  the  part 
of  individuals  here  and  there,  that  they  refused  to  act  as  in- 
structors, ^riss  Delano  and  ^fiss  ]\rcTsaac  were  so  determined 
to  safeguard  nursing  standards,  and  yet  to  give  the  people  at 
large  some  instruction  in  nursing  technique,  that  they  decided 
not  even  to  use  the  word  ''nursing"  in  the  title  of  the  book,  sub- 
stituting the  term  ''Care  of  the  vSick''  in  place  of  "Home  Xurs- 
ing."  These  words  convc^ycd  at  once  the  intent  of  the  course 
and  its  use  in  the  home  for  hygienic  betterment  and  for  the  care 
of  the  sick. 


1360  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Before  the  textbook  was  printed  much  of  it  was  submitted 
to  superintendents  of  training  schools  for  suggestions  and 
criticism.  The  National  Committee  on  Red  Cross  Nursing 
Service  was  also  called  upon  to  review  the  manuscript  before 
it  was  finally  published.  ''The  Home  Nursing  classes,"  stated 
the  Minutes  of  a  meeting  of  the  National  Committee  held  on 
December  10,  1912,  "were  then  considered  and  the  National 
Committee  approved  of  this  undertaking." 

Every  effort  was  then  made  to  place  the  emphasis  upon  the 
course  as  one,  not  to  prepare  women  for  nursing  as  a  livelihood, 
but  as  a  means  of  preparing  them  to  look  after  their  own  health 
and  that  of  the  family  with  more  intelligence.  Instructors 
were  urged  to  make  this  most  clear  to  each  class. 

The  first  year's  work  in  Home  Nursing  classes,  summed  up 
at  the  end  of  1912,  seems  quaintly  simple  as  compared  with  the 
statistics  shown  in  another  part  of  this  chapter.  Miss  Delano 
wrote : 

The  object  of  this  instruction  for  women  is  not  to  fit  them 
for  professional  service,  but  to  make  it  possible  for  them  to 
render  such  service  to  the  sick  in  their  own  homes  as  may 
safely  be  intrusted  to  tbem. 

The  following  classes  have  completed  a  course  in  Elemen- 
tary Hygiene  and  Home  Care  of  the  Sick  under  the  direction 
of  the  Eed  Cross;  South  Manchester,  Conn.,  two  classes; 
Washington,  D.  C,  two  classes;  Philadelphia,  one  class. 

Several  classes  are  now  receiving  instruction  in  Philadel- 
phia, Cincinnati,  El  Paso  and  Paterson,  X.  J.,  and  other 
classes  are  being  organized. 

In  a  class  largely  made  up  of  factory  girls,  recently  ex- 
amined in  Elementary  Hygiene  and  Home  Care  of  the  Sick, 
by  one  of  our  Local  Committees  on  Eed  Cross  Nursing  Ser- 
vice, the  general  average  for  the  class  of  ten,  for  both  written 
and  practical  examinations,  was  over  85  per  cent;  the  highest 
average  being  90  per  cent,  with  only  one  member  of  the  class 
below  80,  her  standing  being  79.5  per  cent,  on  a  scale  of  100. 

In  the  same  report  Miss  Delano  spoke  of  the  possibility  of 
beginning  courses  in  dietetics  and  household  economy.  This 
was  the  first  mention  made  of  the  desirability  of  instituting 
class  instruction  in  these  subjects,  now  so  largely  developed 
under  Ked  Cross  auspices  in  its  teaching  centers.  The  encon rag- 
ing popular  response  to  the  classwork  decided  the  Red  Cross 


CLASS  INSTRUCTION  FOR  WOMEN         1361 

to  augment  its  efforts  by  enlarging  the  list  of  subjects  taught. 
Early  in  1913  the  following  circular  was  issued: 

The  American  Eed  Cross  has  decided  to  organize  classes  of 
instruction  for  women  in  First  Aid,  home  imrsing,  hygiene 
and  allied  subjects^  to  be  given  under  tlie  supervision  of  the 
National  Committee  on  Red  Cross  Xursinjj  Service. 

1.  To  afford  women  the  opportunity  to  learn  first  aid  to 
the  injured  and  to  provide  simple  instruction  in  the  home 
care  of  the  sick. 

2.  To  afford  woinen  the  opportunity  to  learn  how  to  pre- 
pare food  for  the  sick  and  well. 

3.  To  afford  women  the  opportunity  to  learn  how  to  pre- 
pare rooms  and  other  places  for  the  reception  of  the  ill  and 
injured. 

4.  To  afford  women  the  opportunity  to  learn  how  to  pro- 
tect their  own  health  and  that  of  their  families. 

It  must  be  distinctly  understood  that  this  course  of  in- 
struction for  women  is  only  intended  to  prepare  them  to  ren- 
der emergency  assistance  in  case  of  accident,  to  give  more 
intelligeJit  care  to  their  own  families  under  competent  direc- 
tion and  in  exceptional  cases,  to  assist  in  relief  work  under 
the  supervision  of  the  Xursing  Service  of  the  American  Red 
Cross. 

Much  needless  suffering  is  now  caused  the  ill  and  injured 
on  account  of  the  ignorance  of  unskilled  persons.  It  has  been 
said  that  the  fate  of  the  injured  is  dependent  on  the  care 
which  their  injuries  first  receive.  It  is  therefore  necessary 
for  everybody  to  learn  what  to  do  first  in  an  emergency,  and 
what  not  to  do.  This  is  easy  to  learn,  but  the  subject  must 
be  learned.  Xobody  can  be  ex])ected  to  know  this  without 
instruction.  The  number  of  people  injured  in  the  United 
States  is  rapidly  mounting  and  is  now  in  the  hundreds  of 
thousands  annually.  Knowledge  of  first  aid  to  the  injured 
cannot,  it  is  true,  prevent  the  consequent  suffering  entirely, 
but  it  can  be  made  an  important  factor  in  this  result. 

The  health  of  the  family  depends  largely  upon  the  liome 
maker,  and  it  is  most  essential  that  she  have  a  definite  knowl- 
edge of  ])ersonal  and  housebold  hygiene  and  the  ])roper  ])repa- 
ratioii  of  food.  Spei'ial  diet  for  the  sick  is  no  less  essential. 
Scarecdy  a  woman  is  unacquainted  with  the  sick  room  in  her 
own  family  and  some  sim])le  instruction  in  the  care  of  the 
sick  should  he  a  ])art  of  every  woman's  education.  It  is  the 
purpos(>  of  th(>  Red  Cross  to  provide  tliis  instruction. 

This  work  is  just  heing  started  in  this  country,  so  that 
great    results   cannot  yet   he   reportetl.      It   has  already   been 


1362  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

demonstrated  here,  however,  that  instruction  in  first  aid 
will  reduce  deaths  and  serious  results  from  injuries  about 
one-half.  On  railroads  and  everywhere  else  that  the  Ameri- 
can Ked  Cross  has  carried  first  aid  instruction,  all  interested 
are  enthusiastic  in  praise  of  the  benefits  derived. 

The  list  of  classes  conducted  during  the  year  1914  is  his- 
torically interesting,  as  that  fateful  year  made  a  dividing  line 
in  all  fields  of  work. 

1914.  Fifth  Report,  i^ational  Committee  Nursing  Service; 
Completed  Classes :  Washington,  D.  C,  nine  classes ;  South 
Manchester,  Connecticut,  two  classes ;  Manchester,  Massachus- 
etts, one  class ;  Danville,  Illinois,  one  class ;  Paterson,  N.  J.,  two 
classes ;  Providence,  11.  L,  one  class ;  Philadelphia,  Pa.,  six 
classes;  Elyria,  Ohio,  one  class;  Cincinnati,  Ohio,  seven  classes; 
total  number  of  classes,  thirty ;  total  number  of  pupils,  five 
hundred  seven ;  total  number  of  certificates  issued,  two  hundred 
seventy-five.  Current  and  Incomplete  Classes :  Clinton,  N.  Y., 
one  class ;  Basking  Ridge,  N.  J.,  one  class ;  Gladstone  and  Pea- 
cock, one  class ;  Bernardsville,  'N.  J.,  one  class ;  Amesbury, 
Massachusetts,  one  class ;  El  Paso,  Texas,  one  class ;  Cincinnati, 
Ohio,  nine  classes ;  Paterson,  N.  J.,  two  classes ;  Utica,  N.  Y,, 
one  class;  Cleveland,  Ohio,  one  class;  Norfolk,  Va.,  one  class; 
Troy,  N.  Y.,  two  classes;  total  number  of  classes,  twenty-two; 
total  number  of  pupils,  three  hundred  forty-four.  Grand  total, 
fifty-two  classes ;  grand  total,  eight  hundred  fifty-one  pupils. 

The  war  stimulated  the  nursing  activities  of  women  to  an 
intense  degree,  and  this  stimulus  was  heightened  in  1916  by  the 
threat  of  trouble  on  the  Mexican  border.  Miss  Delano  w^rote 
(December,   191G)  :2 

The  interest  in  preparedness  excited  in  this  country  by  the 
European  War,  intensified  in  the  early  summer  by  the  pos- 
sibility of  war  between  the  United  States  and  Mexico  re- 
sulted in  an  extraordinary  increase  in  the  interest  in  the 
courses  of  instruction  given  under  the  auspices  of  the  Ked 
Cross. 

The  demand  by  women  anxious  and  eager  to  be  of  service 
to  their  country,  for  some  form  of  instruction  that  would  in 
a  measure  be  preparatory,  resulted  in  the  recommendation  by 
the  National  Committee  on  Xursing  Service  at  the  last 
annual   meeting,  that  a  combined  course  of  ten  lessons  in 

'Seventli  Annual  Report,   1916. 


CLASS  INSTRUCTION  FOR  WOMEN  1363 

Elementary  Ilygioiic  aixl  Homo  Care  of  the  Sick  and  five  in 
First  Aid  be  arranged  and  put  into  j)ractical  operation.  This 
was  done,  but  as  the  demand  for  wliich  this  course  was  espe- 
cially ])rovided  was  no  longer  urgent,  the  special  course  was 
finally  withdrawn  September  1,  11)1(5,  after  which  the  course 
of  fifteen  lessons  in  Elementary  Hygiene  and  Home  Care  of 
the  Sick  was  adopted  as  the  basis  of  preparation  and  selec- 
tion of  women  for  service  as  nurses'  aides. 


The  lessened  urgency  to  which  ]\Iiss  Delano  here  refers  did 
not  last  long,  for  although  the  menace  of  war  with  ^lexico  re- 
ceded in  the  latter  part  of  1910,  the  next  spring  brought  its 
own  catastrophe,  and  the  teaching  of  nurses'  aides  was  resumed. 
This  has  already  been  described  under  its  own  heading.  We 
return  now  to  ^fiss  Delano's  interrupted  report,  (1916)  in 
which  she  describes  the  ''teaching  center." 


Eed  Cross  classes  for  instruction  have  developed  so  rapidly 
that  Chapters  have  been  urged  to  form  educational  commit- 
tees for  the  pur])ose  uf  supervising  some  of  the  details  of  class 
organization  and  teaching.  A  closer  cooperation  has  been 
urged  between  the  Chapters  and  the  Local  Connnittees  on 
Eed  Cross  Nursing  Service.  This  is  being  accomplished  by 
membership  upon  the  educational  connnittees  of  the  Chapter 
by  one,  or  in  some  cases,  two  or  more  nurses  from  the  Local 
Connnittees  on  Eed  Cross  Xnrsing  Service. 

One  of  tlie  ])i-actical  outgrowths  of  this  interest  by  the 
Chapters  in  the  educational  work  of  the  Red  Cross  has  been 
the  development  of  the  ''Teaching  Center"  with  a  nurse 
director.  Class  organization  and  in  many  cases,  instruction 
may  be  conchicted  by  the  director.  Houses  have  been  loaned 
or  rented,  adecpiate  teaching  equipment  secured  and  by  this 
centralization  more  \iniform  and  ellicient  teaching  has  been 
the  result.  In  some  instances^  all  the  Chapter  activities — ■ 
cutting  and  sewing,  ])reparation  ot"  surgical  supplies,  packing 
and  distribution  as  well  as  the  instruction — have  1)een  cen- 
tralized under  a  K'ed  Cross  inirse  director.  Xew  York. 
Brooklyn.  Philadelphia,  Washington.  Cincinnati.  Cleveland, 
Chicago.  San  Francisco,  Pasadena  and  Los  Angeles  have 
established  such. 

The  classes  iu  Khnnentary  Hygiene  and  Home  Care  of  the 
Sick  lia\e  nnt  oidy  increased  in  number  but  liav(>  extended 
over  a  wider  area.     They  ha\e  been  given  in   Hawaii  and  in 


1364  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

nearly  all  the  states  in  the  country,  while  larger  cities  and 
small  towns  display  equal  interest.  The  classes  are  given 
under  the  auspices  of  Chapters,  clubs,  churches,  schools — 
public  and  private — individuals,  stores,  and  industrial  con- 
cerns. In  many  instances,  where  pupils  cannot  pay  the  class 
fees,  these  have  been  provided  by  persons  interested  in  extend- 
ing this  instruction. 

The  widespread  interest  in  the  courses  of  instruction  given 
under  the  Eed  Cross  has  been  revealed  by  an  unprecedented 
demand  for  qualified  Instructors.  Every  effort  is  being  made 
by  the  Bureau  of  Xursing  to  secure,  through  Local  Commit- 
tees and  the  National  and  Local  Leagues  of  Xursing  Educa- 
tion, the  names  of  nurses  qualified  and  available  for  this 
work. 

Classes  in  Home  Dietetics  were  systematically  launched  with 
the  publication  of  a  textbook  in  1917.  The  first  were  organized 
in  February  of  that  year.  They  rapidly  became  very  popular. 
With  the  great  expansion  of  interest  in  these  courses  due  to  the 
war,  they  were  placed  under  the  Bureau  of  Instruction. 

The  many  groups  acting  as  sponsors  for  class  instruction 
gave  decided  color  to  the  whole  field  of  work,  so  varied  were  their 
forms  and  characters.  They  included  Young  Women's  Chris- 
tian Associations  and  Girls'  Friendly  Societies,  Red  Cross 
Chapters,  women's  clubs,  church  circles,  public  and  private 
schools,  shops,  factories  and  individuals.  The  war  period  added 
semi-military  groups,  such  as  the  encampment  schools  of  the 
Women's  Section  of  the  ^avy  League. 

Early  in  1918,  still  under  the  pressure  of  a  vastly  augmented 
bulk  of  administrative  work  of  all  kinds,  the  decentralizing  sys- 
tem of  organization  already  described  was  effected  by  the  Red 
Cross  and  the  work  of  class  instruction  became  more  and  more 
clearly  defined  as  a  growing,  special  branch  of  activity. 

In  the  earliest  work  of  founding  classes,  either  for  First  Aid 
or  Home  Hygiene  the  Red  Cross  published  simple  suggestions 
on  the  following  lines  to  guide  its  members :  Organizers  of  class- 
work  were  to  be  certain  of  a  suitable  number  of  pupils  who 
would  agi'cc  to  be  regular  in  attendance,  and  who  were  then  to 
select  some  one  from  the  number  to  act  as  president  of  the  class. 
The  president  so  selected  was  to  communicate  with  the  De- 
partment of  Instruction  for  Women  at  National  Headquarters. 
A  roll  was  then  to  be  supplied  to  the  class  president,  on  which 
names  of  class  members  were  to  be  inscribed  and  answers  given, 


CLASS  INSTRUCTION  FOR  WOMEN         1365 

in  respect  to  certain  essentials.  Pupils  under  sixteen  years  of 
age  were  not  to  be  accepted.  The  proper  size  of  a  class  was 
between  ten  and  twenty.  The  class  president  was  expected  to 
find  a  local  physician  or  nurse  to  teach  the  respective  classes. 
The  name  and  address  of  each  physician  or  nurse  was  to  accom- 
pany the  roll  of  pupils'  names.  Before  the  classwork  was 
actually  begun  all  instructors  were  to  be  approved  by  the  Ked 
Cross  and  a  card  of  authorization  issued  from  National  Head- 
quarters. Thus  simply  organized,  the  class  teaching  ran  along 
easily  for  several  years  until  the  increasing  stimulus  of  war 
efforts  made  itself  felt.  By  191G  classes  for  instruction  had 
developed  so  rapidly  that  the  Ked  Cross  Chapters  were  urged 
by  Headquarters  to  form  Educational  Committees  to  supervise 
the  details  of  class  organization  teaching.  The  Chapters  were 
also  encouraged  to  cooperate  closely  with  the  Local  Committees 
on  Red  Cross  Nursing  Service,  which  have  been  spoken  of  in  a 
previous  chapter,  by  placing  one  or  more  of  the  nurses  from 
such  committees  on  the  educational  committees  of  the  Chapters. 
The  Chapters  responded  so  well  and  so  intelligently  to  these  sug- 
gestions that,  from  their  coordinated  educational  efforts  there 
developed  the  Teaching  Center  with  a  nurse  director  described 
by  !Miss  Delano  on  a  previous  page. 

To  facilitate  the  organization  of  classes  as  thoroughly  as 
possible  either  under  the  auspices  of  Chapters  or  other  agencies, 
it  was  necessary  to  develop  careful  plans  and  procedures.  These 
were  worked  out  by  the  Nursing  Service  at  National  Head- 
(}uarters.  The  instructions  were  very  simple  at  first,  and  as 
the  earliest  classes  were  infrequent,  each  one  was  practically 
supervised  from  National  Headquarters.  Finally,  however, 
many  pamphlets  and  separate  forms  were  required  to  explain 
the  procedure,  comprising  as  it  did  the  qualifications  and  ap- 
pointment of  instructors;  financing  the  classes;  fees;  equipment 
for  teaching;  the  methods  of  sending  in  reports;  conduct  of 
examinations;  marking  papers;  certificates;  subject  matter  of 
the  various  types  of  instruction ;  guides  for  instructors  and 
bibliograpiiies  for  students  and  instructors.  So  complete  was 
all  this  material  that  it  forms  a  valuable  part  of  the  records  in 
the  archives  of  the  American  Ked  Cross  at  Washington.  1).  (\ 

The  early  phases  incident  to  the  organization  of  any  project 
are  often  marked  by  difficulties  and  interruptions.  Soon  after 
the  courses  of  instruction  were  set  in  motion,  Marion  Oliver, 
whose  entliusiasiii  and   interest  had  banished  everv  thouirht  of 


1366  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

difficiilty,  was  obliged  to  leave  Washington  and  sever  her  con- 
nection with  these  courses. 

The  effect  of  the  war,  however,  was  to  stimulate  greatly  the 
public  interest  in  all  Red  Cross  work,  and  the  organization  of 
the  Nursing  Service  in  all  its  branches  went  swiftly  on. 

Miss  Delano,  as  chairman  of  the  National  Committee  on 
Nursing  Service  had  assumed,  from  1914  to  1916,  the  entire 
responsibility  of  these  classes.  Upon  the  appointment  of  Clara 
D.  Noyes  as  director  of  the  Bureau  of  Nursing  Service  in  1916, 
the  classes  were  transferred  to  her  general  direction  until  they 
were  placed  under  the  Bureau  of  Instruction  in  April,  1917, 
with  Helen  Scott  Hay  in  charge. 

The  decision  of  the  Red  Cross  at  the  request  of  the  War 
Department,  early  in  1916,  to  prepare  twenty-five  nurses'  aides 
to  form  an  auxiliary  gToup  to  the  nurses  of  each  base  hospital 
then  under  process  of  organization  by  the  Red  Cross  for  the 
War  Department,  gave  a  great  impetus  to  the  course  of  Ele- 
mentary Hygiene  and  Home  Care  of  the  Sick.  The  course  in 
itself  was  not  considered  as  adequate  preparation  for  this  group, 
but  hospitals  acting  as  the  parent  institution  to  a  base  hospital 
were  asked  to  give  each  individual  selected  for  this  group  a 
month's  course  in  the  institution.  Nevertheless  hundreds  of 
women  who  had  finished  the  course  felt  that  it  might  qualify 
them  for  service  in  military  hospitals  should  the  United  States 
become  engaged  in  war.  The  idea  became  more  widespread 
and  the  demand  for  classes  increased.  Particularly  was  this 
true  immediately  after  the  declaration  of  war  in  April,  1917, 
and  during  the  months  that  followed.  The  demand  for  instruc- 
tion increased  beyond  the  ability  of  the  Nursing  Service  to 
provide  facilities  for  it.  The  textbook  on  Home  Dietetics 
which  had  been  issued  during  the  early  winter  of  191G,  also 
attracted  much  interest.  The  demand  for  dietitians  for  service 
in  military  hospitals,  as  well  as  to  act  as  instructors,  became 
almost  as  great  as  that  for  nurse  teachers.  Until  June,  1917, 
]\riss  Noyes  worked  alone  with  these  activities.  She  was  at  the 
ofiice  early  and  late,  Sundays  and  holidays.  The  pressure  was 
so  enormous  that  work  increased  beyond  the  space  capacity  to 
care  for  it.  The  third  floor  of  the  Headquarters  building,  in- 
cluding tlie  gallery,  was  crowdc^d  with  desks,  and  from  approxi- 
mately ten  workers,  including  ^liss  Delano  and  ^liss  Noyes, 
the  nnmber  grew  until  there  were  eighty,  and  still  the  work 
was  bevond  control.     The  details  of  the  classes  formed  a  con- 


CLASS  INSTRUCTION  FOR  WOMEN         136T 

sifloral^lo  part  of  th(^  work  with  wliich  this  office  force  was  busy. 
During  the  sinmner  of  1917,  the  pressure  for  instructors  was 
very  great.  There  were  as  yet  no  Division  officers  to  whom  the 
selection  of  these  nurses  might  be  r(>ferred.  Therefore,  tlic 
Local  Red  (^ross  Nursing  Committees,  of  which  each  state  had 
one  or  more,  were  asked  to  recoumiend  instructors. 

^hmy  times  during  the  crowded  summer  of  1917  several 
baskets  of  papers  of  enrolled  nurses  would  require  examination 
in  order  to  determine  the  (qualifications  for  teaching  the  course 
before  the  instructors'  appointment  card  could  l)e  issued.  Be- 
fore the  card  was  sent  out  the  approval  of  the  Local  Committee 
was  secured.  With  the  offices  so  crowded,  and  the  click  of 
typewriters  and  constant  interruption  making  sustained,  delib- 
erative thought  almost  impossible.  Miss  Noyes  frequently  used 
the  attic  in  which  to  scrutinize  these  credentials.  Even  the 
gravest  occasions  may  have  their  humorous  aspect  and  evidently 
this  impressed  one  well-known  writer — Gelett  Burgess — who, 
in  Colliers  Weekly,  August  1,  1917,  wrote: 

"But  liere  is  the  director  of  the  Bureau  of  Nursing  Ser- 
vice, come  for  a  necessary  conference.  Crowded  into  a  narrow 
space  between  tables,  with  women  pushing,  'excuse  me  I 
excuse  me !'  past  them  every  minute  the  conversation  goes  on 
until — ']\Iiss  Xoyes,  jMiss  Xoyes' — the  head  of  the  Bureau  of 
Nursing  Service  is  called  to  the  long  distance  phone,  where  a 
lady  in  another  city,  who  had  taken  the  examination  in  Home 
Care  of  the  Sick,  wildly  wants  to  know:  'Where  is  my  certifi- 
cate?' ^Fiss  Noyes  ])romises  to  send  it  l)y  special  delivery, 
does  send  it  immediately.  Her  tormentor,  however,  witliont 
waiting  the  necessary  time,  continues  to  write,  phone  and  felc- 
gra])h,  as  if  she  expected  the  certificate  to  arrive  instantane- 
ously by  wireless.  Poor  ^liss  Xoyes  I  In  order  to  do  a  little 
writing  she  lias  to  forsake  her  comfortable  oiliee  and  flee  for 
refuge  to  the  attic." 

This  pressure  continued  until  relieved  by  the  appointment 
of  ^liss  ITay  in  July,  li)l7.  So  rapidly  had  tlu^  woi'k  expanded 
that  ^liss  Hay  found  a  corps  of  1.")  steiiograjihcrs,  six  clerks,  six 
typists  and  on(^  messenger,  who  w(u-e  attending  to  the  details  of 
this  oiu^  activity.  Aft(U'  decentralization  was  completed,  the 
details  of  tlii^  conduct  of  classes  wer(^  gradually  transferred  to 
the  ])ivisi(Ui  offices.  The  number  oi'  \lv(]  Cross  Cha]it('rs  had 
ai'owii  to  :)700  and  a  vastlv  increased  interest  in  the  courses 


1368  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

was  spread  throughout  their  jurisdiction.  As  interest  in  the 
classes  of  Elementary  Hygiene  widened  some  dissatisfaction 
with  the  textbook  was  expressed,  and  revision  seemed  neces- 
sary. Miss  Delano  appointed  a  committee  during  the  summer 
of  1917  to  work  out  a  suggested  plan,  of  which  Anna  C.  Jamme, 
of  California,  was  the  chairman.  Two  other  nurses  formed  the 
committee  of  three;  one  of  these  was  a  Washington  (D.  C.) 
nurse  whose  name  cannot  be  secured  and  the  other  was  Amy 
Hilliard,  who  for  the  moment  put  aside  her  duties  as  general 
superintendent  of  Bellevue  and  Allied  Schools  of  Nursing  to 
come  to  National  Headquarters  and  work  out  this  plan. 

Anne  Hei'vey  Strong,  graduate  of  Bryn  Mawr  College,  of 
the  Albany  Training  School  for  Nurses  and  also  of  Teachers 
College,  at  that  time  professor  of  Public  Health  Nursing,  Sim- 
mons College,  Boston,  was  asked  to  undertake  the  revision, 
using  the  plan  developed  by  the  smaller  committee  and  later 
approved  by  the  National  Committee.  This  she  consented  to 
do.  After  some  delays,  the  book  was  ready  for  circulation  early 
in  1918;  the  name  was  changed  to  ''Home  Hygiene  and  Care 
of  the  Sick"  ;  the  text  revised  and  brought  up  to  date  with  several 
other  changes,  such  as  a  rearrangement  of  contents  and  the 
addition  of  a  bibliography.  At  this  time  an  interest  in  the 
book  held  by  Miss  Mclsaac's  sister  was  bought  by  Miss  Delano. 
By  the  terms  of  Miss  Delano's  will  the  textbook  with  all 
author's  royalties  became  the  sole  property  of  the  American 
Red  Cross. 

Within  the  Division  Departments  of  Nursing,  the  work  in 
connection  with  the  two  courses  of  instruction,  Elementary 
Hygiene  and  Home  Care  of  the  Sick  and  Home  Dietetics,  was 
systematized  on  the  following  plan: 

a.  Advice  to  and  supervision  of,  Chapters  on  matters  of 
general  policy  and  practice  prescribed  by  National  Head- 
quarters. 

b.  Supervision  of  instruction  personnel;  appointment  of 
Chapter  supervisors  of  the  courses  in  Elementary  Hygiene  and 
Home  Care  of  the  Sick,  and  in  Home  Dietetics ;  appointment 
of  instructors  for  Elementary  Hygiejie  and  Home  Care  of 
the  Sick;  cooperation  with  National  Headquarters  in  the 
enrollment  of  r?ed  Cross  Dietitians  and  the  appointment  of 
instructors  for  Home  Dietetics. 

c.  Advice  to  Chapters  on  matters  concerning  compensation 
of  instructors  and  class  fees. 


CLASS  INSTRUCTION  FOR  WOMEN         1369 

d.  Maintenance  of  records  of  instruction  personnel,  and 
forwarding  of  this  information  to  Chapters. 

e.  Study  and  recommendations  as  to  methods  of  promoting 
enrollment  of  students. 

f.  Advice  to  and  cooperation  with,  Chapters  on  matters  re- 
lating to  classrooms  and  classroom  equipment. 

g.  Sunnnarization  for  the  Division  manager  of  reports  of 
class  instruction  work  received  monthly  from  Cha])ters  and 
preparation  of  Division  summaries  for  transmittal  by  the 
Division  manager  to  National  Headquarters. 

With  the  newly  decentralized  system,  the  work  of  the  Bu- 
reau of  Class  Instruction  at  National  Headquarters  was  divided 
and  placed  under  the  supervision  of  two  bureaus  known  respec- 
tively as  (1)  Bureau  of  Elementary  Hygiene  and  Home  Care 
of  the  Sick,  with  Miss  Hay  as  director,  and  (2)  the  Bureau 
of  Dietitian  Service,  with  Miss  George  as  director.  As  the 
volume  of  work  increased,  it  became  necessary  to  appoint  Di- 
vision directors  of  the  Bureau  of  Elementary  Hygiene  and 
Home  Care  of  the  Sick, 

In  January,  1918,  the  Surgeon  General  of  the  Army  re- 
quested that  Miss  Hay  be  released  from  the  Bed  Cross  to  do 
some  special  work  in  his  office  in  connection  with  the  Army 
School  of  Xursing.  Following  !Miss  Hay's  resignation,  Har- 
riette  Sheldon  Douglas,  whose  name  and  interesting  background 
have  already  been  given  in  a  previous  chapter,  became  director 
of  the  Bureau  of  Nurses'  Aides  and  Instruction.  She  continued 
in  that  office  until  December  31,  1921,  when  she  resigned  be- 
cause of  pressing  personal  claims  upon  her  time. 

^Irs.  Isahelle  Wilbur  Baker  succeeded  ^liss  Douglas,  coming 
to  Xatiomil  Headquarters  on  January  1,  1922,  from  the  Xew 
England  Division,  where  she  had  served  successively  as  an 
instructor,  director  of  a  Chapter  teaching  center  and  l)ivisi(m 
Director  of  Instruction  in  Home  Hygiene  and  Care  of  the  Sick. 
This  practical  training  and  experience  was  a  valuable  contri- 
bution to  the  development  of  the  work  at  National  Headtpuir- 
ters.  Mrs.  IJaker  was  a  graduate  of  tlu>  Bhod(>  Island  School  of 
Xursiug  and  ])revi()us  to  her  marriage,  had  been  su})erinten(lent 
of  the  Johnson  ^lemorial  Hospital,  Stattord  Springs,  C\)n- 
necticut. 

During  th(>  period  which  elapsed  between  the  year  1917 
and  the  ycai'  1922.  class  instruction  for  women  increased  to  an 
almost   incredible  magnitude.      Its   character,   too.   altered  per- 


1370  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ceptibly  and  a  marked  difference  in  the  class  of  students,  during 
wartime  and  after,  became  evident.  The  war  brought  out  many 
women  who  had  visions  of  war  nursing,  but  afterwards  the  ex- 
tent of  class  teaching  among  factory  workers,  the  young  women 
of  humble  homes  and,  most  strikingly,  among  rural  families, 
mountain  and  farm  dwellers,  and  little  country  villages,  gave 
gratifying  proof  that  a  solid  and  enduring  work  of  education 
had  been  built  up.  The  number  of  certificates  issued  from 
1914  to  1921  follow:  1914,  273  certificates;  1915,  250  certifi- 
cates; 1916,  3927  certificates;  1917,  31,188  certificates;  1918, 
27,942  certificates;  1919,  49,072  certificates;  1920,  89,748 
certificates;   1921,   61,304  certificates. 

These  figures  do  not  include  thousands  of  women  and  girls 
who  took  the  instruction  but  who  for  various  reasons  did  not 
complete  the  course  and  receive  the  certificate. 

The  peak  of  enrollment  was  reached  in  1920  when  117,908 
pupils  took  the  course.  That  the  enthusiasm  in  this  phase  of 
health  education  should  have  reached  its  height  at  this  par- 
ticular period  was  a  natural  result  of  the  alarm  created  by  the 
influenza  epidemics  of  the  two  preceding  years.  Never  had  the 
necessity  for  preparedness  by  every  woman  against  the  on- 
slaughts of  disease  been  more  gTaphically  and  tragically  em- 
phasized. 

When  this  instruction  was  first  given  there  was  but  one  au- 
tlmrized  form — the  Standard  course.  This  consisted  of  lessons 
totaling  twenty-two  and  one-half  hours  as  a  minimum;  it  was 
conducted  by  an  authorized  Red  Cross  nurse  instructor.  Exam- 
inations, both  practical  and  theoretical,  were  given  at  the  end 
of  the  lessons,  and  certificates  were  granted  to  those  whose 
markings  wore  satisfactory.  In  1920  an  adaptation  and  modi- 
fication of  the  Standard  course  were  authorized.  The  Adapta- 
tion of  the  course  consisted  of  the  same  number  of  hours,  fol- 
lowed by  examinations  and  certificates  as  in  the  Standard  course, 
but  teachers  of  physiology,  biology,  physical  training,  and  home 
economics  and  others  specially  qualified  were  allowed  to  give 
the  theoretical  instruction.  It  was  designed  for  use  in  schools 
and  remote  communities.  Autliorized  Red  Cross  luirse  in- 
structors in  every  instance  were  made  responsible  for  the  course 
and  for  giving  the  practical  lessons.  A  plan  was  worked  out  by 
National  Headquarters  indicating  thos(^  chapters  in  the  Hod 
Cross  textbook  that  might  be  taught  by  the  lay  teacher  and 
those  that  should  be  taught  by  the  nurse  instructor.     By  this 


CLASS  INSTRUCTION  FOR  WOMEN  1371 

arrangement  the  nurse  instructor's  time  was  conserved,  thus 
making  it  possible  for  a  greater  number  of  students  to  have 
the  advantages  of  the  instruction. 

The  ^lodification  was  authorized  for  the  benefit  of  those 
women  who  would  find  it  difficidt  to  take  a  written  test,  for 
women  lacking  a  knowledge  of  English  and  for  girls  too  im- 
niatur(>  to  take  either  Standard  course.  It  covered  the  same 
number  as  the  other  two  of  the  lessons  to  be  given  en- 
tirely by  a  lit'd  Cross  nurse  instructor.  No  written  examina- 
tion was  to  be  re(iuired,  but  practical  tests  were  to  be  given,  and 
at  the  completion  of  the  lessons  a  certificate  granted  to  those 
eligible. 

In  order  to  secure  a  standardized,  efficient  method  of  instruc- 
tion and  to  give  some  special  training  in  teaching  to  instruc- 
tors, institutes  were  held  in  every  Division  under  the  super- 
vision of  the  Division  Directors  of  Home  Hygiene  and  Care  of 
the  Sick,  whose  experience  in  teaching  and  administration  had 
been  demonstrated.  The  educational  benefits  of  these  insti- 
tutes were  invaluable,  they  not  only  enabled  the  Division  Di- 
rectors to  come  into  personal  contact  with  the  instructors  in  their 
Divisions,  but  served  to  improve  the  methods  and  techni(|ue 
of  the  instructors  themselves.  A  still  further  step  leading  to 
the  better  preparation  of  nurses  as  instructors  in  Home  Hygiene 
and  Care  of  the  Sick  was  the  inauguration  in  several  universities 
and  colleges  of  a  short  course  in  methods  of  teaching. 

The  ''Guide  for  Instructors"  was  revised  in  the  spring  of 
1021,  with  the  expectation  that  it  would  help  to  secure  great(>r 
uniformity  of  method  in  presenting  the  information  contained 
in  the  textbook.  It  was  compiled  to  assist  especijilly  the  in- 
structors who  lacked  experience  in  teaching  or  who  had  not 
h'arned  to  apply  teaching  methods  to  the  carc^  of  tli(>  sick  in  the 
home.  This  Guide  as  revised  contained  outlines  of  the  course, 
an  exc(>]lent  explanatory  text,  illustrations  of  nursing  teclmiipu} 
iiiteii(l(Ml  to  standardize  demonstrations,  sugg(>sted  lists  of  (Mpiip- 
nieiit  for  teaching  centers  and  traveling  (^luipnient,  and  lists  of 
substitute  appliances  which  might  be  improvised  from  materials 
available  in  the  simplest  home.  The  substitute  appliances  were 
not  ;'lunisy  devices,  but  ship-shape  and  trig.  The  pamphlet  was 
amply  illustrated.  Miss  Douglas  lavished  her  eneruies  in  en- 
couraging and  devi'loping  resourcefulness  among  the  instrnctoi's 
and  in  this  she  met  with  response  and  enthusiasm  from  the 
Division  direct(U's. 


1372  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Because  of  the  increased  demand  in  rural  communities  for 
these  classes,  itinerant  or  field  instructors  were  appointed  in 
many  of  the  Divisions.  These  instructors  were  supplied  with 
traveling  equipment  which  could  be  transported  very  easily  no 
matter  into  what  remote  districts  they  traveled,  or  by  what 
methods  they  were  carried.  Thus  was  simplified  in  a  great 
measure  the  problem  of  carrying  the  message  of  Home  Hygiene 
to  isolated  regions  where  it  was  impossible  to  set  up  teaching 
centers.  The  instructors  in  the  insular  possessions  of  the  United 
States  and  in  the  foreign  field  were  objects  of  special  interest 
at  Headquarters  and  their  work  was  aided  in  every  way  by  Miss 
^oyes  and  Miss  Douglas.  A  complete  miniature  equipment 
for  demonstrations  in  class  was  made  up  and  sent  to  Alaska 
for  the  use  of  the  instructor  who  conducted  classes  there. 

Miss  Douglas  wrote  (1921)  : 

I  cannot  praise  too  highly  the  splendid  work  many  of  our 
nurse  instructors  have  done.  They  have  been  missionaries  in 
the  true  sense  of  the  word,  overcoming  many  seemingly  in- 
surmountable obstacles  and  never  sparing  themselves  in  order 
to  give  various  groups  this  necessary  instruction. 

Classes  have  been  held  in  all  types  of  schools:  grade,  high, 
parochial  and  private  schools ;  vocational,  Americanization  and 
Continuation  schools;  universities,  colleges  and  normal  schools. 
They  have  been  held  in  industrial  plants,  church  and  commercial 
organizations ;  for  groups  of  Camp  Fire  Girls  and  Girl  Scouts 
and  for  groups  in  Red  Cross  Teaching  Centers.  The  work  has 
been  carried  on  in  Alaska,  the  Dominican  Republic,  Hawaii,  the 
Canal  Zone,  Porto  Rico,  Siberia,  Poland,  Czecho-Slovakia, 
China  and  the  Philippine  Islands.  The  classes  have  included 
missionaries,  Indians,  foreigners,  deaf  mutes  and  the  blind ; 
classes  have  been  conducted  for  the  Chinese  women  of  China- 
town, N.  Y.  C,  for  the  girls  in  the  Crittenden  Homes  and 
other  correctional  institutions,  for  women  and  girls  in  practi- 
cally all  occupations,  and  as  well  those  of  the  leisure  class. 

The  instruction  has  been  related  more  and  more  closely  with 
the  daily  life  and  acts  of  service  of  those  who  have  completed 
it.  The  desire  to  put  the  knowledge  gained  in  these  courses  to 
practical  use  in  the  community  has  been  evident.  In  several 
places  where  this  work  has  been  going  on  "Health  Clubs"  have 
been  organized  which  participate  in  community  projects,  espe- 
cially those  which  aid  in  public  health. 


CLASS  INSTRUCTION  FOR  WOMEN         1373 

The  public  health  nurses  recognize  the  value  of  this  in- 
struction as  an  introduction  to  their  work  in  rural  communities 
and  as  a  means  of  developing  civic  pride.  In  one  community 
a  new  school  house  and  in  another  a  hospital  was  established. 

The  vocational  value  of  this  course  has  been  incalculable. 
Many  a  young  girl,  hesitating  as  to  the  choice  of  a  vocation, 
has  caught  a  glimpse,  through  the  course  in  Home  Hygiene 
and  Care  of  the  Sick,  not  only  of  the  opportunities  for  service 
and  success  that  lie  in  the  nursing  field  but  of  the  realization 
of  any  innate  capacity  she  might  possess  for  this  career.  Schools 
of  nursing  have  already  seen  the  truth  of  this  statement  and 
many  of  their  applicants  have  been  recruited  as  the  direct  result 
of  the  interest  aroused  by  this  instruction. 

From  every  Red  Cross  Division  instances  have  been  reported 
where  young  women,  having  developed  an  interest  in  nursing 
from  these  classes,  were  encouraged  to  enter  a  school  of  nursing. 
'From  one  Division  alone  it  was  reported  that  125  young  women 
had  entered  schools  of  nursing  in  one  year.  Many  were  from 
isolated  homes  in  remote  country  or  mountain  regions  where 
their  opportunities  were  few  and  their  future  most  limited, 
and  who  from  their  Home  Hygiene  classwork  were  led  into 
wider  lives  of  action  and  interest. 

A  certain  Division  Director  of  Home  Hygiene  was  inter- 
viewing a  candidate  instructor: 

"Are  you  familiar  with  our  course?"  she  asked. 

"Yes,"  was  the  reply.  "Probablv  my  desire  to  become  a 
nurse  would  never  have  been  stimulated  but  for  this  Red 
Cross  covirse." 

"This  is  most  interesting!"  exclaimed  the  Division  di- 
rector, ''and  goes  to  show  the  importance  of  presenting  the 
instruction  to  young  girls  as  well  as  to  older  women." 

"All  through  my  training,"  went  on  the  candidate,  "niy 
ardent  desire  was  to  instruct  classes  in  Home  Hygiene  under 
the  Eed  Cross." 

Xecdless  to  say  she  received  the  appointment  as  an  instructor. 

All  over  the  country  during  the  intluenza  epidemics  of  1918 
and  1910  the  groups  who  had  completed  this  course  and  many 
who  had  taken  the  course  in  pr(^])aration  for  the  national  emer- 
gency, gave  volnntarily  of  their  strength,  time  and  service.  Un- 
der the  sup('rvisi(ni  of  nurses  and  physicians  they  took  care  of 
children,  the  aged  and  the  chronically  diseased,  thereby  releas- 


1374.  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ing  the  graduate  nurses  for  the  care  of  the  influenza  patients. 
The  majority  of  these  women  could  not  have  rendered  this 
service  had  it  not  been  for  the  Red  Cross  instruction  in  Home 
Hygiene  and  Care  of  the  Sick. 

Motion  pictures  have  been  utilized  for  class  instruction. 
"Every  Woman's  Problem,"  produced  in  1920,  was  of  such 
simple  universal  appeal  and  genuine  educational  value  that  it 
met  with  a  never-failing  popular  welcome.  It  told  the  story 
of  Mrs.  Helpless  and  how  she  learned,  through  her  course  in 
Home  Hygiene  and  Care  of  the  Sick,  efficient  methods  of  caring 
for  invalid  Aunt  Mary. 

For  the  schools  and  rural  sections  where  the  motion  picture 
could  not  be  used  lantern  slides  were  prepared.  The  slides  with 
captions,  depicted  the  practical  work  of  the  course. 

The  wide  extent  and  popularity  of  the  classes  in  foreign 
fields  as  well  as  at  home  created  a  demand  for  the  translation  of 
the  text-book  on  Home  Hygiene  and  Care  of  the  Sick  in  whole 
or  in  part  into  Czecho-Slovakian,  Korean,  Russian,  Polish  and 
Spanish.  Perhaps  no  other  book  of  its  kind  has  been  so  widely 
translated. 

Among  the  interesting  exhibits  placed  in  the  museum  at 
National  Headquarters  was  a  miniature  reproduction  designed 
to  show  how  a  class  may  be  successfully  conducted  in  an  ordinary 
bedroom  in  an  average  home,  using  home  equipment.  The  room 
contained  two  windows  and  a  fireplace,  providing  almost  perfect 
ventilation.  The  painted  fioor  was  bare  except  for  a  few  rag 
rugs.  Extra  chairs  were  added  for  the  accommodation  of  the 
class  members,  but  otherwise  the  bedroom  furnishings  consisted 
only  of  two  single  beds,  a  dresser,  washstand,  a  bedside  table 
and  a  comfortable  chair.  A  blackboard  stood  at  one  side  of  the 
room,  and  models  and  charts  were  suitably  arranged.  A  hot 
water  bag  w^as  in  evidence.  In  one  of  the  beds  a  member  of 
the  class  acted  as  a  patient  and  reclined  against  pillows  sup- 
ported by  a  suitcase  which  was  utilized  as  a  head  rest.  The 
instructor  in  full  Red  Cross  uniform  instructed  the  members 
of  the  class,  one  of  whom  made  the  empty  bed,  another  carried 
a  tray  to  the  patient,  while  the  ''model"  infant  was  seen  in  the 
foregi'ound  safely  confined  within  his  "kiddie  coop"  improvised 
from  an  inverted  table. 


CHAPTER  XVII 

THE  DIETITIAN   SERVICE 

THE  history  of  Red  Cross  work  in  "Home  Dietetics,"  the 
"Bureau  of  Dietitians'  Service"  or  the  "Nutrition 
Service"  as  it  has  been  variously  called,  falls  easily 
into  three  periods. 

The  first  of  these  covers  the  time  from  the  inception  by  the 
Red  Cross  Nursing  Service  of  work  in  dietetics  to  the  time 
when  the  nation  began  to  make  definite  moves  towards  casting 
in  its  lot  with  the  Allies  in  the  World  War. 

The  second  period  extends,  practically,  from  the  time  of  the 
planning  and  organization  of  the  first  base  hospital  units  to 
the  sigiiing  of  the  armistice. 

The  third  period  is  the  period  of  transition  from  the  acute 
situations  of  war  to  the  more  normal  problems  of  peace,  and 
closes,  in  so  far  as  this  history  is  concerned,  with  the  date  on 
which  the  bureau  was  made  into  an  independent  Red  Cross 
service. 

Th(>  Ivcd  Cross  Nutrition  Service,  as  it  has  come  to  be  called, 
had  its  beginning  in  a  course  of  instruction  in  "dietetics  and 
household  econi my"  which  was  ofi'erod  by  the  National  Com- 
mittee on  Red  Cross  Nursing  Service  along  with  courses  in 
"First  Aid"  and  "Hygiene  and  Home  Nursing."  The  follow- 
ing statement  of  the  purposes  of  these  courses  and  the  plans  for 
them  appeared  in  the  annual  report  for  the  year  l!tl2  : 

It  lias  been  demonstratod  that  the  instruction  of  men  in 
first  aid  will  reduce  deaths  and  serious  results  from  injuries 
about  one-half.  Similar  instruction,  including  liygieno  and 
home  nursing,  is  no  less  im])ortant  tor  women,  hut  has  never 
be(Mi  un(k'rtak('n  on  a  national  scale. 

The  American  Hed  Crcjss  has  decided  to  orj^anize  such 
cdasst's  aiul  has  ])hu-e(l  them  umU'r  the  u'cneral  direction  of 
the  National  Conunittee  on  lu'd  Cross  Nursing  Service.  We 
hope  foi-  the  codijcration  of  state  and  hu-al  committees  and  all 
enroded   I'cd  Cross  nurses. 

The  i-ourse  of  instnution  will  include  1»^  lessons  on  first 
i:i75 


1376  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

aid,  15  lessons  in  hygiene  and  home  nursing  and  15  lessons  in 
dietetics  and  household  economy.  .  .  . 

The  first  aid  courses  must  be  given  by  a  physician,  and 
other  instructions  by  a  lied  Cross  nurse  unless  otherwise 
authorized  by  the  committee  in  charge. 

Miss  Marion  L.  Oliver,  of  Washington,  was  placed  in  charge 
of  the  organization  of  these  classes.  The  reports  for  1013  and 
1914  showed  that  no  regular  work  in  home  dietetics  was  under- 
taken during  these  two  years : 

lOlS — The  instruction  includes  first  aid,  elementary  hy- 
giene and  home  care  of  the  sick,  with  possibly  later  courses  in 
dietetics  and  household  economy. 

191Jf — Soon  after  the  adoption  of  the  general  plan  for  the 
instruction  of  women,  Miss  Marion  Oliver  who  was  placed  in 
charge  of  the  organization  of  these  classes,  was  obliged  to 
leave  Washington  and  give  up  temporarily  the  work  in  which 
she  was  so  much  interested.  The  unusual  demands  made 
upon  the  chairman  of  the  National  Committee  during  the 
past  year  have  made  it  difficult  to  d(j  much  constructive  work 
in  connection  with  these  classes  for  women,  but  we  have  been 
gratified  at  the  evidences  of  interest  and  often  surprised  at 
requests  for  information  from  unexpected  sources. 

A  little  instruction  in  'Vlietetics"  was  sometimes  included  in 
the  courses  in  home  care  of  the  sick  given  hv  nurses  to  classes 
organized  during  the  year  1!)15  and  in  the  earlier  months  of 
the  year  following.  In  a  letter  written  to  ]Miss  C.  E.  ^lason 
of  The  Castle  School,  I'arrvtown-on-thc-IIudson,  under  date  of 
May  4,  lOlG,  ^liss  ]:Joardrnan  stated  tliat  ''200  women  in  the 
Xavai  Service  School  arc  taking  courses  in  First  Aid,  Home 
Care  of  the;  Sick  and  iJietclics  and  Surgical  Dressings.  Tlies<,' 
courses,"  wrote  ^liss  Boardnum,  "are  all  given  under  trained 
nurses." 

While  such  limited  instruction  in  diet  may  have  been  all  that 
was  thought  necessary  under  the  original  plan,  Miss  Delano 
was  (|uick  to  recognize  that  the  country  was  approaching  a  crisis 
in  which  the  best  possible  work  in  each  line  of  service  would 
be  needed.  In  a  letter  to  Pratt  Institute  dated  July  2,  11»15, 
she  stated  that  "one  of  the  instnietors  in  dietetics  in  the  public! 
scIkjoIs   of   Washington,    Miss    Kiitli    'rill'any,    was  good   enougli 


THE  DIETITIAN  SERVICE  1377 

last  year  to  ^ive  a  course  of  lessons  in  Dietetics  which  was 
organized  under  the  auspices  of  the  American  lied  Cross." 

This  was  the  beginning. of  a  correspondence  with  a  number  of 
home  economics  people  in  regard  to  the  preparation  of  a  text- 
book on  the  subject  of  ''Food  Vahies  and  Home  Dietetics"  for 
use  in  similar  classes.  As  a  result,  such  a  book  was  prepared 
by  Miss  Ada  Z.  Fish,  head  of  the  department  of  art  and  home 
economics  of  the  William  Penn  High  School  for  Girls,  Phila- 
delphia. 

The  aim  and  scope  of  this  first  text-book  was  given  in  the 
author's  introduction : 

This  book  is  designed  for  general  use  in  classes  to  be  taught 
under  the  supervision  of  the  American  Ked  Cross  Nursing 
Service.  Tiie  aim  of  the  course  is  to  give  in  a  simple  way  the 
underlying  principles  of  cookery.  These  are  presented  in  fif- 
teen lessons.  There  are  also  directions  for  fourteen  lessons  in 
practical  cookery." 

The  book  was  not  ready  for  circulation  until  in  February,  1917  ; 
meanwhile  little  classwork  was  attempted.  The  Annual  Report 
for  1910  said: 

During  tlie  year  four  experimental  classes  in  dietetics  were 
held,  with  a  total  enrollment  of  43  pupils,  and  36  certificates 
in  this  course  were  issued. 

These  classes  were  organized  under  the  direction  of  ^liss  Noyes 
and  were  taught  by  dietitians. 

The  new  aspects  of  the  work  were  voiced  in  the  same  report : 

A  great  interest  in  tliis  course  in  home  dietetics  has  been 
evinced  and  the  necessity  for  qualified  instructors  as  well  as 
for  dietitians  for  base  hospitals  has  resulted  in  the  organiza- 
tion of  a  national  conmiittee  on  dietitians,  of  which  Miss 
Enmui  A.  (iunther  of  Teachers'  College,  is  the  chairman.  It 
is  hoped  ultinuitely  to  organize  local  connnittees  to  assist 
with  the  work  of  enrolling  dietitians  for  this  purpose. 

At  a  meeting  of  the  National  (^ommittee  on  Red  Cross  Xurs- 
ing  Servic(>  ludd  in  Washington,  December  1:2,  10 Ki,  ^liss  Gun- 
ther's  appointment  was  aj)pr(n-ed.  The  other  nunnbers  of  the 
committee  as  chosen  by  Miss  Guntlier,  Anne  W.  Goodrich, 
F-lva  A,  George  and  Isalxd  Kly  Lord,  were  also  approved.     At 


1378  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

an  adjourned  meeting  on  the  same  date  the  chairman  of  the 
Committee  on  Dietitians  was  made  an  ex-officio  member  of  the 
National  Committee  on  Red  Cross  Nursing  Service. 

At  this  meeting  Miss  Guuther  outlined  very  briefly  the  work 
that  had  been  done  and  such  plans  for  organization  as  had  been 
formulated.  She  spoke  of  the  opportunities  for  dietitians  in 
connection  with  the  Red  Cross,  not  only  as  instructors  in  the 
course  in  Home  Dietetics,  but  as  dietitians  for  base  hospitals 
and  for  such  other  opportunities  as  might  eventually  present 
themselves. 

Even  while  this  committee  was  being  approved  in  the  routine 
of  business  of  the  December  meeting,  Miss  Delano  was  antici- 
pating the  need  for  a  larger  and  more  representative  committee 
in  order  to  compensate  for  the  lack  of  State  and  Local  Com- 
mittees on  Dietitians'  Service.  In  a  letter  to  Miss  Fish  under 
date  of  August  30,  1916,  she  wrote: 

We  are  planning  to  increase  the  Committee  on  Dietitians 
securing  a  representative  woman  in  each  of  the  large  cities 
who  will  help  us  in  securing  instructors  for  the  classes.  Miss 
Gunther  of  Teachers  College  is  chairman  of  this  committee 
and  you  will  no  doubt  hear  from  her  soon  in  regard  to  mem- 
bership on  her  committee,  and  I  do  hope  that  you  will  feel 
that  you  can  accept  the  position.  I  am  quite  sure  that  we 
shall  have  difficulty  in  securing  suitable  instructors  and  shall 
rely  upon  your  interest  and  cooperation. 

The  committee,  as  enlarged  during  the  early  months  of  1917, 
was  composed  of  the  following  members: 

COMMITTEE  ON   RED  CROSS  DIETITIAN  SERVICE 

P]x-officio  Member 

Miss  Jane  A.  Delano,  Chairman,  National  Committee  on  Eed 
Cross  Nursing  Service. 

Miss  Edna  White,  Cliairman,  Ohio  State  University,  Colum- 
bus. Oliio. 

Miss  Emma  Gunther,  Teachers  College,  Columbia  University, 
New  York  City. 

Miss  Isabel  Ely  Lord,  Pratt  Institute,  Brooklyn,  N.  Y. 

Dr.  Euth  Wheeler,  Goucher  College,  Baltimore,  ]\[d. 

Miss  Lenna  Cooper,  Battle  Creek  Sanitarium,  Battle  Creek, 
Mich. 

Miss  Catherine  J.  MacKay,  Iowa  State  College,  Ames,  Iowa., 


THE  DIETITIAN  SERVICE  1379 

Dr.  Agnes  F.  AEorgan,  University  of  California,  Berkeley,  Cal. 
Miss  (rraee   K.  McCullough,  Peter  Bent  Brigham  Hospital, 

Boston,  Mass. 
Miss  Ada  Z.  Fish,  William  Penn  High  School,  Philadelphia, 

Pa. 
Miss  Ettie  Paitt,  University  of  Washington,  Seattle,  Wash. 
Miss  Annie  W.  Coodrieh,  Army  School  of  Nursing,  Surgeon 

OeneraFs  Office,  Washington,  D.  C. 
Miss  Elva  A.  George,  Ked  Cross  Headquarters,  Washington, 

D.  C. 
Miss  Emma  Smedley,  Philadelphia,  Pa. 
Miss  Helen  M.  Pope,  Carnegie  Institute,  Pittshurg,  Pa. 
Miss  Lulu  Craves,  care  ^fodern  Hospital,  Chicago,  111. 
Miss  Flora  Rose,  Cornell  T'ni versify,  Ithaca,  New  York. 
Miss  Violet    Hyley,   Invalid   Soldiers   Commission,   Toronto, 

Canada. 
Miss  Alice  Loomis,  University  of  Xehraska,  Lincoln,  Xebr. 
Miss  Clara  Colburn,  University  of  Chicago,  Chicago,  HI. 

Later,  at  the  suggestion  of  the  chairman,  ^liss  White,  Miss 
Emma  Conley,  who  was  in  Washington  temporarily,  acted  as 
chairman  of  the  committee  during  her  stay  in  order  to  facili- 
tate the  work. 

In  May,  1917,  Miss  George,  a  member  of  the  committee,  a 
graduate  of  Pratt  Institute,  Brooklyn,  and  long  associated  with 
]\rt.  Sinai  Hospital,  New  York  City,  was  brought  to  Red  Cross 
Headquarters  to  take  charge  of  the  enrollment  of  dietitians 
and  the  organization  of  classes  in  Home  Dietetics. 

In  the  face  of  the  prospect  of  w^ar  which  overshadowed  the 
country,  no  better  statement  of  the  organization  aims  and 
obligations  of  the  new  Dietitian  Service  of  the  Red  Cross  could 
have  been  formulated  than  that  contained  in  ^liss  iSToyes'  circu- 
lar letter  to  dietitians,  issued  in  January,  1917: 

The  development  of  the  educational  work  and  the  organi- 
zation of  base  lu)S])ital  units  under  the  aus])ices  of  the 
American  Ped  Cross  has  created  a  demand  for  qualified  and 
experienced  dietitians. 

The  opportunities  for  dietitians  in  this  service  may  be 
grouped  for  the  ])resent  under  two  main  divisions. 

A.  Instructors  in  Home  Dietetics. 

B.  Dietitians  for  base  hospitals. 

Tin'  course  in  Home  Dietetics  given  under  the  auspices  of 
the  American  Ked  Cross  sbouhl  he  iiivcn  hv  a  dietitian  who 


1380  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

meets  the  requirements  as  established  by  the  Central  Com- 
mittee on  Dietitians  of  the  American  Red  Cross.  This  com- 
mittee passes  iipon  the  credentials  of  applicants  and  recom- 
mends to  the  Bureau  of  Nursing  Service  such  dietitians  as 
appear  to  meet  all  the  requirements  for  instructors. 

Classes  in  Home  Dietetics  are  now  being  organized  in  all 
parts  of  the  United  States,  and  it  is  the  desire  of  the  Red 
Cross  to  keep  on  file  at  the  National  Headquarters  as  com- 
plete a  list  as  possible  of  qualified  dietitians  who  are  ready  to 
serve  as  instructors.  A  textbook  has  been  prepared  by  Miss 
A.  Z.  Fish,  William  Penn  High  School,  Philadelphia,  and 
may  be  secured  from  the  Eed  Cross  at  a  cost  of  one  dollar 
($1.00). 

The  course  in  Home  Dietetics  consists  of  fifteen  lessons  of 
three  hours  each.  Full  particulars  explaining  the  manage- 
ment of  the  classes  will  be  forwarded  upon  request. 

Dietitians  are  also  needed  to  take  care  of  the  special  diets 
in  connection  with  the  base  hospitals  now  being  organized 
by  the  Red  Cross.  Base  hospitals  are  organized  around  civil 
institutions  in  time  of  peace  in  order  that  we  may  be  prepared 
in  event  of  war  to  send  out  groups  of  nurses,  doctors  and 
other  personnel  who  are  accustomed  to  working  together. 
The  dietitians  are  enrolled  with  the  nursing  staif  and  at  the 
same  salary,  $50  per  month. 

It  is  also  desired  to  keep  lists  of  dietitians  who  will  be 
available  for  dietetic  work  in  convalescent  hospitals,  refresh- 
ment rooms,  etc.  If  it  is  your  desire  to  enroll  for  any  one  of 
these  services,  kindly  fill  out  the  inclosed  application  blanks 
and  return  to  the  Bureau  of  Nursing  Service,  Washington, 
D.  C. 

The  year  1917  showed  a  rapid  development  of  this  service. 
Professional  home  economics  workers,  although  already  busy 
with  tests,  experiments  and  the  preparation  of  literature  for 
the  solving  of  some  of  the  problems  which  the  country  would  be 
called  upon  to  face  in  the  conservation  of  food  and  other  ma- 
terials and  in  the  safeguarding  of  health,  were  stirred  by  this 
added  opportunity  for  service  under  the  standard  of  the  Ked 
Cross.  The  first  dietitian  was  enrolled  February  3,  1917; 
by  the  end  of  the  year  six  hundred  and  forty-five  dietitians  had 
been  enrolled  as  instructors  and  an  additional  two  hundred  and 
eleven  for  Tied  Cross  service  in  military  hospitals.  The  first 
classes  in  Home  Dietetics  were  organized  in  F\'bruarv  and  by 
the  end  of  ()cti)ber,  1917,  '509  classes  liad  completed  the  course 
of  instruction,  and  2891  certificates  had  been  issued.     At  the 


THE  DIETITIAN  SERVICE  1381 

time  of  making  the  annual  report  classes  in  Home  Dietetics 
were  being  hold  in  one  hundred  and  forty-nine  teaching  centers. 
How  successful  this  bureau  was  in  enrolling  and  assigning 
dietitians  for  war  service  was  summarized  in  Miss  Delano's 
statement  before  the  Twentj-first  Annual  Convention  of  the 
American  Xurses'  Association  in  1918  in  which  she  stated  that 
85  livd  Cross  dietitians  were  then  in  service  in  cantonment  and 
naval  hospitals  while  48  others  had  been  assigned  to  base  hos- 
pital units  and  3  to  French  military  hospitals  under  Red  Cross 
supervision,  making  a  total  of  183. 

"We  were  fortunate,"  concluded  ^fiss  Delano,  "in  developing 
this  service  just  before  the  needs  of  war  came  upon  us,  and  so 
we  have  been  able  to  meet  the  demands  of  the  Army,  the  Navy, 
and  special  divisions  of  our  own  work." 

Although  the  record  of  the  total  enrollment  of  dietitians  by 
the  Red  Cross  during  the  year  1917  was  gratifying,  on  April  6 
but  twenty  had  been  listed  as  qualified  for  service  with  base 
hospital  units.  By  the  end  of  June  the  enrollment  had  reached 
sixty-nine.  Of  these,  nine  had  been  assigned  to  units  which 
sailed  for  France  during  May  and  June.  Later  in  the  year 
Miss  Delano  reported  that  seventeen  were  on  active  duty  with 
base  hospitals  in  France  and  that  eighteen  had  been  assigned 
to  cantonment  hospitals  in  this  country. 

As  is  stated  in  another  chapter  the  first  six  base  hospital  units 
to  be  sent  to  France  from  this  country,  ^lay  and  June,  1917, 
were  loaned  to  the  British  Government  and  assigned  to  work 
with  the  British  Expeditionary  Forces.  These  were  followed 
almost  immediately  by  assignments  to  the  American  Expedi- 
tionary Forces,  to  camps  and  cantonments  in  this  country,  and 
to  the  Xavy. 

The  distinction  of  being  the  first  dietitian  to  enter  active 
service  overseas  may  be  claimed  by  Florence  Bettman  ^  of  Base 
Hospital  Unit  Xo.  10,  Pennsylvania  Hospital,  Philadelphia, 
or  by  Anne  T.  Uphani,^  Base  Hospital  Unit  Xo.  4,  Lakeside 

'  Floipiico  T?('ttnian  was  horn  in  Jersey  City,  N.  J.,  attended  school  at 
Plainfield  Seminary,  and  received  lier  technical  training  in  Boston  and  as 
pupil  dietitian  in  Jefferson  Hospital,  riiiladelphia.  Later  she  lieid  posi- 
tions as  (lietitiun  in  tlie  N'acation  House  of  the  Pennsylvania  Hospital  for 
the   Insane,  and    in   tl:e    i'reshyterian   Hospital.   Pliiladel])hia. 

*Anne  T.  I'phain  was  horn  at  Keene,  New  llain])siiire.  She  attended 
scliool  at  \\  heaton  Seminary  and  completed  the  full  course  in  homo 
econdinics  at  Simmons  C'(dle<:e.  Pxiston.  After  teacliin<r  in  Proctor. 
\'ermont.  for  one  year,  slie  herame  assistant  dietitian  in  Lakeside  Hos- 
pital, Cleveland, 


1382  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Hospital,  Cleveland,  for  the  reason  that  May  8  was  the  date 
on  which  both  of  these  units  sailed. 

A  report  made  by  Miss  Upham  stated : 

I  was  attached  to  Base  Hospital  No.  4,  which  was  located 
at  General  Hospital  No.  9,  British  Expeditionary  Forces,  at 
Konen,  France.  As  dietitian,  I  lived  with  the  nurses.  I  was 
under  the  chief  nurse,  and  was  governed  by  the  same  rules 
and  regulations  as  the  Army  nurses.  My  duties  from  May  25, 
1917,  to  September  1-1,  1917,  consisted  of  the  management  of 
the  nurses'  mess  and  the  housekeeping  duties  of  the  nurses' 
quarters.  From  September  11,  1917,  until  June  10,  1918, 
my  duties  were  to  plan,  prepare  and  serve  food  for  special 
patients.  I  had  no  office  and  no  special  diet  kitcheii.  All  the 
work  was  done  in  the  big  hospital  kitchen  with  British  Army 
rations.  1  also  planned  and  prepared  the  meals  for  the  few 
sick  officer  patients  who  were  in  the  hospital.  During  this 
time,  the  special  diets  had  increased  from  two  on  the  first  day 
to  10  per  cent  of  the  total  number  of  patients  in  the  hospital 
by  June  10,  1918.  On  this  date,  I  was. given  the  complete 
charge  of  the  planning,  preparing  and  serving  of  the  food  to 
all  patients,  as  well  as  planning  and  supervising  the  special 
diets  and  the  officer  patients'  diets.  From  July  1,  1918,  I 
also  had  charge  of  the  cooks  and  kitchen  police,  as  there  was 
no  mess  sergeant  in  the  patients'  kitchen.  I  continued  with 
these  duties  until  January  2oth,  1919,  when  the  hospital  was 
closed.  By  this  time,  1  had  obtained  the  coo])eration  of  the 
nurses,  officers,  and  especially  of  the  enlisted  men  who  worked 
for  me.  I  was  in  a  British  hospital  where  there  had  never 
been  a  dietitian,  consequently  1  had  to  prove  to  the  British 
officials  that  we  could  be  of  service.  I  was  not  hampered,  as 
numy  dietitians  were,  by  a  mess  officer  who  knew  nothing 
ahout  feeding  a  large  number  of  people,  and  yet  thought  he 
knew  it  all.  To  me,  it  was  very  interesting  to  see  how  much 
could  l)c  done  Avitli  very  little  equipnuMit  and  limited 
rations.  .  .  . 

At  first  the  general  opinion  seemed  to  be  that  dietitians 
knew  only  how  to  serve  ice  cream  and  dainty  foods,  which 
were  in)])ossihle  in  France.  Therefore,  the  conclusion  was 
draAvn  that  they  were  useless  members  of  a  war-time  organi- 
zation. 

For  any  one  with  a  sense  of  humor,  there  were  many  funny 
hai)penings.  On  one  occasion  when  tlu^  l)ritish  connnanding 
officer  read  the  roster  of  our  unit,  and  saw  the  word 
"dictil  iaii'"  after  my  I'MUie.  he  said,  "A\diat  kind  of  a  creature 
is  tliat?"     As  it  happeJied,  he  did  not  renuiin  long  enough  to 


THE  DIETITIAN  SERVICE  1383 

find  out  that  "that  creature"  was  of  some  use.  One  day  a 
British  otiicial  was  inspecting  tlie  kitchen,  and  I  was  intro- 
duced to  him  hy  the  British  quartermaster  as  "our  lady 
cook.''  At  first  1  seemed  to  be  considered  as  merely  a  cook 
by  the  English,  and  oftentimes,  much  to  my  disgust,  by  the 
Americans,  who  it  seemed  to  me  should  have  known  better. 

The  Potor  Bent  Brigham  Hospital  Unit  sailed  May  11.  The 
dietitian  with  this  unit  was  Marjorie  Hulsizer,^  of  Winchester, 
]\lass.,  Hospital. 

The  duties  which  fell  to  ]\[iss  Hulsizer,  while  she  remained 
with  the  British  Expeditionary  Forces,  served  as  a  good  illustra- 
tion of  the  lack  of  standardization  of  the  work  of  dietitians  of 
which  ]\Iiss  Upham  wrote.  How(!ver,  this  condition  was  not 
peculiar  to  the  British  military  organization. 

In  a  letter  to  Tied  Cross  Ileadcpuirters  the  chief  nurse  of  the 
unit  spoke  of  Miss  Hulsizer's  assignment: 

Of  course  her  work  is  nothing  like  she  had  expected  or 
hoped,  and  I  do  not  know  whether  she  will  slump  profession- 
ally or  not.  J  hope  not.  But  the  diet  system  of  the  hospitals 
of  the  British  Expeditionary  Forces  is  so  firmly  established 
tliat  it  would  require  an  Act  of  Parliament  to  sanction  the 
intro(hiction  of  a  trained  dietitian,  neither  would  they  know 
what  it  means.  So  she  is  the  "home  sister."  She  looks  after 
our  quarters,  runs  the  mess,  docs  the  marketing,  engineers  the 
laundry  women  and  is  admired  by  everyone  .  .  .  down  to  the 
cook  in  the  kitchen. 

]\Iiss  Hulsizer  herself  wrote  a  breezy  account  of  her  duties 
at  this  time: 

We  draw  rations  every  morning  of  bacon,  rice,  onions, 
])()tat()('s.  tinned  meat.  milk,  cocoa,  jam,  oleomargarine,  ])ork 
and  beans,  sugar,  salt,  tea,  clieese,  bread,  mustard,  j^epper, 
pickles,  and  coal  and  ice  wlu'ii  they  have  it.  1  feed  about 
one  Inindred  and  twenty  people.  We  draw  rations  for  eighty 
and  since  we  are  allowed  three  shillings  for  cacli  ])erson,  we 
take  the  remaiii(l(>r  for  the  one  hundred  and  twenty  in  money 
which  gives  me  what  is  called  mess  nionev.  With  it  1  buy 
fresh  vegetables,  fruit  and  other  things  not  jirocurable  in  the 

Mrarjorie  Hulsizer  was  l)orii  in  Ficiniii^^dn,  New  Jersey,  attended  (^lierlin 
C()ilc;,'e  and  later  jfraduated  fnmi  SiinuKins  C'ellc.^e.  Slic  was  a  pupil 
dii'titiau  in  the  Peter  lieiit  liri^iiani  llespital  Ijcfore  takini,''  up  her  wurk 
at  Wincliester. 


1384  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

rations  or  from  the  canteens  near  camp.  The  old  market 
women  shake  hands  with  me,  tell  me  that  hefore  the  war  is 
over  I  shall  speak  excellent  French,  and  they  complete  the 
occasion  by  handing  me  a  bunch  of  flowers,  a  "souvenir." 
Some  days  we  get  enough  flowers  to  make  'the  mess  hall  a 
regular  bower.  For  marketing  I  am  allowed  a  Red  Cross 
ambulance.  One  of  my  P.  B.  men  goes  with  me  to  carry  the 
baskets  and  the  officers'  mess  cook  goes  in  at  the  same  time  to 
do  his  buying. 

These  ambulances  are  driven  by  girls  from  England.  I  get 
a  different  one  detailed  to  me  each  time  and  I  so  enjoy  talking 
to  them.  Their  regular  work  consists  in  carrying  the 
wounded  from  the  trains  to  the  hospitals. 

The  other  part  of  my  work  is  to  keep  the  Sisters'  quarters, 
seven  huts,  nine  tents  and  seven  alwyns,  or  portables,  and  the 
bathhouses  clean.  For  that  I  had  three  P.  B.  men,  but  they 
have  recently  gone  and  all  I  have  now  is  one  patient  detailed 
to  my  \\ork  full  time  and  two  patients  two  hours  a  day  who 
can  do  no  scrubbing  or  hard  work,  but  we  rub  along  somehow. 

That  things  did  turn  out  well  at  last  for  this  particular  dieti- 
tian, was  chronicled  in  a  letter  which  !Miss  Hulsizer  wrote  to 
the  Director  of  Red  Cross  Xutrition  Service  at  Washington 
after  her  return  from  France : 

After  I  left  the 'B.  E.  F.  in  December,  1918,  }  went  to  an 
American  Hospital.  Base  57.  in  Paris,  for  as  soon  as  I  learned 
that  my  unit,  the  Peter  Bent  Brigham.  was  to 'be  sent  home,  I 
asked  Miss  Hall,  chief  nurse  of  the  Red  Cross  in  Paris,  to 
find  out  if  I  could  be  transferred  to  the  A.  E.  F.  I  felt  that  I 
couldn't  go  home  without  having  the  experience  of  feeding 
the  patients  themselves.  She  immediately  arranged  it  for  me 
with  Miss  Stimson. 

The  hospital  in  Paris,  Xo.  5T,  had  been  a  large  one.  There 
were  nearly  a  thousand  patients  when  1  arrived.  In  my  diet 
kitchen  we  prepared  food  for  four  hundred  and  on  down  to 
fifty,  and  for  one  on  the  day  1  left.  The  work  was  interesting 
and  I  enjoyed  working  with  the  American  soldiers.  They  are 
the  most  considerate,  thouglitful,  intelligent  and  easily  taught 
boys  I  have  ever  seen.  With  the  B.  E.  F.  J  had  been  running 
things  absolutely  on  my  own.  A  certain  sum  of  money  was 
given  me  eacli  week  by  the  chief  nurse  and  1  did  the  buying 
and  kept  the  accounts.  At  Xo.  7u  I  fcnind  a  mess  officer  to 
whom  I  appeared  to  be  responsible.     Xutbing  was  explained 


THE  DIETITIAN  SERVICE  1385 

to  me.  I  was  left  to  "fall  into  things,"  and  I  fell.  The  mess 
orticer  was  a  most  dillicult  one  to  get  along  with,  but  he  was 
really  very  efficient  and  I  respected  his  ability  if  not  his 
personality.  Finally,  one  day,  1  had  a  little  talk  with  him 
"man  to  man"  and  after  that  we  got  along  splendidly.  He 
allowed  me  to  buy,  or  to  have  bought,  nearly  everything  that 
I  needed.  Occasionally  1  had  to  do  a  little  explaining,  but 
usually  my  orders  were  unquestioned. 

On  the  whole,  my  experience  in  France  was  free  from 
friction.  I  wanted  to  tell  you  this,  as  I  have  heard  so  many 
dietitians  say  that  they  have  had  most  uncomfortable  times. 
I  never  have  had  to  do  any  of  the  cooking  myself.  I  was 
always  given  plenty  of  cooks  and  K.  P.'s.  But  I  liked  to  have 
the  boys  feel  that  1  actually  could  do  things  myself,  so  I  often 
spent  a  good  deal  of  time  in  the  diet  kitchen  preparing  food. 

On  June  10  Base  Hospital  Unit  Xo.  2  from  the  Prcsbvtprian 
Hospital  of  ]^ew  York  C^itv  assumed  charge  of  British  ^lilitarv 
Hospital  No.  1  at  Le  Treport,  France.  ]\[ary  Radford  Harold, 
a  graduate  of  the  j\retropolitan  Hospital  School  of  Xursing,  of 
Xew  York  City,  and  special  student  at  Columbia  University, 
acted  as  a  dietitian  with  this  unit,  although  she  was  enrolled 
as  a  reserve  nurse.  Miss  Harold  did  not  sail  with  the  unit 
but  took  up  her  work  later  in  the  summer. 

The  fifth  unit  in  the  assignment  to  the  British,  Base  Hos- 
pital Xo.  I'l,  from  the  Xortli western  University  ]\Iedical  School 
and  Cook  County  Hospital,  sailed  May  19,  on  the  S.  S.  Mon- 
golia. On  account  of  the  tragic  accident  happening  a  few  days 
out,  which  is  described  in  another  chapter,  the  Mongolia  re- 
turned to  Xew  York,  but  on  ^May  22  again  sailed  for  France. 
With  this  unit  were  two  dietitians,  Mary  Lindsley,^  house 
director  and  business  manager  of  the  Illinois  Training  School 
for  Xursing,  and  Margaret  Knight,^  head  resident  of  Willard 
Hall,  Xorthwestern  l^niversity.      Although  ]Miss  Knight's  ap- 

*  ^fary  Lindsloy  was  l)orn  in  Green  Villafje,  Xew  Jersey.  She  attended 
soliool  at  Eastern  Seminary  and  later  ffrailuated  from  Pratt  Institute, 
I^rooklyn.  Slie  was  dietitian  for  tlie  Ilarrisl)iirp  (leneraf  Hospital  for  two 
years,  was  with  the  Woman's  Hospital  of  Xorthwestern  I'niversity  Medical 
School  for  two  years  and  a  half,  and  had  lieen  with  the  Illinois  Training 
School  for  Xursiiiir  for  four  }"cars  at  the  time  of  receivinjx -her  appointment 
t<)    military    service. 

"  Marj^aret  Kni^dit  was  horn  in  Ann  Arbor,  Miciiijjran.  She  graduated 
from  \'assar  College  and  later  received  the  degree  of  Master  of  Arts  from 
Ohio  State  rniversily,  specializing  in  l'"rench.  Her  trainiiig  in  Food  and 
Xutrition  was  received  in  the  Department  of  Home  P>conomics  of  the 
latter  institution. 


1386  PIISTORY  OF  AMERICAN  RED  CROSS  NURSING 

pointment  was  primarily  as  an  interpreter,  she  was  later  as- 
signed to  duty  on  the  hospital  staff. 

All  through  the  report  submitted  by  Miss  Lindsley  there 
radiated  an  optimism  seemingly  untouched  either  by  the  hard- 
ships which  were  beyond  any  one's  control,  or  by  entrenched 
British  custom,  (including  tea  for  breakfast,  which  was  beyond 
"Act  of  Parliament").  Her  description  of  the  bath  accommoda- 
tions gave  evidence  of  her  disposition  to  see  the  best  side  of 
things : 

The  bathhouses  were  in  reality  long  huts  with  a  fire  in  the 
middle  for  heating  the  water.  Xo  other  heat  was  available. 
Finding  one's  bath  day  posted  meant,  at  the  appointed  time, 
putting  on  a  trench  coat  and  rubber  boots  and  tramping 
through  rain  and  slush  to  find  icicles  on  the  edge  of  the  bath- 
tub. And  yet  I  know  of  no  one  who  took  cold,  or  who  was 
otherwise  made  ill,  by  the  tramps  through  the  wet,  or  from 
taking  a  bath  in  the  cold  place. 

Perhaps  the  most  trying  thing  in  the  whole  situation  was  the 
"long  arm"  method  which  she  was  called  upon  to  use  in  doing 
her  w^ork.  The  British  military  mess  system  was  well  organ- 
ized and  no  woman,  dietitian  or  otherwise,  was  allowed  access 
to  the  mess  kitchen.  In  spite  of  the  fact  that  Colonel  Collins, 
commanding  officer  of  the  unit,  made  an  earnest  plea  to  the 
Division  Director  of  Military  Service  that  Miss  Lindsley  be 
allowed  a  diet  kitchen,  the  thing  simply  could  not  be  done. 
Her  suggestions  and  orders  were  all  formulated  in  consultation 
on  the  outside  and  reached  the  kitchen  through  the  top  ser- 
geants. Nevertheless,  she  reported  as  among  the  things  which 
made  the  work  pleasant  and  interesting,  the  "working  with  the 
sergeants  to  secure  greater  variety  in  their  messes,  making 
substitutions  for  the  regular  army  ration  aiid  formulating  new 
recipes  for  using  the  limited  materials  to  be  had."  The  value 
of  such  a  service  as  this  following  the  not  infrequent  occasions 
when  the  German  submarines  had  "beaten  them  to"  the  food 
transports,  can  well  be  imagined. 

Auotlier  paragraph  of  ^liss  Lindsley's  report  showed  that 
war  has  its  playtime  as  well  as  its  more  serious  business : 

Perliap?  one  of  the  most  interesting  experiences  we  had  was 
our  Field  Day.  July  4,  1918.  As  the  British  had  entertained 
us  at  different  times  with  their  field  sports,  the  officers  and 


THE  DIETITIAN  SERVICE  1387 

men  of  our  unit  decided  it  was  up  to  us  to  entertain  them 
with  some  real  American  sports.  The  Fourth  of  July  was  the 
day  set,  aiul  invitations  were  sent  out  to  all  the»surroundin<^' 
camps.  Back  of  our  camp  was  a  plain  between  two  slopin<f 
hills  and  this  was  selected  as  our  natural  amphitheater.  The 
day  was  perfect  and  it  was  a  beautiful  sight  to  see  the  iiniform 
of  each  of  the  Allied  Forces  against  the  background  of  green 
hills  and  blue  sky.  The  "Silver  Queen,"  a  large  British 
dirigible,  which  ])atrolled  our  coast  on  the  lookout  for  sub- 
marines, came  in  and  tloated  over  the  amphitheater.  Farther 
out  in  the  Channel  were  "submarine  chasers"  ready  for  any 
action  that  might  be  demanded  of  them. 

While  the  sports  were  in  progress  a  fleet  of  German  obser- 
vati(in*])lanes  flew  over,  dropping  some  of  their  light  bombs, 
which  burst,  making  little  curly  clouds  in  the  air,  but  not  one 
of  the  three  thousaiul  spectators  left  his  place,  so  interested 
was  every  one  in  the  sports  and  so  sure  that  nothing  more  than 
an  observation  fleet  would  be  passing  so  early  in  the  after- 
noon. [One  would  be  glad  to  believe  that  the  Germans  pur- 
posely selected  their  lightest  bombs  as  a  concession  due  to  the 
occasion.     Ed.] 

The  tea  and  sandwiches  which  were  served  after  the  sports 
were  finished  represented  work  to  which  the  camp  kitchen 
crews  had  contributed  all  tlieir  spare  time. 

In  concluding  licr  report  Miss  Lindsley  stated: 

^\ii\  T  summarize  my  experience  by  saying  that  to  me  the 
diilicultics  of  the  situation  never  seemed  to  be  very  great,  but 
the  opportunities  of  it  wore  so  tremendous  that  there  was  not 
time  enough  in  the  day  to  encompass  them.  Imagination  was 
required  and  adaj)tability  was  required,  and  when  these  two 
were  put  together  the  ditliculties  were  never  insurmountable. 

]\Iiss  Kniglit's  account  of  her  experiences  in  the  same  hos- 
pital read  in  part  as  follows: 

We  reached  Camiers  June  11,  1917,  late  at  night.  What 
we  could  see  of  the  hospital  seemed  to  be  only  huge  tent 
wards  with  a  few  frame  and  metal  buildings  for  administra- 
tion otlices.  o])erating  rooms,  cook  houses,  etc.  Tliere  wcn> 
only  three  wr.rds  not  under  canvas  and  our  hospital  had  ISoi) 
beds,  later  eidarged  to  '22~)0.  'Hie  women's  quarters  were  one- 
story  huts  with  rooms  for  two:  the  l)atlihouse  in  a  separate 
metal  buihling.  and  llie  kiteluMi,  iness  and  sitting  room  in  a 
larg(>r  hut  soinewliat  more  eai'efully  built.  Tlie  niglit  of  our 
arrival  we  slept  on  boards  with  straw  mattresses,  hut  within  a 


1388  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

few  days  our  army  cots  had  arrived,  and  with  the  addition  of 
some  essentials,  such  as  a  basin  and  pitcher,  a  table,  an 
improvised  chiffonier  and  curtains,  a  room  became  fairly 
comfortable  for  the  warm  months  of  the  year.  But  in  the 
winter  the  cold  Avas  almost  unendurable;  four  pounds  of  coal 
per  person  per  day  is  a  pretty  small  ration  and  we  always 
saved  it  until  we  could  both  be  in  the  room,  when  our  little 
stove  did  its  best  for  us. 


When,  during  the  war,  Miss  Knight's  parents  received  a 
letter  from  her  in  which  she  gave  an  account  of  the  fuel  al- 
lowance, they  proceeded  to  weigh  out  four  pounds  of  coal  in 
order  to  visualize  more  clearly  just  what  the  possibilities  of 
such  an  amount  of  fuel  might  be,  and  as  Mrs.  Knight  reported, 
**We  looked  at  that  little  heap  of  coal  and  then  looked  at  each 
other." 

Miss  Knight's  report  continued : 

The  work  given  the  dietitians  was  different  in  each  hospi- 
tal. Sometimes  they  cared  for  the  nurses'  home,  with  perhaps 
occasional  assistance  given  to  the  officers'  mess.  In  other 
places  the  dietitian  prepared  food  for  especially  sick  patients ; 
still  elsewhere  she  would  have  charge  of  the  general  hospital 
diet  kitchen  or  the  general  walking  patients'  dining  hall. 
This  last  was  my  special  assignment. 

The  dining  tent  seated  320,  eight  at  a  table.  Our  serving 
was  done  cafeteria  style  and  all  the  food  carried  across  an 
open  lot  from  the  cook  house.  We  had  an  improvised  dish 
warmer,  a  huge  box  lined  with  pieces  of  tin  that  were  cracker 
boxes  flattened  out.  The  shelves  were  of  woven  wire  fencing 
and  the  heat  was  furnished  by  a  little  oil  stove  on  the  bottom 
slielf.  When  the  meal  was  finished,  the  soldiers  took  their 
dishes  to  the  exit  and  deposited  them  in  boxes  from  which 
they  were  taken  by  tlie  dish-washers,  washed  and  sterilized. 
The  washing  was  done  out  of  doors;  only  a  canvas  stretched 
over  tent  poles  protected  the  dish-washers.  We  had  six  army 
stoves  each  holding  a  huge  pot  which  was  kept  constantly 
filled  witli  water.  It  took  nearly  all  of  one  man's  time  to 
keep  these  six  fires  going  and  the  containers  filled  with  water. 
Sometimes  we  fed  1450  each  meal;  that  meant  dishes  were 
washed  and  returned  to  the  serving  table  constantly.  Tlie 
best  we  could  do  was  to  serve  725  per  hour  and  the  sight  of 
that  long  line  of  wounded  and  sick  men  standing  patiently 
in  the  mud  and  rain  waiting  for  their  meals  will  always  stay 
in  my  memory.    We  had  a  waiting  tent  for  them,  where  tliey 


THE  DIETITIAN  SERVICE  1389 

could  sit  till  a  chance  came  to  get  into  the  dining  tent,  but 
nothing  would  induce  them  to  use  it  no  matter  what  the 
weather.  The  herding  instinct  was  too  great  or  else  the  army 
habit  of  a  cue  was  too  strong  to  overcome. 

In  the  afternoons  and  evenings  the  dining  tent  was  used 
as  a  club  room.  We  always  managed  to  i<eep  one  of  the  three 
stoves  going  and  the  men  would  gather  in  groups  around  the 
warm  oasis  on  a  winter  night  to  write,  play  cards  or  read. 

The  two  Christmases  were  the  bright  spots,  the  rest  of  the 
nearly  two  years  of  overseas  work  was  made  up  of  hard  work, 
air  raids,  cokl,  rain,  uncertainty  of  supplies,  w"ounded,  sick 
and  complaining  men.  As  professional  dietitians,  we  had 
little  chance  to  put  into  practice  the  training  we  had  received ; 
as  women  we  had  the  chance  of  a  lifetime  to  use  as  best  we 
could  what  was  given  us  of  equipment  and  supplies  and,  best 
of  all,  to  give  to  hundreds  of  men  a  bit  of  cheer  and  kindness. 
To  see  the  lines  smooth  out  of  a  nerve-worn  face,  the  gruffer 
traits  of  human  beings  slip  into  the  background  under  your 
efforts,  those  are  the  things  that  should  remain  in  our  minds 
as  in  a  measure  offsetting  the  horrors  and  the  weariness  and 
the  anxieties  of  those  months. 

The  last  unit  to  assume  charge  of  a  British  hospital  during 
the  year  1017  was  Base  Hospital  Unit  Xo.  21,  of  the  Washing- 
ton University  ^Nfedical  School  of  St.  Louis,  Ivachcl  Watkins 
of  Barnes  Hospital,  St.  Louis,  was  the  dietitian. 

Although  the  dietitians  in  the  British  area  carried  on  their 
work  under  the  distinct  limitations  of  an  old  and  rigid  military 
system,  they  succeeded  in  making  their  usefulness  felt  and  five 
of  the  number  were  decorated  by  the  British  Government. 

The  splendid  enthusiasm  shown  by  the  dietitians  at  this  time, 
both  at  home  and  overseas,  was  eqimlled  only  by  the  anomalous 
nature  of  their  status  when  once  they  were  assigned  to  active 
duty.  Although  the  Military  Department  had  rc(piested  the 
Bed  (^ross  to  maintain  an  enrollment  of  women  professionally 
trained  as  dietitians,  nothing  was  done  in  the  way  of  defining 
the  duties,  rights  and  privileges  of  these  dietitians  after  their 
sen-vices  were  accepted.  The  .ATanual  for  the  ^Tedical  Depart- 
ment of  the  United  States  Army  for  1910,  stated: 

Sec.  2;]9,  Bage  85 

When  llic  number  of  sick  requiring  special  diet  is  large,  the 
coniinaiuliiig  otlicer  of  tlic  hospital  may  establish  one  or  more 


1390  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

diet  kitchens  for  the  preparation  of  their  food,  under  the 
immediate  direction  of  such  skilled  dietists  as  are  available. 
Competent  dietists  belonging  to  the  Nurse  Corps  may  be 
assigned  to  this  duty.  Eules  for  the  management  of  diet 
kitchens  will  be  prescribed  by  the  commanding  officer  of  the 
hospital  according  to  the  particular  needs  of  each  case. 

And  in  Section  760,  page  227,  the  enumeration  of  personnel 
allowed  a  base  hospital  concluded  with  the  following: 

46  nurses,  female  (1  chief  nurse,  1  assistant  to  chief  nurse, 
41  in  wards,  2  in  operating  room,  1  dietist). 

There  appeared  in  all  this  little  more  than  a  rather  vague 
idea  that  some  competent  nurse  might  be  intrusted  with  special 
dietary  work. 

The  information  given  out  by  the  Red  Cross  under  date  of 
August  5,  1916,  did  not  go  much  farther  in  the  matter  of  status. 
In  a  circular  letter  to  the  chief  nurse,  "in  re  to  dietitians  for 
base  hospital  units,"  Miss  Delano  said : 

It  has  been  decided  that  if  a  dietitian  is  appointed  as  a 
member  of  the  unit  she  shall  be  counted  as  one  of  the  fifty 
nurses  and  will  probably  receive  the  same  salary  allowed  to 
nurses.  I  think  it  important  that  there  should  be  no  mis- 
understanding in  regard  to  the  dietitian  being  under  the 
direction  of  the  chief  nurse  of  the  unit,  as  otherwise  there 
might  be  friction  and  difficulties.  .  .  . 

It  was  evident  that  Miss  Delano  was  proceeding  along  the 
line  indicated  in  the  Manual  of  the  Medical  Department  in 
thus  rating  the  dietitians  as  ''competent  dietists  belonging  to 
the  Xurse  Corps."  But,  according  to  regulations,  members  of 
the  Army  Xurse  Corps  "shall  be  graduates  of  hospital  training 
schools."  Since  dietitians  received  their  training  from  quite 
another  source  tliey  could  not  be  included  and  no  provision  for 
military  rating  for  a  woman  outside  the  Army  Xurse  Corps 
had  been  made  by  the  ^Military  Department — a  situation  which 
could  not  then  bo  remedied  except  by  Act  of  Congress.  As 
such  action  was  almost  beyond  the  possibility  of  securing  at 
the  time,  nothing  remained  for  the  dietitian  but  a  position  as 
a  civilian  employee,  and  the  following  circular  was  sent  out 
from  Red  Cross  Headquarters,  October  '2,  1917: 


THE  DIETITIAN  SERVICE  1391 

When  a  dietitian  is  not  a  nurse  she  comes  under  the  head- 
ing of  a  civilian  employee  and  should  be  included  in  the 
civilian  list.  Each  chief  nurse  should  communicate  with  the 
medical  director  in  order  to  reserve  a  vacancy  for  the 
dietitian  in  this  group.  If  this  is  not  done,  there  will  be  no 
opportunity  to  secure  salary  and  transportation.  When  the 
dietitian  is  a  civilian  employee  a  base  hospital  may  take  out 
()5  nurses.  When  the  dietitian  is  also  an  enrolled  Red  Cross 
nurse  she  may  be  included  as  one  of  the  (55  nurses. 

The  Eed  Cross  provides  a  uniform  for  dietitians  consisting 
of  a  gray  worsted  dress,  cape,  long  uister  and  black  vclour  hat. 
This  should  be  worn  with  gray  gloves  and  high  black  boots 
with  low  heels. 

The  result  was  that  the  dietitian  found  herself  still  in  the 
Nurse  Corps,  but  "not  of  it,"  a  civilian  employee  'Svitli  a  differ- 
ence," and  also  without  rank  in  a  situation  where  authority 
was  the  first  requisite  in  getting  things  accomplished.  Added 
to  this,  complications  in  connection  with  the  Xursing  Service 
itself  overseas  were  requiring  strict  attention  from  Ked  Cross 
Headquarters,  the  American  Dietetics  Association  had  not  yet 
been  organized,  and  the  American  Home  Economics  Association, 
deeply  engrossed  as  it  was  with  the  work  of  food  conservation, 
was  giving  little  thought  to  dietitians  beyond  encouraging  them 
to  enroll  for  service  under  the  Red  Cross. 

Manifestly,  so  far  as  the  dietitians  were  concerned,  the  sit- 
uation could  be  summed  up  in  Kipling's  lines  descriptive  of  a 
certain  military  faux  pas.  ''It  got  beyond  all  orders."  That 
it  did  not  also  get  "beyond  all  'ope"  was  due  to  several  reasons. 
First,  the  American  Expeditionary  Forces  were  guiltless  of 
much  of  the  tradition  that  belongs  to  an  old  and  crystallized 
military  organization,  and  the  "civilian"  dietitians  were  re- 
ceived with  a  fair  degree  of  composure  if  not  always  with  posi- 
tive enthusiasm.  Perhaps  a  second  reason  why  the  dietitians 
"muddled  through"  as  well  as  they  did  was  that  they  were  in  a 
sense  undisciplined;  their  training  had  given  them  some  knowl- 
edge of  subject  matter,  along  with  a  general  desire  to  put  this  to 
practical  use,  but  they  were,  themselves,  little  used  to  the  disci- 
pline of  either  the  soldier  or  the  nurse  and,  as  a  consequence, 
they  went  into  the  work  "on  their  own,"  little  troubled  by 
notions  of  precedent,  proceeding  as  fast  and  as  far  as  the  com- 
manding otHc(>r  or  the  mess  otticer  would  ])('rmit.  Surely  a 
third   reason  for  whatever  stu'cess  the  dietitians  mav  have  to 


1392  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

their  credit  is  due  to  the  fact  that,  given  the  opportunity,  they 
were  able,  in  most  instances,  to  demonstrate  the  value  of  their 
service ;  recognition  was  sometimes  slow  in  coming  but  it  usually 
came. 

Following  the  Circular  of  October  2,  1917,  already  quoted, 
no  formal  action  in  regard  to  dietitians  was  taken  during  the 
remainder  of  the  year,  but  a  few  excerpts  from  the  report  of 
a  dietitian,  Mrs.  MacPhadyen  ^  who  was  with  one  of  the  first 
base  hospital  units  of  the  American  Expeditionary  Forces 
illustrated  well  some  of  the  points  which  have  just  been  made. 
In  her  report  she  said: 

We  sailed  from  New  York  August  7th,  1917,  arriving  in 
St.  Nazaire  August  20th,  1917.  On  arrival  we  found  that 
all  Eed  Cross  nurses  and  dietitians  were  transferred  to  the 
Army.  We  did  not  feel  very  happy  about  this,  but  of  course 
there  was  nothing  to  do  but  make  the  best  of  it. 

HoAvever,  the  Eed  Cross  did  not  forsake  us.  After  we 
arrived  at  our  destination  we  received  many  things  which 
added  to  our  comfort, — blankets,  sweaters  and  warm  clothes, 
which  were  greatly  needed,  as  our  first  winter  was  very  cold. 

I  found  that  no  provision  had  been  made  by  the  Army  for 
special  diets  or  diet  kitchens.  It  was  a  case  of  using  my  own 
initiative  and  doing  what  I  thought  best  in  my  own  depart- 
ment. I  was  allowed  to  have  several  chests  of  cooking  uten- 
sils and  equipment  sent  by  the  Red  Cross,  and  I  began  my 
work  by  taking  a  corner  of  the  main  kitchen  and  making 
special  diets  for  the  sick,  which  after  two  weeks  numbered 
about  fifty.  ^ly  first  patients  fared  well,  I  assure  you.  .  .  . 
Finally,  our  commanding  officer,  seeing  I  was  determined  to 
have  a  diet  kitchen,  came  to  my  rescue  and  provided  suitable 
quarters,  also  furnishing  all  extra  equipment  needed,  such  as 
a  gas  range  and  cooking  utensils.  The  Red  Cross  ranges 
were  put  into  the  main  kitchen  for  cooking  light  diets,  of 
which  I  also  had  supervision. 

Everything  moved   alojig  smoothly.     I   soon   had  a  well- 

*Mrs.  Margaret  ^racPhadycn  was  born  in  Ivernie,  Aberdeenshire,  Scot- 
land. Slie  was  graduated  from  ]MacDonald  Ontario  Agricultural  College 
in  1913.  and  the  following  year  was  instructor  in  domestic  science  and 
food  value  for  the  Agricultural  Department  of  Toronto.  Her  hospital 
work  previous  to  her  entering  military  service  was  done  in  Harlem  Hos- 
pital, in  Bellevue  and  in  the  Ontario  Ladies  Hospital.  On  October  10, 
1918,  Mrs.  MacPhadyen  resigned  from  tlie  ^Medical  Department  of  the 
United  States  Army  and  accepted  a  position  as  dietitian  with  tlie  Bureau 
of  Hospital  Administration,  American  Eed  Cross  Headquarters.  Hotel 
Regina,  Paris.  ^Irs.  MacPhadyen  was  assigned  to  U.  S.  Base  Hospital 
Unit  No.  9,  New  York  Hospital  Unit. 


THE  DIETITIAN  SERVICE  1393 

equipped  and  up-to-date  diet  kitchen,  one  that  would  compare 
favorably  with  those  of  many  New  York  hospitals.  Our 
patients  increased  rapidly.  I  rarely  had  less  than  three 
hundred  light  and  special  diets,  and  during  the  drive  five  or 
six  hundred.  I  did  my  best  to  represent  the  lied  Cross  and 
to  do  the  work  I  knew  they  would  wish  me  to  do. 

In  a  letter  to  Miss  George,  under  date  of  January  31,  1918, 
Mrs.  MaePhadyen  stated: 

There  are  some  things  in  regard  to  the  work  here  which  I 
would  like  to  tell  you  about.  To  begin  with,  there  seems  to 
be  a  vague  idea  of  wliat  we  are  really  here  for. 

1  have  had  to  do  all  my  own  planning.  Fortunately,  I  have 
a  splendid  commanding  oflicer,  who  has  done  everj'thing  in 
his  power  to  aid  the  work.  The  chief  nurse,  I  am  sorry  to 
say,  has  not  been  of  much  assistance,  thinking  at  first,  appar- 
ently, that  I  did  not  "belong"  because  I  was  a  "civilian." 
This  going  as  a  "civilian"  is  a  strange  arrangement  and  very 
disagreeable.  ...  I  was  able  to  take  my  place  and  to  hold  my 
own  after  I  came  here,  but  a  younger  and  less  experienced 
person  would  have  been  completely  discouraged.  .  .  .  There 
is  another  matter  I  wish  to  know  about, — they  are  asking 
officers,  enlisted  men  and  nurses  to  take  out  insurance.  I 
wished  to  do  so  but  was  told  that  I  could  not,  as  I  was  a 
"civilian." 

In  ^lay,  1917,  Congress  authorized  the  establishment  of 
thirty-two  camps  and  cantonments  in  this  country,  and  in 
September  the  Red  Cross  was  called  upon  to  furnish  dietitians 
for  this  sen-ice.  Here  they  served  as  administrative  dietitians, 
as  diet  supervisors  or  as  instructors  in  dietetics  in  the  Army 
School  of  Xursing. 

As  might  be  expected,  conditions  under  which  the  dietitian 
worked  varied  as  widely  in  the  diti'erent  cantonments  as  in  the 
base  hospitals  overseas.     Thus,  from  one  dietitian: 

The  three  months  1  spent  at  Camp  Wadswortli  were  not  as 
])]t'asaiit  as  tlicv  nii'iht  hav(>  been  because  tlic  status  vi'  Aw 
dietitian  was  so  very  uncertain.  Pai't  of  the  time  1  was  under 
the  chief  nurse,  and  part  of  the  time  umh-r  the  mess  ullicer. 
There  were  no  ruh's  or  regulations  (oiicerning  me. 

And  this  from  a  dietitian  at  Camp  Shelby: 


1394  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  am  directly  responsible  to  the  mess  officer  and  the  com- 
manding officers,  and  am  rated  with  the  officers. 

Judging  from  the  following  report  from  a  dietitian  at  Camp 
Greene,  Korth  Carolina,  things  were  not  so  bad — merely  a  trifle 
confused : 

The  mess  officer  under  whom  I  work  is  very  progressive 
and  is  getting  things  into  fine  shape,  improving  all  the  time. 
.  .  .  Are  there  any  special  rules  for  the  dietitians,  especially 
as  to  hours,  or  do  they  keep  the  same  hours  as  the  nurses,  and, 
if  so,  what  hours  are  the  nurses  supposed  to  have  ? 

IsTotwithstanding  the  fact  that  work  in 'the  cantonment  hos- 
pitals did  not  afford  the  inspiration  which  accompanied  service 
overseas,  something  of  the  spirit  of  the  "trenches"  was  usually 
evident  whenever  things  got  a  bit  thick.  To  quote  a  report  from 
Camp  Travis : 

I  have  been  here  two  weeks  as  dietitian,  and  I  find  my 
position  a  peculiar  one.  ...  I  supposed  that  when  we  were 
sworn  in  that,  for  the  period  of  the  war,  we  were  members  of 
the  Army  ^urse  Corps.  .  .  .  Xow  1  find  that  we  are  listed  as 
civilian  employees  and  have  no  military  standing  .  .  .  but, 
whatever  my  standing,  it  will  make  no  difference  with  my 
work  which  1  am  trying  to  do  as  well  as  I  can. 

"Carrying  on"  in  the  face  of  more  serious  difficulties  was 
indicated  in  this  report  from  a  dietitian  at  Letterman  Hospital: 

I  have  been  assigned  to  the  diet  kitchen  in  the  officers' 
ward,  and  have  been  disappointed  in  finding  much  manual 
work  to  be  done  by  dietitian.  .  .  .  Heretofore,  as  you  know, 
nurses  have  had  charge,  the  last  one  having  been  in  this  diet 
kitchen  for  more  than  two  years.  She  was  a  hard-working 
German  woman,  willing  to  stay  on  duty  all  hours,  and  who  did 
much  of  the  actual  (ooking  herself.  ...  1  took  the  matter 
up  with  Miss  Keener,  the  chief  nurse,  who  sees  the  situation 
as  1  do.  and  slie  in  turn  took  it  to  the  commanding  officer. 
He  was  very  kind  biit  said  he  could  give  me  no  extra  hel]). 
He  said  to  simplify  the  menus  and  to  cut  out  all  special  diets, 
giving  the  semi-solid,  light  and  full  diets  practically  the 
same.  .  .  .  This  very  morning,  after  the  order  had  been 
given  to  retrench  on  specials,  the  wrath  of  the  ward  medical 
chief  came  down  upon  my  head,  for  he  wished  to  test  a  four- 


THE  DIETITIAN  SERVICE  1395 

day  diabetic  diet.  Wlien  I  explained  the  situation  he  saw- 
things  my  way  and  returned  to  his  duties — but,  /  did  the 
diets  for  him,  as  1  know  I  always  will  do  if  it  is  at  all  possible. 

The  work  of  giving  instruction  in  the  Army  School  of  Nurs- 
ing was  attractive  to  most  of  the  dietitians  assigned  to  this  duty. 
The  extracts  quoted  below  from  the  report  of  Irma  Latzer 
(now  Mrs.  Gamble),  a  graduate  of  the  University  of  Illinois, 
give  a  picture  of  this  phase  of  the  work  of  dietitians,  and,  at 
the  same  time,  throw  a  side  light  upon  the  confusion  wrought 
everywhere  by  the  never-to-be-forgotten  epidemic  of  influenza. 
She  stated : 

I  was  at  the  Base  Hospital  at  Camp  Grant  from  theimiddle 
of  September,  1!)18,  to  the  middle  of  the  following  April. 
Because  of  my  previous  experience  [  was  assigned  the  duty  of 
giving  instruction  in  dietetics  to  the  students  in  the  Army 
School  of  Xursing. 

Three  days  after  1  arrived  at  camp  the  "flu"'  epidemic 
reached  us  and  classes  could  not  be  started  until  the  epidemic 
had  passed.  During  that  time  every  one  served  where  most 
needed  in  caring  for  the  sick  as  they  were  brought  to  the 
hospital  by  tlie  hundreds. 

1  was  given  charge  of  the  nurses'  mess.  The  meals  were 
not  hard  to  plan  or  prepare,  for  the  allowance  per  person  was 
liberal  and  the  detail  help  was  ])lentiful.  Of  course  the  "flu" 
did  not  pass  up  cooks  and  waitresses,  but  with  volunteer  help 
from  Kockford  we  all  managed  to  be  fed. 

When  the  time  came  for  classes  to  begin  it  was  not  a  dilTi- 
cult  problem  to  equi]i  tlie  diet  kitchen.  Lieutenant  Colonel 
D.  C.  Micbie,  conunandiiig  officer  of  the  Base  Hospital,  was 
dee])ly  interested  in  the  welfare  of  the  student  nurses  and 
through  liim  and  Miss  Anna  Williamson,  chief  nurse,  the 
purchasing  of  good  and  adequate  equipment  was  ('omj)ara- 
tively  easy.  ...  A  complete  set  of  kitchen  utensils  for  every 
desk  and  one  large  electric  range  made  it  as  easy  to  teach 
dietetics  in  the  army  as  in  any  modern  university  classroom. 

The  students  were  an  interesting  grou])  to  work  witli. 
Although  they  varied  as  to  age  and  previous  school  training 
all  were  there  for  a  definite  purpose  and  eager  to  make  the 
best  use  of  th(M'r  time  and  opportunities. 

The  course  outlined  for  tlie  Army  Scliools  of  Xvirsing  was 
followed  as  clostdy  as  practicable.  l)ut  this  course  was  preceded 
by  four  deinoiistration  lessons  to  aid  the  students  in  their 
practical   work  on  the  wards.     The  student  group  had  to  be 


1396  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

divided  into  four  sections  because  of  the  large  number  md 
their  different  times  of  arrival  at  camp.  Every  section  upon 
the  completion  of  its  course  gave  a  dinner  to  which  were 
invited  the  various  commanding  officers  of  Camp  Grant  and 
members  of  the  faculty  of  the  Army  School  of  Nursing. 

The  course  in  dietetics  was  followed  by  a  lecture  course  in 
diet  in  disease,  in  which  the  students  were  also  keenly  inter- 
ested. 

Of  course,  overseas  service  was  the  hoped-for  goal  of  many 
of  the  dietitians  who  entered  service  here,  and  it  can  be  believed 
that  the  following  note  which  reached  Miss  George  was  intended 
to  carry  a  hint : 

I  have  been  on  duty  at  Camp in  the  dietitian  service 

since  January  10th,  and  I  find  that  the  experience  in  an 
army  diet  kitchen  here  .  .  .  would  certainly  be  very  valuable 
by  way  of  introduction  to  hospital  work  abroad. 

In  no  calling  or  profession  does  each  individual  measure  up 
to  standard  in  matters  of  training,  experience,  executive  ability, 
personality  or  tact.  Dietitians  were  no  exception  to  the  rule, 
and  in  view  of  the  responsibility  which  came  to  the  individual 
dietitian,  the  wisdom  of  the  requirement  made  by  the  War 
Department  that,  before  being  assigned  to  duty  overseas,  the 
dietitian  must  serve  in  a  cantonment  hospital  in  this  country 
may  be  appreciated.  The  following  letter  from  Dr.  Ruth 
Wheeler  to  Aliss  George  of  the  date  of  May  2,  1918,  gave  an 
indication  of  the  sifting-out  process. 

When  you  can,  will  you  have  some  one  look  into  conditions 

in  our  side  of  the  work  at  Camp — ?    Eeports  have  come 

to  me  that  there  are  lour  dietitians  there,  no  one  of  whom  has 
sufficient  training  herself  to  enable  her  to  train  the  others  or 
to  direct  the  whole  scheme  really  well.  One  of  our  alumnae 
wlio  is  there  says  she  is  doing  nothing  that  any  maid  servant 
could  not  do.  ...  I  have  written  her  that  her  job  just  now  is 
to  be  thankful  that  slie  is  in  such  a  fortunate  position  for  get- 
ting the  knowledge  and  ex])erience  she  needs.  .  .  .  She  is 
probably  doing  as  important  work  as  she  is  capable  of  right 
now. 

Two  dietitians  died  while  in  the  service  in  cantonment  hos- 
pitals in  this  conutry.  Olive  Ward  Xorcross,  of  Worcester, 
^fassacliusctts,  a  liTaduafo  of  the  State  Xormal  School  at  Tram- 


THE  DIETITIAN  SERVICE  1397 

ingham,  Massacliiisotts,  died  September  26,  1918,  at  Camp  Dix, 
New  Jersey.  ^leda  !Morse,  of  Foxboro,  ^lassacluisctts,  also  a 
graduate  of  Framiiigbam  Normal  School,  died  December  24, 
1918,  at  Camp  Taylor,  Kentucky. 

By  the  end  of  June,  1918,  eighty-two  dietitians  were  on  duty 
in  the  cantonment  hospitals  in  this  country.  This  number  was 
greatly  augmented  during  the  following  months  and  at  the  close 
of  the  fiscal  year  June  130,  1919,  one  hundred  and  forty-three 
were  on  duty  in  the  United  States  and  Hawaii. 

As  dietitians  were  not  named  in  the  enumeration  of  positions 
open  to  enlistment  in  the  Navy,  the  one  dietitian,  Henrietta  L, 
French,'^  who  saw  Naval  service  abroad,  enlisted  as  a  yeoman 
(f)  and  later  functioned  as  a  dietitian.  Miss  French  entered 
the  service  in  October,  1917,  and  was  assigned  to  Naval  Base 
Hospital  No.  2  at  Strathpeffer,  Scotland. 

Fifteen  dietitians  served  in  Naval  hospitals  in  this  country, 
five  being  assigned  to  the  Great  Lakes  Naval  Training  Station 
Base  Hospital  with  Mildred  G.  Stiles  ^  as  head  dietitian.  Miss 
Stiles  was  assigned  to  duty  February  8,  1918,  and  resigned 
from  the  service  in  June,  1920,  on  account  of  ill-health.  During 
this  time  she  served  in  the  hospital  at  the  Norfolk  Naval  Base, 
with  the  Naval  Hospital  at  Annapolis  and  New  York  Naval 
Hospital. 

Taken  in  cross-section,  the  Navy  seems  to  have  regarded  the 
innovation  of  the  dietitian  strictly  from  the  point  of  view  of 
the  ''special  interest"  involved.  This  statement  from  a  Naval 
officer : 

With  all  this  difficulty  of  getting  food,  I  want  a  dietitian 
who  can  tell  nie  what  to  use  if  I  haven't  the  particular  article 
of  food  which  1  should  have. 

And  this  from  "before  the  mast:" 

"We  got  auotlier  one  o'  them." 

"One  o'  what  ?" 

"One  o'  them  as  wants  to  take  our  l)eans." 

Mloiirietta  L.  Frcncli  j^'raduatcd  in  Ilmiie  Ecdiiomics  at  Lewis  Institute, 
Chicafjo,  and  subsoquciitly  lield  tiie  position  of  dietitian  at  Miidlavia  Sani- 
tarium at  Kramer.  Indiana,  in  tiie  I'liiversity  of  California  Hospital  and 
in   tl:c  Xaval    Base    Hospital    at   Stanford.   California. 

■*  Mildred  O.  Stiles  <rraduated  frfim  Simmons  ColIcL'e  in  liU.").  was  dieti- 
tian in  tlie  X'ermont  Sanatoria  at  I'ittsford.  NCitiiunt.  for  one  year,  and 
later  with  tlie  \'.  \\  .  C.  A.  in  Alhany,  \.  \  ,  and  \\it!i  the  same  oriranizat ion 
at     \'oun''stowii.    Ohio. 


1398  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

The  Navy  being,  perforce,  a  more  or  less  self-sufficient  insti- 
tution early  made  arrangements  with  several  universities  to 
have  instruction  in  dietetics  given  to  their  Hospital  Corps  men. 
Of  this  work,  Gertrude  Thomas  of  the  University  Hospital, 
Minneapolis,  Minnesota,  wrote  to  Miss  George  in  March,  1918: 

At  present,  besides  the  hospital  work,  I  am  engaged  in 
teaching  dietetics  to  Hospital  Corps  men  for  the  iSTavy.  This 
work  is  very  interesting  and  we  have  begun  classes  for  the 
second  group  of  one  hundred  men. 

Of  the  little  group  of  fifteen  dietitians  who  served  with  the 
Navy,  two  made  the  supreme  sacrifice.  These  were  Irene  I. 
Jury  of  Washington,  D.  C,  a  graduate  of  the  Lucy  Webb  Hayes 
National  Training  School  of  Washington,  who  died  at  the  Naval 
Hospital  at  Pelham  Bay  Park,  N.  Y.,  December  9,  1918,  and 
Hortense  Elizabeth  Wind,  of  Ann  Arbor,  Michigan,  a  graduate 
of  Iowa  State  College,  who  died  December  10,  1918,  at  Norfolk, 
Virginia. 

Subsequent  to  the  issuance  of  the  circular  letter  of  August 
5,  1917,  already  quoted,  the  matter  of  the  status  of  dietitians 
received  little  attention  until  the  following  spring.  At  a  spe- 
cial meeting  of  the  National  Committee  on  Red  Cross  Nursing 
Service  held  at  National  Headquarters  March  14,  1918,  !Miss 
George,  who  was  present  by  invitation,  reported  the  assignment 
of  130  dietitians  to  duty  in  the  Army,  Navy  and  Red  Cross. 
Quoting  from  the  Minutes  of  the  meeting: 

A  discussion  followed  on  the  duties  and  responsibilities 
of  dietitians  in  military  hospitals,  including  relation  of 
dietitian  to  commanding  officer.  Miss  Nutting  stated  that 
the  dietitians  felt  that  they  could  do  more  efficient  work  if 
tliey  were  under  the  direct  authority  of  the  commanding 
officer  rather  than  the  divided  responsibility  to  the  mess 
sergeant  and  to  the  chief  nurse. 

The  committee  adjourned,  however,  without  taking  any 
formal  action  in  the  matter. 

Naturally  the  American  Dietetics  Association  wliich  had 
been  organized  in  Cleveland  the  previous  October  with  Lulu 
Graves,  head  dietitian  of  Cleveland  Lakeside  Hospital,  as 
president,  and  Lena  F.  Cooper,  head  of  the  Battle  Creek 
Sanitarium    School    of    Home    Economics,    as    first    vice-presi- 


THE  DIETITIAN  SERVICE  1399 

dent,  was  interesting  itself  in  plans  to  simplify  the  situation  for 
the  dietitians  in  active  service.  Also  the  Division  of  Food  and 
Nutrition  of  the  Sanitary  Corps  of  the  Army  gave  promise  of 
being  able  to  understand  to  some  extent  the  difficulties  of  the 
dietitians.  A  brief  statement  of  the  organization  and  initial 
activities  of  this  division  is  copied  from  the  report  of  the 
Surgeon  General  June  30,  1910,  Vol.  II  : 

In  xVugust,  1917,  there  was  organized  in  the  oflice  of  the 
Surgeon  General  a  Division  of  Food  and  Nutrition  and  its 
officers  "were  authorized  by  letter  of  the  Secretary  of  War 
dated  October  Ki,  1917,  to  inspect  food  supplies  in  camps,  to 
endeavor  to  improve  the  mess  conditions  and  to  study  tbe 
ration  suitability  and  food  requirements  of  the  troops.  Offi- 
cers of  tliis  division  were  sent  to  camps  in  the  United  States 
and  while  in  camp  gave  instruction  to  cooks,  mess  officers  and 
unit  commanders  and  also  made  extensive  studies  of  ration 
requirements  and  suitability.  In  March,  1918,  it  was  decided 
to  send  a  group  of  these  otiicers  to  ihe  American  Expedition- 
ary Forces  to  organize  similar  work  in  France.  To  this  end, 
on  ]\Iarch  7,  six  officers  left  the  States  for  that  purpose.  This 
party  proceeded  first  to  England  and  remained  there  from 
March  16  to  April  2.  .  .  .  One  officer  was  left  in  England  to 
continue  the  work  there  and  on  April  3  the  other  five  officers 
proceeded  to  France,  reporting  to  the  chief  surgeon  at  Tours 
on  April  l'-^.  .  .  .  Each  officer  visited  and  inspected  organi- 
zations in  his  sector  (assigned  him)  and  reported  his  observa- 
tions. Later  the  group  came  together  at  Dijon.  The  follow- 
ing extract  from  the  report  of  tlie  director  of  the  section 
summarizes  the  results  of  this  preliminary  survey : 

The  results  of  this  preliminary  inquiry  and  of  the 
reports  and  conferences  led  to  the  conclusion  that 
altliough  the  garrison  ration  being  issued  generally  to 
troops  was  adequate  as  to  total  food  material  and  the 
quality  of  the  articles  as  a  rule  good,  in  many  places  the 
feeding  of  the  men  was  poor,  due  in  large  part  to  the 
unfamiliarity  of  the  mess  sergeants  and  cooks  with  the 
ration  in  kind  and  to  their  general  inefficiency  under  the 
conditions  existing  in  l"'rance.  to  a  lack  of  interest  in  or 
attention  to  nu'ss  conditions  by  company  commanders 
and  higher  officers,  and  in  the  advance  section,  wliere 
daily  automatic  issue  was  in  force,  to  the  issuc^  of  too 
many  components  on  a  siimle  day,  in  corrcs])oii(!ingly 
small  amounts,  i.e..  to  an  unwise  issue  system.  Tlier(>  was 
nearly  cNcrywhei-e  great  waste  of  food,  with  conseciuent 
underfeed in<r.  .  .  . 


1400  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

As  a  result  of  this  conference  it  was  decided  by  the 
director  of  laboratories  to  establish,  with  the  consent  of 
the  chief  surgeon,  a  section  of  food  and  nutrition  in  that 
office. 

Meanwhile,  under  date  of  March  15,  Miss  Cooper  wrote  to 
Major  Murlin  of  the  Food  and  Nutrition  Division  reporting  to 
him  a  conference  which  she  had  had  with  Colonel  Furbush  of 
the  Surgeon  General's  office.  Major  Murlin's  reply  dated  March 
25,  was  in  part  as  follows : 

Owing  to  the  fact  that  I  have  been  absent  from  the  office 
for  a  week  your  letter  of  March  15th  has  just  come  to  my 
attention. 

I  am,  of  course,  interested  in  what  you  tell  me  about  your 
conference  with  Colonel  Furbush.  My  own  impression  is  an 
agreement  with  what  Colonel  Furbush  told  you,  viz.,  that  the 
proposed  arrangement  could  scarcely  be  accomplished  at  the 
present  time.  I  am  not  at  all  sure  but  that  the  Surgeon 
General  would  take  an  altogether  dilferent  view  of  the  matter, 
particularly  if  your  president  and  yourself,  or  some  other 
committee,  should  wait  upon  him  in  person  and  lay  the  matter 
before  him. 

Whatever  you  do  along  this  line,  you  should  be  careful  to 
make  it  clear  that  the  matter  has  not  originated  with  my- 
self. In  other  words,  I  am  not  requesting  that  the  dietitians 
be  brought  under  this  division,  where  I  think  they  belong.  I 
feel  with  you  that  matters  are  not  satisfactory  either  to 
the  dietitians  or  to  the  Army  officials.  .  .  . 

As  indicated  by  this  letter  it  was  hoped  that  the  Dietitian 
Service  might  be  made  a  part  of  the  Food  and  Nutrition  Di- 
vision, but  on  account  of  other  demands  made  upon  both  Miss 
Graves  and  Miss  Cooper  the  plan  was  not  put  forward  officially. 
Somewhat  aside  from  this,  however,  the  rather  exhaustive  set  of 
suggestions  quoted  below  and  formulated  in  part  by  the  New 
York  Dietitians  Association  was  sent  informally  to  the  Surgeon 
General's  office : 

suggestions  for  the  guidance  of  dietitians  in  service 
under  the  war  and  navy  departments 

Eesponsibilities  and  Duties 

It  should  be  understood  by  the  officer  of  tlie  hospital  to 
which    a    dietitian    is    assigned,    whether    she    comes    in    the 


THE  DIETITIAN  SEUVK'E  1401 

capacity  of  an  administrative  dietitian  or  as  a  special  diet 
supervisor. 

Administrative  Dietitians  shall  be  under  the  supervision  of 
the  Commanding  Officer,  to  whom  they  will  make  all  com- 
plaints, criticisms  and  suggestions.  Tlieir  responsibilities  and 
duties  should  be  outlined  by  the  Commanding  Officer  and 
facilities  for  desk  work  supplied.  Power  to  report  workers  to 
the  Commanding  Officer. 

They  will  cooperate  with  the  medical  staff,  the  Chief  Nurse 
and  the  Quartermaster's  department. 

They  will  be  under  the  social  supervision  of  the  Chief 
Nurse. 

The  duties  of  administrative  dietitians  will  be  the  making 
of  menus,  regulating  of  dietaries,  the  supervision  of  prepara- 
tion of  food,  and  the  control  of  sanitary  conditions  under 
which  food  is  prepared,  direction  of  transportation  of  food  to 
serving  kitchens,  requisitioning  on  Quartermaster's  depart- 
ment, supervision  of  cafeteria  service  in  mess  halls. 

t^pecial  diet  supervisors  shall  be  under  the  supervision  of 
the  Commanding  Officer,  but  shall  be  directly  responsible  to 
the  chief  medical  officer.  They  shall  be  responsible  to  the 
Commanding  Officer  in  all  matters  pertaining  to  cooperation 
with  other  departments.  Shall  have  proper  kitchens  and 
equipment. 

They  will  be  under  the  social  supervision  of  the  Chief 
Nurse. 

The  duties  of  special  diet  supervisors  shall  be  supervision  of 
the  preparation  of  soft,  light  and  liquid  diets,  and  special 
diets.  Transportation  of  same  to  ward  serving  rooms,  requi- 
sitioning for  diet  kitchen  needs  to  Quartermaster's  depart- 
ment, have  complete  control  of  the  diet  kitchen  working  force, 
subject  to  the  Commanding  Officer's  direction. 

Uniforms 

The  duty  uniform  should  be  plain  white,  made  like  the 
nurses'  No.  400.  The  Ked  Cross  duty  uniform  of  blue  crepe, 
with  white  collars  and  cuffs  and  apron,  may  be  purchased  after 
assignment  to  duty.  The  Ked  Cross  cap  may  be  worn,  if  the 
dietitian  is  enrolled  in  the  I?ed  Cross  service. 

A  gray  uniform  may  be  purchased  after  assignment  to  duty, 
made  in  the  style  of  the  .Vrmy,  or  tlie  Navy,  nurses'  uniforms. 

A  gray  cape  is  issued  by  tlie  Ked  Cross  after  assignment  to 
duty. 

Insignia 

The  Dietitian  may  wear  a  l?ed  Cross  dietitian's  badge  if 
she  is  enrolled  under  the  Uvd  Cross. 


1402  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

She  should  be  permitted  the  use  of  the  letters  U.S.  and  the 
caducei  with  the  letter  U  added.  (Xote  that  the  Sanitary 
Corps  wear  caducei  with  the  letters  S.C.  added.) 

Enlistment 

The  dietitian  should  either  be  enlisted  for  three  years' 
service,  or  be  counted  as  a  reserve. 

Rank 

Where  responsibility  entitles,  the  dietitians,  like  the  nurses, 
should  be  considered  for  a  ranking  position. 

Salaries 

Administrative  dietitians,  as  for  chief  nurse. 
Special  Diet  Supervisor,  $00  a  month,  with  traveling  ex- 
penses and  maintenance,  as  for  enlisted  and  reserve  nurses. 

Leave 

As  for  nurses. 

Release 

For  illness  or  other  serious  causes,  only. 

Transfers  to  Other  Services 

At  the  discretion  of  the  Surgeon  General's  office,  dietitians 
may  be  transferred  from  one  service  to  another. 

In  discussing  the  above  suggestions  with  ]\Iiss  George,  ^liss 
Xoyes  merely  expressed  doubt  as  to  their  having  any  weight 
with  the  Surgeon  General.  As  a  matter  of  fact  Circular  Xo.  27, 
famous  among  dietitians,  and  issued  by  the  Surgeon  General 
May  13,  1918,  showed  the  influence,  nor  of  the  ''suggestions," 
but  of  the  report  made  bv  the  Division  of  Food  and  Xutrition. 
The  circular  in  full  was  as  follows: 

american  expeditionary  forces 
Circular  Xo.  27 

1.    Al)MIXlSTl!ATTON  OF  ^IeSSES FfNCTION  OF  DlETITIAN  : 

The  reports  of  medical  inspectors  and  officers  of  the  Food  and 
X'utrition  Section  show  tliat  the  a(hninistration  of  messes  is, 


THE  DIETITIAN  SERVICE  1403 

as  a  rule,  the  least  efficient  and  satisfactory  part  of  hospital 
administration.  The  defects  noted  are  a  monotonous  and  ill- 
halanced  dietary,  poor  service,  and  lack  of  cleanliness  in  the 
kitchen  and  the  kitchen  personnel.  These  inspections  show 
that  the  Commanding  Officers  have  not  made  the  proper  use  of 
the  agency  which  is  especially  intended  to  correct  tliese  defects, 
that  is,  to  make  the  proper  use  of  the  dietitians  who  have 
been  assigned  to  the  base  hospitals  to  use  their  expert  knowl- 
edge for  the  correction  of  these  defects  and  to  exercise  the 
constant  vigilance  and  attention  to  detail  which  is  necessary 
to  successful  administration  of  mess. 

Dietitians  are  trained  experts  in  nutrition  and  food  prepa- 
ration. Jf  not  trained  nurses,  they  are  civilian  employes 
having  a  status  analogous  to  a  trained  nurse.  The  function 
of  the  dietitians  is  to  supervise  the  preparation  not  only  of  the 
special  diets,  but  to  make  out  the  bills  of  fare  and  supervise 
the  preparation  of  all  food  furnished  by  the  government.  Tiie 
dietitian  has  expert  knowledge  of  which  the  Commanding 
Officer  should  make  the  fullest  use  for  the  benefit  of  his  com- 
mand. She  should  be  able  to  relieve  the  mess  officer  from  the 
burden  of  details  required  to  secure  a  well  balanced  ration, 
proper  variety  and  preparation  and  a  good  service.  The  mess 
officer  should  make  a  daily  inspection,  accompanied  by  the 
dietitian  and  the  mess  sergeant,  to  see  that  the  details  of  a 
good  service  are  carried  out  fully  and  completely. 

Like  all  other  women  of  the  personnel  of  a  base  hospital, 
the  dietitian  is  under  the  disciplinary  authority  of  the  Chief 
Nurse. 

While  "scraps"  of  official  paper  arc  always  valued  as  things 
to  conjure  by,  it  is  doubtful  if  the  issuance  of  this  order  had  the 
etToct  of  modifying  directly  the  situation  of  the  dietitian  in 
any  particular  hospital.  As  has  been  previously  suggested, 
the  dietitian  made  her  way  in  the  military  service  largely  by 
the  force  of  her  personality.  As  late  as  December  0,  1018,  in 
an  address  ^  given  before  the  American  Public  Health  Associa- 
tion in  Chicago,  Major  Hoskins,  of  the  Division  of  Food  and 
Xutrition  said : 

At  times  it  is  difficult  to  secure  the  nice  adjustments  de- 
manded wlien  a  woman  dietitian  without  military  status,  a 
mess  officer,  previously  a  hotel  manager,  and  an  old  Army 
mess  sergeant  are  required  to  cooperate  in  the  same  kitcluMi. 

'Reported    in    tlic   Amrrira))  Jnurval  nf   Public   Uralfh,  Juno,   1919. 


1404  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Mary  Pascoe,  of  the  University  of  Nebraska,  and  dietitian 
in  Base  Hospitals  No.  8,  No.  117  and  No.  214,  June,  1918, 
to  July,  1919,  said: 

No  changes  having  been  made  in  the  duties  of  mess  officers 
or  sergeants  at  the  time  the  above  duties  of  army  dieti- 
tians were  formulated,  the  immediate  carrying  out  of  these 
duties  would  have  been  absolutely  impossible  unless  one  could 
have  succeeded  in  having  these  individuals  remain  more  or 
less  in  a  comatose  condition.  A  perusal  of  the  Army  Cooks' 
Manual  will  show  definitely  that  a  strict  adherence  to  these 
duties  on  the  part  of  the  dietitian  would  result  in  immediate 
friction  with  those  persons  with  whom  it  was  absolutely 
necessary  to  cooperate — the  mess  officer  and  the  mess 
sergeant. 

However,  in  time  I  did  find  it  possible  to  Justify  to  myself 
my  presence  in  France,  even  though  the  results  I  was  able  to 
obtain  fell  short  of  what  I  had  hoped  to  do  when  I  reached 
France.  ...  At  all  times  I  had  the  sympathy  and  the  backing 
of  the  commanding  officer. 

Again  in  contrast,  quoting  from  the  report  of  another  dieti- 
tian i^" 

I  was  allowed  none  of  the  many  other  duties  ascribed  to  the 
dietitian  by  "Ford"  ^^  and  by  Paragraph  1  in  the  Circular 
No.  27  issued  by  the  Chief  Surgeon  of  A.  E.  F.  ]\ray  13,  1918. 
When  the  commanding  officer  refused  to  allow  me  even  the 
administration  of  the  diet  kitchen  unmolested  by  the  mess 
officer,  I  asked  on  Oct.  29,  1918,  through  proper  channels,  for 
transfer,  but  heard  nothing  of  it. 

That  '^Circular  27"  could  and  did  work  "overtime"  in  some 
instances  may  be  gleaned  from  a  quotation  from  the  report  of 
Sara  Scllers,^^  dietitian,  Base  Hospital  No.  22: 

^"Gertrude  Palmer,  dietitian,  Base  Hospital  Xo.  46.  Complete  report 
on  file  in  the  odice  of  Nutrition  Service,  Red  Cross  National  Headquarters. 

"'•Details  of  Medical  Military  Administration."  by  .Joseph  H.  Ford,  B.S., 
A.M..  M.D..  Col.  Medical  Corps'.  U.  S.  Army.  .July.  1018. 

"Sara  Sellers  (now  ]\Irs.  Arthur  T.  Schunck )  was  born  at  Lebanon.  Ohio. 
She  was  graduated  in  Home  Economics  from  Ohio  State  University  in  V.)\'.i, 
and  later  entered  St.  Luke's  Hospital,  New  York  City,  as  pupil  dietitian. 
Following  tliis  she  was  dietitian  at  Ellis  Hospital.  Schenectady,  N.  Y. 
After  eiglit  months'  work  at  Michael  Reese  Hospital,  Chicago,  she  returned 
to  St.  Luke's  as  head  dietitian,  which  position  slie  held  imtil  she  was 
assigned  to  Base  Hospital  No.  22.  During  her  stay  in  New  York  she 
taught  classes  in  canteen  work  under  the  Y.  \V.  C.  A. 


THE  DIETITIAN  SERVICE  1405 

I  maintained  the  position  of  chief  executive  of  the  kitchen 
and  the  kitchen  personnel.  Both  the  mess  sergeant  and 
kitchen  sergeant  were  responsible  to  my  orders.  Matters  of 
discipline  were  attended  to  by  the  mess  sergeant.  The  mess 
otlicer  acted  as  my  superior  othcer  in  name  only — or  in  such 
instances  as  sending  requests  through  channels,  etc.,  according 
to  Army  routine.  In  all  matters  of  menu,  diet,  sanitation  of 
the  kitchens  and  mess  halls  1  was  responsible.  My  position 
was  maintained  by  the  orders,  support  and  cooperation  of  the 
commanding  ofhcer  and  by  the  loyalty  of  the  mess  sergeant. 

Tiie  kitchen  of  our  original  unit  was  entirely  inadequate 
and  imiwssible.  I  submitted  plans  for  its  reconstruction  and 
personally  supervised  a  group  of  carpenters  who  made  the 
desired  changes.  j\Iy  plans  met  with  the  approval  of  the 
camp  commandant,  also  of  Major  Gore.  The  kitchens 
assigned  to  Unit  22  and  supervised  by  the  mess  department 
of  No.  22  were  constructed  by  the  engineers  according  to  my 
plans.  The  original  plans  contained  :^4-inch  sinks  in  a 
kitchen  which  was  designed  to  serve  1000  patients,  besides 
other  inadequate  fittings.  The  maximum  number  served  from 
the  reconstructed  kitchen  was  3200  patients. 

Between  June  15th  and  30th  I  was  on  temporary  duty  with 
Base  Hospital  Xo.  (5  at  Talance,  Bordeaux.  I  was  ordered  to 
make  a  survey  of  the  kitchens,  mess  halls,  service,  waste, 
sanitation  and  organization.  This  I  did,  and  submitted  a 
formal  report  to  the  commanding  officer,  Colonel  Babcock. 

The  following  graphic  and  altogether  human  description  of 
some  of  her  experiences  as  given  by  Miss  Ilungate,^^  will  be 
of  interest  just  her(>.  Jt  will  be  noted  that  Miss  Hungate  did 
not  sail  for  ovcn'seas  until  Angiist,  1918,  some  time  after  the 
^Military  Department  had  issued  the  order  referred  to  above, 
^liss  Ilungate's  report  read  in  part  as  follows: 

After  a  session  of  several  months  at  Camp  Wheeler, 
Georgia.  1  became  the  one  hundred  and  oneth  feminine  mem- 

"  ^Fary  Taylor  Tltinjrate.  (now  'Sirs.  W.  F.  Bennett  of  Qiiantico,  Vir- 
•rinia  i  was  liorn  in  Ndiraska.  She  was  <rrante(l  tlie  A.H.  dci^rce  from  the 
I'niversity  of  Nebraska  in  1015,  and  following  this  received  a  year  of 
special  training,'  in  dietetics  under  Dr.  Edna  1).  Day  at  tlie  I'niversity  of 
Kansas.  l''or  a  year  and  a  half  she  was  head  of  the  Domestic  Science 
Department  and  manager  of  tlie  school  cafeteria  of  the  Twin  Falls.  Idaho, 
public  schools.  February  1.  1917,  she  was  made  a  sujiervisor  ami  ajrent  of 
the  Redpatli-Horner  Chautauqua.  She  bepan  her  work  as  dietitian  in  the 
army  at  Camp  Wheeler,  (icor<iia,  Marcii  1,  1!)1S.  and  was  sent  to  France 
in  the  fcdlowinj,'  August.  Here  she  serxcd  until  duly.  l!t]!).  Subsequent 
to  her  r(>turn  from  overseas  siie  was  apj)oint('d  to  Walter  Heed  Hospital 
and  later  to  the  I'niteil  States  Army  Department   Hospital  al  Hcjnolulu. 


1406  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ber  of  Base  Hospital  Xo.  51,  an  organization  which  originated 
in  Boston,  but  which  contained  about  thirty  others  who,  like 
myself,  Avell  remember  tbeir  first  trip  east  to  Chicago.  The 
doctors  and  hospital  corpsmen  of  the  unit  were  sent  overseas 
first,  while  the  nurses  were  retained  in  New  York,  being  out- 
fitted with  uniforms  and  schooled  in  military  drill.  The 
hundred  nurses  all  wore  street  uniforms  of  blue  serge,  blue 
velour  hats  and  tan  shoes;  while  I,  the  dietitian,  the  one 
hundred  and  oneth,  was  duly  fitted  out  in  a  similar  suit  of 
gray,  a  black  hat  and  black  shoes.  Tbere  was  no  question 
about  it,  I  was  the  odd  member  of  the  family ;  my  clothes 
served  only  to  indicate  that  I  was  with,  but  not  of  the  unit. 
Furthermore,  no  one  seemed  to  know  just  what  I  was  there 
for,  or  just  what  to  do  with  me  after  I  arrived.  But  during 
those  long  hours  of  drill  in  tlie  hot  Armory,  I  was  in  my 
glory,  because  the  officer  in  charge  divided  us  into  squads 
according  to  our  heights,  and  my  gray  uniform  was  permitted 
to  blend  inconspicuously  with  the  blue  ones.  At  last  our  flag 
was  dedicated,  our  trunks  and  suitcases  locked,  our  days  of 
drill  were  over  and  we  were  to  embark  for  ''overseas,'*  We  had 
spent  hours  in  that  sweltering  Armory  practicing  the  process 
of  embarking,  with  military  precision,  on  an  imaginary  boat, 
and  when  the  great  day  arrived  we  were  all  ready  to  swing  into 
formation  and  march  up  the  gangplank  like  a  group  of  vet- 
erans. But  how  different  was  the  reality!  We  stood  for 
hours  down  at  the  pier  at  Hoboken.  (I  remember  that  I 
perspired  entirelv  through  the  back  of  my  only  gray  silk 
blouse,  which  turned  it  a  brilliant  henna,  but  nevertheless  I 
dressed  up  in  said  blouse  for  the  ensuing  six  months). 
Finally,  they  admitted  us  to  the  boat.  Oh,  the  tragedy  of  it 
all!  Those  hours  of  rehearsal  were  forever  wasted,  because, 
instead  of  forming  into  squads  and  marching  double-file  up 
the  gang-plank,  we  scurried  in  through  a  coal-hole  doA\n  in  the 
bowels  of  the  ship,  and  T,  with  my  gray  suit  and  black  hat, 
trailed  in  the  rear  as  pleased  as  Punch  over  being  allowed  to  go 
along,  even  thougli  no  one,  myself  included,  had  any  definite 
ideas  about  just  what  T  was  going  to  do. 

Miss  Hnngate's  storv  jfs  it  proceeded  showed  that  once  mor3 
the  "one  hundred  and  oneth"  was  found  mingling  inconspicu- 
ously with  the  "hundred." 

My  chronicle  must  inchifle  a  sketch  of  the  welcome  we 
received  when  we  arri\ed  at  Brest,  in  August,  1918.  At  that 
time  Brest  was  not  considered  the  most  attractive  place  in 
France,  and  T  am  positive  tluit  it  was  never  slandered.     We 


THE  DIETITIAN  SERVICE  1407 

left  the  Ship  La  France  in  "lighters"  and  soon  had  parked  our 
suitcases  on  the  pier,  used  same  lor  convenient  seats  and  set- 
tled down  in  the  drizzle  awaiting  the  appearance  of  Army 
trucks  to  carry  us  up  to  Pontanezan  Barracks,  where  we  were 
to  be  quartered.  Our  numbers  were  now  303,  as  units  Xo.  55 
and  No.  50  were  in  our  convoy.  Finally  a  train  of  huge 
trucks  put  in  an  appearance  and  I  think  that  most  of  us 
received  a  real  thrill  as  we  bumped  along  over  the  cobble- 
stones to  our  destination.  From  every  liouse  and  shop  were 
excited  groups  of  French  waving  the  Tricolor  or  the  Stars  and 
Stripes  and  shouting  a  welcome  to  the  American  women.  We 
waved  our  flags  and  shouted  ourselves  hoarse  in  return.  By 
the  time  we  reached  Pontanezan  Barracks  we  were  all  su- 
premely pleased  with  ourselves  and  camped  on  our  suitcases 
in  front  of  Xapoleon's  old  headquarters,  indifferent  to  the 
drizzle  overhead  and  unconscious  of  the  consternation  we 
were  causing  within  the  historic  old  building.  But  when  three 
hours  had  elapsed  without  any  disposition  being  made  of  us 
we  began  to  notice  that  our  "dress  up"  uniforms  were  becom- 
ing slightly  damp  and  that  mess  call  would  not  be  unwelcome. 
Finally  a  second  lieutenant  stepped  out  from  headquarters 
and  looked  us  over:  three  hundred  and  three  women  deject- 
edly sitting  on  suitcases  awaiting  their  fate.  He  did  not  seem 
pleased  with  our  appearance,  for  after  an  audible  "My  God ! 
Three  hundred  women  I"  he  turned  his  back  and  went  inside. 
It  seemed  tliat  we  were  not  expected ;  in  fact,  previous  to  this 
time  but  one  group  of  women  had  landed  at  Brest,  the  other 
detachments  having  gone  by  wa}-  of  Southampton  and  Le 
Havre.  ^Moreover,  at  that  particular  instant  one  hundred 
thousand  American  troops  were  wallowing  in  the  Brittany 
mud  and  under  such  circumstances,  tlie  problem  of  finding 
shelter  for  three  hundred  women  extra  was  a  serious  one 
indeed.  But  the  impossible  was  accomplished  and  we  were 
quartered  in  some  partly  constructed  hospital  wards  which 
furnished  us  with  bods  and  slielter  even  though  they  did  not 
provide  so  necessary  a  convenience  as  a  water  supply  for  the 
first  twelve  hours. 

Base  ITospital  Xo.  51  was  one  of  the  eight  hospitals  which 
coni])rise(l  the  Justice  Hospital  group  just  outside  the  city  of 
Toiil.  .  .  .  Our  unit  arrived  here  at  three  o'clock  in  the 
morning  of  Sept.  11,  1918.  The  memorable  San  ^riliiel  drive 
began  on  the  Iv'th  and  before  we  had  time  to  get  our  bearings 
we  were  fairly  inundated  by  the  stream  of  patients  which 
poured  in  almost  incessantly  for  four  days  and  nights.  ...  I 
had  no  time  to  draw  up  a  jilan.  to  perfect  an  organization,  or 
to    do   anything   except    the   work    that   crowded    me   at   the 


1408  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

moment.  I  was  given  a  range  in  one  corner  of  the  main 
kitchen.  At  first  my  only  helper  was  a  walking  patient,  a  lad 
who  had  been  gassed  and  who  was  notoriously  slow  both  in 
thought  and  in  action.  Later  he  was  reinforced  by  two 
French  women  who  gave  very  good  assistance  though  they 
were  not  cooks  nor  could  they  understand  English.  There 
was  one  thing  that  we  did  accomplish  all  through  this  busy 
time  and  that  was  to  always  have  a  boiler  of  hot  cocoa  or  soup 
available  in  the  receiving  ward.  The  condition  of  the  patients 
as  tliey  were  admitted  was  most  pitiable,  all  were  hungry  and 
had  been  without  hot  food  for  days.  The  physicians  decreed 
that  tlie  hot  drink  was  advisable  even  for  those  that  went 
direct  to  the  operating  room  and  for  those  cases  which  did  not 
demand  immediate  surgical  attention  we  supplied  bread  and 
jam  in  addition. 


Miss  Hungate's  report  also  indicated  a  rather  free  interp; 
tation  of  the  prerogatives  of  a  "civilian"  employee  in  the  Arm 


^- ^re- 

lian"  employee  in  the  Army : 

On  October  the  sixth  I  was  given  two  very  small  rooms  on 
the  first  floor  of  the  main  hospital  building  for  a  diet  kitchen 
and  with  my  gassed  cook  and  two  French  women  I  moved  in. 
This  moving  was  a  verj'  simple  process,  as  I  was  given  no 
utensils  lo  work  with,  and  it  was  with  difficulty  that  we 
borrowed  (?)  a  few  necessary  articles  from  the  already  inade- 
quate supply  of  the  main  kitchen.  ...  To  add  to  the  diffi- 
culties was  the  omnipresent  lack  of  water.  The  French 
always  retained  the  control  of  the  water  supply  and  the  only 
hours  that  it  could  be  drawn  were  from  seven  to  ten  in  the 
morning  and  from  three  to  five  in  the  afternoon.  Often  the 
water  would  be  shut  off  before  we  had  even  filled  the  G.  I. 
cans,  which  never  seemed  to  hold  enough  even  when  full.  I 
added  to  my  meager  store  of  kitchen  utensils  by  making  a 
personal  trip  to  the  group  supply  warehouse  and  persuading 
the  officer  in  charge  to  give  me  what  he  had.  I  had  no  au- 
thority for  drawing  these  precious  articles,  so  did  not  trust 
them  to  our  own  supply  sergeant  for  delivery  (lie  had  too 
many  equally  insist'^nt  demands  for  them  and  would  have 
assuredly  divided  them  among  the  three  other  kitchens),  so  I 
had  them  borne  to  my  kitchen  on  a  litter  and  settled  with  the 
Quartermaster  later. 

^fiss  Hungate's  story  of  the  Thanksgiving  dinner  of  Base 
Hospital  No.  51  is  full  of  human  interest: 

Tlianksgiving  day,  1018.  will  always  be  a  "red-letter"  dav 
in  mv  memorv.     The  war  was  at  last  over ;  Thanksgiving  had 


THE  DIETITIAN  SERVICE  1409 

attained  a  new  significance.  Base  Hospital  51  planned  to 
celebrate  with  food,  and  every  delicacy  that  would  add  to  our 
dinner  was  purchased,  regardless  of  cost.  The  kitchen  forces 
worked  overtime,  cooks  labored  all  night  in  order  to  insure  a 
quarter-section  of  pumpkin  pie  to  every  patient  that  could 
eat  same  with  even  a  semblance  of  impunity.  The  wards  took 
on  a  most  festive  appearance  as  the  "up  patients"  decorated 
them  lavishly  with  greens,  ornaments  made  from  Ilershey 
wrappers  or  other  bright  materials,  and  the  frames  that  sup- 
ported those  poor  wrecks  of  crippled  bodies  were  festooned  like 
carnival  bootiis.  But  on  Thanksgiving  eve,  we  girls  received 
a  shock  that  almost  brought  tears.  A  hospital  train  was  due 
in  the  early  morning  and  three  hundred  of  our  patients  were 
to  leave  for  a  port  of  embarkation.  It  seemed  hard  to  send 
those  lads  away  without  their  feast.  Some  of  them  had  been 
in  the  hospital  for  weeks  and  had  not  grumbled  even  when  the 
fare  was  both  meager  and  monotonous.  The  goody  box  which 
the  nurses  had  packed  in  New  York  had  been  set  aside  for 
Thanksgiving,  and,  on  hasty  consultation,  we  decided  to 
devote  its  contents  m  preparing  a  treat  for  those  patients. 
Some  of  the  girls  made  fudge  and  the  Red  Cross  provided 
cigarettes  and  matches,  so  when  those  men  lined  up  for 
evacuation  the  next  morning  the  nurses  were  there  with 
cornucopias  of  goodies  and  each  patient  was  sent  away  with  the 
"bon  voyage"  of  his  floor  nurse  ringing  in  his  ears.  The  hand 
of  fate  seemed  mysteriously  to  evacuate  those  patients  on  that 
particular  morning,  for  by  the  time  that  dinner  was  to  be 
served  their  number  was  almost  replaced  by  the  raggedest, 
most  forlorn  bunch  of  stragglers  I  have  ever  seen.  They  were 
for  the  most  part  British  soldiers,  filthy,  hungry  and  footsore. 
Some  had  spent  four  years  of  hard  labor  in  the  salt  mines 
of  Metz,  and  when  the  Germans  gave  them  their  freedom 
they  set  forth  without  rations,  proper  shoes  or  transporta- 
tion. Our  hospital  sheltered  over  two  hundred  of  tlicse  ex- 
prisoners,  gave  them  baths,  clean  clothing  and  beds,  and,  l)est 
of  all.  was  able  to  share  the  turkey  and  goose  and  pumpkin 
pic.  Had  it  not  been  for  the  timely  evacuation  of  the  morning 
we  would  have  been  forced  to  feed  tliem  the  "corned  willie," 
the  hardtack  and  coffee  of  an  emergency  moal.  I  have  never 
seen  a  more  cosmopolitan  gathering  seated  around  a  single 
board  than  the  one  which  graced  the  table  after  the  "chow" 
had  been  sent  out  and  the  kitchen  force  sat  down  to  its  feast. 
Beside  the  student  from  Colgate,  who  had  enlisted  in  the  hos- 
pital corps  in  order  to  drive  an  ambulance,  sat  an  ex-acrobat 
from  Ringling's.  The  cooks,  ono  handsome  Italian,  one  F.ast 
Side  Jew.  a  \'iri!;inia  neiiro  and  an  An<:li)-Sax(in  who  liad  for- 


1410  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

merly  labored  in  a  Kentucky  brewery,  occupied  the  seats  of 
honor.  The  three  "Hinies,"  prisoners  of  war,  whom  we  all 
liked  and  respected  in  spite  of  race  prejudice;  one  Russian,  a 
lad  whom  we  had  adopted  after  his  daily  pilfer  of  our  garbage 
cans  and  who  never  did  learn  to  savvy  the  strange  tongues 
which  surrounded  him;  and  three  volatile,  chattering  French 
women. 

Miss  Hiingate  quoted  a  stock  query  from  mess  sergeants,  with 
her  equally  stock  responses;  also  a  few  other  amusing  notes 
are  included: 

"Now,  Lady,  would  you  mind  explaining  to  me,  just  what  is 
a  'dietitian  ?'  You  see,  you  are  the  first  one  of  your  kind  I 
have  ever  met,  and  I  would  really  like  to  know  what  you  do  ?" 

"Certainly.  A  dietitian  is  a  'lady  mess  sergeant.'  The 
female  of  the  species  is  more  deadly  than  the  male — that's 
why  they  invited  us  to  come  to  war."' 

A  mess  officer,  evidently  not  speaking  under  instructions 
from  the  chief  nurse,  said  to  a  dietitian  who  reported  to  him 
for  duty :  "We  have  enough  'diet  cooks.'  Hadn't  you  rather  do 
nursing  on  the  wards  ?"  But  it  is  to  be  assumed  that  here, 
again,  the  function,  if  not  the  status,  of  the  dietitian  was  pre- 
sented convincingly,  in  view  of  the  fact  that  the  hearty  co- 
operation of  the  mess  officer  was  soon  accorded  to  this  dietitian 
in  her  work. 

]\Irs.  Thurman,  of  Base  Hospital  No.  41,  reported : 

Many  funny  things  happened,  but  one  thing  stays  in  my 
mind  most.  I  was  relieving  a  nurse  in  one  of  the  wards,  taking 
care  of  a  patient,  a  dear  boy,  just  eighteen,  who  was  coming 
out  from  under  ether.  He  was  making  a  lot  of  noise,  and  I 
said,  "Oh,  Earl,  do  be  quiet;  just  remember  the  boy  next  to 
you,  whose  back  is  almost  blown  away,  and  he  is  not  scream- 
ing."   He  replied,  "Yes !  but  that's  him,  and  this  is  me."  .  .  , 

This  from  Ruth  Shott,  of  Evacuation  Hospital  Xo.  19 : 

One  mess  officer  insisted  on  serving  tripe  to  all  patients 
because  it  was  cheap  and  he  had  purchased  an  oversupply. 

And  this  from  ]\Iiss  Palmer: 

There  was  Aimce,  our  gay,  cheery  little  French  helper,  wlio 
had  lost  cvervtliing  in  the  war.     The  bovs  all  studied  French 


THE  DIETITIAN  SERVICE  1411 

in  order  to  talk  with  her  and  wrote  out  little  notes  from  their 
French  books  for  her.  She  promised  to  go  back  to  America 
with  mo,  but  she  married  the  mess  sergeant  and  came  home 
with  him  instead. 

In  passing,  a  brief  quotation  from  Bertha  Baldwin,  whose 
report  follows,  is  respectfully  referred  to  whom  it  may  concern : 

Just  as  I  was  leaving  one  hospital,  the  commanding  oflicer, 
in  obedience  to  a  general  order  just  gone  out  from  ]Iead- 
quarters,  asked  me  to  assist  with  the  general  mess.  The  mess 
officer  was  a  doctor,  a  specialist  in  nose  and  throat,  but  knew 
nothing  about  foods  and  kitchens.  The  acting  mess  sergeant 
was  an  ex-butcher,  and  he  it  was  who  made  out  the  menus. 

An  account  of  the  work  of  the  dietitians  who  served  directly 
under  the  Red  Cross  overseas  would  constitute  an  entire  chapter 
in  itself.  A  formal  report  of  the  Diet  Kitchen  Service  was  sub- 
mitted to  the  Red  Cross  by  Bertha  Baldwin,^^  Red  Cross  dieti- 
tian; also  Miss  Baldwin  furnished  the  Bureau  at  Xational 
Headquarters  with  a  more  personal  account  of  her  sixteen 
months  of  service.  In  the  interest  of  brevity  excerpts  are  made 
in  order  from  these  reports : 

The   Diet   Kitchen    Section   was  organized   in   September, 

1917,  as  a  part  of  the  Medical  and  Surgical  Division  of  the 
Department  of  ^lilitary  Affairs,  with  ^Iiss  Ruth  Morgan  as 
chief.  The  personnel,  American  Red  Cross  registered  dieti- 
tians sent  from  the  United  States  and  auxiliary  dietitians 
recruited  in  France,  were  attached  directly  to  the  section 
registering  with  the  main  Bureau  of  Personnel.  When  the 
Women's  Bureau  of  Hospital  Service  was  established  in  July. 

1918,  the  Diet  Kitchen  Section  still  remained  a  part  of  tlie 
^Medical  and  Surgical  Division. 

On  August  24th,  1918,  in  the  reorganization  of  the  Ameri- 
can Rod  Cross  the  Service  of  Diet  Kitchens  remained  under 

"  Bertlia  X.  I'aldwin  was  born  in  Cloverdale.  Cowley  County,  Kansas. 
Slic  was  <rra(luati'(l  from  Milwaukco-Downer  Collej^o,  Milwauki'f.  Wis.,  and 
in  1909  received  tlie  B.S.  degree  at  Teachers  College,  Colunihia  University, 
N.  V.  City.  She  also  jjursiied  graduate  work  at  Columbia  liiiversity  Fel).. 
191")  and  Feb..  191t!.  She  held  the  following  j^ositions  before  guiiig  overseas: 
asst.  dietitian.  X.  V.  City  Hospital,  BlaekwelTs  Island.  Sept..  1!)0!)  to  Jan.. 
1910;  dietitian.  Jewish  Hospital,  Brooklyn,  1910:  asst.  superintendent. 
Manhattanville  Day  Xursery,  X.  Y.  C,  Angnst.  1914.  to  Jan..  191.");  in- 
structor in  dietetics,  Sciiool  of  Home  lu-onomics.  Hattlc  (reek  Sanitarium. 
I91t)  to  1917.  Sailed  for  France  February  8.  191S  for  service  under  the 
American    Red    Cross. 


1412  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

the  Bureau  of  Hospital  Administration  of  the  Medical  and 
Surgical  Department,  but  the  dietitians  were  placed  under  the 
Bureau  of  Nurses. 

On  January  14,  1919,  by  order  of  the  director  of  the 
Medical  and  Surgical  Department,  the  Service  of  Diet 
Kitchens  was  placed  under  the  Bureau  of  Nurses  in  order  to 
have  the  work  more  closely  connected  with  the  personnel  of 
dietitians. 

On  February  1,  1919,  the  Dietitian  and  Diet  Kitchen  Serv- 
ice were  a  part  of  the  Bureau  of  Nurses. 

The  service  totaled  20  dietitians,  assistant  dietitians  and 
auxiliary  dietitians. 

The  demands  for  dietitians  far  outnumbered  the  personnel 
available.  Although  most  base  hospitals  had  brought  over 
dietitians  on  the  staff,  all  new  hospitals,  base,  camp  and 
American  Red  Cross,  did  not  have  them.  The  dietitian's 
work  justified  itself  sufficiently  to  create  a  demand  for  larger 
personnel  of  trained  professional  workers. 

ACTIVITIES 

The  work  of  the  service  started  by  cooperating  with  other 
organizations  and  individuals  for  diet  kitchens  in  French 
hospitals.  At  the  same  time  plans  for  the  work  with  the 
A.  E.  F.  were  formed. 

The  first  activity  of  the  diet  kitchen  section  was  its  coopera- 
tion with  the  Bien-etre  du  Blesse  in  installing  diet  kitch- 
ens in  French  hospitals.  This  was  suggested  as  early  as  Aug- 
gust,  1917,  and  on  December  21,  1917,  the  formal  agreement 
was  signed  between  Madame  la  ]\Iarquise  d'Andigne  for  the 
Bien-etre  du  Blesse  and  Miss  Ruth  Morgan  for  the  Ameri- 
can Red  Cross. 

In  February,  1918,  an  American  Eed  Cross  dietitian  {^liss 
Baldwin  herself)  was  assigned  to  the  Bien-etre  du  Blesse  to 
supervise  the  American  Eed  Cross  interests  in  the  kitchens. 
She  was  made  chief  dietitian  of  the  Bien-etre  du  Blesse 
(dietitian  en  chef)  and  organized  and  supervised  the  work  of 
all  the  kitchens  on  American  dietary  lines  adapted  to  the 
French  military  hospital  conditions. 

From  a  geiicral  point  of  view  the  work  was  most  satisfac- 
tory and  useful  for  the  very  sick  and  wounded,  although  it 
never  reached  the  scientific  basis  found  in  the  States.  Tlie 
American   Ked   Cross  ceased  its  cooperation   in  maintaining 


THE  DIETITIAN  SERVICE  1413 

these  kitchens  on  February  1,  1919,  and  considered  it  a  priv- 
ilege to  hand  over  the  equipment  and  remaining  food  stuff  to 
the  Service  de  Sante  for  further  use. 

Through  tlie  service,  15  dietitians  or  auxiliary  dietitians 
were  supplied  to  the  hospitals  of  the  A.  E.  F.  and  if  the 
personnel  had  permitted  many  more  requests  would  have  been 
tilled. 

Diet  kitchens  were  installed  in  several  hospitals,  and  dieti- 
tians or  auxiliary  dietitians  assigned  for  the  work.  Two 
dietitians  were  assigned  to  organization  work  of  American 
lied  Cross  diet  kitchens  in  A.  E.  F.  hospitals. 

At  St.  Xazaire  the  dietitian  ^^  advised  in  the  building  of  a 
big  main  kitchen,  organized  a  cafeteria  mess  for  1000  con- 
valescent patients,  organized  a  complete  diet  kitchen  and 
serving  room  which  served  from  -400  to  500  individual  diets. 
She  also  standardized  diets  in  hospitals  and  did  advisory  work 
for  neighboring  camp  hospitals. 

...  in  the  hospital  at  Komorantin  and  the  officers'  hospi- 
tal in  Paris,  the  auxiliary  dietitians  did  splendid  work  in 
catering  to  the  very  sick  men,  cooking  and  serving  American 
delicacies. 

Through  the  Bureau  of  Hospital  Administration  the  dieti- 
tians commenced  cooperating  in  the  food  and  nutritive  prob- 
lems of  all  hospitals  under  the  American  Red  Cross.  Plans 
for  standardizing  rations  and  menus,  for  administering  the 
food,  departments  in  the  hospitals  and  for  regulating  the  req- 
uisitions and  purchases  of  foods  were  under  way  in  Novem- 
ber at  the  time  of  signing  of  the  Armistice.  .  .  . 

In  June,  1918,  the  commissioner  received  a  request  from 
the  Army  that  the  American  Red  Cross  purchase  equipment 
for  100  diet  kitchens  to  be  donated  to  the  Army  on  the  requi- 
sitions approved  l)y  the  Chief  Surgeon's  office,  Tours.  The 
list  for  such  equipment  was  immediately  made  by  an  Ameri- 
can Red  Cross  dietitian  and  the  equipment  ordered. 

One  of  the  America]i  Red  Cross  representatives  attached  to 
tlie  Second  Army  Cor])s  serving  witii  the  B.  1^.  F.  asked  in 
SeptcniK'cr.  li»lS,  if  the  American  Red  Cross  could  train 
soldier  cooks  in  special  cooking  for  the  sick,  so  tliat  men 
having  slight  cases  of  grippe,  dysentery,  etc.,  could  have  the 
projier  foods  in  their  regiments  and  thus  avoid  being  sent 
back  to  the  base  hospital.  Plans  were  worked  out  between  the 
Laura  J.  Hawlov. 


1414  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

chief  surgeon  of  the  Second  Army  Corps  and  the  chief  of  the 
Diet  Kitchen  Service,  and  an  American  Red  Cross  dietitian 
arranged  a  two  weeks'  course. 


GENERAL  WORK  AT  G.  H.  Q. — A.  R.  C. 

To  this  service  was  referred  the  many  questions  and  de- 
mands of  a  dietetic  nature  that  came  in  to  General  Head- 
quarters. A  dietitian  was  practically  always  attached  to  the 
office  or  available  through  the  courtesy  of  the  chief  of  the 
Bureau  of  Hospital  Administration.  The  requirements  of 
food  per  month  of  the  American  Red  Cross  hospitals  and  of 
nurses'  homes  were  estimated,  the  menus  of  various  hospitals 
looked  up  and  sent  out  on  request. 

In  spite  of  limited  personnel  and  difficulties  of  obtaining 
food  and  equipment,  the  dietitian  and  Diet  Kitchen  Service 
thoroughly  justified  itself  and  was  of  inestimable  value  to  the 
Army.  The  appreciation  of  the  French  Government  encour- 
ages the  Service  to  hope  that  the  work  thus  started  wall  be  of 
lasting  value. 

Some  idea  of  the  operation  by  the  American  Red  Cross  of 
diet  kitchens  in  Army  hospitals  may  be  gleaned  from  the 
following  excerpts  from  General  Instruction,  507,  issued  by 
the  approval  of  C.  C.  Burlingame,  Director,  Medical  and 
Surgical  Department,  and  included  in  Miss  Baldwin's  official 
report : 

In  certain  instances  the  American  Red  Cross  furnishes 
equipment  for  the  diet  kitcheiis  in  the  American  Army  hos- 
pitals, and  in  addition  may  furnish  special  diet  materials  for 
their  operation ;  and  may  also  assign  personnel.  When  op- 
erated by  the  American  Red  Cross  in  Army  hospitals  diet 
kitchens  shall  be  under  the  Bureau  of  Xurses,  Medical  and 
Surgical  Department. 

Equipment  for  diet  kitchens  should  be  issued  only  upon  the 
request  of  the  commanding  officer  with  tlie  further  approval 
of  the  Chief  Surgeon  of  the  Army,  or  the  chief  surgeon  of 
the  section  in  which  the  hospital  is  located. 

The  personnel  for  operating  these  diet  kitchens  consists 
either  ot  dietitians,  nurses  or  iiurses'  aides,  with  dietary  expe- 
rience. All  personnel  for  this  purpose  will  be  supplied 
througii  the  Hurcjui  of  Xurses.  The  personnel  so  assigned  to 
the  commanding  officer  will  necessarily  conform  to  all  regu- 


THE  DIETITIAN  SERVICE  1415 

lations  concerning  conduct  and  hours  of  duty  of  nurses,  as  laid 
down  by  the  commanding  officer  and  chief  nurse  of  that 
hospital. 

The  American  Red  Cross  in  placing  these  special  diet 
kitchens  in  Army  hospitals  is  not  attempting  to  operate 
within  the  hospitals  independently  of  tiie  commanding  officer. 
It  must,  therefore,  be  remembered  that  the  American  Red 
Cross  is  operating  the  diet  kitchens  as  a  part  of  tiie  hospital, 
entirely  under  the  established  hospital  administration. 

The  purpose  of  establishing  these  diet  kitchens  functioning 
exclusively  under  the  Medical  and  Surgical  Department  is  to 
provide  special  foods  for  the  sick.  They  should  not  be  diverted 
from  this  purpose  and  become  canteens.  The  diet  kitchen 
becomes  an  official  part  of  the  hospital  and  in  serving  food  to 
the  sick  must  be  closely  supervised  by  the  officials  of  the 
hospitals. 

In  her  personal  account  Miss  Baldwin  says : 

The  fall  of  1917,  when  the  American  Red  Cross  began 
preparing  for  the  year's  work,  plans  were  made  for  special 
foods  for  the  future  sick  and  wounded,  and  through  the  Bien- 
etre  du  Blesse — a  Franco-American  society — diet  kitcliens 
were  subsidized  for  P>ench  hospitals.  The  needs  of  the 
American  hospitals  when  our  Army  would  be  needing  their 
services  were  arranged  for.  In  December,  1917,  trained 
registered  dietitians  were  cabled  for. 

...  I  was  the  first  to  be  sent  over  for  American  Red  Cross 
work,  arriving  February  19,  1918. 

I  was  loaned  to  the  Bien-etre  du  Blesse  to  look  after  the 
American  Red  Cross  interests,  under  ^liss  Ruth  ^lorgan,  chief 
of  the  diet  kitchen  section,  under  Dr.  Burlingame.  The 
Bien-etre  du  Blesse  made  me  chief  dietitian  to  install  and 
organize  and  supervise  all  their  diet  kitchens,  to  standardize 
the  equipment,  the  diets,  the  menus  and  the  reci])es.  ...  1 
was  transferred  temporarily  to  American  service — American 
Red  Cross  Hospital  Xo.  101.  The  men  who  had  volunteered 
for  the  trench  fever  experiment  had  just  been  sent  out.  about 
70  in  number,  and  I  assisted  in  the  food  part  of  tlie  work. 

.  .  .  The  greater  part  of  June  and  July.  I  was  at  American 
Red  Cross  ^lilitary  Hospital  Xo.  3  (Officers),  Paris.  1  went 
over  to  install  and  organize  a  diet  kitchen.  i)ut  took  cliargt'  of 
the  main  kitchen  with  soldier  cooks  when  the  Fr.Mich  t'hef  and 
his  assistants  left,  and  later  was  asked  by  the  C.  O.  to  assist 
the  mess  ofhcer  for  tlie  general  mess  in  tlic  main  kitclien. 
Although  the  hospital  was  not  a  large  one.  it  was  overcrowded 


1416  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  the  cooking  facilities.     I  was  acting  chef  for  a  couple  of 
weeks  until  permanent  arrangements  could  be  made. 

In  September,  Dr.  Burlingame,  chief  of  the  Bureau  of 
Hospital  Administration  of  the  Medical  and  Surgical  Depart- 
ment, asked  for  my  assignment  as  dietitian  for  the  bureau  to 
aid  in  the  food  situation  in  all  American  Red  Cross  hospitals. 
I  continued  the  work  I  had  begun  on  rations  and  menus.  As 
this  work  was  entirely  organized,  it  was  stopped  by  the 
Armistice. 

Since  all  work  in  the  military  line  was  practically  finished, 
in  February  I  was  assigned  to  the  Social  Center  of  the  chil- 
dren's work  in  the  19th  Arrondissement.  The  food  clinic  for 
the  three  dispensaries  was  held  there,  with  food  consultations 
for  mothers,  and  a  feeding  class  for  undernourished  children, 
and  conferences  with  mothers  and  teachers  were  to  be  devel- 
oped. The  middle  of  April  the  organization  of  the  work  was 
entirely  changed  and  my  work  finished.  At  this  time  a 
Frenchman,  executive  secretary  of  a  large  society  interested 
in  nutrition  and  hygiene,  asked  for  my  services  to  give  lec- 
tures at  the  Academy  of  Medicine  on  the  work  of  the  die- 
titians at  home.  The  American  Red  Cross  did  not  feel  that 
this  could  be  arranged,  as  the  bureaus  were  closing  so  soon. 

Miss  Baldwin's  concluding  paragraph  is  of  interest  as  it 
expressed  the  opinion  of  a  woman  of  broad  general  training  as 
well  as  special  training  in  her  profession : 

Dietitians  were  needed  very  badly  in  every  American  Red 
Cross  department  and  bureau  which  had  to  do  with  food,  as 
well  as  in  the  hospitals.  Food  was  too  scarce  to  waste,  and 
those  untrained  in  food  lines  cannot  appreciate  the  value  and 
possibilities  of  foods.  If  there  could  liave  l)een  a  Food  Bureau 
which  handled  and  supervised  food  stuffs  for  all  departments 
— buying,  standardizing  of  recipes,  menus,  rations,  etc.,  with 
people  trained  scientifically  and  practically,  it  would  have 
been  quite  worth  while.  In  the  hospitals  dietitians  are  indis- 
pensable, bec-ause  neither  soldier  cooks  nor  French  chefs  (no 
matter  liow  good  their  cooking)  can  appreciate  what  sick  men 
need  or  want.  Even  in  the  staff  mess  for  doctors,  nurses  and 
men,  the  dietitian  has  proved  herself  invaluable.  There  were 
continuous  demands  from  the  Army  for  dietitians.  If  the 
American  Red  Cross  could  have  developed  the  Dietitian 
Service,  a  most  vital  part  of  war  work  would  have  been 
reached. 


THE  DIETITIAN  SERVICE  1417 

Personally  1  have  enjoyed  immensely  my  service  in  France. 
All  my  work  has  been  professional,  which  only  a  dietitian 
could  have  done.  Because  of  that  1  felt  as  if  I  were  really 
of  use. 

Sprightly  echoes  of  Miss  Baldwin's  report  may  be  traced  in 
the  following  extracts  from  a  letter  written  by  Laura  J.  Haw- 
ley  ^'  to  Miss  George,  under  date  of  September  9,  1918,  Paris: 

I  told  you  of  the  joyful  welcome  I  received  at  Red  Cross 
headquarters  when  1  arrived — because  I  was  to  work  with  the 
French — and  how  in  the  twinkling  of  an  eye  they  mysteriously 
changed  their  attitude  and  asked  me  to  go  into  a  base  hos- 
pital. 

I  was  very  much  disappointed.  For  that  reason,  I  investi- 
gated the  situation  as  thoroughly  as  I  could.  I  spent  some 
time  with  Miss  Baldwin  and  found  out  just  what  she  had  done. 

...  to  go  back  a  long  way — the  original  cable  for  six 
dietitians  came  about  in  this  way :  ^Ime.  d'Andigne  found  her 
work  growing  rapidly  and  was  unable  to  get  suitable  assist- 
ants. She  therefore  came  to  an  agreement  with  the  Red  Cross 
by  which  they  supplied  the  dietitians  and  a  certain  amount  of 
equipment,  I  believe — and  she  supplied  the  food — for  the  diet 
kitchens  and  paid  the  dietitians.  Sliortly  afterward  she  de- 
cided to  use  volunteers  and  a  second  cable  was  sent  asking  for 
volunteers. 

There  was  more  or  less  friction  and  a  good  deal  of  feeling 
on  the  part  of  the  Red  Cross  that  ^Ime.  d'Andigne's  work  was 
too  slow  in  being  organized.  ^liss  Baldwin  in  the  meantime 
fitted  in  very  liappily.  pleasing  both  factions,  though  ^liss 
INIorgan  felt  things  went  pretty  slowly — through  no  fault  of 
Miss  B.'s  of  course. 

Then  I  appeared.  ]\liss  ^Morgan  and  Mmc.  d'Andigne  got 
together.  (Both  of  these  women  are  exceedingly  erratic  and 
altogether  chnrming.)  The  outcome  of  the  interview  was  that 
for  the  time  the  Red  Cross  decided  to  open  no  more  kitchens 
imdcr  tlie  Bien-rire  du  BJes.'^e.  ^Ime.  d'A.  offered  to  pay  me 
a  salary  and  put  me  at  once  at  the  front  in  a  diet  kitclien  if  I 
would  leave  tlie  Red  Cross,  rather  if  1  could  leave.  She  was 
not  asking  me  to  leave.  She  told  me  she  was  anxious  to  have 
graduate  dietitians  and  could  pay  them  li(>rsolf. 

"Laura  .Tay  llawley  was  l)orn  in  Salt  Lake  City.  Slio  studied  at 
■Rockford  (Illinois)  C'ollopo  and  at  Stout  Institute.  Menomonie.  Wis.  She 
acted  as  dietitian  for  the  Oirton  School  at  Winnetka.  111.  and  also  for  the 
Conprepational  Trainin;:r  Scliool.  Cliicajio.  Her  military  order  states, 
"Vou  will  sail  April   10,   1918.  for  service  in   French  military  hospitals.'" 


14.18  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Through  her  wide  social  acquaintance  she  has  the  entree 
into  many  French  hospitals  where  the  American  Red  Cross 
cannot  go  at  all — that  is  why  the  American  Red  Cross  has  co- 
operated with  her. 

All  this  sounds  very  mixed  up  and  is  mixed  up — but  so  is 
the  whole  situation. 

I  was  sent  to  St.  Xazaire,  where  the  Army  has  a  regular 
Army  hospital — not  a  Red  Cross  one.  The  C.  0.  had  asked 
frantically  for  a  Red  Cross  dietitian — and  I  was  loaned.  Dr. 
Burlingame  said  I  could  make  the  job  as  big  as  I  wanted  to, 
for  the  proposition  was  probably  the  worst  in  France.  All  I 
can  say  is  that  /  hope  it  was  the  worst. 

Quite  unoflficially  I'll  tell  you  the  sewer  was  backed  up  4 
inches  in  the  basement  kitchen,  where  the  cooking  was  done 
in  garbage  cans.  The  food  was  frightfully  prepared.  The 
officers'  trays  were  impossible. 

Everything  is  wretchedly  slow  over  here — but  this  is  what  I 
have  done.    I  am  afraid  you  will  not  think  it  is  very  much. 

1.  Built  new  kitchen  for  enlisted  men's  mess  (conva- 
lescent), introducing  cafeteria  system  of  service, 

2.  Had  new  diet  slips  printed. 

3.  Built  and  equipped  diet  kitchen  and  serving  rooms. 

4.  Standardized  liquid  and  soft  diets. 

5.  Invented  system  for  serving  soft  diets  directly  from 
diet  kitchen  to  patients  in  outlying  shacks.  (Official 
report  has  been  made  on  this  to  A.  E.  F.  Headquarters 
as  suggestive  to  other  hospitals.) 

In  the  meantime  I  have  run  the  original  diet  kitchen. 

I  have  gone  all  around  France,  more  or  less,  seeking  sundry 
necessaries — breaking  all  the  rules  in  the  army,  but  getting 
away  with  it. 

This  week  T  am  in  Paris  seeking  a  lot  of  new  equipment  for 
our  main  kitchen.  The  mess  sergeant  has  been  up  and  found 
nothing — so  I  am  particularly  delighted  to  have  located  the 
impossible  myself. 

A  British  dietitian  and  a  volunteer  worker  have  been 
offered  to  me  as  understudies  but  I  would  rather  wait  a  little 
longer  and  have  an  honest  to  goodness  dietitian. 

This  is  a  stupid  letter,  sticking  to  facts.  Some  day  I'll  try 
to  write  you  an  interesting  one.  My  address  is  care  American 
Red  Cross,  Paris. 

I  don't  know  of  any  two  dietitians  over  here  doing  the  same 
thing.     But  each  problem  is  unique. 

1  have  been  very  thankful  to  have  no  rank.  I  do  not  like 
having  our  uniforms  like  the  nurses'  aides — absolutely  un- 
professional women. 


THE  DIETITIAN  SERVICE  1410 

Space  permits  of  no  more  than  a  passin^^  notice  of  the  work 
done  bv  the  dietitians  in  the  Red  Cross  Imts.  Miss  Hazen's  ^'^ 
report  (juoted  below  contained  tliree  interesting^  tonchis:  A 
tribnte  to  the  splendid  work  of  the  many  practically  nntrained 
''hut"  workers;  an  evidently  innocent  contrasting  of  the  atti- 
ludes  of  mind  of  two  commanding  officers,  and  an  entirely 
naive  statement  that  the  real  interest  of  a  dietitian  is  the  feed- 
ing of  the  sick: 

^[y  work  in  France  was  rather  unique  because,  while  \  had 
had  more  theoretical  diet  work,  having  taught  the  three  years, 
and  as  much  practical  work  as  many  of  the  girls,  I  did  less 
actual  diet  work  than  most  of  the  dietitians. 

The  few  weeks  1  spent  at  American  Ked  Cross  Xo.  5  at 
Auteuil,  Paris,  was  as  dietitian.  When  the  hosjjital  was  closed 
there  I  was  sent  to  Vichy  to  take  charge  of  the  kitchen  of  the 
IJed  Cross  recreation  hut.  .  .  . 

The  girls  in  charge  were  doing  splendid  work,  but  they 
were  not  accustomed  to  working  with  the  huge  quantities  of 
material  necessarily  handled,  which  were  almost  beyond  them, 
and  they  welcomed  my  arrival.  At  that  time  we  were  serving 
cocoa  in  the  afternoon  between  one-thirty  aiul  three;  the  time 
had  to  be  limited  because  there  were  such  swarms  of  boys  that 
the  line  often  reached  clear  through  the  ball  aiul  down  the 
street  for  a  block. 

Xot  only  did  we  serve  the  I'ocoa  in  the  but,  but  at  the  sug- 
gestion of  Colonel  \Vel)b.  the  connnanding  officer  of  the  center, 
cocoa  and  sandwiches  were  served  to  every  boy  after  be  came 
from  his  bath.  This  was  done  because  so  nuiny  of  them 
seemed  weak  and  hungry  following  the  bath. 

At  that  time  we  were  serving  from  !M)  to  I'iO  gallons  of 
cocoa  a  day  and  from  1"200  to  ISOO  enormous  sandwiches. 
I  did  none  of  the  serving  but  simply  had  charge  of  the 
kitchen. 

After  Christmas  as  tlu^  work  grew  easier,  we  started  the 
making  of  special  delicacies  to  >r\\i]  into  tlu'  lios]utals.  In 
working  in  the  hospital  I  bad  found  ibc  hoys  craving  the  little 
sjiecial  tilings  such  as  they  bad  liad  at  Iionic  With  the  consent 
of  the  colonel  a  system  was  workcil  out  wlicrchv  wc  t-ould  dis- 

"  Gertnuk'  Ilazcn  was  tiorii  in  Chctopa.  Kansas.  Slic  stu(]ic<]  at  IJaker 
I'niversity.  lialdwiii.  Kansas,  and  at  tlic  ('arn('j.'i('  Institute  of  'rcciinoloj^y 
at  I'ittshiirfih.  T.atiT  slic  ri'Ci'ivfd  the  dcLTt'c  df  Master  of  Arts  at  tiie 
I'niversity  of  Kansas.  She  was  an  instnictnr  in  lidiiie  ecdndniics  in  the 
Abilene.  Kansas.  Ilij,'h  School,  also  in  the  Howard  I'ayiie  .liiiiior  ('ol!e<xe 
at    Favette,   .\Iisst)uri. 


1420  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

cover  the  things  the  boy  was  craving  so  much  and  get  that 
thing  to  him.  I  did  a  great  deal  of  that  work  myself,  because 
I  liked  to  keep  in  touch  with  the  hospital  life,  but  I  went  into 
the  hospital  only  after  the  day's  work  was  over  because  I  did 
not  have  a  minute  of  spare  time  during  the  day. 

.  .  .  The  doctor  and  the  nurses  were  loud  in  the  praises  of 
our  work,  because  most  of  the  cases  were  building  cases  and 
food  was  the  main  thing.  We  found  it  was  necessary  to  appeal 
to  the  boy's  whims  to  get  him  started  eating,  but  once  started 
he  would  eat  not  only  the  things  we  sent  up  but  also  his  regu- 
lar mess. 

When  I  was  sent  to  Savenay  in  March  there  was  no  food 
served  in  any  of  the  huts  outside  of  the  candies  and  Red  Cross 
cookies.  I  started  right  in,  trying  to  find  what  was  needed 
and  the  most  economical  way  of  getting  it  done.  Within  ten 
days  after  my  arrival  we  were  serving  cocoa  in  each  of  nine 
huts.  I  secured  the  cooperation  of  the  Army  mess  sergeants 
there,  so  that  they  made  the  cocoa  for  us  in  the  Army  mess 
kitchens  while  we  furnished  the  materials. 

We  sent  some  food  into  the  hospitals  there  but  the  request 
of  Colonel  Cooper  was  obeyed,  for  he  felt  that  it  would  result 
in  a  dissatisfaction  with  the  army  food.  However  the  doctor 
told  me  that  I  pulled  two  boys  through  who  never  would  have 
lived  had  it  not  been  for  that  catering  to  their  appetites. 

...  I  thought  perhaps  you  would  enjoy  knowing  just  what 
one  dietitian  in  France  did  when  she  was  sent  out  of  the 
beaten  path.  You  see  I  was  accustomed  to  the  college  women 
as  we  had  them  in  the  huts,  and  I  knew  nurses.  I  had  had  a 
thorough  grounding  in  the  scientific  principles  of  nutrition 
and  food  preparation,  and  I  declare  1  used  everything  I  knew. 

It  is  rather  a  far  cry  from  the  gallons  of  cocoa  and  the  hun- 
dreds of  sandwiches  mentioned  in  ^liss  Hazen's  report  to  the 
more  or  less  domestic  atmosphere  of  Miss  Douglas'  ^^  work  as 
director  of  the  personnel  houses  of  the  South  Serbian  unit  in 
Saloniki.  It  must  be  mentioned,  however,  that  ^[iss  Douglas 
enjoyed  a  brief  sway  in  a  military  hospital.  She  wrote  Miss 
George  under  date  of  June  G,  1019  : 

"  E.  Constance  Douglas  was  born  in  Bradley,  California.  She  grad- 
uated from  the  University  of  California  in  101")  and  later  did  post-grad- 
uate work  at  Columbia  University,  X.  Y.  City.  Slie  tauglit  domestic 
science  in  Shasta,  Cal.,  High  School  for  a  year  and  from  May  to  October. 
1918,  was  dietitian  in  Garfield  Hospital,  Washington.  D.  C.  She  entered 
Red  Cross  service  in  October,  1919.  It  is  interesting  to  note  that  the 
directcjr  (jf  the  lied  Cross  unit  with  whicli  she  served  in  Saloniki  speaks 
of  her  as  being  "intelligent"  and  as  having  a  good  "disposition." 


THE  DIETITIAN  SERVICE  1421 

I  believe  T  wrote  you  from  Paris — or  rather  from  American 
Red  Cross  Hospital  Xo.  101  in  Xeuilly,  about  the  first  of 
January.  1  was  a  patient  there  for  over  two  weeks,  and  as 
soon  as  I  recovered  was  asked  to  take  the  place  of  dietitian. 
That  meant  transferring  to  the  French  Commission  which  at 
first  disapi)ointed  me,  but  seemed  the  thing  to  do,  and  turned 
out  very  happily.  The  work  was  no  joke  as  1  had  to  be  house- 
keeper also,  the  previous  one  having  succumbed  to  the  flu,  but 
1  enjoyed  it  all,  from  marketing  days  twice  a  week  to  training 
the  French  maid  to  prepare  special  diets,  keeping  my  ac- 
counts, and  visiting  the  employment  bureaus.  .  .  . 

Miss  Delano  was  at  the  hospital  about  a  week  while  I  was 
first  there,  and  seemed  so  well  and  lit  when  she  left  that  it 
seemed  incredible  to  hear  of  her  death.  .  .  . 

I  came  down  to  Saloniki  in  ]\Iarch  via  Rome,  Tarento, 
Itea  and  Bralo,  the  last  three  towns  designating  the  British 
route  of  transportation  into  the  Balkans.  The  British  cer- 
tainly provided  for  us  most  carefully  all  along  their  line  and 
it  was  quite  fun  staying  in  their  camps  and  meeting  the 
"Sister."  Also  they  represent  sanitation  and  cleanliness  which 
is  more  than  I  can  say  for  the  native  inhabitants.  I  think  it 
would  amuse  our  people  at  home  to  see  the  members  of  our 
group  starting  up  country  with  canteens  of  boiled  water,  large 
pieces  of  unbleached  muslin  to  cover  the  railway  chairs,  and 
other  precautions  against  sickness  and  "cooties.'' 

Here  at  Saloniki  1  have  charge  of  the  housing  and  feeding 
of  the  Soiitli  Serbian  unit  personnel  and  such  of  the  general 
staff  as  are  still  stationed  here.  We  expected  to  do  relief  work 
with  the  refugees  here  in  which  case  I  planned  to  establish 
food  clinics  in  connection  with  the  medical  diiiics,  but  none 
of  it  has  materialized  to  date.  We  have  three  two-story 
houses  and  a  flat,  in  the  better  part  of  the  town  and  right 
down  near  the  water  front. 

The  greater  part  of  our  supplies  come  from  our  own  ware- 
houses, but  I  also  purchase  through  the  British  canteen,  the 
French  bazaar  and  get  some  few  things  from  tlie  Italian 
■warehouse.  1  have  a  jierfcctly  good  littU^  Ford  three  after- 
noons a  week,  one  time  of  whicli  i  go  out  to  the  American 
Farm  for  fresh  milk,  cream  and  butter,  and  usually  stay  to 
tea  with  Doctor  and  Mrs.  House.   .  .   . 

There  are  practically  no  hospital  diets  to  ju'i^pare  here  as 
our  ])ers()nnel  are  verv  seldom  sick  and  only  occasionally  are 
patients  brought  down  from  tb(^  country.  altlioui:-h  a  U-w  days 
ago  I  had  both  a  typhus  and  a  ty|ihoid  recuperation  case 
come  in  together.  1  iind  mysell'  doelor  and  inir>e  liotli  for  our 
own  few  cases,  and  in  fact  my  line  dl  actixity  is  <piite  \aried. 


1422  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

I  am  sure  I  shall  graduate  with  a  Ph.D.  in  something  when  I 
get  through  here. 

.  .  .  The  chief  maladies  we  have  to  guard  against  are  ma- 
laria, dysentery,  typhus  and  typhoid,  and  cholera  possibly.  I 
keep  our  drinking  water  boiled  and  all  food  from  the  open 
market  carefully  washed  and  well  cooked.  I  have  both  Greek 
and  Serbian  help  besides  some  Bulgarian  prisoners,  so  con- 
versation is  carried  on  by  "signs  and  wonders." 

This  may  not  be  technically  dietetic  work  but  it  is  inter- 
esting and  worth  while.  Anyway,  almost  no  one  over  here 
is  doing  what  he  planned  when  he  started. 

For  two  of  the  dietitians  w^ho  served  overseas  there  was  to  be 
no  home  coming.  Cara  Mea  Keech,  of  Santa  Ana,  California, 
a  graduate  of  Milwaukee-Downer  College,  and  serving  with 
Base  Hospital  No.  68,  died  October  18,  1918,  and  was  buried 
in  England.  Marian  Helen  Peck,  of  Green  Spring,  Ohio,  a 
graduate  of  the  Boston  School  of  Domestic  Science,  died  Febru- 
ary 17,  1919,  at  Base  Hospital  No.  44  and  was  buried  at  Su- 
resnes,  France. 

A  report  of  some  homely  "peacetime"  work  came  from  the 
Red  Cross  Commission  for  Albania  in  1920,  in  a  letter  from 
the  chief  nurse,  ]\Iiss  Caroline  Robinson,  to  Miss  Hay.  It  read 
in  part  as  follows : 

In  Koritza,  Miss  Palmer  is  taking  charge  of  the  house.  As 
she  has  a  good  cook  it  does  not  require  much  of  her  time  so 
she  and  Miss  Brown  have  a  children's  clinic  in  the  morning 
and  give  instruction  in  practical  work  in  the  afternoon,  Miss 
Brown  visiting  the  homes. 

Miss  Oades  is  holding  sewing  classes,  which  make  clothing 
for  the  children.  Slie  is  also  super\ising  the  orphanage  and 
has  a  small  school  for  children  who  do  not  attend  the  public 
schools.  1  hope  they  will  be  able  to  (;lothe  tbeee  children  and 
turn  tliem  over  to  the  public  schools  as  there  are  at  least  13 
schools  in  Koritza. 

Early  in  the  year  1919  the  question  of  the  duties  and  status 
of  dietitians  in  military  hospitals  again  received  attention. 
On  March  8,  Circular  I.etter  No.  131  was  issued  by  the  ofhce 
of  the  Surgeon  General  to  Commanding  Officer,  G(>neral,  Base 
and  Port  of  Embarkation  Hospitals,  Department  Surgeons  and 
Camp  Surgeons,  Certain  Post  Hospitals,  Surgeons,  Independent 
Posts,  Air  Service: 


THE  DIETITIAN  SERVICE  1423 

1.  A  consideration  of  the  duties  and  status  of  dietitians  in 
a  number  of  military  hospitals  indicates  the  necessity  for  a 
general  statement  defining  rather  exactly  the  dietitian's  place 
and  duties.  It  is  realized  that  any  such  general  statement  will 
be  subject  to  modification  when  applied  to  individual 
hospitals. 

2.  RELATIOy  OF  DIETITIAN  TO  HOSPITAL  STAFF. 

The  dietitian  is  responsible  as  far  as  her  professional  work 
is  concerned  to  the  commanding  oflicer  of  the  hospital.  As 
assistant  to  the  mess  officer,  she  cooperates  with  him  and  the 
chief  nurse.  The  chief  nurse  of  the  hospital  will  send  in  a 
separate  efficiency  report  of  dietitians,  monthly,  basing  this 
report  not  only  on  her  own  observations,  but  on  those  of  the 
mess  officer  as  well.  Socially,  the  status  of  the  dietitian  should 
be  that  of  nurses,  and  in  matters  of  conduct  she  is  under  the 
authority  of  the  chief  nurse. 

3.  STATUS. 

The  dietitian  is  a  civil  employee  of  the  ^ledical  Depart- 
ment, but  to  place  a  competent  dietitian  on  the  same  basis 
with  cooks  and  maids  is  an  injustice  to  her  and  a  disadvan- 
tage to  the  hospital  in  which  she  is  working.  Dietitians 
designated  as  head  dietitians  receive  an  additional  $5.00  per 
month.  Dietitians  performing  the  duties  of  head  dietitians 
but  not  so  designated  should  be  recommended  for  such 
appointment. 

4.  DUTIES. 

(a)  Of  the  head  dietitian. 

Reports  to  the  chief  nurse,  or  ward  surgeon,  deficiencies  of 
service  found  in  wards  in  order  that  these  may  be  corrected 
through  ])roper  channels.  Reports  deficiencies  of  preparation 
and  service  found  in  tlie  mess  hall  and  kitchens,  to  the  mess 
officer.  Inspects  serving  of  food  in  all  the  wards  and  has  the 
responsibility  of  seeing  that  it  is  properly  prepared.  Super- 
vises and  assigns  the  work  of  her  assistants.  Is  responsible 
for  the  planning  of  all  patients'  menus  but  confers  with  moss 
officer  concerning  market  conditions  before  approving  menus. 

(b)  Of  the  dietitian. 

Have  immediate  supervision  of  the  preparation  of  food  in 
the  general  patients'  mess,  sick  officers'  mess  and  nurses'  mess 
(if  desired  by  commanding  officer).  They  also  have  charge 
of  the  filling  of  the  food  carts.  Have  immediate  supervision 
of  general  diet  kitchen.  Plan  menus  (these  to  be  approvtMJ. 
however,  before  use  by  the  head  dietitian).     Have  direct  re- 


1424  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

sponsibility  for  the  preparation  of  diets  and  should  be  sup- 
plied with  sufficient  help  to  relieve  them  of  the  details  of  this 
preparation.  Visit  wards  to  confer  with  ward  surgeons, 
nurses  and  in  suitable  cases  with  patients  regarding  special 
diets. 

5.  EQUIPMENT. 

The  head  dietitian  should  have  an  office  provided  with  a 
desk,  the  office  to  be  located  in  a  quiet  place  near  the  mess 
department  or  diet  kitchen. 

G.  The  value  of  the  dietitian  to  the  hospital  is  largely  de- 
termined by  the  degree  to  which  cooperative  relations  are  es- 
tablished. Conferences  at  regular  intervals,  in  which  the 
commanding  officer  meets  with  the  head  dietitian,  chief  nurse 
and  mess  officer,  are  recommended. 
By  direction  of  the  Surgeon  General : 

C.  K.  Darnall, 
Colonel  Medical  Corps,  U.  S.  A. 
Executive  Officer. 

In  June,  1919,  the  United  States  Public  Health  Service  issued 
Bureau  Circular  Letter  No.  173  to  the  "Medical  Officer  in 
Charge,  United  States  Marine  and  Public  Health  Service  Hos- 
pitals," in  regard  to  dietitians'  service.  The  instructions  and 
specifications  contained  in  this  circular  are  practically  identical 
with  those  issued  by  the  office  of  the  Surgeon  General,  but  a  few 
rather  interesting  variations  are  noted  under  their  special  head- 
ings (the  italics  are  the  author's)  : 

BeJation  of  Dietitian  to  Hospital  Staff. 

.  .  .  She  is  expected  to  work  in  coordination  vrith  sucli 
other  officials  including  the  chief  nurse  as  may  be  designated 
by  the  officer  in  charge.  The  effi'ciency  of  the  dietitian's  ser- 
vices will  be  determined  from  reports  of  ward  surgeons  who 
are  directly  responsible  for  the  prescribing  of  diets.  The  chief 
nurse  will  also  render  a  monthly  statement  of  the  efficiency 
of  the  service  of  foods.  The  dietitian  has  social  status  equal 
to  that  of  the  chief  nurse,  but  subject  at  all  times  to  such 
regulations  and  restrictions  as  may  be  in  force  governing  all 
nurses  in  the  service  of  the  hospital. 

2.  Status. 

Tlie  dietitia])  is  a  civil  scientific  employee  of  the  bureau, 
and  is  not  to  he  placed  on  the  same  basis  with  cooks  and  maids. 
To  do  so  is  an  injustice  to  her  and  a  disadvantage  to  tlie 
hospital.  .  .  . 


THE  DIETITIAN  SERVICE  1425 

While  perhaps  few  persons  could  have  been  found  sordid 
enough  to  have  desired  the  prolongation  of  the  war,  the  fact  re- 
mains that  the  sudden  termination  of  actual  hostilities  came  as  a 
distinct  shock  to  numbers  of  persons  engaged  in  absorbing  war 
activities,  and  cherishing  ecpiallj  absorbing  plans  for  future 
accomplishment.  The  vicissitudes  of  the  dietitians  offer  a  case 
in  point.  Since  the  earlier  months  of  the  war.  Miss  Thompson 
had  felt  the  need  for  a  supervising  dietitian  to  care  for  the 
business  of  the  service  in  the  office  of  the  Surgeon  General. 
No  funds  being  available  for  the  salary,  she  at  last  hit  upon 
the  plan  of  placing  such  a  person  upon  the  pay-roll  as  a  clerk 
in  the  Army  Nurse  Corps.  Miss  Cooper,  who  had  volunteered 
for  the  service,  was  appointed  by  Miss  Thompson,  but  only  in 
time  to  take  the  oath  of  office  on  the  day  of  the  signing  of  the 
Armistice,  a  little  late  to  bring  much  in  the  way  of  aid  and 
encouragement  to  the  dietitians  in  the  overseas  service. 

The  method  of  the  appointment  was  a  makeshift,  but  it  indi- 
cated a  willingness  on  the  part  of  ^liss  Thompson  to  see  the 
affairs  of  the  Dietitian  Service  directed  by  a  person  of  that  pro- 
fession. The  duties  assigned  to  ^liss  Cooper  included  the  gen- 
eral supervision  of  the  work  of  all  dietitians,  responsibility  for 
the  recruiting,  assigimient,  transfer  and  discipline.  In  the 
course  of  her  work  ^liss  Cooper  inspected  the  dietary  depart- 
ments of  thirty  Army  hospitals.  The  portion  of  Miss  Cooper's 
report  which  was  published  in  the  Report  of  the  Surgeon  Gen- 
eral, U.  S.  Army,  to  the  Secretary  of  War,  1919,  Vol.  11,  Page 
1127  is  given  below: 

The  Dietitian  Service  although  a  comparatively  new  branch 
of  the  Medical  Department  has  grown  considerably  in  size  and 
importance  since  the  beginning  of  the  war,  at  wliich  time 
there  were  no  dietitians-  attacbefl  to  army  hospitals.  At  the 
close  of  the  fiscal  year,  June  30,  1918,  there  were  KJl  die- 
titians in  the  service.  At  the  time  of  the  siirning  of  the 
Armistice.  November  11,  1918,  there  were  ^o*')  dietitians.  Of 
this  number  84  served  overseas;  the  remaining  272  were  dis- 
tributed among  97  base,  general  and  ])()st  hospitals  of  the 
United  States.  Since  the  signing  of  tlie  Armistice  the  num- 
bers have  been  gradually  decreased,  lltl  having  been  dis- 
charged or  are  under  orders  to  proceed  to  their  homes  for  dis- 
charge from  the  service.  Tliere  arc  still  "iS  overseas  or  en 
route  t(j  this  country.  There  are  1  13  still  in  this  country  and 
Hawaii,  distril)uted  among  i')'2  liospitals.  Nine  (9)  new  ap- 
])ointments  have  been  made  to  fill  vacancies. 


1426  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Early  in  Xovember,  1918,  a  supervising  dietitian  was  ap- 
pointed and  assigned  to  duty  in  the  Surgeon  General's  office. 

The  increasing  demand  on  the  part  of  hospitals  for  addi- 
tional dietitians  and  complimentary  verbal  reports  from  com- 
manding officers  are  evidences  of  the  popularity  of  this  branch 
of  the  service.  Some  of  the  larger  hospitals  have  had  as  many 
as  ten  dietitians.  During  the  epidemic  of  influenza  the  die- 
titians proved  themselves  of  inestimable  value  in  organizing 
forces  for  the  feeding  of  the  sick  and  well.  Three  dietitians 
lost  their  lives  during  the  epidemic  and  several  others  were 
seriously  ill  from  it.  It  seems  unfortunate  that  these  profes- 
sional women,  who  worked  side  by  side  with  nurses,  doctors 
and  enlisted  men,  should  not  have  the  privilege  of  War  Risk 
Insurance. 

The  value  of  food  and  nutrition  for  both  sick  and  well  has 
come  to  be  recognized  as  such  an  important  factor  in  army 
life  that  it  is  believed  that  the  dietitians  have  come  to  be  a 
permanent  factor  in  all  well  regulated  Army  hospitals  as  well 
as  civilian  hospitals. 

Unfortunately  for  the  development  of  the  office,  Miss  Cooper's 
leave  of  absence  from  her  work  in  the  Battle  Creek  School  of 
Home  Economics  could  not  be  extended  and  she  relinquished  her 
position  in  the  Surgeon  General's  office  in  July,  1919.  To  suc- 
ceed Miss  Cooper  it  was  not  easy  to  find  a  dietitian  possessed 
of  the  degree  of  training,  discrimination  and  executive  ability 
which  the  situation  demanded,  and  who  would  be  willing  to 
accept  the  position,  or  who  could  be  spared  from  whatever 
position  she  might  be  filling.  However,  previous  to  her  de- 
parture, Miss  Cooper  had  written  to  Josephine  Happer,  a  grad- 
uate of  the  University  of  Illinois,  who  was  then  dietitian  at 
Jefferson  Barracks,  asking  her  to  undertake  the  work.  This  Miss 
Happer  consented  to  do,  but  was  transferred  to  Walter  Bced 
Hospital,  presumably  for  the  reason  that  the  budgets  of  all  the 
departments  were  being  reduced  to  such  an  extent  that  the  Army 
Xurse  Corps  no  longer  had  sufficient  funds  to  allow  for  the 
salary  of  a  supervising  dietitian.  She  remained  on  the  pay-roll 
at  Walter  Reed  Hospital  but  was  sent  to  the  Surgeon  General's 
office  on  temporary  duty.  From  this  time  on  the  office  became 
an  empty  title.  In  reporting  her  experience  Miss  Happer 
wrote : 

'S\\  duties  while  at  the  Surgeon  General's  office  were  chiefly 
the  transferring  of  dietitians  from  one  hospital  to  another. 


THE  DIETITIAN  SERVICE  1427 

keppinfj  records,  answoririfj  letters  from  dietitians,  in  fact  all 
letters  concerning  dietitians.  Dnrinj;  the  time  1  worked 
in  the  Snr^eon  General's  ofhce  I  worked  at  Walter  Heed  for 
two  weeks  when  a  numher  of  the  dietitians  were  sick.  Most  of 
the  work  was  done  under  the  supervision  of  Major  Stimson, 
or  of  some  of  her  assistants. 

With  the  passing  out  of  tho  rule  permitting  fiold  cmployeos  to 
occupy  a  bureau  or  office  position,  ]Miss  llapper  was  transferred 
to  Camp  Dix  in  the  early  part  of  February,  1020,  and  ^fajor 
Stimson  took  over  the  work  of  the  office.  The  following  letter 
from  Major  Stimson  to  ^liss  Cooper,  under  date  of  February 
10,  1920,  is  self-explanatory  as  to  subject  matter,  but  in  passing 
it  might  be  said  that  possibly  any  dietitian  with  sufficient  train- 
ing and  experience  to  make  her  acceptable  to  the  profession 
would  have  hesitated  to  accept  as  predetermined  a  position  as 
the  one  here  suggested.     ^lajor  Stimson  wrote : 

It  is  not  at  all  my  desire  to  take  over  tho  Dietitian  Ser- 
vice, but  for  the  time  being  it  is  necessary  for  me  to  do  so.  I 
have  been  searching  diligently  for  some  accredited,  graduate 
dietitian  who  is  also  a  graduate  nurse,  into  whose  hands  I  can 
put  the  Dietitian  Service.  Such  a  person  could  be  appointed 
into  the  Army  Xurse  Corps,  and  there  would  be  no  dilficulty 
about  the  payment  of  her  salary. 

Such  in  brief  is  the  story  of  the  supervising  dietitian  under 
the  Army  Xurse  (^orps.  To  say  that  it  was  here  an  empty  name 
is  not  to  criticize  the  Xurse  Corps  as  s\u*h.  A  similar  maladjust- 
ment would  have  persisted  had  the  dietitians  l)een  placed  under 
any  alien  service.  The  problem  of  suitable  food  for  the  army 
extended  beyond  the  hospital  and  the  dietitians  should  have  been 
included  in  and  answerable  to  the  general  Food  and  X'utrition 
Division  of  the  military  organization. 

Detinite  recognition  of  the  work  of  the  dietitians  came  to 
them  in  various  ways.  I'he  bestowing  of  decorations  by  the 
1  British  (loveniment  upon  five  of  tliose  who  served  with  the 
British  Kxjx'ditionary  Forces  has  already  been  nuMitioned. 
That  the  American  Kxpeditionary  Forces  had  approval,  if  not 
"decorations,'"  to  offer  was  related  by  Miss  llungate  in  the 
concluding  paragrajth  of  her  report: 

In  July,  inin,  1  found  nivsolf  fiiir  of  all  the  remaining 
iliotitiaiis  nf  tlic  A.  K.  V.,  on  Ijoard  tiie  I niprnilor  and  bound 


1428  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

for  home.  Of  course  we  exchanged  experiences  and  found  no 
two  had  faced  parallel  conditions.  We  had  all  gotten  so  far 
from  our  training,  from  our  ideal  of  a  dietitian  and  her  work, 
that  most  of  im  were  inclined  to  be  disappointed  in  our  results. 
A  brigadier  general  who  was  a  fellow  passenger  did  much 
to  hearten  us  and  reestablish  our  morale.  He  wanted  to  per- 
sonally meet  and  thank  some  dietitians  for  their  good  work. 
He  said  that  his  only  experience  in  an  Army  hospital,  some 
years  before  the  war,  had  branded  them  in  his  consciousness 
as  places  of  badly  selected  food,  poorly  prepared,  and  utterly 
unfit  for  the  sick.  To  his  surprise,  when  he  became  a  patient 
in  an  A.  E.  F.  hospital  he  was  served- trays  of  palatable,  well 
chosen  food,  and  upon  inquiry,  learned  that  a  college  trained 
dietitian  was  responsible.  He  was  so  enthusiastic  over  our 
work  that  he  thought  it  should  not  be  confined  to  hospitals 
alone,  but  should  be  extended  to  the  feeding  of  the  entire 
Army,  where  cooks  and  mess  sergeants  could  be  given  train- 
ing and  supervision  in  the  preparation  of  food  and  the  bal- 
ancing of  menus. 

And  Major  Hoskins,  who  visited  nearly  every  camp  and 
cantonment  hospital  in  this  country,  had  this  to  say:    . 

When  the  dietitians  first  came  into  the  Army,  they  encoun- 
tered many  difficulties  incident  to  the  introduction  of  women 
into  what  had  previously  been  in  the  military  experience  a 
strictly  masculine  pursuit.  I  have  much  admiration  for  the 
skill  with  which  they  met  these  tactical  difficulties,  and  the 
valuable  service  they  rendered  to  the  army. 

!More  to  be  appreciated  than  any  of  the  foregoing  was  the 
approval  voiced  by  Surgeon  General  Ireland  when  he  stated  ^' 
that  the  dietitians  had  proved  themselves  of  such  value  to  the 
Army  that  the  organization  of  an  Army  general  hospital  staff 
which  did  not  include  them  could  scarcely  be  contemplated  any 
more  than  one  which  did  not  include  nurses. 

Tlio  home  work  of  the  Xnrsing  Service  and  with  it  the 
Dietitian  Service  paralleled  tlie  work  abroad  throughout  the 
war  period.  In  March,  liHS.  the  Bureau  of  Instruction  was 
divided  into  a  Bureau  of  Instruction  and  Nurses'  Aides  and  a 

"Testimonial  ofTcrrd  by  tlie  Surfroon  Ooneral  at  a  special  meeting  of  the 
Xatioiiai  Committee  on  Red  Cross  Nursing  Service  called  at  Red  Cross 
Headquarters.  January  fl,  ir_2.  to  consider  a  proposal  to  eliminate  the 
Nutrition   Service  oi  tiie   Red   Cross. 


THE  DIETITIAN  SERVICE  1429 

Bureau  of  Dietitian  Service.  Miss  George  assumed  responsi- 
bility for  the  latter  under  the  guidance  of  the  Committee  on 
Dietitian  Service. 

At  this  time  the  United  States  faced  the  possibility  of 
several  years  of  war.  The  course  in  Home  Dietetics  was  sup- 
plemented in  June,  1918,  by  the  publication  of  a  manual  on 
"Kmeriicncy  Cooking  for  Large  Groups  of  People,"  a  pamphlet 
intended  ''as  a  guide  for  instruction  in  cooking  for  large  groups 
of  people  in  emergencies,  such  as  fires,  floods,  the  movement  of 
troops,  etc.,  which  Ked  Cross  Chapters  are  frequently  called 
upon  to  meet."  Several  months  later  material  for  a  course  in 
"War  Diet  in  the  Home"  was  issued.  Instruction  in  Home 
Dietetics,  as  in  Home  Hygiene  and  Care  of  the  Sick,  was  first 
carried  on  entirely  by  National  Headquarters  dealing  directly 
with  the  local  organizations  giving  the  courses.  But  following 
the  decentralization  in  March,  1918,  Division  Directors  of 
Xursing  were  made  responsible  for  all  details  pertaining  to 
these  classes.  The  plan  was,  however,  to  appoint  special  direc- 
tors of  this  service  under  the  nursing  service  in  each  Division, 
and  during  the  year  following  directors  were  appointed  in  the 
Atlantic  Division  and  in  the  Central  Division.  The  appoint- 
ment of  instructors  continued  to  be  made  from  Xational  Head- 
quarters. 

As  has  been  shown  earlier  in  this  chapter,  the  original  course 
in  Home  Dietetics  was  planned  to  ''give  in  a  simple  way  the 
underlying  principles  of  cookery,"  but  this  was  soon  found  to 
be  inadequate  to  the  needs  of  the  time.  The  limitations  and 
restrictions  of  the  food  supply  were  putting  upon  the  people 
the  task  of  making  substitutions  for  this  or  that  food  material 
which  chanced  to  be  at  the  time  either  unol)tainablc  or  needed 
for  the  fighting  forces.  The  hardships  consecineiit  to  the  use 
of  unaccustomed  foods  was  found  to  be  more  than  a  (piostion  of 
f(u-egoing  one's  preferences.  As  a  matter  of  fact,  certain  ''sub- 
stitutes," so  called,  were  in  many  cases  not  snl)stitutes,  no 
matter  in  wliat  form  they  were  served.  It  IxH-anic  evident  that 
a  knowledge  of  what  f<wds  to  select  in  order  to  supply  the 
varied  nutritional  needs,  of  the  body  was,  broadly  sj^eaking,  of 
more  inijxtrtance  than  tli(>  ability  to  prepare^  food  well.  The 
home  economics  workers  of  the  country  had  been  modifying 
their  teaching  to  make  it  consistent  with  results  of  observations 
being  made  in  the  nutrition  laboratories  of  the  country,  and 
the  ni'cd  for  a  revision  of  the  lied  Cross  course  in  Hume  Die- 


14,30  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

tetics  became  apparent.  Accordingly,  in  the  spring  of  1918, 
Mabel  Wellman,  Head  of  the  Department  of  Home  Economics 
of  the  University  of  Indiana,  was  asked  by  the  bureau  to 
prepare  a  course  which  should  be  based  upon  the  principles 
underlying  the  selection  of  adequate  food  and  emphasize  the 
importance  of  these  as  compared  with  mere  skill  in  food 
preparation. 

While  Miss  Wellman  prepared  the  bulk  of  the  course,  Dr. 
Dorothy  Reed  Mendenhall,  of  the  University  of  Wisconsin, 
furnished  the  material  for  the  lessons  on  infant  feeding  and 
food  for  the  child,  and  Caroline  Hunt,  of  the  U.  S.  Department 
of  Agriculture,  States  Relations  Service,  wrote  the  chapter  on 
"Calculation  of  the  Dietary."  As  rapidly  as  this  material  could 
be  gotten  in  shape  it  was  sent  out  to  the  classes  by  the  bureau 
in  typewritten  form  pending  the  time  when  the  lessons  could 
be  unified  and  printed  as  a  textbook. 

Unfortunately  for  the  class  work  in  Home  Dietetics  the  work 
of  preparing  the  new  course  of  lessons  was  retarded  through 
pressure  of  other  obligations  which  seemed  of  more  importance 
at  the  time.  In  January,  1919,  Miss  George  wrote  Miss 
Delano,  who  was  then  in  Paris: 

We  have  gone  very  slowly  with  the  Home  Dietetics  plans. 
...  So  many  of  our  very  good  committees  on  dietitians  are 
elusive  these  days;  they  all  seem  to  have  an  enormous  lot  to 
do  under  any  number  of  different  organizations. 

The  workers  in  the  field  were  not  slow  in  seeing  that  a  new 
impetus  had  been  given  to  the  whole  subject  of  food  and  nutri- 
tion and  that  the  Red  Cross  was  faced  by  an  added  responsi- 
bility concerning  it.  In  a  letter  to  ]\Iiss  George,  ^liss  Sells, 
director  of  Dietitian  Service  of  the  Atlantic  Division,  said : 

Home  Dietetics  has  no  popularity  because  the  available 
instructors  have  tried  to  teach  according  to  the  textbook. 

A  little  later  ]Mrs.  Mehlig,  director  of  the  service  for  the 
Central  Division,  wrote: 

In  one  case  the  texture  of  the  custard  interested  the  teacher 
more  than  its  use  in  the  diet,  its  digestibility  or  its  composi- 
tion. There  has  been  so  much  criticism  of  our  text  that  1  feel 
the  need  for  holding  our  instructors  up  to  a  very  higli 
standard. 


THE  DIETITIAN  SERVICE  1431 

She  added: 

Miss  Marlett,  of  Wisconsin,  writes  me  that  the  Red  Cross 
course  will  have  to  he  sufficiently  worth  while,  before  the  Ex- 
tension teachers  will  be  warranted  in  teaching  it. 

In  August,  Lettie  G.  Welch,  director  of  the  Nursing  Service 
of  the  Mountain   Division,  wrote  to   National   Headquarters: 

It  is  very  gratifying  to  know  that  a  complete  change  of  plan 
for  Home  Dietetics  instruction  has  been  made.  I  trust  that 
the  revised  plan  proves  more  feasible  than  the  previous 
one.  .  .  . 

It  is  my  desire  to  assist  in  this  activity  to  the  fullest  extent 
possible. 

The  widening  scope  of  the  Dietitian  Service  was  suggested 
by  Miss  George,  in  a  letter  to  Miss  Noycs,  requesting  authoriza- 
tion to  represent  the  Red  Cross  at  the  meeting  of  the  American 
Home  Economics  Association  to  be  held  in  Blue  Ridge,  North 
Carolina,  in  June,  1919: 

It  is  desirable  to  present  to  the  American  Home  Economics 
Association  the  revised  Red  Cross  course  in  Home  Dietetics. 
Several  members  of  the  Committee  on  Dietitians  will  be  pres- 
ent, and  will  present  the  matter  and  lead  in  discussions  that 
may  arise.  A  rough  draft  of  the  outlines  is  being  prepared  by 
the  Department  of  Agriculture  in  cooperation  with  the  Red 
Cross  which  will  be  ready  by  June  2Gth. 

Another  object  in  having  a  Red  Cross  representative  at 
the  meeting  is  to  arrange  for  cooperation  with  tlie  Home 
Demonstration  agents  through  the  States  Relations  repre- 
sentatives who  will  bo  present,  in  organizing  Red  Cross  classes. 

It  will  also  be  pertinent  to  the  establishment  of  tliis  edu- 
cational work  in  the  Soutli  to  confer  witli  the  large  representa- 
tion of  household  economics  people  from  the  Southern  states 
who  will  be  present. 

In  granting  the  authorization  requested  Miss  Noves  said: 

r  shall  be  very  glad,  indeed,  to  have  you  attend  the  conven- 
tion which  meets  at  Blue  Ridge,  X.  C..  and  U\A  sure  that  it 
will  be  greatly  to  the  advantage  of  the  Dietitian  Service  of 
the  Red  Cross. 

On  July  ir>,  1919,  ]\[iss  George  resigned  her  position  as 
director    of    the     Bureau     of     Dietitian     Service;     ^larszarct 


1432  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Sawyer,  a  graduate  of  the  University  of  Illinois,  succeeded  her 
at  National  Headquarters. 

The  year  following  her  graduation  Miss  Sawyer  studied  at 
Cornell  Medical  School  and  llussell  Sage  Institute  of  Pathology 
in  New  York  City.  Following  this  she  was  made  instructor  of 
applied  nutrition  in  the  State  University  of  Iowa,  where  she 
remained  for  three  years.  Because  of  the  service  she  was  able 
to  render  when  the  medical  staff  of  the  University  was  depleted 
by  war  time  demands,  Miss  Sawyer  was  not  called  into  active 
war  service  until  it  was  decided  to  make  some  test  observations 
upon  the  diet  of  aviators.  In  October,  1918,  she  was  ordered 
to  report  for  duty  at  Ellington  Field,  Houston,  Texas,  but  she 
was  shortly  transferred  to  Rockwell  Field,  San  Diego,  Cali- 
fornia. Later  she  was  assigned  to  Walter  Reed  Hospital  on 
detached  duty,  remaining  there  until  July,  1919,  when  she  was 
made  director  of  the  Bureau  of  Dietitian  Service. 

Because  of  Miss  Sawyer's  special  training  and  interest  in  the 
subject  of  applied  nutrition  the  date  which  saw  her  assumption 
of  the  position  would  seem  to  constitute  a  natural  dividing 
point  between  the  work  which  the  bureau  found  at  hand  during 
the  war  and  which  ]\riss  George  had  so  faithfully  directed,  and 
the  new  field  which  was  opening  up  before  it. 

With  the  prospect  of  being  able  to  place  a  director  of  the 
service  in  each  of  the  Divisions,  the  need  for  the  very  large 
Committee  on  Dietitian  Service  was  no  longer  apparent.  At 
a  meeting  held  in  Cincinnati  on  September  11,  1019,  the  Com- 
mittee on  Red  Cross  Dietitian  Service  made  the  following 
recommendations  to  the  National  Committee  on  Red  Cross 
Nursing  Service : 

I.  That  the  present  committee  of  nineteen  members  be  re- 
duced to  five  members. 

II.  That  the  national  director  of  the  Bureau  of  Dietitian 
Service  act  as  the  secretary  of  the  National  Committee  on 
Red  Cross  Dietitian  Service. 

III.  That  a  director  of  the  Bureau  of  Dietitian  Service  be 
placed  in  each  of  the  Division  offices. 

IV.  That  the  memhers  of  the  committee  be  Dr.  l?uth 
Wheeler,  head  of  Department  of  Home  Economics,  Goucher 
Colle<:e,  Baltimore,  ^Id. ;  ]\Iiss  Kdna  N.  White,  head  of  De- 
partment of  Home  Economics,  Ohio  State  University,  Colum- 
hus,  Ohio;  ]\Iiss  Lena  F.  Cooper,  director,  School  of  Home 
f]conomics,  Battle  Creek  Sanitarium.  Battle  Crock,  Michifran; 
]\Iiss   Elva    A.    George,    former    director    of   tlie    Bed    Cross 


THE  DIETITIAN  SERVICE  1433 

Bureau   of    Dietitian    Service,   and    Miss   Margaret    Sawyer, 
present  director,  Bureau  of  Dietitian  Service. 

By  unanimous  vote,  Dr.  Wheeler  was  elected  chairman  of  the 
National  Connnittce  on  Kcd  Cross  Dietitian  Service. 

At  a  meeting  of  the  Xational  Committee  on  Red  Cross 
Xursing  Service  at  Washington,  D.  C,  December  9,  1919,  these 
recommendations  were  approved. 

At  this  same  meeting  the  chairman  announced  that  the  text- 
book on  dietetics  would  be  discontinued  and  a  new  course,  of  a 
lesson  plan  type,  which  was  then  under  preparation,  would 
be  used. 

Also,  it  was  moved  by  Miss  Palmer  that  the  director  of  tlie 
Department  of  Xursing  further  investigate  the  privileges  to 
which  nurses  were  entitled  in  the  War  Risk  Insurance  and 
report  back  to  the  Advisory  Committee. 

^Irs.  Higbee  moved  to  amend  by  inserting  "and  dietitians" 
after  luirscs.     The  motion  as  amended  was  carried. 

The  secretary  of  the  Committee  on  Dietitian  Service  ex- 
pressed a  wish  that  the  name  of  the  bureau  be  changed.  It  was 
decided  that  this  be  referred  back  to  the  director  of  the  Depart- 
ment of  Nursing  and  the  secretary  of  the  Committee  on  Dieti- 
tian Service  for  adjustment.  (The  change  of  name  to  Bureau 
of  Nutrition  Service  was  noted  in  the  Annual  lieport,  June  30, 
1920.) 

Although  the  impetus  which  the  war  had  given  this  bureau 
had  been  very  considerable,  each  month  of  the  transitional 
period  of  1919-1920  marked  a  further  demand  for  development 
in  the  field  of  nutrition.  At  a  later  meeting  of  the  National 
(V)nnnittee  on  Red  (^'ross  Nursing  Service  held  April  14,  11»2(>, 
in  Athinta,  Georgia,  a  very  interesting  and  extensive  program 
was  reconnnended  by  the  Committee  on  Dietitians  and  was  in 
nart  as  follows : 

Tlie  qualifications  for  enrollment  in  the  Dietitian  Service 
of  tlu'  American  Ked  Cross  sliall  he  graduation  from  an  ac- 
credited school  of  home  economics.   .   .   , 

All  courses  shall  he  given  hy  enrolled  IJed  Cross  dietitian 
instructors. 

State  Connnittoes  on  Ked  Cross  Dietitian  Service  shall  he 
fonneil   in  each  state.   .   .   . 

Tlie  organization  of  the  National  and  State  ( 'dinniitlt'es  on 
IJeil    Cross    Dietitian    Service    shall    he    woi'ked    uut    hv    the 


1434  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

director,  Department  of  Nursing  and  the  director,  Bureau  of 
Dietitian  Service,  and  shall  include  the  following  points: 

A.  The  National  Committee  on  Eed  Cross  Dietitian 
Service, 

1.  The  National  Committee  on  Red  Cross  Dietitian  Ser- 
vice shall  he  composed  of  five  members,  three  of  whom  shall  be 
nominated  by  the  American  Home  Economics  Association  and 
two  by  the  American  Dietetic  Association. 

2.  The  members  of  the  National  Committee  on  Eed  Cross 
Dietitian  Service  shall  be  members  of  the  National  Commit- 
tee on  Eed  Cross  Nursing  Service. 

3.  All  members  shall  be  enrolled  Eed  Cross  dietitians. 

4.  A  quorum  of  this  committee  shall  consist  of  three  mem- 
bers. 


The  method  of  appointment  of  members  of  the  State  Com- 
mittee on  Red  Cross  Dietitian  Service,  their  qualifications 
and  the  functions  of  these  committees  were  also  outlined. 

It  was  also  recommended  that  the  program  of  the  Dietitian 
Service  showing  activities  already  undertaken  and  the  sug- 
gested extension  be  worked  out  by  the  Department  of  Nursing. 

''Any  one  nutrition  center,"  the  report  continued,  "may 
include  all  or  part  of  the  following  adaptations." 

I.  A  center  where  nutrition  clinics  for  children  who  are 
suffering  from  malnutrition  may  be  held.  These  children  are 
followed  into  their  homes  where  the  mothers  are  given  instruc- 
tion and  help. 

II.  A  center  to  which  any  individual  or  agency  may  refer 
its  nutrition  problems. 

III.  A  center  where  food  for  the  sick  may  be  prepared  and 
distributed  upon  request  from  any  agency,  physician,  dispen- 
sary, hospital,  or  public  liealth  nurse,  and  wliere  individuals 
may  be  sent  for  instruction  in  the  preparation  of  food  for 
special  diseases. 

]\riss  Sawyer  presented  the  report  to  the  National  Committee. 
It  was  moved  by  jMiss  Gladwin  that  the  recommendations  made 
ill  the  report  as  read  be  incorporated  in  the  material  to  be  pre- 
pared by  the  chairman  and  later  referred  to  the  members  of 
the  National  (Jominitteo  on  Ked  Cross  Nursing  Service.  This 
was  carried.  The  chairman  explained  that  it  would  be  neces- 
sarv  to  include  the  five  members  of  the  Committee  on  lied  Cross 


THE  DIETITIAN  SERVICE  1435 

Dietitian  Service  in   the  National   Committee  on  Red   Cross 
Nursing  Service. 

The  report  of  the  Bureau  of  Dietitian  Service  for  the  year 
ending  June  30,  1920,  told  its  own  story: 

The  fiscal  year  may  be  considered  the  transitional  year  in 
the  development  of  the  Bureau  of  Dietitian  Service.  The 
responsibilities  assumed  during  the  war  necessarily  had  to  be 
continued  and  at  the  same  time  a  definite,  constructive,  work- 
able program  had  to  be  developed  in  harmony  with  the  gen- 
eral peace  program. 

As  the  Army  had  no  supervising  dietitian  since  January  1, 
19*^0,  this  bureau  has  acted  as  a  recruiting  agency  for  the 
Army  as  well  as  for  the  Navy  and  United  States  Public 
Health  Service.  It  has  also  acted  in  an  advisory  capacity  to 
the  dietitians  being  discharged  from  the  service  and  has  been 
the  means  of  putting  many  of  them  in  touch  with  openings,  as 
well  as  aiding  many  liospitals  in  securing  dietitians. 

The  Bureau  of  Dietitian  Service  has  2,387  enrolled  dieti- 
tians. These  women  are  all  trained  in  home  economics. 
Forty-four  members  were  enrolled  during  the  fiscal  year,  14 
as  hospital  dietitians  and  30  as  instructors  in  Food  Selection, 
making  a  total  enrollment  of  509  hospital  dietitians  and  1.8T8 
instructors. 

The  supplying  of  dietitians  to  the  Army,  Xavy  and  United 
States  Public  Health  Service  hospitals  and  the  extension  of 
its  course  in  Home  Dietetics  were  the  main  activities  of  this 
bureau  on  July  1,  1919.  In  developing  the  health  program 
of  the  American  Ked  Cross  it  soon  became  apparent  that  the 
activities  in  the  field  of  nutrition  would  have  to  t)e  exteiuled 
to  meet  the  health  needs  of  the  communities.  This  concej)- 
tion  necessitated  the  complete  reorganization  of  the  bureau 
and  its  activities. 

A  definite  policy  of  cooperation  was  worked  out  with  the 
States  Kelations  Service  of  the  Department  of  Agriculture 
and  in  each  of  the  four  Divisions  in  which  a  director  of  the 
bureau  has  been  placed,  a  definite  plan  of  cooperation  has 
been  efTected  with  each  State  Extension  Service. 

It  was  decided  that  the  most  elfective  contribution  this 
bureau  could  make  to  the  health  program  was  tlie  develoj)- 
ment  of  nutrition  classes  for  undernourished  children,  the 
establishment  of  hot  school  lunclics.  and  t!ie  extension  of  its 
course  in  Food  Selection. 

Special  nutrition  classes  for  undernourished  children  \ven> 
carried  on  in  Red  Cross  Chapters  under  the  li^adersliip  of 
nutrition  experts.     The  nutrition  worker  organized  and  cuii- 


1436  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

ducted  these  classes,  followed  the  children  into  their  homes, 
where  she  assisted  the  mother  in  solving  the  food  problems 
relative  to  the  diet  of  the  entire  family,  and  also  cooperated 
with  the  social  worker  and  the  public  health  nurse  in  special 
cases  wherein  they  needed  advice  and  assistance.  Three  nu- 
trition centers  were  established  during  the  fiscal  year,  while 
138  nutrition  clinics  were  conducted  in  the  Atlantic  and 
Southern  Divisions. 

Because  the  development  of  nutrition  classes  for  under- 
nourished children  promises  to  be  the  most  important  activity 
of  the  bureau  and  because  there  is  great  need  of  standardizing 
the  conduct  of  them,  a  plan  whereby  there  will  be  at  least  one 
center  in  each  Division  for  the  training  of  nutrition  workers 
has  been  begun.  An  effort  is  being  made  to  establish  these 
centers  in  cooperation  with  a  Department  of  Home  Economics. 
Such  a  cooperative  plan  is  being  worked  out  between  Teach- 
ers College  and  the  Xew  York  County  Chapter,  and  Peabody 
College  and  the  Nashville  Chapter. 

The  course  in  Food  Selection,  replacing  the  former  course 
in  Home  Dietetics,  comprises  a  study  of  foods  and  the  factors 
which  determine  the  selection  of  an  adequate  diet  for  the 
family.  During  the  fiscal  year,  162  classes  were  held  and 
1,497  students  certified  in  this  course. 

The  Bureau  of  Dietitian  Service  stimulated  an  interest 
in  hot  school  lunches  and  assisted  in  their  establishment 
through  Chapter  Committees  on  Xursing  Activities,  or  the 
Chapter  School  Committee  of  the  Junior  Eed  Cross  in  coun- 
ties not  served  by  a  Home  Demonstration  agent,  and  in  locali- 
ties where  the  request  came  from  the  Extension  Service. 

The  administrative  work  of  the  bureau  had  demanded  almost 
the  entire  attention  of  the  director  and  the  need  for  assistance 
became  apparent.  In  jS^ovember,  1920,  Anna  R.  Van  ^Meter, 
a  graduate  of  the  University  of  Illinois,  and  for  several  years 
a  member  of  its  faculty,  also  later  professor  of  Home  Eco- 
nomics at  Ohio  State  University,  was  made  assistant  director 
of  the  bureau,  ^fiss  Van  dieter's  first  work  after  coming  to 
National  Headquarters  was  the  making  of  necessary  revisions 
in  the  lessons  in  Food  Selection.  Within  a  few  months  the 
long-promised  textbook  was  published  and  ready  for  distri- 
bution. 

During  the  months  following  the  sudden  contraction  in  war 
activities  the  Red  Cross  passed  through  many  transitional  and 
teiitiitive  phases  in  matters  of  organization  and  administration, 


THE  DIETITIAN  SERVICE  1437 

and  the  Nutrition  Service  had  its  full  share  of  these  experi- 
ences. 

A  special  meeting  of  the  nutrition  members  of  the  National 
Committee  was  called  for  August  17,  1920.  Miss  Noyes,  chair- 
man, Miss  Edna  White,  Miss  Kuth  Wheeler,  ^Miss  Elva  A. 
George  and  ^liss  [Margaret  Sawyer  were  present. 

The  chairman  explained  that  the  meeting  had  been  called  to 
discuss  the  transfer  of  the  Nutrition  Service  from  the  Nursing 
to  the  Health  Service,  according  to  a  proposal  made  to  Dr. 
Farrand  by  Mr.  Munroe  and  Dr.  Peterson,  director  of  Health 
Service.  She  stated  that  inasmuch  as  the  program  of  the  service 
had  changed  with  the  development  of  the  health  program  of 
the  Red  Cross  she  felt  willing  to  see  the  service  developed  on 
an  independent  basis,  particularly  as  a  profession  other  than 
the  nursing  profession  was  involved ;  but  she  saw  no  reason  for 
it  to  be  changed  from  its  present  position  and  placed  under 
medical  direction  in  Health  Service,  and  she  felt  that  no  good 
argument  had  been  offered  to  convince  her  of  the  advantages  of 
such  a  change.  She  stated  further,  however,  that  if  the  Nutri- 
tional Committee  agreed  that  such  a  change  seemed  desirable, 
she  would  offer  no  further  objection. 

The  members  of  the  committee  expressed  themselves  as  in 
harmony  in  general  with  ^liss  Noyes'  point  of  view. 

Miss  Sawyer  stated  that  she  thought  that  a  service  which 
recruited  its  personnel  from  a  distinct  professional  group 
should  not  be  administered  under  any  different  group,  and  for 
that  reason  recommended  that  the  Nntritiou  Service  be  made 
an  independent  service.  However,  if  the  Health  Service  were 
made  to  include  all  of  the  health  activities  of  the  Ived  Cross, 
nutrition,  as  one  of  the  activities,  would  necessarily  have  to 
be  included. 

The  meeting  then  adjourned  to  ]Mr.  Munroe's  office. 

^Ir.  Munroe  stated  that  he  felt  that  it  was  an  administrative 
matter  and  that  for  such  reasons  he  wished  to  sec  the  transfer 
of  Uie  Nutrition  Service  to  the  Health  Service.  The  Nutrition 
Committee  expressed  their  desin^  to  see  an  independent  service 
but  finally  agreed  to  accept  the  decision  of  the  general  manacer 
that  nutritional  work  should  b(>  transferred  to  the  Health 
Service, 

Notwithstanding  the  apparent  finality  of  ^Ir.  ^Munroe's 
ruling,  no  formal  steps  were  taken  to  effect  thi^  transfer  and 
the  matter  was  lost  sight  of  following  the  appointment  by  Dr. 


1438  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

Farrand  of  a  committee  (later  known  as  "The  Chairman's 
Committee  of  Inquiry")  to  conduct  a  study  of  the  entire  Red 
Cross  organization.  The  results  of  the  findings  of  this  com- 
mittee in  so  far  as  they  affected  the  Nutrition  Service  were 
shown  by  the  following  excerpts  from  the  committee's  report 
submitted  January  12,  1921 : 

Nutrition  Service:  Nutrition  Service  should  have  distinc- 
tive recognition  as  a  part  of  the  program  and  should  include : 

A.  Development  at  National  Headquarters  of  general  poli- 
cies and  national  contacts  and,  in  each  division,-  of  state  con- 
tacts, with  assistance  to  the  chapters  in  developing  their  local 
contacts. 

B.  Information  and  advice  for  the  benefit  of  personnel  in 
each  division  and  of  executive  secretaries  and  paid  workers  as 
well  as  officers  and  volunteers  in  the  chapters,  concerning  nu- 
trition service  and  ways  of  enlisting  and  using  trained  local 
volunteer  personnel  in  this  service. 

C.  Development  of  a  suitable  text  for  classes  in  Food  Se- 
lection and  of  a  procedure  for  organizing  and  conducting 
such  classes. 

D.  Arrangements  for  enrollment  and  training  of  .workers 
in  nutrition  service  who  will  be  available  for  employment  by 
Army  and  Navy  and  other  government  hospitals  and  by  chap- 
ter committees  and  civilian  hospitals. 

The  Minutes  of  the  meeting  of  the  Central  Committee,  Jan- 
uary 29,  1921   (page  1821),  included  the  following: 

VOTED :  That  the  Central  Committee  approves  in  general 
the  report  of  tlie  Chairman's  Special  Committee  of  Inquiry, 
more  particularly  the  fundamental  change  from  a  depart- 
mental organization  to  a  line  and  staff  organization,  etc.  .  .  . 
and  that  it  is  the  hope  of  the  Central  Committee  that  the 
transformation  can  be  completed  by  July  1,  1921. 

The  Aimual  Ivoport  of  the  Rod  Cross  Nutrition  Service  for 
the  year  ended  -Juno  30,  1921,  told  the  remainder  of  the  story, 
in  so  far  as  it  is  connected  with  this  history,  and  was  in  itself 
both  a  recapitulation  and  a  forecast  of  the  Red  Cross  Nutrition 
Service. 

Nutrition  Service  operated  as  the  Bureau  of  Nutrition 
Service  in  the  Department  of  Nursing  until  the  general  re- 


THE  DIETITIAN  SERVICE  1439 

organization  plan  of  the  American  Red  Cross  went  into  effect, 
April  1,  1!)21.  Since  then  it  has  operated  as  a  separate  ser- 
vice. It  lias  continued  the  work  of  enrolling  women  trained  in 
home  economics  to  act  as  dietitians  in  hospitals  of  the  Army, 
Navy  and  United  States  Public  Health  Service,  or  as  in- 
structors in  the  course  in  Food  Selection.  The  standards  for 
enrollment  are  being  raised  through  a  more  critical  considera- 
tion of  the  qualiilcations  of  each  candidate  than  was  possible 
under  the  pressure  of  war  conditions.  Twenty-two  hospital 
dietitians  and  101  instructors  were  enrolled  during  the  year. 
The  total  enrollment  at  the  end  of  thefiscal  year  was  2,514. 

The  line  of  activities  of  the  service  determined  upon  last 
year  in  conformity  with  the  general  plan  of  permanent  opera- 
tions of  the  American  Ked  Cross  has  been  continued.  Co- 
operation with  the  States  Eelations  Service  of  the  United 
States  Department  of  Agriculture  has  been  strengthened,  and 
in  those  divisions  in  which  the  service  has  a  director  the  work 
in  cooperating  with  ihe  State  Extension  Service  is  progress- 
ing satisfactorily. 

The  prevalence  of  malnutrition  among  children  of  the  na- 
tion, rich  and  poor  alike,  as  shown  by  inspections  made  by 
physicians,  is  a  menace  to  the  health  of  the  nation  and  as  such 
constitutes  an  emergency  which  calls  for  help  from  the  Red 
Cross.  Such  aid  is  being  given  by  the  Xutrition  Service  as 
rapidly  as  its  resources  will  allow,  along  the  following  lines: 

1.  Nutrition  classes  for  undernourished  children. 

In  schools  in   cooj}eration   witli  the  school  physician 

and  the  school  nurse. 
In  community  centers  allied  with  social  organizations. 
In  cooperation  with  Home  Demonstration  agents. 
In  cooperation  with  the  Public  Health  Service. 

Reports  for  the  year  show  1,114  nutrition  classes  conducted 
with  an  enrollment  of  2"^,0i)()  children.  Four  thousand,  i^eyen 
hundred  and  thirty-two  visits  were  made  to  the  homes  of  these 
children. 

A  training  center,  to  give  tlie  nutrition  specialist  the  tech- 
nique for  the  conduct  of  nutrition  classes,  is  now  in  operation 
in  New  York  City  through  the  coo])eration  of  Teachers'  Col- 
lege, Columbia  University,  and  the  New  York  County  Chapter. 
A  similar  training  course  of  six  weeks  was  begun  in  June  at 
the  State  University  of  Iowa,  the  Department  of  Home  Eco- 
nomics and  the  University  College  of  Me(licine  co()))erating 
with  the  special  instructor  in  nutrition  from  the  Red  Cross. 
Several  other  universities  have  shown  great  interest  in  this 
j)lan  and  have  asked  that  they  be  allowed  to  establish  similar 
relations  with  the  Red  Cross. 


1440  HISTORY  OF  AMERICAN  RED  CROSS  NURSING 

2.  Classes  in  Food  Selection. 

Organized  among  the  mothers  of  children  in  nu- 
trition classes. 

Organized  among  other  groups  as  an  independent 
Chapter  activity. 

Organized  in  cooperation  with  Home  Demonstration 

agents. 

These  classes  are  conducted  by  instructors  selected  from  the 

list  of  enrolled   dietitians.     The  textbook,  "The  Red   Cross 

Course  in  Food  Selection,"  has  been  revised  and  published 

recently. 

During  the  year  reports  were  received  from  163  classes  in 
Food  Selection  and  1,587  certificates  were  issued. 

3.  Hot  lunches  for  school. 

Nutrition  Service  has  worked  in  cooperation  with  the 
Junior  Red  Cross  Service  and  with  the  Home  Demonstration 
agents  and  teachers  in  stimulating  an  interest  in  providing 
hot  lunches  in  schools.  Two  hundred  and  twenty-seven  such 
activities  were  reported. 

4.  Nutrition  training  courses  for  Red  Cross  personnel. 

In  the  special  training  courses  for  Chapter  executive  secre- 
taries, which  are  being  developed  by  a  number  of  educational 
institutions  in  cooperation  with  the  Red  Cross, '  varying 
amounts  and  phases  of  home  economics  are  included,  depend- 
ing entirely  upon  the  point  of  view  and  experience  of  tlie  in- 
structors. In  some  cases  the  material  included  has  been  ade- 
quate, in  others  not.  To  meet  this  situation  the  Nutrition 
Service  is  preparing  a  suggestive  outline  of  material  to  be 
included  in  the  training  course  for  Red  Cross  secretaries  and 
field  representatives. 

Inasmuch  as  most  of  the  Cliapter  Executive  Secretaries  and 
Puldic  Health  Nurses  receive  their  field  training  in  urban 
communities,  rather  than  in  rural,  it  is  the  desire  of  the  Xu- 
trition  Service  to  plan  a  course  which  will  deal  witli  the  prob- 
lems of  the  rural  liome  in  distinction  from  those  of  the  city 
home. 

In  concluding  this  chapter  it  may  be  said  that  history  defines 
its  own  limits  both  as  to  suljject  matter  and  emphasis,  and  it 
has  in  this  case  claimed  the  greater  space  for  the  war  work  of 
the  dietitians. 

But  with  tills  part  of  the  story  ended,  the  major  interest  of 
the  Nutrition  Service  is  seen  to  hark  back  to  the  original  idea 
of  education.  Not  a  spectacular  service  to  be  sure — this  slow 
and  painstaking  work  of  lielping  established  agencies   in  tlicir 


THE  DIETITIAN  SERVICE  1441 

none  too  easy  task  of  readjusting  their  programs  to  meet  the 
demonstrated  need  for  more  rational  and  consistent  education 
in  regard  to  adequate  food.  Nevertheless,  it  has  been  a  service 
which  has  embodied  to  a  high  degree  the  spirit  of  the  Red 
Cross,  which  impels  to  the  lending  of  aid  wherever  needed. 


APPENDIX 


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1443 


1444 


APPENDIX 


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APPENDIX 


1445 


P2 


5 
< 

Kate  Liddle 
Rachel  Ben  ham 
Alice  Claude 
Mabel  Peters 
Josephine  Gillies 
Augusta  Morse 
Mrs.  Annie  Humphrey 
Lora  Roser 
Elizabeth  Swingle 
Sara  Mansell 
Jane  Powers 
Mrs.  Anna  Allen 
Myrtle  Archer 
Mrs.  Susan   F.  Apted 
Amy  Beers 
Catherine  Sinnott 
Anna  Sangey 
Frances  J.  Burch 
Amanda  Metzger 

5 

5 

John  H.  Jopson 

S.  E.  Getty 

S.  E.  Landjert 

I.  Lindenberger 

Lewis  K.  Xetf 

E.  S.  \'an  Duyn 

Alexander  Xicoll 

J.  B.   Fattic 

Donald  ^IcCrae,  Jr. 

S.  V.  King 

Ralph  A.  Stewart 

Addison  G.  Brenizer,  Jr. 

W.  ]?attle  :Malone 

R.  R.  Smith 

J.  Fred  Clarke 

Richard  A.  IJarr 

\V.  S.  Snodgrass 

M.  E.  Lott 

D.  M.  Ottis 

- 

I'reshyterian   Hospital,  Pliiladelphia 

Wcstciiester  County  Associated  Hospitals,  Yoiikers,  X'.  Y. 

Spokane,  W'asli.    (no  parent  institution) 

(ity   Hospital,  Louisville,  Ky. 

Harlem    Hospital,   Xew   ^'ork   City 

I'niversity  Medical  College  Hospital,  Syracuse,  N.  Y. 

i'"or(iham    Hospital,  Xew   York  City 

St.  Jolin's    Hospital,   Anderson,   Ind. 

Council   BlufFs,   Iowa    (no  parent  institution) 

Allegheny  (general  Hospital,  Pittsburgh,  Pa. 

i'lowi'r  Hospital,  Xew  York  City 

('luulotte,  X.  C.    (no  parent  institution) 

(M'lieral  Hospital,  Memphis,  Tenn. 

I'.utterworth-Hlodgett  University,  Grand  Rapids,  Mich. 

.Icllcrson  County  Hospital,  Fairfield,  Iowa 

\  aiidcrbilt    University,  Xashville,  U'enn. 

I  Iiivcrsity  of  Arkansas,  Little  Rock,  Ark. 

l'.aylor    University,    Dallas,   Texas 

St.  .lolin's   Hospital.  Springfield,  111. 

<:^-^^-^-Z^--4.-^y.O'^Z'-'i--^>-^ 

1446 


APPENDIX 


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APPENDIX  1447 


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1448 


APPENDIX 


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AITEiNDIX  1449 


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1450 


APPENDIX 


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1452 


APPENDIX 


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APPENDIX  1453 


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APPENDIX 


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APPENDIX 


1455 


Base  Hospitals  Organized  by  the  American  Red  Cross  for  the  United 
States  Navy 


Parent  Institution 

Director 

Chief  Kurse 

1. 

l?rooklvn,  N.  Y. 

Dr.  \V.  H.  Brinsmade 

Frances  Van  Ingen 

2. 

San  Francisco,  Calif. 
(  Lane  Hospital) 

Dr.  Stanley  Stillman 

C.  Elizabeth  Hogue 

3. 

Los  Angeles,  Calif. 

Dr.  Rea  Smith 

Sue  Dauser 

4. 

I'rovidence,  R.  L 
( Hhode  Island  Hospital) 

Dr.  George  A.  Mattingly 

(Jrace  Mclntyre 

5. 

IMiiladelphia,  Pa. 
( Methodist  Episcopal 
Hospital 

Dr.  Robert  I>cConta 

Alice  Garret 

6. 

Seattle,  Wash. 

Dr.  Milton  G.  Sturgis 

I?lanche  Fairweather 

7. 

Houston,  Texas 

Dr.  Judson  L.  Taylor 

-Maggie  E.  House 

8. 

Ricliniond,  Va. 

Dr.  A.  M.  Willis 

Bernice  Hall 

Naval  Station  Hospital  Units  Organized  by  the  American  Red  Cross 
I'OR  THE  Uniteh)  States  Navy 


Location  of  Parent 
Institution 

Director 

Chief  Xurse 

L 

Pittsburgh,  Pa. 

Dr.  Nelson  H.  Clark 

(Jrace  Anthony 

2. 

( St.  Margaret's  Hospital ) 
Philadelphia,  Pa. 

Dr.  John  A.  McGlinn 

Catherine  Moran 

3. 

(St.  Agnes'  Hospital) 
Montclair,  N.  J. 

Dr.  James  Hanan 

Blanche  Kennedy 

4. 

(Mountainside  Hospital) 
Brooklyn,  N.  Y. 

Dr.  John  A.  I^ess 

Helen  Grady 

5. 

(St.  Mary's  Hospital) 
Columbus.  Ohio 

Dr.  V.  A.  Dodd 

Carrie  E.  Churchill 

6. 

(Grant  Hospital) 
-Austin,  Texas 

Dr.  Z.  T.  Scott 

Nell  Freund 

7. 

(Seton  Infirmary) 
Toledo,  Ohio 

Dr.  Charles  W.  Moots 

Daisy  Mapcs 

9. 

l'>oston,  Mass. 

Dr.  L.  R.  G.  Crandon 

Emily  I'ine 

(organizing  nurse) 

10. 

Minneapolis,  Minn. 

Dr.  Clifford  Henry 

Crecentia  Dicdcricks 

11. 

San  Francisco,  Calif. 

Dr.  Carl  P.  Jones 

Myrtle  G.  Chandler 

13. 

Minneapolis,  Minn. 

Dr.  William  E.  Roberts 

Sadie  Murphy 

14. 

St.  Louis.  Mo. 

Dr.  L.  C.  McAmis 

Grace  Lieurance 

15. 

Dubuque.  Iowa 

Dr.  John  C.  Hancock 

Frances  Pedcrsen 

1(5. 

Philadelphia,  Pa. 

Dr.  M.  B.  Miller 

Winifred  Brown 

17. 

Seattle,  Wash. 

Dr.  John  S.  MoBride 

Edna  L.  Robinson 

18. 

Duluth,  Minn. 

Dr.  Arthur  Collins 

M.  Oliye  Graliam 

19. 

St.   Louis,   Mo. 

Dr.  R.  B.  H.  (Jradwohl 

Gcnevieye  Thorpe 

20. 

St.  Paul,  Minn. 

Dr.  0.  W.  llolcomb 

Mabel  Larson 

1456  APPENDIX 

Navy  Detachmbh^ts  Organized  by  the  American  Red  Cross  for  thb 
United  States  Navy 

Training  School  Organizing  Nurse 

Newton  Hospital,  Newton  Lower  Falls,  Mass Mary  M.  Riddle 

St.  Luke's  Hospital.  New  Bedford,  Mass Susan  E.  Emmott 

Union  Hospital,  Fall  River,  Mass Anna  E.  Rothrock 

St.  Luke's  Hospital,  New  York  City Carrie  E.  Bath 

Orange  Memorial  Hospital,  Orange,  N.  J Bessie  Millman 

Protestant  Episcopal   Hospital,  Piiiladelphia Katherine  Brown 

Allegheny  General   Hospital,   Pittsburgh,  Pa Lettie  Draling 

Columbia  Hospital.  Washington,  D.  C Lucy  Minnigerode 

Providence  Hospital,  Washington,  D.  C Sister  Flavia 

University  Hospital,  Charlottesville,  Va Margaret  B.  Cowling 

Pasadena'  Hospital,  Pasadena,  Cal Lila  Pickhardt 

St.  Luke's  Hospital.  San  Francisco,  Cal Esther  A.  Brown 

Seattle  General  Hospital,  Seattle,  Wash Ethelyn  Hall 

St.  Luke's  Hospital,  Seattle,  Wash Johanna  Burns 

San  Francisco  Hospital,  San  Francisco,  Cal Katherine  Flynn 

Anna  Jaques  Hospital,  Newburyport,  Mass Jessie  Grant 

Butler  Hospital,  Providence,  R.  I Evelyn  C.  Jehan 

Children's  Hospital,  Boston,  Mass Elizabeth  E.  Sullivan 

Children's  Hospital,  Portland.  Maine Editli  L.  Soule 

Garfield  Memorial  Hospital,  Washington,  D.  C...  Agnes  G.  Hayes 
Eastern  Maine  General  Hospital,  Bangor,  Maine.  .Ida  Washburne 

Georgetown  Hospital,  Washington,  D.  C Barbara  Sandmaier 

German  Hospital,  New  York  City Charlotte  Grim 

Hartford   Hospital,  Hartford,  Conn Lauder  Sutherland 

House  of  Mercy  Hospital,  Pittsfield,  Mass Mary  Marcy 

John  Sealy  Hospital,  Galveston,  Texas C.  L.  Shackford 

^Slaine  General  Hospital,  Portland,  Maine Margaret  M.  Dearness 

Maiden  Hospital,  Maiden.  Mass Charlotte  M.  Perry 

Boston,    Mass.,    Local    Committee    on    Red    Cross 

Nursing  Service   Julia  E.  Reed,  Sec'y 

Epworth  Hospital,  South  Bend,  Ind Margaret  R.  Parker 

Fargo.  N.  Dak Ethel  Stanford 

State  University  Hospital,  Oklahoma  City,  Okla..Edna  Holland 
Local   Committee   on   Red   Cross  Nursing  Service, 

Salt  Lake  City,  Utah Daraaris  A.  Bceman,  Sec'y 

City  and  County  Hospital,  St.  Paul,  Minn Frances  U.  Campbell 

St.  Vincent's  Hospital  Aiumnie  Association Bertha  A.  Thompson 

St.  Joseph's  Hospital,  St.  Paul,  Minn Sister  Mary  Charles 


American  Red  Cross  Military  Hospitals  in  Great  Britain 

American  Red  Cross  Military  Hospital  No.  4 — Mossley  Hill,  Liverpool 
American  Red  Cross  Military  Hospital  No.  21 — Paignton,  South  Devon 
American  Red  Cross  -Military  Hospital  No.  22 — Lancaster  Gate,  London 
American  Red  Cross  Militarv  Hospital  No.  23 — St.  Katharine's  Lodge, 

London 
American   Red  Cross  Military  Hospital  No.  24 — Baroda  House,   London 

An  American  Red  Cross  Military  Hospital  of  wenty-cight  beds  was 
opened  near  Dublin,  Ireland,  October'  15,  l!fl8,  to  s-  'e  American  mechanics 
from  four  aerodromes. 


APPENDIX  1457 


AMHaiicAN  Red  Cross  Convalescent  Hospitals 

American  Red  Cross  Convalescent  Hospital  No.   101 — T^ingfield,  London 
American  Red  Cross  Convalescent  Hospital  No.   102 — Wimbledon,   London 
American  Red  Cross  Convalescent  Home  for  Nurses — Putney,  London 


American  Army  Hospitals  i.\  Great  Britain 

United  States  Army  Rase  Hospital  No.  204 — Hursley  Park 

United  States  Army  Base  Hospital  No.  .i.i — Portsmouth 

United  States  Army  Base  Hospital  No.  37 — Dartford 

United  States  Army*  Base  Hospital  No.  2!) — Tottenham 

United  States  Army  Base  Hospital  No.  40 — Sarisbury  Court 

United  States  Army  Camp  Hospital  No.  35 — Winchester 

United  States  Army  Camp  Hospital  No.  40 — Knotty   Ash,   Liverpool 

United  States  Army  Camp  Hospital  No.  34- — Romsey 

United  States  Army  Camp  Hospital  No.  30 — Soutliampton 


American  Red  Cross  Military  Hospitals  in  France 

No.  1 — Neiiilly-sur-Seine 

No.  2 — ."j  Rue  Puccini,  I'aris 

No.  3 — 4  Rue  de  Chevreuse,  Paris 

No.  5 — Auteuil.  Paris 

No.  6 — Bellevue,  Paris 

No.  7 — Jouillv-Seine-et-Marne 

No.  8— Malabry 

No.  9 — 32  Boulevard  des  Batignolles   (for  skin  diseases) 


Amehican  Red  Cross  Hospitals  in  France 

No.   101 — 2  Boulevard  de  Chateau,  Neuilly  (for  personnel  of  Red  Cross  and 

other  welfare  orf^anizations) 
No.  102 — Neufchateau   (for  contagious  diseases) 
No.   103 — 44  Rue  Chauveau,  Neuilly    ( overtiow  hospital  for  A.R.C.  Military 

Hospital   No.    1 )  " 

No.   104 — Beauvais,  L'Kcole  Professionelle 
No.   105 — Jouilly,  maintained  for  French  wounded  after  the  witlidrawal  of 

Americans 
No.   107 — Jouy-sur-Morin 
No.   10i» — Kvreux,  Dr.  Fitcli's  Hospital 
No.   110 — Coincy,  Aisne 
No.   Ill — Chateau-Thierry,    Aisne 
No.   112 — Auteuil,  Paris    (under  construction) 
No.   113 — Cognac,  for  the  Czechoslovak  Army 
No.   114— Toul 

L'Hopital  dcs  Allies,  at  the  Chateau  d'Aiuiel.  near  Campeigne;  Ambu- 
lance Chirurgical  St.  Paul:  the  temporary  formation  at  Chantilly ;  the 
Daly  Unit  and  l/f:colr  <Ic  Li'ijion  <lr  Ihrniu  ur  at  St.  Denis  wtTc  other  col- 
unnis  assisted  by  Auu'ricau    Hcil   Cross   funds,   pcrsuruiel   and   supplies. 


1458  APPENDIX 

Amebicak  Red  Cboss  Infirmakies  in  France 

No.  1 — Dijon  No.  6 — Limoges 

No.  2 — Bourges  No.  7 — Brest 

No.  3 — Angers  No.  8 — Bordeaux 

No.  4 — Nantes  No.  9 — St.  Nazaire 
No.  5 — Tours  (St.  Pierre  du  Corps) 

American  Red  Cross  Dispensaries  in  France 

No.  of  Dis- 
pensary Visits  Made 

No.       1 28,000 

No.       2 12,435 

No.       3 3,397 

No.       4 433 

No.       5 3,748 

No.       6 1,715 

No.       7 5,999 

No.       8 1,804 

No.       9— A.R.C.  Military  Hosp.  24,500  (Out-patient  clinic) 

No.  102— A.R.C.  Hospital 15,316  (Dispensary  connected  with  No.  102) 

Total 97,347 


American  Red  Cross  Convalescent  Homes  foe  the  American  Expedi- 
tionary Forces  in  France 

No.  1 — St.  Julien,  Gironde 

No.  2 — Hotel  Regina,  Biarritz 

No.  3 — Morgat 

No.  4 — St.  Cloud,  Paris 

No.  5 — Vatan-Indre,  Issoudun 

No.  6 — Le  Croisic 

No.  7 — Rochefort-en-Terre-Morbihan 

No.  8— Chateau  de  Villegenis,  near  Paris 

No.  9 — Chateau  de  Saumery,  Huisseau-s-Cosson 

No.  10 — Alvignac 

No.  11— Hotel  du  Cap  d'Antibes 

Location  of  American  Red  Cross  Nurses'  Homes  in   France 

Paris,  41  rue  Galilee 

Passy,  5  and  7  rue  Louis  Boilly 

Neuilly,  17  Avenue  St.  Foy 

Paris,   118  rue  de  la  Faisandorie 

Paris,  4  rue  Ciievreuse,  A.R.C.  M.II.  No.  3 

St.   Denis,   Base   Hospital   No.   41 

Paris,   17  rue  Aujjruste-Comte,  Base  Hospital  No.  57 

Dijon,  Hotel  du  Jura 

Talonce,  Base  Hospital  No.  6 

Bordeaux,  2  Cours  du  Juliet 

Le  Croisic 

Cannes,  Hotel   Biarritz 


APPENDIX 


1459 


Nurses'  Recreation  Clubs  Built  by  the  American  Red  Cross  for  Regu- 
lar AND  Reserve  Members,  Army  Nurse  Corps,  A.E.F.,  France 


Angers,  Base  Hospital  No.  27 
AUerey,  Base  Hospital  No.  26 
Bazoilles,  Base  Hospital  No.  18 
Bazoilles,  Base  Hospital  No.  48 
Baccarat 

Beaune,  Base  Hospital  No.  61 
Beaune,  Base  Hospital  No.  80 
Brest,  C  Hospital  No.  33 
Brest,  Base  Hospital  No.  65 
Chateauroux,  Base  Hospital  No.  9 
Donjeux,  Military  Hospital  No.  11 
Limoges,  Base  Hospital  No.  24 
Le  Valdahon,  C.  H.  No.  12 


Nantes,  Army 

Nantes,  Base  Hospital  No.  11 
NeufcliAteau,  Base  Hospital  No.  66 
Rimaucourt,  Base  Hospital  No.  58 
Rimaucourt,  Base  Hospital  No.  64 
Rimaucourt,  Base  Hospital  No.  52 
Rimaucourt,  Base  Hospital  No.  59 
Savenay,  Base  Hospital  No.  8 
Tours,  Base  Hospital  No.  7 
Toul,  J]vacuation  Hospital  No.  1 
Vittel,  Base  Hospital  No.  23 
Vertuzey,  Base  Hospital  No.  1 
Bazoilles,  Base  Hospital  No.  60 


Hospitals,  Dispensaries,  and  Convalescent  Homers  of  the  American 
Red  Cross  Children's  Bureau  in  France 

Toul: 

Asile  Caserne  de  Luxembourg,  an  orphanage. 
Children's  Hospital. 
Maternity  Hospital. 
Dispensary  Service: 
Toul. 
Nancy. 
Luneville. 
Neuve  Maison. 
Gerbeviller. 
fipinal. 
Foug. 
Dinard: 

Children's  colony,  dispensary  and  infirmary. 
Damarie-lea-Lys.  near  Melun : 

Children's  colony. 
Nesle: 

Children's  hospital. 
Dispensaries. 
Amiens: 

Dispensary  and  public  health  nursing  service. 
Kvian-lcs-Hains: 
Chate'.et  Hospital  for  Children. 

Medical  examination  for  every  rapatrie  child  entering  France. 
Lyons: 

Chflteau  des  Halles,  St.   Foy  I'Argontiere,  a  convalescent  liome  for  chil- 
dren, originally  a  hospital. 
Hospital  \'i<)l('t,  for  children  suffering  from  contagious  diseases. 
Hospital   HoKzman,   for   children   suffering  from  acute  diseases. 
La  Chaux.  an  orjjhanage. 
Child   \V<'lfare  Exposition. 
St.    I^;ti('nnc: 
Dispensary. 

ChautiiloiK'tte  Hospital    for   Children. 
Child   Welfare   Kxposition. 


1460  APPENDIX 

Marseilles: 

Dispensary  and  milk  station. 

Temporary  cliildren's  hospital  and  preventorium. 

Child  Welfare  Exposition. 
Toulouse : 

Child  Welfare  Exposition. 
Bordeaux: 

Dispensary  and  visiting  nursing. 

Child  Welfare  Exposition. 
Blois: 

Dispensary  and  visiting  nursing. 
Corheil : 

Dispensary  and  visiting  nursing. 
Paris: 

Levallois  Dispensary,  38  rue  de  Gide. 

Crenelle  Dispensary,   17  rue  de  L'Avre. 

Censier  Dispensary,  20  rue  de  Censier. 

La  Courneuve  Dispensary,  58  rue  de  la  Convention 

Mignottes  Dispensary,  rues  des  Solitaires  et  des  Mignottes. 

Dispensaire  Marie-Lannelongue,   12!)  rue  de  'Jolbiac. 

Edouard  Pailleron  Dispensary,  9  rue  Edouard  Pailleron. 

Poteau  Dispensary,  41  rue  de  Poteau. 

Assistance  Publique,  40  rue  du  Pre-Saint-Gervais. 

L'Argonne  Dispensary,  21  bis,  rue  de  I'Argonne. 

La  Jussienne  Dispensary,  2  rue  de  la  Jussienne. 

Dispensaire  des  Matlnirins,  .32  rue  des  Matluirins. 

Patronage — Franco-American  pour  la  Premiere  Enfance,  35  rue  Dareau. 

Bobigny  Dispensary. 
Paris:     Other   institutions: 

Hopital  ^larie-IIelenc.  77   rue  Arago. 

Bicetre  Hospital.  1!)  rue  du  Pasteur. 

La  Pouponniere  de  Porcliefontaine,  Versailles. 
Rouen : 

Dispensary   and    social    service. 
Dijon : 

Creclie  at  Camouflage  Camp,  American  Expeditionary  Forces. 
Dieppe: 

Medical  examination    (staff  from  Evian-les-Bains)    for  rapatrie  children. 
Le  Ghuidier: 

Contagious  hospital  and  dispensary  for  Belgian  refugee  children. 
Le  Havre : 

Dispensary  and  small  cliildren's  hospital. 

PrINCIPAI,     irOSPnAI/S    and    DiSPEXSAIUKS    An)F,D    or    ESTAnUSIIED    BY    TIIE 

Americax  Red  Cross  Bureau  ov  Refugees  in  Fra.n'ce 

The  British  and  American  Friends'  ^lalernity  Hospital.  Clialons-sur-Marne. 

Hosjjifal  for  Sick  Babies.  Britisli  and  Ajuerican. 

Friends'   Surgical   Hospital,   Scrmaize-les-Bains. 

Dispensary  L'Accuei]  Franco-American.  12  rue  Boissy  d'Anglas,  Paris. 

Refujzee  Hospital.   Beanvais. 

Emergency   Canteens,   various    (Inres  de  Paris. 

St.   Sulpice   Hospice.   Paris. 

H()S[)ital   and    Disjieiisary.   Limoges. 

Ho-;[)ital    and    Dispensary.   Angouleme. 

Refugee    Dispensaries,   two.   X'ajence. 


APPENDIX  1461 

Hospitals  and  Dispex.saries  of  the  American  Red  Cboss  Bubeiau  or 
Tuberculosis  in  Fr.\nce 

Tuborculosis  pavilions  at  Hligny,  Briis-sous-Forges,  near  Paris. 

Tuberculosis  pavilions,  L'Hopital  .S'/.  Joseph,  Paris. 

Barracks  of  tho  Assistance  Publique,  Paris. 

L'Hopital   Bt^nevole  l^ftis,  Paris. 

Etiitli  Wharton   Sanatorium,  Yerres. 

Asile  iSte.   Kugenic,  Lyons. 

Tuberculosis  Dispensary,  Cours  Gainbetta,  Lj-ons. 

Edward  T.  Trudcau  Sanatorium,  at  l^lessis-Kobinson,  near  Paris. 

Women's  Tuberculosis  Hospital,  Blois. 

Tuberculosis  Dispensary,  Blois. 

Joint  Dispensaries  of  the  Rockefei.ler  Commission  for  the  Prevention 
OF  Tuberculosis  in  France  and  the  Amehica.n  Red  Cross 

Paris: 

Dispensary  de  I'Argonne,  19th  Arrondissement. 

Dispensary  des  Mij^nottes,   19th  Arrondissement. 

Dispensary  de  la  (ilaciere,   13th  Arrondissement. 

Dispensary  des  Mathurins. 
Department  Eure-et-Loir : 

Chartres. 

Chateaudun. 

Dreux. 

St.  Reniy-sur-Avre. 

Nogent-le-Rotrou. 

Xortii  Russia 

American  Red  Cross  Hospital,  Archangel,  Russia. 

Italy 

AMERICAN    RP:D    CROSS    HOSPITALS 

Rimini  Refugee  Hospital. 

Befugee   Hospital.  CaTiicattini   Bague,   Sicily. 

American   Red  Cross  Naval  Hospital,  Genoa. 

American   Red  Cross   Hospital,   Padua. 

American   RihI  Cross  Hospital.  Rome. 

Convalescent  Hospital   for  Tuberculosis  Cliildren,  Taormina. 

AMERICAN    RED    CROSS    DISPENSARIES 

Cesanatico.  Naples. 

Bellaria.  Avellino. 

Cliioggia.  \'illa  San  Giovanni. 

(ienoa.  Taormina. 

Florence. 

AMERICAN    RED    CR0S8    TEACHING    CENTERS 

Nurses'  Center,  Milan. 

Rome         (Course  of  training  for  piiblic  healtli  visitors). 

Genoa  '"        '"  "  " 

Florence        "        "  "  " 

Palermo         "         ''  "  '" 


1462  APPENDIX 

Palestine 

ameeican  red  cboss  hospitals 

American  Red  Cross  Surgical  Hospital,  Jerusalem. 

Turkish  Municipal  Hospital,  Jerusalem. 

Children's  Hospital  &  Dispensary,  Jerusalem. 

Tent  Hospital,  Wadi  Surar  Refugee  Camp. 

Infectious  Disease  Hospital,  Jaffa. 

American  Red  Cross  Hospital,  Ramleh. 

American  Red  Cross  Civilian  Hospital,  Haifa. 

American  Red  Cross  Hospital,  Acre. 

American  Red  Cross  Cholera  Hospital,  Tiberias. 

American  Red  Cross  Hospital  and  Dispensary,  Es  Salt. 


AMERICAN  BED  CBOSS  DISPENSARIES 

Carmelite  Convent,  Mount  of  Olives. 

Franciscan  Monastery,  Bethany  Road. 

Bucharlea,  Jerusalem  District. 

Dispensary  in  connection  with  the  Greek  Hospital,  Jerusalem  District. 

Convent  of  the  Holy  Cross,  Jerusalem  District. 

Russian  Convent,  Jerusalem  District. 

Bishop  Gobat's  School,  Jerusalem  District. 

David's  Tower,  Jerusalem  District. 

Ludd. 

ROUMANIA 

American  Red  Cross  Hospital,  Roman. 
American  Red  Cross  Dispensary,  Roman. 
American  Red  Cross  Dispensary,  Jassy. 
Child  Health  and  Feeding  Units  in  1919-1922. 


MOXTENEGRO 

Podgoritza, : 

American    Red    Cross    hospital,    dispensary    and    public    health    nursing 
service. 
Niksic: 

American  Red  Cross  hospital,  dispensary,  soup  kitchen  and  public  health 
nursing. 
Kolaskin: 

American  Red  Cross  dispensary. 
Cctinje: 

American    Red    Cross   hospital,   day   nursery,   orphanage,    public   health 
nursing. 

Albania 

Scutari : 

American  Red  Cross  dispensary,  public  health  nursing  and  orphanage. 
Kroya: 

American  Red  Cross  dispensary  and  public  health  nursing. 
Tirana: 

American  Red  Cross  hospital,  dispensary,  public  health  nursing,  health 
instruction. 


APPENDIX  1463 

Durazzo : 

Public  health  nursing  (to  a  small  extent). 
Elbasan : 

American  Red  Cross  dispensary  and  public  health  nursing. 
Kavaja: 

Mobile  dispensary  service. 
Koritza: 

American    Red    Cross    hospital,    dispensary    and    public   health    nursing 
service. 

Greece 

Refugee    Relief    Stations    at    Tyrnovo-Sieniew,    Dedeagatch    and    Xanthi, 

Macedonia. 
Civilian    Relief    Stations    (nurses    assigned   there)    on   Samos,   Chios   and 

Mitylene. 
Kavala : 

American  Red  Cross  dispensary  and  public  healtli  nursing. 
Rodolivas: 

American  Red  Cross  dispensary  and  public  health  nursing. 
Prava : 

American  Red  Cross  dispensary  and  public  health  nursing. 
Drama: 

American  Red  Cross  dispensary  and  public  health  nursing. 
Serres : 

American  Red  Cross  dispensary  and  public  health  nursing. 
Athens: 

Child  welfare  clinic,  classes  for  training  native  health  visitors. 
Patras: 

Child  Welfare  station. 
Crete: 

Child  Welfare  station. 

NoETH  Sbibbia 
Kragujavatz: 

Sewing  rooms  and  public  health  nursing. 
Cuprya : 

American  Red  Cross  hospital,  dispensary  and  public  health  nursing. 
Kraljevo: 

American  Red  Cross  dispensary  and  chain  of  sewing  room  at  Kraljevo, 
^lilanovatz,  Cliachak,  Terznik  and  Krushevatz. 
Palanka: 

Serbian  military  hospital  aided  by  nurses,  other  personnel  and  supplies. 
Petrovatz: 

American  Red  Cross  hospital   (summer  only)   and  dispensary  and  mobile 
dispensary    service    in    neigliboring    villages    of    Scotonye,    Meienica, 
Paslianatz  and  Runovitch. 
Pozarevatz: 

American   Rod   Cross   general   hospital   dispensary,   tuberculous   hospital 
and   an   orphanage. 

South  Skrbia 
Pirot: 

American  Red  Cross  dispensary,  public  health  nursing  and  distribution 
of  supplies. 
Leskovac : 

Assignment  of  nurses  and  supplies  to  a  Serbian  Military  Hospital. 


1464  APPENDIX 

Vranja: 

Assignment  of  nurses  to  the  Scottish  Women's  Hospital  Unit,  establish- 
ment   of    American    Red    Cross    soup    kitchens,    sewing    rooms    and 
orphanage. 
Prizren : 

American  Red  Cross  hospital,  orphanage  and  soup  kitchen. 
Skoplji : 

Assignment   of   nurses   to   Vardar   and   Half   Moon    (Serbian)    Military 
liospitals. 
Gostivar: 

American    Red    Cross    hospital,    dispensary,    public   health   nursing    and 
general   relief. 
Monastir : 

Assignment  of  nurses  to  the  American  Women's  Hospital,  establishment 
of  American   Red   Cross   sewing  rooms  and  distribution   of  general 
relief. 
Kavadar : 

American  Red  Cross  dispensary,  orphanage  and  general  district,  tubercu- 
losis and  infant  welfare  nursing  service. 
Gevgeli : 

Public  health  nursing  and  public  distribution  of  general  relief. 


SIBB2SIA 
AMERICAX  RED   CROSS  HOSPITALS 

Russian  Island  Hospital,  Vladivostok. 

Assistance  to  Fortress  Hospital,  Vladivostok  Harbor. 

Assistance  to  Czech  Naval  Hospital,  Vladivostok. 

Vladivostok  Refugee   Hospital. 

]\Iorskoi    (British  Naval)    Hospital,  Vladivostok. 

Emergency  Hospital  American   IJed  Cross  Jjarracks  Xo.  7,  Vladivostok. 

Teaching  Center,  Xo.   10  St.  IN'ter  the  Great  Street,  Vladivostok. 

St.  Luke's  llos])ital.  Tokyo.  -Tapan. 

Surgical  Pavilon,  Harliin  Military  Hospital,  Harbin,  Manchuria. 

Puclialoo  Hospiial,  Manclnnia. 

Cliolera  work  in  Cliiiiese  City  Hospital  and  Russian  City  Hospital,  Harbin, 

Mancliuria. 
Assistance    to    Hospital    of    tlie    Russian    Railway    Service    Corps,    Harbin, 

Manchuria. 
Government   Iniinigration    Station   Hospital,   Clieliabinsk. 
American   Red   Cross  Hospital,  Tunien. 
American  Red  Crcjss  Hospital.  Omsk. 
American  Red  Cross  Hospital,  Tomsk. 
Assistance    in    e(jui})nicnt    and    su])plit's    to    Czech    Invalid    Hospital,    Petro- 

jjavlosk. 
Anti-ty|)lms   Disinfecting  and  ]'>a1li  Station,  Ekaterinburg. 
Anti-tyjilius  Hospital,  Petropavlosk 
American   Hcd   Crdss   Ibispit;'!.  N()\<i-Xikolanvsk. 
American    lied    Cidss    Hospital.    Iikntsk. 
Division  No.  2,  l!iissi;iii  .Militarv  Hospital,  Czeclio-Slovak  Irkutsk,  Hospital 

(A.i:.C.i    Irkutsk. 
Military  City   ildsjiiial.  near  Irkutsk. 

American    INd   ('ross    ii(is|iital   and    dispcTisary.  \erkline-Udinsk. 
Provost  Guard    Hospital,   X'erkline-rdiiisk. 
Kmergenc}-  Typiuis   Hospital,  \'erkline-Udinsk. 


APPENDIX  1465 


DISPENSARIES    AM)    DE-NTAL    CI.IMCS 

Railroad  Dispensary,  Irkutsk. 

Knier<,'ency  DresHinj^  Car,  l{ailroad  Station,  Irkutsk. 

Dontal  tliiiic,  Kkali-rinburg. 

Dental  Clinic,  Cheliabinsk. 

MISCELLANEOUS 

Hospital  train  biiilt  and  supplied  by  American  Red  Cross  for  Czecho- 
slovak Army,   12  cars. 

Complete  Anti-'rypbiis  train  built  and  supplied  by  American  Red  Cross  for 
Allied  Kxpeditioiuiry   Force. 

Five  relief  trains  sent  out  to  middle  and  western  Siberia,  averajre  value 
of  rcdief  and   nu'dical  supj)lies  and  e(]ui]iment,  .'*:4.")0.0()n. 

Supplies  of  hospital  e(piipnient,  sur<,ncal  (lressin<.rs.  drujrs  and  instruments 
lo  Ivussian  and  Czech  hos])itals  at  TiuiU'n,  I';ka1erinbur<^,  Cheliabinsk, 
'rai<.Mr,  Omsk.  Nikolsk  atid  \'ladi\ ostnk. 

Children's  Colony,  Russian  Island,  Madivostok  Harbor. 


AMERICAN  RED  CROSS  CHILD  HEALTH  UNITS 

January-April,  1922 

(564  ambulatoria  and  milk  stations  established;  68  local  hospitals  aided.) 


Albania 

Durazzo 

Scutari 

Tirana 

Austria 

Anisteltin 

Leising 

Badeno 

Linz   (2  stations) 

Bischofshofen 

Mistelback 

Brixlegg 

Murau 

Bruck 

Murzzuschlag 

Brunnau 

Neunkirchen 

D.  Landsberg 

Okufstem 

Ebensee 

Reid 

Kggonberg 

Reutte 

Fold  Kirchen 

Rottenman 

Freistadt 

Saalfelden 

Frohnleiten 

Salzburg 

Gmunden 

Scharding 

Gras  Furstenfeld   (4  stations) 

Spittal 

Hallein 

Stanis 

Hall  Innsbruck 

(2  stations) 

Steyr 

Itzling-Gniol 

Stockirau 

Judenburg 

St.  Polten 

Kirchdorf 

St.  Veit 

Kitzbuncl 

Vienna   (41  stations) 

Klagenfurt    (2  stations) 

Villach 

Kleinmunchen 

Voitsberg 

Kroms 

Wells 

Landeck 

Weiz 

Lt'ibnitz 

Wiener  Ncustadt 

Leoben 

Wolfsberg 

Czecho-Slovakia 

Ash 

^loravska  Ostrava 

Ban   Bystrica 

IMost 

I'xTc^'sas 

Ahinkacevo  (with  2  rural  branches 

Bratislava 

Otomouc 

l'>ino 

Oziskov 

IJiuicjovico 

Pardubice 

Dviir   Kralove 

rizcn 

llodoiiin 

Prague 

Jihlava 

Pribram   (with  2  rural  branches) 

K OS ire 

Susicc   (witli  2  rural  branches) 

Libcrec 

1466 


APPENDIX 


1467 


Greece 


Athens  (6  stations) 


Salonika  (in  and  about  Salonika,  7 
stations) 


HUNGABY 


Baja 

Balassagyarmat 

Bekescsaba 

Budapest   (21  stations) 

Debrecze 

Eger 

Esztfrgom 

Gyula 

Gyor 

Hodmezovasarhely 

Jaszbereny 

Kaposvar 

Kecskemet 

Kiskunfelegyhaza 

Mako 


Mlskolcz 

Napykanizsa 

Xyirecyliaza 

Papa 

Pecs 

Satoraljaujheli 

Szepcd 

Szpglfd 

Szcklsfclicrvar 

Szokszar 

Szolnok 

Szomtiillicly 

Ujpcs 

Veszprem 

Zalaegerszec 


Montenegro 

Cetinje   (since  January  1,  1022,  maintained  l)y  local  doctors) 

Kolashin   (since  March  1,  1022,  maintained  by  a  local  doctor) 

Niksic 

Podgoritza  (one  local  health  station  formed  in  March,  1022,  being  a  com- 
bination of  American  Red  Cross  and  two  local  organizations.  On 
March  31,  transferred  entirely  to  local  authorities) 

Vir-Pazar  (since  January  1,  1922,  running  imder  local  doctors) 


Poland 


Alexandrow  (near  Torun),  1  ambulatorium. 

Alexandrow   (  near  Rciers) ,  1  ambulatorium. 

Augustow,  1  ambulatorium  and  a  hospital  aided. 

Baranowicze.  2  ambulatoria.  a  milk  station  and  a  hospital  aided. 

Bedzin,  1  ambulatorium  and  a  milk  station. 

Biala   (near  Warsaw),  1  ambulatorimu. 

Biala   (near  Krakow),  1  ambulatorium  and  milk  station. 

Bielsk.  2  ambulatoria. 

Blaszki,  1  ambulatorium. 

Bobkrii,  1  and)uIatorium  and  a  hospital  aided. 

Borszozow,  1  ambulatorium  and  a  hospital  aided. 

Brodnica,  1  ambulatorium  and  a  milk  station. 

Brody,  1  ambulatoriimi  and  a  milk  station. 

Brzesc-Litewiski,  1  ambulatorium  and  a  milk  station. 


1468  APPENDIX 

Brzezany   (near  Lwow),  1  ambulatoriiim. 

Brzeziny   (near  Warsaw),  1  ambulatorium,  a  milk  station  and  a  hospital 

aided. 
Bydgoszcz,  2  ambulatoria,  a  milk  station  and  a  hospital  aided. 
Chajny,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Chelm,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Chelmno,  1  ambulatorium  and  a  milk  station. 
Chodziez,  a  hospital  aided. 

Chrzanow,  1  ambulatorium  and  a  milk  station. 
Ciochanow,  1  ambulatorium  and  a  hospital  aided. 
Cieszyn,   1  ambulatorium. 

Crodno,  1   ambulatorium  and  a  hospital  aided. 
Czeladz,  1  ambulatorium  and  a  milk  station. 

CzestrochoMa,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Czortkow,  1  ambulatorium. 
Dabrowa,   1   ambulatorium. 
Dawidgrodek,  2  ambulatoria. 
Domaczewo,   1   ambulatorium. 
Elogzow,  1  ambulatorium  and  a  milk  station. 
Garwolin,  1  ambulatorium. 

Gostynin,  1  ambulatorium  and  a  milk  station. 
Grajewo,  1  ambulatorium. 

Grodekjac,  1  ambulatorium  and  a  hospital  aided. 
Grudziadz,  1  ambulatorium  and  a  milk  station. 
Halicz,  1  ambulatorium. 

Jaroslaw,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Jaworow,  1  ambulatorium  and  2  hospitals  aided. 
Kalisz,  1  ambulatorium  and  a  milk  station. 
Kalusz,  1  ambulatorium  and  a  milk  station. 
Kielce,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Kolo,  1  ambulatorium. 

Kolomyja,  1  ambulatorium  and  a  milk  station. 
Konstanty,  1  ambulatorium. 
Kovel,  1  ambulatorium  and  a  milk  station. 
Korzec,  1  ambulatorium. 

Krakow,  4  ambulatoria,  a  milk  station  and  a  hospital  aided. 
Krasnostaw,   1   ambulatorium. 
Krokovviec,  a  hospital   aided. 

Krzemieniec,  1  ambulatorium  and  a  hospital  aided. 
Kutno,  1  ambulatorium  and  a  milk  station. 
Lenino,  1  ambulatorium  and  a  hospital  aided. 
Leczyca,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 
Lida,  2  ambulatoria. 

Lodz,  .3  ambulatoria  and  6  milk  stations. 

Lomza,  2  ambulatoria,  a  milk  station,  and  a  hospital  aided. 
Lublin.  2  aml)u!atoria,  a  milk  station  and  2  hospitals  aided. 
Lubonil,  1   aml)ulatorium. 
Luck,  1  ambulatorium  and  a  milk  station. 
Luniniec,   1   ani])ulat()rium. 

Lwow,  2  ambulatoria,  a  milk  station  and  2  hospitals  aided. 
Micdzyrzcc,    1   ambulatorium. 
Mikdlajow,    1    ambulatorium. 

Minsk-Mazowiec'ki,    1   ambuhitorium  and  a  milk  station. 
Mlawa,  1  ainbiiiatoriiini  and  a  hospital  aided. 
Xicswioz.   1    ainhulatoriuin  and   a   li()s|)ital  aided. 

Xovoprodck.   1   ainhuhitoriimi,  a   milk  station  and  a  hospital  aided. 
Xowy  Sac'z,  1  amlailatoriiim  an<l  a  milk  station. 


APPENDIX  1469 

Nowy  Tare,  1  ambulatorium,  a  milk  station  and  a  hospital  aided. 

Olyka,  1   anihulatoriuni. 

Opatowt'k,  2  ainhulatoria. 

Ostrow,  1  anihulatoriuni.  a  milk  station  and  a  hospital  aided. 

Oltynia,    1   anihulatoriuni. 

Pahianict".   1   anihulatoriuni. 

Peczenizyni,   1  anihulalorium  and  a  hospital  aided. 

I'iotrkow,   1   anihulatoriuni   and  2   milk  stations. 

IMnsk,   1   anihulatoriuni,  a  milk  station  and  2  hospitals  aided. 

Plock,  ;{  amhulatoria,  a  milk  station  and  a  hospital  aided. 

Plonak,   1   anihulatoriuni  and  a  milk  station. 

Podhaice,   1  amhiihitorium  and  a  hospital  aided. 

Poznan,  3  amhulatoria. 

Pruzany,  1  anihulatoriuni  and  a  hospital  aided. 

Przasnysz,  1  anihulatoriuni  and  a  hospital  aided. 

Przemorsk,  2  amhulatoria. 

Przemuslany,   1   amhulatorium. 

Przcmysl,  1  anihulatoriuni  and  a  milk  station. 

Pulawy.    1    aniliulatorium. 

Pultusk.   1  anihulatoriuni  and  a  hospital  aided. 

Radoni.   1  anihulatoriuni,  a  milk  station  and  a  hospital  aided. 

Hawa    Ruska,    1    anihulatoriuni. 

Rosyszoze,    1    anihulatoriuni. 

Rowne,  1  anihulatoriuni  and  a  milk  station. 

Rzoszow,   1  anihulatoriuni,  a  milk  station  and  2  hospitals  aided. 

Rzgow,   1  amhulatorium. 

Rypin,  1  amhulatorium  and  a  milk  station. 

Sanihor,  2  amhulatoria  and  a  milk  station. 

Sandomiorz,  a  hospital  aided. 

Sarny,  1  amhulatorium  and  a  hospital  aided. 

Sejny,  1  amhulatorium  and  a  hospital  aided. 

Siodlce,  2  amhulatoria  and  a  hospital  aided. 

Sicrpc.   1  amhulatorium  and  a  milk  station. 

Skierniewicc,  1  amhulatorium  and  a  milk  station. 

Slonini,   1  amhulatorium. 

Socliaczew,  a   liospital  aidod. 

Sosnowice,  1  amhulatorium,  a  milk  station  and  a  hospital  aided. 

Stawiszyn,  1  amhulatorium. 

St.  Kol.   Bialowicza.  1  amhulatorium. 

Stolhcc,   1  amhulatorium  and  a  hospital  aided. 

Stolin.   1   amhulatorium. 

Stryj.  1   amhulatorium  and  a  milk  station. 

Strykow.   1    amhulatorium. 

Sukjowck,   1   amhulatorium. 

Swicciaiiy,  1    amhulatorium. 

Szczuczyn,  1   amhulatorium. 

Szicrz.   1  amhulatorium.  a  milk  station  and  2  hospitals  aidod. 

'raniohrzcfj,   1   aMihulatorium. 

Tarno])ol.  ."?  amhulatoria,  a  milk  station   and  a   hospital  aidod. 

Tarnow,   1  amhulatorium.  a  milk  station  and  a  hospital  aidod. 

Tozow,  1   amhulatorium  and  a   hospital  aidod. 

Tcloohany.    1   amhulatorium  and  a   liospjtal  aidod. 

'riuniaoz.  1   amhulatorium. 

Tomaszow,    1    amhulatorium  and  a   milk   station. 

Torun,   1  amhulatorium  and  a  milk  station. 

Tuszyn,   1   amhulatorium. 

Wagrowioc,  a   hospital  aided. 


1470  APPENDIX 

Warsaw,  6  ambulatoria,  8  milk  stations  and  2  hospitals  aided, 

Wegrow.  1  ambulatoriiim. 

VVieleczka,   1  ambulatorium. 

Wielun,  1  ambulatorium  and  a  hospital  aided. 

Wilno,  3  ambulatoria,  2  milk  stations  and  3  hospitals  aided. 

VVloclawek,  1  ambulatorium  and  a  milk  station. 

Wlodzimierz  Wolynski,    1    ambulatorium,   a   milk   station  and  a   hospital 

aided. 
Wolomin,  a  hospital  aided. 

Zakopane,  2  ambulatoria  and  a  hospital  aided. 
Zbaraz,   1   ambulatorium. 

Zdunska-Wola,  1  ambulatorium  and  a  milk  station. 
Zolkiev,   1   ambulatorium. 
Zydaczow,  2  ambulatoria,  a  milk  station  and  a  hospital. 


Serbia 

Alelexandrovatz  Krupanj 

Bajna  Bashta  Lazarevac 

Belgrade  Pozega 

Blace  Razanj 

Chiliegovatz  Trstenik 
Kosjerici 


West  Russia  and  Baltic  States 

December,  1921-April,  1922 

esthonia 

Arensburg  (Kuresaare)  Paide 

Azeri  Pernau,  3  stations 

Baltisch-Port  Petseri 

Dorpat  (Tartu),  3  stations  Pihla 

llarku  Rakvere 

Johvi  Rapiva 

Kamarovka  Reval,  4  stations 

Keila  Riisipcre 

Kose  Sindi 

Kullamaa  Slol)odka 

Kunda  Sunr  Miltsi 

Kuresaar  Tapa 

Liluila  Torgu 

Loksal  Vairara   District 

Luganuse  Warbla 

Mois  Wigala 

Muraste  Wilijandi    (Fellin) 

Narva,  3  stations  Woru 

Nomme  Wrangelstein 


APPENDIX 


1471 


LATVIA 


Aiskraukle 

AUasch 

Hirsche 

Boldera 

Chaiissee 

Dignaja 

Dvinsk,  3  stations 

Eglaine 

Friedrichstadt 

Goldingen 

Griva 

Hasonpoth 

Jacobstadt 

Jeoabmicsta 

Kraslawa 

Kreslavka 

Kreiisberg 

Libau,  3  stations 

I-udscn 

Martini 

Mazeikiai 


Milgrarvis 

Mitau 

Mitauer 

Muhlen 

Muhlgraben 

Ogre 

Plavinas 

Puspkin 

Resbiza,  2  stations 

Riga,  7  stations 

Ritter 

Rucava 

Salas 

Schaulen   (Shavli) 

Serrene 

Suntaschi 

Talsen 

Tomes 

Tuckum 

Wendau 

Wenden 


LITHUANIA 


Alexota 

Alytoa 

Ambulatory  No.  7 

Kermolitis 

Kozpikai 

I\ovno,  4  stations 


Mazeikai 

Meriampol 

Schaulen 

Slaboda 

Vilkoviski 

Wilkowischi 


American  Red  Cross  Nurses  Cited  and  Decorated  During  the 
European  War  * 

Aaron,  Marjorie Medaille  d'Honncur  dcs  Epidcmies,  French 

Addison.  Sara Medal  of  Military  Mrrit.  Greek 

Allison,  Grace  E lioyal  Red  Cross,  1st  Class,  British 

Allison,  Ruth  Hovey  (Mrs.).  Croix  de  Guerre,  bronze  star,  French 

.     ,  i  IX-  /Red  Cross    (silver  nunlal ) ,  Serbian 

Anderson,  Anna  \N <  ,,  r  ai  t.'     i  • 

(_  C  ross  of  Mercy.  Serbian 

Anderson.  Lyda  W Austrian  Red  Cross 

ArtiistroufT.  (irace  E Medaille  d'llonneur  des  Epideniiea    (bronze) 

Arnold.   Elizabeth Medaille  d'llonneur  des  P^pidemies,   French 

Arvin,  Mary  W Royal  Red  Cross.  2nd  class.  Hritisb 

4    ,       ,.,.     ,    ,,  /  I'nioTi  des  Feinnies  de  France  (<'old  medal) 

Aslie.   Elizabeth <  ,,    ,    .,,      .,,,  ,       ,,    .  ,     ^        ... 

\  Medaille  d  lionneur  des  hpidemies   (silver) 

Bailey,  Helen Cross  (if  Mercy.  Serbian 

Baker,  Aurel Medaille  d'Honncur  des  Epidemics 

•  From  ncwsp.Tpcr  clippinRs  and  corrcspondciu'o.  a  list  of  nurses  who  have 
Vu'fn  citf'd  and  decorated  during  the  Europi'an  War  was  madi'  o\it  and  qui's- 
tionnaircs  sent  to  each  nurse.  Tliis  Honor  Roll  was  then  coiniiiltKl  from  the 
rt'turnt'd  questionnaires.  l)ut  the  editors  of  tliis  History  cannot  miarantee  that 
this  li«t  contains  tlic  names  of  all  .\merican  Ked  Cross  nurses  cited  and  dec- 
orated. E.  1*. 


1472  APPENDIX 

Baker,  Bessie Medaille  d'Honneur  des  Epidemies  (silver) 

Baker,  Katherine  Volk Silver  Red  Cross  Medal,  Hungary 

Balen,  Anna Royal  Red  Cross,  2nd  class,  British 

Bartlett.  Kathryn Gold  Cross  of  St.  Anne,  Russian 

Bauer,  Caroline Red  Cross  Medal,  3rd  class,  German 

Bedell,  Ruth  E Medaille  d'Honneur  des  Epidemies 

Beers,  Amy Medaille  d'Honneur  des  Epidemies   (silver) 

Bender,  Lulu  G Cross  of  Mercy,  Serbian 

Bentley,  Grace Red  Cross  Silver  Medal,  Austrian 

Berry,  Nettie  Josephine.  .  ..  Royal  Red  Cross,  2nd  class,  British 

Beulshausen,  ]\Iary Cross  of  ^lercy,  Montenegrin 

Bigelow,  Helen Medaille  d'Honneur  des  Epidemies   (silver) 

Blackstone,  Eleanor Red  Cross,  Serbian 

Bogart,  Eugenia Cross  of  Mercy,  Serbian 

Bonncson,  llarriet  M Cross  of  Mercy,  Serbian 

Borg,  Ida  A Medaille  d'Honneur  des  Epidemies 

Boyle,  Sara  Jane Medaille  d'Honneur  des  Epidemies 

Bowen,  Mary  M iSIedaille  d'Honneur  des  Epidemies 

Bradv,  Bernice (  ^^^  Cross   Serbian 

\  Cross  of  Mercy,  Montenegrin 

Brcndell,  ]\Iyrtle  L Medaille  d'Honneur  des  Epidemies 

Broaddus,  P^mnia Medaille  d'Honneur  des  Epidemies 

Broussard.   Eunice Croix  de  Guerre  with  bronze  star 

Brownell.  ^lary  A Regina  Maria,  Queen  Marie  of  Roumania 

Bullard,  Florence Croix  de  Guerre  with  bronze  star 

Burtress    Edith  /  ^^^  Cross,  Serbian 

^      '  \  Cross  of  Mercy,  Montenegrin 

Briggs,  Helen  May Royal  Red  Cross,  2nd  class,  British 

Burcham.  Daisy Royal  Red  Cross,  2nd  class,  British 

Burky,  Florence Royal  Red  Cross,  2nd  class,  British 

Butler,  Rose  Kate Royal  Red  Cross,   1st  class 

Cairns,  Helen  W Cross  of  Mercy,  Montenegrin 

Camblos,  Jacqueline Medaille  d'Honneur  des  l^pidemies 

Carothers,  Dora  C Medaille  d'Honneur  des  Epidemies 

Carruthers,  Isabelle Royal  Red  Cross,  2nd  class,  British 

Carson,  Anno  L Royal  Red  Cross,  2nd  class,  British 

Cassidy,  Rose  A I\Iedaille  d'Honneur  des  Epidemies 

Chaney,  Emily  D Red  Cross,  Serbian 

!  Royal  Red  Cross,   1st  class,  British 
Citation,  U.  S.  Base  Hospital  No.  2,  January, 
ini8 
Roval  Red  Cross.   1st  class,  British 
C  itation  by  the  British 

Clark,  Susanne Medaille  d'Honneur  des  Epidemies   (silver) 

Clay,  Josepliine  A Palmes  Academiq>u>s.  French 

r^  ,,      1,  , ,      r^i  f  Croix  do  Guerre,  lironze  star 

Lonnellv,  l5cttv  Clara <  i>  -j-  i    ti        i  ti    i  r^  n    i     i 

\Bri1isli  Royal  Red  Cross,  2nd  class 

Cormier.  Bernadette Medaille  d'Honneur  des  Epidemies    (silver) 

Corning,  Alice Medaille  d'Honneur  des  Epidemies 

(Croix  de  Guerre 
Medaille  de  la  Reconnaissance    (French 
Army) 
Cox,  Katlierine Order  of  Elizabeth,  Belgian 

„             11    Ti    T  f  Medaille  de  la  Reine  (with  cross),  Belgian 

Cromwell.  R.  Lee |  (,^,,^^  ^^  ^^    ^^^^^^^  j^^,^^j^^ 

Croslev.  Sara  W Cross  of  Mprcy,  Serbian 

Cuppaidge.  Constance Royal  Red  Cross,  2nd  class,  British 


APPENDIX 


1473 


Donnison,  Faith. 


Delano,  Jane  A. 


DeLozier,  Mary  M.  . . . 
Diamond,  Mary  Anna. 
Dingrlev,  Nellie 


Driver,  A.  Madjje 

Dunlop,  Margaret  A 

Dyer,  Genevieve  E 

Ebbs,  Helen  Jane 

Eisenliard.   Nettie 

ElU'tt.  Josephine  S 

Elliott,  Mrs.  Helen  Bri<r>j:s. 

Elwood,  Bessie  Lydia 

Emerson,  Martha  F 


Einslcv,  Lvdia  Evanfreline. . 
Enjrel."  Mrs.  Austa  White.. 
Evans,  l8al)el  Wakeman... 
Evers,  Emma  Elise 

Ferj^uson,  Edna  Allison..  .  . 


Ferj^uson.  Ida  M. .  . 

Ferries.   Eva 

Finnell,  I'ranoes  G. 

Fit/.trerald,  Alice. .  . 


Foerster,  Alma 

I'olckemer.  Elizabeth   M. 
I'nincis,  .Marv  L 


f  Red  Cross,  Serbian 
\()rder  of  St.  Sava  (Class  V),  Serbian 
Distinguished  Service  Medal,  United  States, 

posthumously  awarded 
Distinguished  Service  Medal   (gold) 
American  Red  Cross,  posthumously  awarded 
Medal  awardetl  by  the  Austrian  Government 

for  aid  rendered  in  time  of  war 
.American  Red  Cross  Medal  of  Merit 
Medal    awarded    bv    Pan-American    Exposi- 
tion, to'oi 
.Medal   awarded   by   American   National    Red 
Cross  in  grateful  memory  of  her  devoted 
and  distinguished  service,  lOOS-lOlO 
Medal  awarded  by  the  National  Institute  of 
Social    Sciences   for    service   of    high    and 
inestimable  value  to  her  country 
Order  of  the  Japanese  Red  Cross 
Panama-Pacific    Exposition   Medal   conferred 
upon  Miss  Delano  as  collaborator  in  the 
<»xliibit    prepared    by    the    United    States 
Government 
Medaiile  d'llonncur  des  Epidemics    (silver) 
Medaille  d'Honneur  des  Epidemics   (silver) 
Medaiile  d'Honneur  des  Epidemics 

(Medailles  de  Vermeil) 
Medaille  d'Honneur  des  Epidemics    (silver) 
Royal   Red  Cross.   1st  class,  British 
Citation,  by  Sir  Douglas  Haig 
War  Decoration,  .3rd  degree,  Austrian 
Royal   Red  Cross,  2nd  class,  British 
Royal  Red  Cross,  2nd  class,  British 
Regina  Maria    (Class  Ila),  Roumanian 
Royal  Red  Cross,  2nd  class,  British 
Citation,  by  Sir  Douglas  Haig 
Royal  Red  Cross,  2nd  class,  British 
Silver  Medal,  1st  class,  with  War  Decoration, 

Hungarian  Red  Cross 
Royal   Red  Cross 

Royal   Red  Cross,  2nd  class,  British 
Royal   Red  Cross,  2nd  cla.ss,  British 
German  Red  Cross,  bronze  medal,  ."Jrd  class 
Royal   Red   Cross,  2nd  class,   British 
Britisli  Certificate  of  Merit 
Croix  de  (iiu'rre,  bronze  star 
\  Medaille  de  la  Reconnaissance 

Cross  of  Mercy,  Serbian 
f  Cross  of  Mercy,  Serbian 
Red  Cross    (silver),  Serbian 
Medal  of  Royal  Red  Cross,  British 
Italian   Decoration 
Florence  Niglitiiigalc  Medal 
Hiternational  Red  Cross 
St.  Aniic"s  Medal.  Russian 
Royal   Red  Cross.   1st  class.  l?riti<h  Citation 
Medaille  (riionnenr   des    Fiiiilruiies    (  silver  i 


1474  APPENDIX 

„             T      11  f  Cross  of  Mercy,  Serbian 

Francy,  Luella i^^^  Cross  (silver) ,  Serbian 

„      .        „    , ,  J  Red  Cross  Medal 

Frasms,  Ruth |  Citation,  Germany 

Frederick,  Le  Rue Royal  Red  Cross,  2nd  class,  British 

Gardner,  Agnes  J Medaille  d'Honneur  des  Epidemics  (silver) 

Gavin.  Hilary  C Medaille  d'Honneur  des  Epidemics  (silver) 

Gerhard,  Eva Royal  Red  Cross,  2nd  class,  British 

n           J    /-I     i     J    TIC  f  Royal  Red  Cross,  2nd  class,  British 

Gerrard,  Gertrude  M I  ci^tion,  by  Sir  Douglas  Haig 

o-i  Tif  til     Tvf  J  Croix  de  Guerre,  bronze  star 

Gibson,  Matilda  M \  Citation,  signed  by  General  Petain 

Gilborne,  Alice Regina    Maria,    3rd    class    (Queen    of    Rou- 

mania) 

Giles    Bertrice  l^^^  ^^"^^^   (silver),  Serbian 

lilies,  liertrice ^  ^^^^^  ^^  Mercy,  Serbian 

Gilliland,  Inez. Cross  of  Mercy,  Serbian 

^,    ,    .      ,T         T7.  f  Florence  Nightingale  Medal 

Gladwin,  Mary  E |  International  Red  Cross 

Glauber,  Marie  C Medal  of  Military  Merit,  Greek,  4th  class 

Gould,  Elspeth  Anna Royal 'Tied  Cross,  2nd  class,  British 

Hadsall,  Edith  L Medaille  d'Honneur  des  Epidemics  (silver) 

Hagadorn,  Alice Medaille  d'Honneur  des  Epidemics  (silver) 

Haile,  Elizabeth Cross  of  Mercy,  Serbian 

TT  u    n       •     \f  /  Roya^l  R^^  Cross.  1st  class,  British 

Mall,  L-arrie  M <  cj^ation,  by  Sir  Douglas  Haig 

TT      -li        r\i-   •     r?  /Medaille  d'Honneur  des  Epidemies  (silver) 

Hamilton,  Olivia  E |  ^^^^^  ^^  ^^^^^^^  Montenegrin 

Hanchette,  Lou  S Medaille  d'Honneur  des  Epidemies  (silver) 

Harold,  Mary  R Royal  Red  Cross,  2nd  class,  British 

Hartwell,  Jennie  V Medaille  d'Honneur  des  Epidemies  (silver) 

XT     .       M        T?r     V.  +1,  /Medal  of  Military  Merit,  4th  class,  Greek 

Hartz,  Alma  Elizabeth <  ^  f  -.^  nt     t.  • 

'  \  Cross  of  Mercy,  Montenegrin 

Havey,  Malinde Royal  Red  Cross,   1st  class,  British 

Hasson,  Esther  Voorhees. ..  .     Medaille  d'Honneur  des  Epidemies 

Haviland,  Sybella Cross  of  Mercy,  Serbian 

(Florence  Nightingale  Medal 
International  Red  Cross 
Regina  Maria  (Class  Ila),  Roumanian 
Hayes,  Myrtle  Elizabeth ...  .     Royal  Red  Cross,  2nd  class,  British 

Heath,  Maud Cross  of  Mercy,  Serbian 

Henry,  Ethel Medaille  d'Honneur  des  Epidemies 

Hill    Afla  r  Medaille  d'Honneur  des  Epidemies 

'  \  Royal  Red  Cross,  2nd  class,  British 

Hoagland.  Jennie  P Medaille  d'Honneur  des  Epidemies,  bronze 

Holmes,  Katharine  W Queen  Maria  Cross,  Roumania 

Horn,  Matilda  H Croix  de  Guerre 

Horner,  Blanche Medaille  d'Honneur  des  Epidemies 

Tzen,  Clara  J Medaille  d'Honneur  des  Epidemies 

T„ff„„„   AT..,i„i„: v<  /Croix  de  Guerre 

Janrav,  Aladeleine  t s  ut     •  t>  »  t^        i. 

\    Jnsigne  en  Bronze,     trench 

James,  Agnes  F Medaille  d'Honneur  des  Epidemies  (silver) 

Jeffrey,  Lucy  W Medaille  d'Honneur  des  Epidemies 

Jeffery,  Jane Distinguished  Service  Cross,  American 

Jessup,  Elsie Cross  of  Mercy,  Montenegrin 

Jolinson,  Florence  M Florence    Nightingale    Medal,    International 

Red  Cross 


APPENDIX  1475 

Johnson,  Helen Union  des  Femmes  de  France  (silver) 

Johnson,  Lena  Margaret. ..  .     Cross  of  Mercy,  Montenegrin 

Johnson,  Lillian Croix  de  Guerre  with  bronze  star 

T  ,      ,        ,,             .  w  /  Hed  Cross   (silver),  Serbian 

Johnston,  Margaret  W |<^.^^^^  ^^  ^j^^^^^  g^^^^i^^ 

Jordan,  Pauline Kegina  Maria,  Roumanian 

Jorgensen,  Sigrid Croix  de  Guerre  with  gold  star 

Kacena,  Blanche Medal  of  Military  Merit,  Greek 

Kehoe,  Frances  M Medaille  d'llonneur  des  Epidemies  (silver) 

Kennedy,  Mary Royal  Red  Cross,  2nd  class,  British 

Kerrigan,  Helen Palmes  Academiques,  French 

(  St.  Anne's  Silver  Medal,  Russian 
Kiel,  Sophia  V j  St.  Anne's  Gold  Medal,  Russian 

I  Queen  Elizabeth  Medal,  Red  Cross,  Belgian 

,,.        T  •  J  Red  Cross   (silver),  Serbian 

Kipp,  Lorrame <  ,„  ,  ,,  o    u- 

'^^'  {  Cross  of  Mercy,  Serbian 

Kirk,  Mrs.  ICmily  Holland..      Medaille  d'Honneur  des  Epidemies   (silver) 

Knapp,  Grace  M Medaille  d'Honneur  des  Epidemies   (silver) 

T^     ,      i.    11'    T    ,.:  /  Silver  Medal  of  Honor,  with  War  Decoration, 

Kochert,  \V.  Louise <  a      t.  •       t>    i  r^ 

'  \        Austrian  Red  Cross 

Krans,  Ella  M Medaille  d'Honneur  des  Epidemics   (silver) 

Kreigli,  Laura  L Cross  of  Mercy,  Serbian 

Lauridsen,  Karen Medaille  d'Honneur  des  Epidemies   (silver) 

Leete,  Harriet  L Red  Cross,  Serbian  / 

Lester,  Minnie  A Royal  Red  Cross,  2nd  class,  British 

Lewis,  Lydia Royal  Red  Cross,  2nd  class,  British'.   ^ 

Lewis,  Mary  Elizabeth Royal  Red  Cross,  2nd  class,  British      ' 

Lister,   Hannali Croix  de  Guerre,  bronze  star       •  •        '  •■ 

Ixjmbard,  Arabella  A Medaille  d'Honneur  des  Epidemies   (silver") 

Loughran.  Nellie ^ledaille  d'Honneur  des  Epidemies   (silver) 

Lyon,  Elizabeth  C Royal  Red  Cross,  2nd  class,  British 

,,  ^  o       u  f  Red  Cross,  Serbian 

;McC  arron,  Sarah <  ^  ,  Vr  o     i  • 

'  1  t TOSS  of  Mercv,  Serbian 

[Distinguished  Service  Cross,  American 
McClelland,  Helen  Grace...  .  I  Royal  Red  Cross,   1st  class,  British 

[citation,  by  Sir  Douglas  Haig. 
McCloskey,  Louise  Helenne. .      Royal  Red  Cross,  British 

IDistinguislied  Service  Cross,  American 
Croix  de  Guerre,  bronze  star 
Roval  Red  Cross,  2nd  class,  British 
British  Military  Medal 
MacUonald,  Irene Cross  of  Mercy,  Serbian 

Af.i^^...  11    Af^-:     T  /Red  Cro.ss,  Serbian 

JNlcDowell,  Mane  L (r\    i         *  oj.    o  i  r^i        tt\     e     i  • 

'  1  Order  of  St.  Sava   (Class  V),  Serbian 

Af.^f.ii        XT  4.  /Hed  Cross  ^ledal,  Serbian 

-Maciadden,   Kate <  ^^    i   i     r  >r  o     i  ■ 

\  .Medal  of  Mercy,  Serbian 

McGee,  Mary  Gertrude Medaille  d'Honneur  des  Epidemies    (silver) 

MacCiiilivray,  Editli Royal  Red  Cross,  2nd  class,  Briti.sli 

Mao(Jieg()r,   Flora Medaille  d'Honneur  des  Epidemies    (silver) 

McCiuire.  .Margaret  C Red  Cross  Medal,  2nd  class,  Hungarian 

McKernan.  Inza  G ^ledaille  d'Honneur  des  Epidemies    (silver) 

McKnight.  Lillian  S Royal  Red  Cross.   British 

McKee,  Inez Royal   Red  Cross.  2nd  class,  British 

McLannan.   \'era Royal   Red  Cross,  2n(l  class,  British 

McLaiigliliii.  Kinily Royal   Red  Cross.   1st  class,   Britisli 

McMaiiigill,  Kila  J Croix  de  Guerre,  bronze  star.  French 

MacNeal,  .laiie  (" Roval  Red  Cross,  2iid  class,   British 


14T6  APPENDIX 

MacXulty,  Carolyn Croix  de  Guerre,  bronze  star,  French 

Martin,  Florence  J Medaille  d'Honneur  des  Epidemies   (silver) 

Martin,  Isabelle .,     Military  Degree,  4th  class,  Greek 

Mauffray,  Helena Medaille  d'Honneur  des  Epidemies 

TFlorence  Nightingale  Medal 
Meirs,  Linda  K ]  International  Red  Cross 

I  Croix  de  Guerre,  bronze  star 

(  Cross  of  St.  Anne,  Russian 
Metcalf ,  Mrs.  Maud  H ■I  Cross  of  Mercy,  Serbian 

[  Cross  of  St.  Sava,  Serbian 

Miller,  Elsie  L Royal  Red  Cross,  2nd  class,  British 

Miller,  Mrs.  Lena  B Royal  Red  Cross,  2nd  class,  British 

Minnigerode,  Lucy Gold  Cross  of  St.  Anne,  Russian 

Mitchell,  Elizabeth Cross  of  Mercy,  Montenegrin 

Monroe,  Edith Medaille  d'Honneur  des  Epidemies 

Morrison,  Edna  M ^ledaille  d'Honneur  des  Epidemies   (silver) 

,,     .         T,    ,,  f  Roval  Red  Cross,  2nd  class,  British 

Morton,  Ruth '   ^^^j^  ^^  ^^^^^^^  ^^^^^^  ^^^^ 

X'  1         -\f  u  1  -V7-  I   Red  Cross,  Serbian 

kelson,  Mabel  V <   ^  ^  Vr  Af     ^ 

'  \  Cross  of  Mercy,  Montenegrin 

Nelson,  Mary  K Palmes  Academiques 

Nicholson,  Ann  Estella Royal  Red  Cross,  2nd  class,  British 

Norwich,  Margaret Cross  of  Mercy,  Serbian 

X-  rit         -r,  i.4.  f  Medal  awarded  by  the  National  Institute  of 

Noyes,  Clara  Dutton <         ^     -lo- 

•'     '  \         Social  Sciences 

Nye,  Sylvene  A Croix  de  Guerre,  gilt  star 

Obear,  Evelyn  E Regina  Maria   (Class  Ila),  Roumanian 

O'Brien,  Agnes  V Royal  Red  Cross,  2nd  class,  British 

O'Hara,  Anne  M Cross  of  Mercy.  Serbian 

O'l^ary,  Margaret Regina  Maria   (Class  Ila) ,  Roumanian 

Olsen,  Lydia  Josephine Medaille  d'Honneur  des  Epidemies   (silver) 

O'Neill,  Mrs.  Mary  Agnes. . .  Cross  of  Mercy,  Serbian 

r>  1       T7I       T  (  Roval  Red  Cross,  2nd  class,  British 

Parmelee,  Eva  Jean <    ^,\..         at   i   i    ^  vt-  i 

'  \  Military  Medal,  Britisii 

Parrish,   Minnie Cross  of  ^lercy,  Montenegrin 

Parsons,  Marion  G Royal  Red  Cross,  1st  class,  British 

Patmore,  Amy  F Medaille  d'Honneur  des  Epidemies 

'Regina  Maria  Cross,  Roumanian 

Medaille  d'Honneur  des  Epidemies   (silver) 

Dec()rate<l  by  the  Japanese  Red  Cross  with  a 

Florence  Niglitingale  medal,  tliis  being  a 

special    medal    of    that    organization    and 

not    to    be    confused    with    the    Florence 

Nightingale   ^ledal    of    the   International 

Red  Cross 

Perry,  Edith  V IMedaille  d'Honneur  des  Epidemies   (silver) 

I'erry,  Jennie  E Croix  de  Guerre,  bronze  star 

Peterson,   Hanna   S Roval  Red  Cross,  2nd  class,  British 

Phillips,  Mrs.  Julia  S. Order  of  St.  Sava    (Class  V).  Serbian 

T),  -iij        T         •     T  /  Roval  Red  Cross,  1st  class,  British 

Phillips,  Lawrie  L <  at  "i    -n      im  i       t-    •  i       •       /   -i        \ 

'  [.Medaille  dJlonneur  des  Epidemies   (silver) 

Porter,  Emily Medal  of  Military  ^lerit,  Greek 

Potts,  Susan  D Cross  of  ^lercy,  Serbian 

Powers,  Margaret  M Roval  Red  Cross,  2nd  class,  liritish 

Proctor,  Elizabeth /  J!^^!  Cross^  (silver ) ,  Serbian 

1  (  ross  of  JNlercy,  Seibian 

r\  .  a  -\r  I  Ked  Cross    (silver).  Serbian 

Quammen,  Sena  M <  , ,  ^   ,/  c     i  • 

1  (  ross  of  -Mcrcv.  Serbian 


Patterson,  Florence  M. 


APPENDIX  1477 

Quinsler,  Mrs.  Edna 

McCouglilin    Distinguished  Service  Medal,  American 

T.   J  ta    T  •II'  /  Medaille  d'Horineiir  des  Epidemics 

Radclin,  Lilhan <  ,,     .      ,     .,  ...     .     ^ 

'  \  Croix  de  CiiuTrc.  gilt  Htar 

Ranney,  Susan Regina  Maria   (CIuh.s  Ila  ) ,  Roumanian 

Reid,  Agnes Mt-daille  d'lloniu'ur  des  Epidemics   (silver) 

Rice,  Marion  M I'alincs  Acadeniiques 

Riciiardson,  Agnes  H Croix  de  Guerre,  bronze  star 

Rickcr,  Frances  E Medaille  d'lionneur  des  Epidemics   (silver) 

Ricketts,  Mary  II Cross  of  Mercy,  Serbian 

Reynolds.  Clara  P Red  Cross  Honor  Medal,  Austrian 

Robbins,  Emma  G Red  Cross,  Serbian 

Robertson,  Katharine  M....  Regina  Maria   (Class  Ila),  Roumanian 

Robertson,  Ruth  I Medaille  d'Honneur  des  Epidemics   (silver) 

Roche,  Mary  Jane Royal  Red  Cross,  2n(l  class,  Hritish 

Rogers,  Emma  Hart Cross  of  Mercy,  Serbian 

Rose,  Esther  M Cross  of  Mercy,  Serbian 

r>  Ar.,^:-,^   T  /Cross  of  Mercv,  Serbian 

Ross,  Alanon  J <  ,,    ,  ^  /     i       ^    t-     i  • 

'  \  Red  Cross   (silver),  Serbian 

Ross,  Mary  B Cross  of  Mercy,  Serbian 

T,  A      „  t;.  f  Cross  of  Mercv,  Serbian 

Rowe,  Anna  E <  -.,    ,  ^  /    i       \    o    t  • 

'  1  Red  Cross   (silver),  Serbian 

Russell,  Martha  M j  ^^^'^'^  ^'*^^';!"f  p    '^''"^'^ 

'  \  international  Red  Cross 

Ryan,  Lulu  B Medaille  d'Honneur  des  Epideinies   (silver) 

T>  IT-    -e     1  Af  /Red  Cross   (silver),  Serbian 

Ryan,   \A  inifred  M <  ^,  ^  , /  c-     i  • 

•^      '  \  Cross  of  Mercy,  Serbian 

Sahol,  Elina  P. Croix  de  Guerre,  bronze  star 

oi    T  1       Af        T        T)-       1      /  Croix  de  Guerre,  bronze  star 
St.  John,  Mrs.  Jane  Kignol..  <  „       i   r.    i  r-  o    i     i  t>    a-  i. 

'  *=  \  Royal  Red  Cross,  2nd  class,  British 

Sands.  Tyldesley  L Royal  Red  Cross,  2iid  class.  British 

Schmitt,  Dolly  Belle Royal  Red  Cross,  2nd  class,  British 

Schortield,    Minnie Roval  Red  Cross,  2nd  class.  British 

Scott.  Eleanor  M Royal  Red  Cross,  1st  class,  British 

Seratini,  Olive  E Royal  Red  Cross,  2nd  class.  British 

Sharpe.  Anna  M Croix  de  Guerre,  bronze  star 

Siegel,  Louisa  E German  Medal 

Smith,  Alice  O Croix  de  Guerre,  bronze  star 

c-     -ii     Af  11     Tj  /Red  Cross   (silver),  Serbian 

Smith,  Mollv  Bawn <  .^  ^  , /  c     i  • 

'  -  \  Cross  or  Mercy,  Scrliian 

Spencer,  Ruth  Helen Royal  Red  Cross.  1st  class,  British 

Snow,  ^lary  L Cross  of  Mercy,  Serbian 

c,,       ,         1      T    T     1    1  [  Distinguished  Service  Cross,  American 

Stambaugh,  .1.    Isabel <  ,,        i*^,,    ,    ,,  .->    i     i  i,   •.•  i 

'^    '  \  Koyal    Red   Cross,   2iul   class,    Hntisli 

Steplienson,  Mary  E Koyal   Red  Cross,  2iid  class.   British 

f  Distinguished  Service  Medal,  American 

Royal   Red  Cross.  1st  class.  British 

Stimson,  Julia  C ]  Medaille  de  la  Reconnaissance    (  French 

Armv) 

[citation,*  by  Sir  Douglas   Haig 

Strub,  Ann Medaille  (I'llonneur  des  Ej)ideiiiies    (silver) 

Swayse,   Ktlie   M Cross  of   Mercy,   Serbian 

Taft.    Nora Medaille  (riioniieiir   des   Epideinies 

Tarr,  Kebecea  Josephine.  ..  .      Medaille  d'lloinieiir   des   Epideinies   (bronze) 

Taylor.  Man.e Royal   Red  Cross,   1st  class.   Hritisli 

Taylor,   I'lmebe   F ('r<ii\   de   (Jiierre    I  bronze  stari 

Tlioinas.    Klieii  J (ieriiiaii  lied  Cross.  2ii(l  class.  Nurse  Order 


1478  APPENDIX 

n-,                 r»        t:>  /  Distinguished  Service  Medal,  American 

Ihompson,  Dora  E |  Companion  of  British  Empire 

Thompeon,  Sarah  R Croix  de  Guerre 

Tibbells,  Ursula Cross  of  Mercy,  Serbian 

Tittman,  Anna  L Gold  Medal  on  the  Ribbon  of  St.  Anne,  Rus- 
sian 

Todd,  Louise  M Croix  de  Guerre,  bronze  star 

Torrance,  Rachel  C Regina  Maria  (Class  Ila),  Roumanian 

Turner,  Lila  B Croix  de  Guerre,  gilt  star 

Tymon,  Margaret Medal  of  Military  Merit,  Greek 

Urch,  Daisy  D Royal  Red  Cross,  1st  class,  British 

Vuagniaux,   Emily Croix  de  Guerre,  bronze  star 

Walkinshaw,  Arvilla Royal  Red  Cross,  2nd  class,  British 

Wallace,  Olive  S Royal  Red  Cross,  2nd  class,  British 

Warwick,  Bessie  Mae Medaille  d'Honneur  des  Epidemics 

Watkins,  Jeannette Medaille  d'Honneur  des  Epidemics 

Watson,  Helen  R Cross  of  Mercy,  Montenegrin 

Watson,  Isabel Medaille  d'Honneur  des  Epidemics 

Weir,  Ruth Regina  Maria  (Class  Ila) ,  Roumanian 

Whedon,  Rhobie Cross  of  Mercy,  Serbian 

Wilcox,  Mabel Order  of  Elizabeth,  Belgium 

Wilday,  Grace German  Red  Cross  Medal,  3rd  class 

Wilkins,  Maud Medaille  d'Honneur  des  Epidemics 

Williams,  Kathryn Cross  of  Mercy,  Serbian 

Williamson,  Mildred Red  Cross   (silver),  Serbian 

Wilsey,  Marrietta Order  of  St.  Sava   (Class  V),  Serbian 

Wilson,  Eleanor Cross  of  Mercy,  Serbian 

Wiltzius,  Henrietta /  g'""^^.  °^  ^^7;,  Montenegrin 

\  Red  Cross,  Ist  Order,  Serbian 

Wood,  Edith  L Cross  of  Mercy,  Serbian 

Worley,  Pearl  M Medaille  d'Honneur  des  Epidemies 


APPENDIX 


1479 


American  Red  Cross  Nurses  Wuo  Died  in  War  Skrvice  or  as  a  Result 
OF  Disability  Contracted  Therein 

War  Service— April  6,  I'Jll,  io  November  J  I,  lUt9 


Awrsc 


Date  of  Death 


I 'lace  of  Death 


Allen,  Phoebe  .  .  .  .  , 
Aniundson,   Esther 


Anderson,  Nora  Emelie. 

Athay,  Florence  

Aubert,  Lillian 

Ayres,  Mrs.  Edith 

Babcock,  Hazel  E 

Bailey,  Margaret  S 


Baird,  Laura  A.  .  . 
Baldwin,  Jessie  P. 

Bartlett,  Frances  , 


Becker,  Edith  G.. 
Bellman,  Jeanette 

Berry,  May 


Bishop,  Aniv  L 

Bradiield,  Edith 

Bradley.  Laura  Belle. 

Brandon,  Hazel    

Breen,  Anne  M.  C .  .  .  . 


Brock,  Monica 


Buck,  Lydia  Muriel. 
Buell,  (Jrace  (t 


Buman,  Rose  E.  .  .  . 
Burk.  Ethel  Marion. 
ButU'r,  Einnui  M. .  .  . 
Bvrne,  Louise   E  .  .  . 


Byron.  Patricia  Irene. 
Cairns.   Mary   Kav... 


Campbell.  Florence  W, 


Oct. 
Oct. 

Jan. 

Nov. 

Oct. 

May 

March 

Oct. 

Oct. 
Feb. 


2.S,  litis 
20, 1918 

16,1919 

12,1918 

0,1918 

20. 1917 
12,1919 
16,1918 

16. 1918 
6, 1919 


Oct.   27,  1918 


Dec. 
Nov. 


21,1918 
12,1918 


Dec.      30,  1917 


Oct. 
May 
Oct. 
Oct. 
Nov. 


15, 1918 
5, 1918 
24,1918 
.30,  1918 
17,1918 


Nov.     29,  1918 


Dec. 
Oct. 

Oct. 
Oct. 
April 

Oct. 


March 
Sept. 


L'),  1918 
8, 1918 

1.3,  1918 

18. 1918 

8,  1918 

14, 1918 

28. 1918 
20,  191 S 


Nov.      18.  1918 


Cardwell,  Marv  B. 


Oct. 


4,  litis 


Ft.  Slocuni,  N.  V. 
Base  Hospital  No.  3.), 

A.  E.  F. 
Base  Hospital  No.  68, 

A.  E.  F. 
Base  Hospital  No.  67, 

A.  E.  F. 
Walter  Reed  Gen.  Hospital. 

Washington,  I).  C. 
On  board  S.S.  Monf/olia, 

Base  Hospital,  No.  12 
Camp  Hospital  No.  33, 

A.  E.  F. 
Hospital  Train  No.  58, 

A.  E.  F. 
Camp  Merritt,  N.  J. 
Evacuation  Hospital  No.  4, 

A.  E.  F.,  Coblenz,  Germany 
Base  Hospital  No.  11"). 

A.  E.  F.,  Vichy,  France 
Ft.  Benjamin,  Harrison,  Ind. 
Base  Hospital  No.  18, 

A.  E.  F. 
Base  Hospital  No.  32, 

A.  E.  F.,  France 
Ft.  Rilev,  Kans. 
Ft.  Sill.'Okla. 
Camp  Dodge,  Iowa 
Camp  Kearney,  Cal. 
Base  Hospital  No.  48, 

A.  E.  F. 
St.  Elizabetli's  Hospital, 

Washington.  1).  C. 
Ft.  Logan  Roots,  Ark. 
Base  Hospital   No.  ilS. 

A.  E.  F. 
Camp  Pike.  Ark. 
Camp  Fremont.  Cal. 
Camj)  Dodge.  Iowa 
(ien.  Hospital  No.  1.  New 

York  City. 
Camp  McArtlnir.  Texas 
Base  Hospital  No.  .')4, 

A.  v..  v..  Brest.  France 
While  on  h'avc  in  Nice.     At- 

faclied    liasi'    Hospital    No. 

9.  A.  K.  v.,  France 
San  Antonio,    i'exas 


1480 


APPENDIX 


Americax  Red  Cross  Xxrses  Who  Died  in  War  Service  or  as  a  Result 
OF  Disability  CoxxfiACTED  Therein 


Xurse 


Casstevens,  Geneva 


Date  of  Death 


Oct.       14,  1918 


Casterline,  Drusilla  Marie Dec.      31,  1918 


Catties.  Edith  June.... 
Cecil,  ^Irs.  Katherine  W 

Chandler.  Florence 

Christenson.  Mabel  C.  .  . 
Christman,  Caroline  H. . 


Clements,  Anna  Gertrude.  .  .  . 
Cochran,  Cecil  J 


Collins,  Tlieresa  V 

Connelly,  Katlierine  R. 

Coover,  Etta 

Cosgrove,  Anna  M 


Courtney,  Helena  J. 
Cox,   Charlotte  A.  .  . 


Cunimin<rs,  ^lary  H . 

Cupp,  Lillian  F 

Dalilbv,  Anna  Marie. 
Dalton,  Ella 


Davis,  Cora  Belle. 
Delano.  Jane  A .  .  . 
Dent,   Katherine    . 

Dingley,  Nellie  M. 


Dodson,  Kate 

Donovan.  Helen  Frances. 
Dowd,  Helen  Fi-anees.  .  .  . 


Druinmond.  Henrietta  I. 

Eastman.  Lizzii'  F 

Eisfeldt,  Thelnia  T 


Emery,  Mary  I'ranccs. 


Erickson,  Alma  M. .  . 
Erickson.  I'aTinie  M. 
Evans,  Maud    


Fairchild.  Helen 


Oct. 

April 

Oct. 

Oct. 

Oct. 


27, 1918 
18,1918 
1.3,  1918 
22, 1918 
6,1918 


Jan.  31, 1919 

(after  war) 

Oct.  15,  1918 

Oct.  7,  1918 

Oct.  16,  1918 

Oct.  16,  1918 

June  1,  1919 


Oct.  7,  1918 

Sept.  28,  1918 

Oct.  22,  1918 

Oct.  7,  1918 

Nov.  26,  1918 

May  25,  1919 


Oct. 

April 

June 


Jan. 

Sept. 

Jan. 


Oct. 
Oct. 
Jan. 


Oct. 
Oct. 
Feb. 


6, 1918 
15, 1919 
16,1918 


Aug.     28,  1918 


21, 1919 

30,  1918 

2,  1921 

10,1918 

14. 1918 

26. 1919 


May        1,  1919 


28. 1918 
6,  1918 

13. 1919 


.iJun.      18,1918 


Place  of  Death 


Camp  Hospital  No.  40, 

A.  E.  F. 
Naval  Hospital,  Mare 

Island,  Cal. 
Ft.  Douglas,  Utah 
Camp  Wheeler,  Ga. 
Ft.  Riley,  Kans. 
Camp  Lewis,  Wash. 
Evacuation  Hospital  No.  6, 

A.  E.  F. 
General  Hospital  No.  12, 

North  Carolina 
U.  S.  P.  H.  S.  Hospital, 

Huntsville,  Ala. 
Camp  Dix,  N.  J. 
Camp  Gordon,  Ga. 
Ft.  Riley,  Kans. 
U.    S.    Army    Embarkation, 

Hospital  No.  4,  New  York 

Citv 
Group  "D",  A.  E.  F. 
]?ase  Hospital  No.  42, 

A.  E.  F. 
Ft.  Sam  Houston,  Texas 
Camp  Gordon,  Ga. 
Xaval  Hospital.  Norfolk,  Va. 
Camp       Hospital       No.       4, 

A.  E.  F.,  Chateau-Thierry, 

France 
Camp  Gordon,  Ga. 
Savenay,  France 
Hase  Hospital  No.  24, 

A.  E.  F. 
Mobile  Oper.  t'nit  No.  1, 

A.  E.  F. 
Camp  Travis,  Texas 
Camp  Dix,  N.  J. 
Fitzsimmons  General  Hos- 
pital, Denver,  Colo. 
Neviers,  France,  A.  E.  F. 
(amp  stills,  L.  I..  New  York 
Camp  Hospital  No.  52, 

A.  E.  F. 
General  Hospital  No.  2, 

Ft.  :\Icllenrv.  Md. 
Ft.   Logan.  Colo. 
Cam  J)  Slierman,  Ohio 
I'.ase  Hospital  No.  103, 

A.  E.  F. 
P.asc  Hospital  No.  10, 

France,  A.  E.  F. 


APPENDIX 


1481 


American'  Red  Cross  Nirses  Who  Dikd  in  War  Service  or  as  a  Result 
of  disablmty  contracted   1  herein 


\urse 


Dntcof  Doith 


I'larr  of  1  tenth 


Falkinburg,  Grace  M. 
Karney,   Ruth    H.  .  . . 
Ficken,  Magdalene   .  . 


Fisclicr,  Catherine  Marie 

Flannery,  Bride  Mary  Agnea. . 


Fletcher,  Lucy  N. 
Forrest,  Fileen  L. 


Foster.  Hazel    

Franklin,   Emma  M. 

Furr.  Alma  M 

C.allilier,  Nellie  G... 


Girvin,  Hester  Marie. 
Golden,  Katherine  V. . 


Good,  Mottie 


Oct.  t),  lOlH 

Oct.  22.  litis 

Oct.  20,  1918 

Oct.  13,  1918 

Sept.  15,  10 10 


May        G,  1018 
Oct".         0,1018 


Oct.  3,  1018 

Oct.  28.1018 

Aug.  ().  1018 

Oct.  0,  1018 

Oct.  8.1018 

Feb.  13,1010 

Sept.  25,1918 


Oct.         9,1918 
March    9.1018 


Good,  Victoria 

Gore,  Ora  Margaret 

(Jornian,  Beatrice  M Oct.  21.1018 

Goshorn,  Ethel  May \  Nov.  28.  1018 

Graham,  Florence  Beatrice.  .  .    May  27,  1010 

Grant,  Myrtle  E :viarch  10,  1919 

Greene,  Kathervne  E '  Oct.  22,  1918 

Grimes,  :Margaret \  Oct.  9,  1918 

(iroves,   Elma  Irene i  Oct.  19,  1918 

Ilagadorn,  Alice  B .May  25, 1919 


Hankiuson.  Florence  G Oct.       25,  1918 


Ilaniey,  Edna 


I  lard v.  Sabra  R 

llcalv.  Marv 

Hccli't.  Mrs.'  Fclicita. 


llert/.og.   Mcda    L 
Ilidell,   Marie   L. 


Nov.  14,  1918 

Oct.  4,1918 

Oct.  4.1918 

Feb.  8,  101!) 


Jan.         5.1010 

Sept.     20.  101  S 


Hill,   Elina   Wilson j  .Tan.        2.  1010 

Iliiitiin.  Florence  A '.Tan.      20.1918 

linlTiuMn.    Katlieriiie    Sept.     2l»,  1018 


(amp  l.ee.  \'a. 

!"t.  Sam  Houston.  Texas 

Gciural  Hf)spital  No.  1,  New 

York 
Cam])  Dix,  N.  .7. 
l'rovi<lenc(>  City  Hospital, 

l'rovi(h'nce.  R.  1. 
Hase  Hospital  No.  (i.  A.  E.  F. 
Base  Hospital  No.  (iO, 

A.  i:.  F. 
(ami)  -'^''•l'^-  Ta  I..  N.  Y. 
Camp  Cody.  N.  Mex. 
Camp  Slielby.  Miss. 
Base  Hospital  No.  (J2. 

A.  !•:.  F. 
('ani[)  Jackson,  S.  C. 
Evacuation  Hosy)ital  No.  2. 

A.  E.  F..  Col)ienz.(Jermany 
Waller  Reed  Hospital, 

Washington.  1).  C. 
Naval  Hospital.  N.  V. 
Cam])  Travis.  Texas 
Ft.  SaTii  Houston.  Texas 
Camp  Gordon,  (^a. 
Camp  Hospital  No.  4. 

A.  E.  F..  France 
U.  S.  Naval  llos])ital.  Great 

Lakes.  111. 
Base  Hospital  No.  8.  A.  E.  F. 
Camj)  Lee.  Va. 
(Jrou])  "C"'.  (Icneral  Hos- 
pital No.  0.  A.  E.  F. 
Camp       llos])ital       No.       4, 

A.  E.  F..  Cliateau-Tiiierry, 

France 
Camp  Custer.  ^lich. 
(icneral  llos]iilal  No.  1, 

N(>\v  ^■(l^k  Citv 
(;rnui)  "E".  A.  E'.  F. 
( 'aiiiji  Cptdii.  N.  ^'. 
Hase   Hospital    Nd.   105. 

A.  E.  F. 
Cain])   McClrllan.  Ala. 
Naval   Ibi^jiilal.  I'hiladcl- 

pliia.  I'a. 
l.ci  irniiaii    llii-pital.  San 

l"i-aiiciscn.  (  al. 
r.a<r    il.Kpital    No.    12. 

A.    K.    ]■■.,    l-r.uicc 
Mcilii;il    Drparimcnt    I'ase 
lio-iiital  N...   114.  A.  E.  F. 


1482 


APPENDIX 


American  Red  Cross  Nurses  Who  Died  in  War  Service  or  as  a  Result 
OF  Disability  Contracted  Therein 


Xurse 


Date  of  Death 


Place  of  Death 


Hogan,  Agnes 

Hokanson,  Edith  B. 

Hollenback.  Lottie  . 

Hurley,  Nell 

Ireland,  Alice  A. .  . 


Irwin,  Katherine  P., 
Jacobs,  Gertrude  E. 


Jennings,  Lucy  Eunice. 

Jessen,  Anna  W 

Johnson,  Inez  E 

Jones,  Mamie 

Joyce,  Kathryne   


Keirn,  Margaret  Eleanor. 


Kemper,  Anna  E .  . 
Kimball,  Florence 


Kirketerp,  Daisy  M. 
Klinfelter,  Ina  E. .  .  . 


Knapp,  Estelle  A..  .  . 
Knowles,  Miriam  E . 

Kotte,  Emma 


Kuhlman,  Margaret 
Kulp,  Harriet  L.  .  . 


Larsen,  Anna  E. 
Larsen,  EfTie  A. 
Lea,  Alice    


Leach,  Ethel  O. 


LeClaire,  Florence  .  .  . 
Ledden,  Claire  Aunes. 


Lcdford,  Inia  I 

Leo,  Elizabeth    Frances. 

Lidc,  Julia 

Licb.   Mario   L 


Sept. 

March 

Jan. 
Oct. 
Fob. 

June 

April 

Sept. 
Aug. 
Jan. 
Dec. 
Sept, 


17, 1919 
1919 


3 

18 
3 

24 

22 

30 
22 

30 
31 

27 


Oct.       13 


Sept. 
Oct. 

Oct. 

Oct. 

Oct. 
Nov. 


March  15 


Oct. 
Dec. 

Oct. 
Dec. 
Dec. 

Oct. 

Oct. 
May 

Oct. 

Oct. 

Feb. 

Mav 


1918 
1918 
1918 

1918 

1922 

1918 
1922 
1921 
1918 
1918 

1918 

1918 
1918 

1918 

1918 

1918 
1917 

1919 

1918 
1918 

1918 
1918 
1918 

1918 

1918 
1919 

1918 

1918 

1919 

1921 


Naval  Hospital,  Washing- 
ton, D.  C. 
Naval  Hospital,  Great 

Lakes,  111. 
Ft.  Riley,  Kans. 
Camp  Bowie,  Texas 
Base  Hospital  No.  34, 

France 
Evacuation  Hospital  No.  2, 

A.  E.  F. 
St.  Joseph's  Hospital, 

Phoenix,  Ariz. 
Camp  Sherman,  Ohio 
New  York,  N.  Y. 
Albany,  N.  Y. 
Camp  Logan,  Texas 
Evacuation  Hospital  No.  4, 

A.  E.  F. 
Base  Hospital  No.  58, 

A.  E.  F. 
Camp  Jackson,  S.  C. 
Base  Hospital  No.  22, 

A.  E.  F.,  France 
U.  S.  Embarkation  Hospital 

No.  1,  Hoboken,  N.  J. 
General  Hospital  No.  1,  New 

York  City 
Camp  Meade,  Md. 
Base  Hospital  No.  18, 

A.  E.  F.,  France 
Naval  Hospital,  Great 

Lakes,  111. 
Camp  Sherman,  Ohio 
Camp  Hospital  No.  12, 

A.  E.  F. 
Camp  Sherman,  Ohio 
Camp  Dodge,  Iowa 
Naval  Hospital.  Great 

Lakes,  111. 
Edgcwood  Arsenal,  Edge- 
wood,  Md. 
Camp  Devens,  Mass. 
Base  Hospital  No.  94, 

A.  E.  F.,  France 
Base  Hospital  No.  116, 

A.  E.  F. 
Base  Hospital  No.  47, 

A.  E.  F. 
Base  Hospital  No.  17, 

A.  E.  F. 
honkers.  N.  Y. 


APPENDIX 


1483 


American  Red  Cross  Nurses  Who  Died  in  War  Service  or  ah  a  Resli.t 
of  disahility  contracted  therein 


Xurae 


Linn,  Loi3 

Lippold,  Antoinette  W. 


Lowe,  Grace  Mabel. 
Lundholin,  Rutli  V. 


Lundholm,  Viola 
Lynch,  Esther  R. 


Lyon,  Gladys  Nancy 

McBride,  Nettie  Grace. . . 

McCord,  Crystal  E 

MacDonald,  Elizabetli  L. 


McDowell,  Jessie  R. .  .  . 

McGrath,  Laura  O 

McGuire.   Catherine  J. 
McGurtv,  Catherine   .  . 


Mcintosh,  Jennie 
MacKav,  Lillias  . 


McKittrick,  Marguerite  R. 
McMullen,  Anna  M 


McXerney,  Elizabeth  M. 
Maescher,  Ella   


Malloch,  Grace  I^ee. 

Mariner,  Jessie  R.. 
Marshall,  Harlan  . . 


Martin,  Constance 

^fartin,  Sylvia  Elizabeth. 


Mercer,  Jane  R 

Metealf.  Elizabeth  M.. 
Metcalf,  Mildred  Anna. 


Miclicau,  Grace  Bell 


duller,  Cecelia  E 

Millinan,  Dorothy  Beth. 

Minick.   Marv   E 

Moakh'v,  Helen  A 


Date  of  Death 


Oct. 
Nov. 

Oct. 
Oct. 


Oct.  11 

Aug.  10 

Dec.  19 

Dec.  23 

Dec.  18 

Oct.  20, 

Oct.  11 

Oct.  3 

Oct.  10 
March  19 


Oct. 
Dec. 


April    19 
Oct.        6 


Oct. 
Nov. 


Jan.      10 


Oct.  10 

May  18 

Sept.  17 

Aug.  10 


Oct. 
Oct. 
Oct. 


Oct.       28 


Oct. 
Oct. 


Oct. 
An.'. 


13 


1918 
1918 

1918 
1918 

1918 
1920 

1918 

1918 

1918 

1918 

1918 
1918 
1918 
1919 

1918 
1918 

1919 
1918 

1918 
1918 

1919 

1918 
1919 

1918 

1921 

1918 
1918 
1918 

1918 

1918 
1!)1S 

191S 
191S 


Place  of  Death 


Camp  Sherman,  Ohio 
Base  Hospital  No.  61, 

A.  E.  F. 
Ft.  Mcpherson,  Ga. 
Base  Hospital  No.  58, 

A.  E.   F. 
(Jroup  "D",  A.  E.  F. 
Temple  Baptist  Mem.  San., 

Dallas,  Texas 
Base  Hospital  No.  68, 

A.  E.  F. 
American  Hospital  Tumen, 

Western  Siberia 
Evacuation  Hospital  No.  1, 

A.  E.  F. 
Base  Hospital  No.  .35, 

A.  E.  F. 
Camp  McArthur,  Texas 
Camp  (irant.  111. 
Camp   Lee,  Va. 
Base  Hospital  No.  54, 

A.  E.  F. 
Rock  Island  Arsenal,  111. 
Edgewood   Arsenal,  Edge- 
wood,  Md. 
Saginaw,  Mich. 
Emergencv  Hospital  No.  2, 

A.  E.  F'. 
Camp  Dix,  N.  J. 
Base  Hospital  No.  25, 

A.  E.  F. 
Base  Hospital  No.  55. 

A.  E.  F.,  Ton  I.  France 
Camp  Hancock,  (ia. 
(Jeneral  Hospital  No.  40, 

St.   Louis,   Mo. 
Naval  Hospital.  Chelsea, 

Mass. 
r.  S.  P.  H.  S.,  Ft.  Thomas 

Ky. 
Naval  Hospital.  New  York 
Ft.  McPlierson,  Ca. 
Naval  Hospital,  Newport, 

R.  T. 
Base  Hospital  No.  68, 

A.  E.  F. 
Camp  Sh<'rnian.  (^hio 
Base  Hosi.ital  No.  31, 

A.  K.  F. 
Camp  Dtnoiis,  Mass. 
Fort  Bliss.  Texas 


1484 


APPENDIX 


American  Red  Cross  Nurses  Who  Died  in  War  Service  or  as  a  Result 
OF  Disability  Contracted  THERaN 


Nurse 


Date  of  Death 


Place  of  Death 


Moeschen,  Frances  W. .  . 
Morrison,  Sophia  Ellen . 

Morton,  Hazel  E 

Moss,  Marie  Antoinette. 


Sept.  7 

Feb.  10 

Oct.  28 

Oct.  9 


Mimn,  Maud  Amelia. 
Murphy,  Alice  V 


Dec. 

Oct. 


Murphy,  Anne  M. . . 
Murphy,  Lillian  M. 

Murphy,  Teresa  M. 

Nevvkirk,  Hattie  M. 


Noring,  Ella  M.  . 
Norton,  Mary  .  . 
Nurney,  Mary  C. 


O'Brien,  Camille  Louise. 
O'Conner,  Carmilite   . .  .  . 


Sept.  28 

Oct.  10 

Nov.  9 

April  2 

Oct.  10 

Sept.  28 

Oct.  8 

April  18 

Feb.  13 


O'Conner,  Gertrude 
O'Connor,  Mary  E. . 


Feb. 
Oct. 


Ophaug,  Helga  J. 
Orchard,  Helen    . 


Orgren,    Clara   M.  . 
Overend,  Marion  L. 


July       1 
March  20 

Oct.         6 

June     16 


Owens,  Lillie  May..  .  . 

Parr,  Margaret  I 

I*arrv,  Aurora  E 

P.Hk",  Garnett  Olive.  . 
Pennington,  Pearl  W. 


Oct. 
Oct. 
Oct. 
Oct. 


Peoples,  Mary  L 
Pepoon,  Lucile  . 


June  25 
Oct.  16 
Nov.     24 


Perkins,  Ettie  M. . 
Petrie,  Evelvn  V.. 
Phillips,  Meryl  G. 


Oct. 
Mav 
.Ma*y 


Place,   Edna   E. 
Poolo,  Frances 


Sept.  29 
Oct.    8 


1918 
1919 
1918 
1918 

1918 
1918 

1918 
1918 

1918 

1918 

1918 
1918 
1918 

1919 

1919 

1919 
1918 

1918 
1918 

1918 

1918 

1918 
1918 
1918 
lOlS 
1918 

1918 

1918 

1918 
1918 
1918 

1918 

1918 


Base  Hospital  No.  42,  A.  E.  F. 
Minot,  N.  D. 
Camp  Cody,  N.  Mex. 
U.  S.  Base  Hospital,  Edge- 
wood,  Md. 
Camp  Mills,  L.  I.,  New  York 
Base  Hospital  No.  68, 

A.  E.  F. 
Camp  Lee,  Va. 
Naval  Hospital,  Hampton 

Roads,  Va. 
Headquarters    Base    Section 

No.  3,  S.  O.  S.,  A.  E.  F. 
On  way  to  Camp  Beauregard, 

La. 
Camp  Merritt,  N.  J. 
Camp  Jackson.  S.  C. 
U.  S.  Hospital  No.  10, 

Boston,  Mass. 
Camp  Hospital  No.  25, 

A.  E.  F..  France 
Base  Hospital  No.  113, 

A.  E.  F.,  Savenay,  France 
Base  Hospital  No.  7,  A.  E.  F. 
U.  S.  Hospital  No.  19, 

Axalia,  N.  C. 
Ft.  Sheridan,  111. 
U.  S.  Naval  Hospital, 

Charleston.  S.  C. 
Base  Hospital  No.  29, 

A.  E.  F.,  London.  England 
Base  Hospital  No.  3,  A.  E.  F., 

France 
Camp  Lee,  Va. 
Camp  Grant,  111. 
Camp  Taylor,  Ky. 
Great  Lakes  Naval  Hospital 
Camp  Jackson,  Columbia, 

S.  C. 
Naval  Hospital,  Puget 

Sound,  Wasli. 
Base  Hospital  No.  12, 

A.  E.  F. 
Camp  Meade,  Md. 
Ft.  Oglethorpe,  Ga. 
(Jeneral  Hospital  No.  1, 

New  York  Citv 
Naval  Hospital,' Philadel- 
phia, Pa. 
Fort  Ontario,  N.  Y. 


APPENDIX 


1485 


American  Red  Cross  Nirses  Who  Dikd  in  War  Service  or  as  a  Result 
OF  Disability  Contkactku   Iiikkkin 


A'Mrsc 


Price,  Cornelia  L. 


Quigley,  Pauline  A. 
Kagan,  Mabel  A. .  .  . 


Raithel,  Hattie  M. 


Reed,  Inez  E 

Regan,  Mary  Josephine. 


Reveley,  Annie  Dade . . 
Roberts,  Annabel  S. . . . 
Robinson,  Genevra  . .  . . 
Robinson,  Violet  E.  .  . . 
Rockwell,  Vera  ^larie. 


Rodgers,  Teresa  Elizabeth. 
Rose,  Lovie  Lucinda 


Rover,  Norcne  M. 


Russ,  Freda    

Sage,  Helen  C 

Sargent.  Helen  M.  .  . 

SaiuT,  Clara  11 

Sclieirer,  Mary  J. .  .  . 
Sclionheit,  Charlotte 

Schreiber,  Orma  A.  . 


Scluircnian,  Olive 

Seavey,  Ruth    

Sebastian,  Mrs.  Mary  McF.  . 


Scih'r,  Parbara  L 

Se\  iiiDur,   Nina  Louise. 


Shrojx',  Lydia  D 

Siiiion,  Mrs.  Vera  Se-ott. 

Stenstad.   Julia    

Story.   Amber    R 

S\iiuiies.  Kathleen  E... 

Taylor.    Eva    

Teinplin.  Xaniiii   

Thomas.  Mary    

Iliompson,  Alloe  L 


Date  of  Death 


Oct.         9,  1!)I8 


Oct. 
Oct. 


18,  1018 
1, 1018 


Nov.        2,1918 


March 
Oct. 

Oct. 

Jan. 

Oct. 

Nov. 

Sept. 


Oct. 
Oct. 


7,1019 
23,  1920 

18,1918 

17,1918 

22,1918 

2,1018 

21,1918 

28,1018 
.10,1918 


Sept.     17,1918 


Oct. 

21, 

1018 

Oct. 

5, 

1018 

Oct. 

20, 

1018 

Nov. 

14, 

1018 

Oct. 

0. 

1018 

Dec. 

6, 

1018 

Oct.         0,1018 


Oct. 

11, 

1018 

Oct. 

IG 

1018 

Oct. 

2.3, 

1018 

( )ct. 

21. 

1018 

Oct. 

10, 

1018 

Julv 

14. 

10. 

1017 

<  )ct'. 

1018 

Nov. 

.5. 

1018 

N(.v. 

20. 

lois 

Oct. 

4. 

1018 

Ffh. 

2(;. 

11)10 

Oct. 

t>. 

1018 

Oct. 

2o 

1018 

Oct. 

24, 

1018 

Place  of  Death 


Camp  McClellan,  Anniston, 

Ala. 
Camp  Custer,  Mich, 
iiase  Hospital  No.  17, 

A.  E.  F. 
Pase  Hospital  No.  29, 

A.  E.  F.,  London,  England 
Ft.  Riley,  Kans. 
filockner   Sanatorium,   Colo- 
rado Springs,  Colo. 
Evacuation  Hospital  No.  4, 

A.  E.  F. 
Pase  Hospital  No.  2,  A.  E.  F., 

France 
Base  Hospital  No.  G8, 

A.  E.  F.,  France 
Gardiner  Ceneral  Hospital, 

(iardiner,  Maine 
Naval  Hospital,  Clielsea, 

Mass. 
March  Field,  Riverside,  Cal. 
Pase  Hospital  No.  08, 

A.  E.  F.,  England 
Pase  Hospital  No.  46, 

A.  E.  F. 
Camp   Fremont.  Cal. 
Camp  Tavlor,  Kv. 
Fort  Sloc'um,  N.'Y. 
Camp  Dodge.  Iowa 
Kllis  Island.  N.  V. 
Mobile  Hospital  No.  3, 

A.  K.  F..  France 
Paso  Hospital  No.  49, 

A.  E.  F. 
Camp  Meade,  Md. 
Cani])  Taylor,  Ky. 
National  Militarv  Home, 

Ind. 
Camp  Dodge,  Iowa 
A.  K.  C.  Hospital  No.  2, 

France 
Ft.   Hayard.  N.  Mex. 
I't.   Ivilcy.   Kans. 
l''t.  .'^ncUing,  Minn. 
Drowncii  in  Lake  Michigan 
(;roii|.  "D".  A.  E.  F. 
Camp  Siicrmaii.  Ohio 
Ft.  Slicridaii.  111. 
Camp  Cody.  X.   Mcx. 
Naval    liasc    Uosiiital,    Scot- 
land 


1486 


APPENDIX 


American  Red  Cboss  Nurses  Who  Died  in  War  Service  or  as  a  Result 
OF  Disability  Contracted  Therein 


Nuise 

Date 

of  Death 

Place  of  Death 

Tliorsen,  Emma  J 

Nov. 

24, 1918 

Camp  Dodge,  Iowa 
C    S.    A.    General    Hospital 
No.  28,  Ft.  Sheridan,  111. 

Tompkins,  Agnes 

Jan. 

6, 1920 

Trank,  Florence  M. 

Oct. 

8,1918 

Base  Hospital  No.  58, 
A.  E.  F. 

Travis,   Goldie   X. . 

Oct. 

6,1918 

Fort  Snelling,  Minn. 
Naval  Hospital,  Charleston, 
S.  C. 

Treichler,  Amy 

Feb. 

14, 1918 

Trimble    Marie  E.. 

Sept. 

13, 1918 
21,  1918 

Chelsea  ^lass. 

Turner,  Marion  Pearl 

Oct. 

Naval  Hospital,  Mare 

Island,  Cal. 

Turner,  Phyllis  M .  . 

Sept. 

28, 1918 

U.   S.   General  Hospital  No. 
1,  New  York 

Viberg,  Judith  S. .  . 

Oct. 

14,  1918 

Camp  Lee,  Va. 

Camp  Hospital  No.  71, 

Vietmeier,  Ida  Henr 

ietta 

Jan. 

8,1919 

A.  E.  F.,  France 

Volland,  Magdelena 

M 

Sept. 

22, 1918 

Base  Hospital  No.  23, 
A.  E.  F.,  France 

Walch,  Caroline  Rose 

Oct. 

18,1918 

Camp  Travis,  Ft.  Sara 

Houston,  Texas 

Walker,  Anna  A.  .  . 

June 

15,1919 

Base  Hospital  No.  55, 
A.  E.  F. 

Ward,  Lillian  

Oct. 
July 

22,1918 
12, 1918 

Camp  Greene,  N.  C. 
Base  Hospital  No.  15, 
A.  E.  F. 

Ward,  Nellie  J.  .  .  . 

Watkins,  Gladys   .  . 

Oct. 

16,1918 

Base  Hospital  No.  56, 
A.  E.  F.,  France 

Weigiier,  Alberta  1. 

Jan. 
Nov. 

20,  1919 
6,1918 

Ft.  Riley,  Kans. 

Weiniann,  Elizabeth 

II.'.'.'.!'.'. 

Base  Hospital  No.  62, 

A.  E.  F. 

Weise,  Rose 

:\Iay 

20,  1922 

Fitzsimmons  General  Hos- 

pital, Denver,  Colo. 

Wellman,  ^Maybelle 

Oct. 

15,1918 

General  Hospital  No.  1,  New 
York 

Wells,   :\Iatilda   F.  . 

Oct. 
Jan. 

15. 1918 

29. 1919 

Camp  Eustis,  Va. 
Vancouver   Barracks,   Wash. 

Welsh,  Georgiana  M 

ary 

Wessel,  Dorothy  11. 

June 

4, 1919 

St.  John's  Hospital,  Spring- 
field, 111. 

West,  Anna  Belle  F 

Oct. 

21,1919 

Walter  Reed  Hospital, 
Washington.  I).  C. 

Whalley,  En  a  M..  .. 

Oct. 

15,  1920 

Fitzsinuiioiis  General  Hos- 
pital, Denver,  Colo. 

Wheeler,  Luella  Matilda 

Jan. 

14,1919 

Camp  Hospital  No.  12, 

A.  E.  F.,  France 

\Miiteside,  Lydia  V. 

Oct. 

21, 1918 

Base  Hospital  No.  26, 
A.  E.  F. 

Wiggins,  Daisy  E.  .  . 

Oct. 

22. 1918 

Camp  Codv,  N.  .Mex. 

\VilIiams,  Annie  M.  . 

Oct. 

15,  1!)1S 

Base  Hospital  No.   19, 
A.  E.  F. 

Winchester.  Edith  M 

ay 

May 

17,  ]!)19 

Armenia 

appp:xdix 


1487 


American  Red  Cross  Nurses  Who  Died  in  War  Service  or  as  a  Resllt 
of  dlsaklmty  contracted  therein 


\urse 


Wood,  Helen  Burnett 

Wortli,  Margaret  W 

Wright,  Mayme  L 

Young,  Alice  M 

^'oung,  Florence  M 

Young,  Hose  A 

Young,  Mrs.  Rose  Kirkwood. 


Dale  of  Death 


May      20,  1D17 
Oct.      2.3,  1918 


Oct. 

5, 

1918 

Oct. 

4 

1018 

Oct. 

23, 

mis 

Nov. 

28, 

1917 

June 

23 

1!»1!) 

/'lure  of  Death 


On   board   S.S.   Monffolia  en 

route  to  France 
Mase  Hospital  No.  48, 

A.  E.  F..  France 
Camp  (Jrant,  111. 
Camp  Sevier,  S.  C. 
Camp  Devens,  Mass. 
Camp  Shelhy.   Miss. 
St.   Luke's  Hospital,  New 

York 


Appendix  to  List  of  American  Red  Choss  Nihsks  Who   Dikd  in  War 
Service  or  as  a  Result  of  Disaisii.itv  Contuac  tkd  Tiikkkin 

After  ccmsideration  and  by  a  special  autliori/.ation  from  Miss  Noyes,  the 
folbnving  nurses  were  posthumously  awarded  Ked  Cross  medals  and  cita- 
tions, along  with  the  other  nurses  on  tliis  list  wlio  died  in  war  service,  or 
as  the  result  of  disability  contracted  therein. 

In  almost  every  case  tlie  nurse  died  of  influenza,  or  pneumonia  following 
influenza,  during  tlie  1918  epidemic,  just  after  travcd  orders  for  military 
service  had  been  issued  to  her,  but  before  slu^  luid  oj)port unity  to  execute 
the  oath.  With  but  probably  two  or  three  excejitions,  all  these  nurses  had 
been  assisting  the  Red  Cross  in  caring  for  intluenza  patients  while  waiting 
for  tlieir  travel  orders  for  militarv   service. 


Xtirsr 


Date  of  Death 


Place  of  Death 


lireen,  Mar<raret  M. 


Davis,   Elsie  :\I 

Downs,  Mayme  T 

Dunl)ar,  Ramona  Canfield  .  . 


Enmions,  Eva   

Enulaml,  Margaret 


Cuest,  Mabel  P 

Houghton,  llcden  C 

liuliiigs.  Haiina  Priscilla..  .  . 

.I()r(hih'ii.  Lydia    

Jowcrs,  Alberta  McPherson, 


Millar.  iMuiice    

O'Coiuior.   Marguerite  R, 

Ostergren.  Alice 

Stageu,   Charlotte  S 

Wiialev.  Abiirail  M 

Whiteiv,  Mrs.  Anna  E.  . 


Oct.   2t).  1918 


Oct.  23.1018 
Oct.  2."),  1918 
Oct.   10.1918 


St.  ^'incent's   Hospital,  New 

York  Citv 
Ship  Yards",  Philadelphia 
V.   S. 

Presbvterian  Hospital,  New 
York  City 
November.  1918    V .  S. 
Oct.       1,-),  lOlS  I  Washinirton    Park   Hospital, 

Chicairo,  111. 
Oct.       .30.  1018  ^  r.  S. 
Nov.        2.  1918    Calif.nnia 
(ktober,      101  S  :  C.   S. 
Nov.      14,  1018    r.   S. 

Dec.         ").  1018    South   Highland   Intirmary, 
ilinningliani,  Ala. 

Oct.     30, 101  s    r.  S. 

Oct.        11.  I'.'IS    CliicMgo 

Oct.       0.  ioi<;   r.  s. 
Autr.       8.  1017    r.  S. 

Oct.         11.  1010     (  'li;irh'stnii.   S.  ('. 

April,  1018     i!riti>li    Ia.    i-'orcc^.   France 


1488 


APPENDIX 


American  Red  Cross  Dietitians  Who  Died  in  War  Service  or  as  a 
Result  of  Disability  Contracted  Therein 


Dietitian 

Jury,  Irene  I 

Keech,  Cara  Mea 

Morse,  Meda 

Norcross,  Olive    

Peck,  Marian  Helen 

Wind,  Hortense  Elizabeth 


Date  of  Death 


Dec.  9,  1918 

Oct.  18,  1918 

Dec.  24,  1918 

Sept.  26,  1918 

Feb.  17,  1919 

Dec.  10,  1918 


Place  of  Death 


Naval  Hospital,  Pelham  Bay 

Park,  New  York 
Base  Hospital  No.  68, 

France 
Camp  Taylor,  Louisville,  Ky. 
Camp  Dix,  N.  J. 
France 
Norfolk,  Va. 


INDEX 


Abramson,  Mrs.  Jennie  A.,  on  con- 
ditions at  Vittel,  France,  501 
Palestine  Commission,   8i)2 
Accueil  Franco- A mericain,   830 
Acevcdo,      Eufrenia     L.,     Children's 

Bureau  at  Toul,  7G6 
Acre,  Palestine,  Red  Cross  hospital 

at,  !)03 
Adams,     Mabel     K.,     assistant     on 
Nurse     Corps     of     the     Public 
Health   Service,   1028 
chief    nurse,    Base    Hospital    No. 
13,  508 
Addison,  Sara  R.,  at  National  Head- 
quarters, 240 
relief  work  in  fireoce,   1112 
relief  work  in  Macedonia,  1114 
with  Service  de  Hante,  58G 
Agramonti,  Dr.  Aristide,  yellow  fe- 
ver work  by,   14 
Ahrens,    ^linnio    11.,    Committee    of 
Transfer,   1021 
director  Central  Division  of  Amer- 
ican  Red  Cross,  247 
on  mobilization  of  nurses,  Chica- 
go,  404 
pul)lic  liealtli  nursing,   1303 
Aides,  Red  Cross,  955 
Alaska,    public    health    nursing    in, 

1:538 
Albania,   relief  work  in,   1107-1110, 

1182 
Albaugh,      Rachael      Independence, 
1023 
assignment  of  nurses,  1019 
campaign    for    nurses,    1000 
chief  of  Division  of  Institutional 
and    StudeTit    Assignment,    1017 
Delano  Memorial  Committee,  1051 
in    iiitluen/.;i    ejjidemic,   !t75 
Albriglit,    Josephine,    in    cliarge    of 
public  healtli  nursing  at  Vladi- 
vostok.  933 
Aldford     House,    used    as    hospital, 

721 
Alexander,   Amy,   Delano   Memorial 
Committee,  1051 


Ale.xander,  Mrs.  Charles  B.,  Com- 
mittee on  Nurses  for  the  Philip- 
pines, 62 

Allan,  Ida  J.,  chief  nurse  of  U.  S. 
Army  Camp  Hospital  35,  428 

Allen,  Ethan.  Committee,  Memorial 
Fund  to  American  Nurses, 
1048 

Allen,  Mary  Sherman,  president, 
Texas  Red  Cross  State  Nursing 
Committee,  130 

Allen,  Dr.  May,  medical  director  at 
Dinard,  France,  769 

Allenby,  General,  893 

Alliance    Hospital,    Yvetot,    France, 
195 
personnel  of,  196 
work  of,  196 

Allison,  Grace,  cliief  nurse  of  U.  S. 
Base  Hospital  No.  4,  339,  443 
on   embarkation   of   unit   of   Base 

Hospital  No.  4,  414 
superintendent  of  luirses  of  Lake- 
side Hospital,   Cleveland,   Ohio, 
328 

Altman,  Henrietta,  visit  to  devas- 
tated   France,    989 

Alunuue  Societies  of  Graduate 
Nurses,   organization   of,   20 

"Amberiiiu"  treatment  for  burns. 
Oil 

Ambrose,     Editli,     as     Chautauqua 
nurse,   1055 
at  emergencv  liospital  at  Jouy-sur- 
Morin,  0(i8 

American  ambulance,  at  Neuilly, 
France,  535 

American  Committee  for  Armenian 
and  Syrian  Kelief.  SS9 

American    Expeditionary    Forces    in 
France,  4S5.  032 
nursing  service  of.   (i34.  ti05 
shortage  of  nurses   for.  515 

Amerii'uii  I'eih'rat ion  of  Nurses,  af- 
liliation  witli  National  Red 
Cross  Society.  71,  74,  94 


organization  of,  71 


14S9 


1490 


INDEX 


Americati  Journal  of  Nursing,  on 
civic  obligations  of  nurses  for 
Red    Cross   enrollment,    82 

on  Retl  Cross  reorganization  and 
hope  of  alliliation  with  nurses, 
74 

publicizing.  Red   Cross   events,   77 

report  from,  on  Red  Cross  afHlia- 
ti(m,  71 

reprint  of  Red  Cross  Central 
Committee  circular  on  recruit- 
ing nurses,  75 

special     military     number,     May, 
1018,  on  extra-cantonment  serv- 
ice, 394,  395,  399,  400,  402,  415 
American    ^Medical    Association,    co- 
operation   with   American    Red 
Cross.    12G 
American   Mission   hospitals,  volun- 
teer work  in  Siberia,  914 
American  National  Red  Cross,  neu- 
tral character  of,  22 

non-sectarian  character  of,  22 

organization  of,  25 

Relief  Committee,  26 

reorganized,  aim  and  purpose,  75 
American  Nurses'  Association,  1022, 
1219 

afliliation  of  American  Red  Cross 
nurses  with,  71,  74,  123 

Twentieth      Annual      Convention, 

387-388 

American  Nurses'  Club,  London,  425 

American  Red  Cross,  cooperation  of, 

with  U.  S.  Medical  Corps,  031 

foreign  program  of,  closed,  1914- 
1915.  >S'ce  ]Mercy  Ship  Expedi- 
tion. 

general  reorganization  of,  1909, 
101 

in   France,   establishment  of,   532 

plan  of  nurses'  enrollment  for, 
105 

proclamation    relating    to,    issued 
by    President    Taft,    1911,    120 
American     Red     Cross     Commission 

for  Europe,  484,  (512 
American   Red  Cross  Commission  to 

France,  379 
American    Red   Cross  hospital   serv- 
ice, 030,  031 
American  Red  Cross  hospitals: 

Ccmvalescent  Hospital  No.  101, 
Lingfleld,  England,  434 

Convalescent  Hospital  No.  102, 
\\'imblc(h)n,  England.  438 

Hospital  No.  5,   Paris,  747 


American  Red  Cross  hospitals: 
Hospital  No.  100,  731 
Hospital  No.  101,  Neuilly,  France, 

(511 
Hospital  No.  103,  Neuilly,  France, 

on 

Hospital    No.    104,    at    Beauvais, 
590 

Hospital  No.   105,  604 

Hospital     No.     109,     at     Evreux, 
France,  609-610 

Hospital     No.     110,     at     Coincy, 
France,  616 
moved  to  Villers-Dancourt,  617 

Hospital    No.     Ill,    at    Chateau- 
Thierry,  617 

Hospital    No.     114,    Luxembourg, 
622,  770 

transferred  to   Fleury-sur-Aire, 
623 

hospital    in    North    Russia,    680, 
684 

hospitals  in  war  zone,  612 

hospitals,  two  types  of,  532,  533 

Military   Hospital   No.    1,   535 

Military   Hospital   No.   3,   748 

Military    Hosi^ital    No.    4,    Liver- 
pool, 427 

Military   Hospital   No.   5,  at  Au- 
teuil,  France,  599 
recreation  hut  of,  601 

Militarv   Hospital    No.   6,   at   St. 
Chmd,  610 

Military   Hospital  No.  21    ("Old- 
way  House") ,  429 

Militarv  Hospital  No.  22,  London, 
430 

Militarv  Hospital  No.  23,  London, 
430 

Military  Hospital  No.  24,  London, 
430 

Military    Hospital    No.     107,    at 
Jouy-sur-M(irin,   0,   605 
bombed  by  enemy  aviators,  008 

military      liospital,      at      Jouilly, 
France,  003 

militarv  hospitals,  operation  of, 
533 
American  Red  Cross  Motor  Corps, 
and  extra-cantonment  zones, 
404 
American  Red  Cross  Nursing  Serv- 
ice.    Kce  Nursing  Service. 

Executive  Connnittee  of  National 
Conunittee   on,   259,   260 

relaticm  of,  to  Army  Nurse  Corps, 
313 


INDEX 


1491 


American    Red    Cross   ofTicials    sub- 
ject to  military  jurisdiction  of 
United    States,   534 
American  Red  Cross  Bureau  of  Per- 
sonnel, 1573 
American   Hed   Cross  Headquarters, 

23.J,  230 
American     Red     Cross     Town     and 
Country  Xursinj,'  Service,  name 
clianf^ed    to    lUireau    of    Public 
Ilealtb  Nursing  Service,  347 
American     Relief    Clearing    House, 

531 
American     troops,     brigaded     with 
French   and  British,  579 
sent  to  Siberia,  911 
American      Women's      War      Relief 

Fimd,  Connnittee  of,  140 
Amiens,  air  raid  on,  405 

conditions      at      evacuation      of, 

March,  1918,  831 
work    of    Children's    Bureau    at, 
774 
Anderson,  Colonel  Henry  W.,  Com- 
missioner    for    Balkan    States, 
1083,   1100 
medical     director     in     Roumania, 

1128 
organization     of     American     Red 
Cross      Commission      for      Rou- 
mania,  882 
Anderson,   P]va,  public  healtli   nurs- 
ing, 1303 
Anderson,    Frances,    301.    302 
Anderson,     Mrs.     Larz,     Town     and 
Coimtrv     Nursing     Committee, 
1219 
Anderson,  Lyda.   at  National  Head- 
quarters.  240 
director.     Southwestern     Division 
of    American    Red    Cross,    24(), 
1038 
nursing  scliool  in  Constantinople, 

1170 
on  Austrian  suhlicr.  170 
on  care  of  wouiuh'd  in  \'i('nna  Red 

Cross    iidspital,    ICS 
on  ditlicult  it's   with   individuals  (.f 

units.  171 
on  (ierinan  examination  of  travtl- 

lers  cro-siiig  tlic  Ixirdrr.   171 
oTi    sliortagc  of    food   and   supplies 

in  N'icniia.  ItiO 
supervisor    of    Mercy    Ship    i'!\pe- 
ditioM    liii      K.    KIS 
Angers.    I'ranee.    l'.    S.    Xav\-     i'lase 
lln>pital    No.    1,  at.  72S,"7;55 


Anglican  order,  nursing  services  of, 
in  Civil   War,  8 

Angouleme,  France,  Red  Cross  dis- 
pensary at,  838 

"Annex,"  (irst  American  Red  Cross 
iiospital  in  North  Russia,  080, 
084 

Anselmi,  Kinilia  Malatesta,  Italian 
representative  at  Cannes  Con- 
ference, 11.38 

Apted,  Mrs.  Susan,  at  American 
Red  Cross  Military  Hospital 
No.  5,  at  Auteuil,  001 

A(juit(ini(i,  collision  with  .S'..S'.  Shaw, 
727 

Archer,  Frances  B.,  Chateau  des 
Halles   iiospital,   781 

Archer,  Beatrice,  Palestine  Commis- 
sion, 892 

Arizona,   rural   nursing  in,    1228 

Arkwrigiit,  Mrs.  Preston  S.,  Wo- 
man's Advisory  Committee,  300 

Armenia,  American  Red  Cross  funds 
for,  891 

Armenia  Proper,  888 

Armenian  and  Syrian  Relief.  Amer- 
ican Committee  of,  889 

Armories,  Red  Cross  emergency 
nurses   sui)plie(i  to,  02 

Armstrong.  Dr.  Iv  K.,  medical  chief, 
Clifitelet  Iiospital,  779 

Armstrong,  Mrs.  W.  N.,  in  Army 
Nurse  Corps  legislative  efforts, 
08 

Army,  relati(m  of  nursing  service 
to,  310-380.  Sec  also  under 
Nursing  Service. 

Army    and    Navy    Nurse    Corps,    in- 
crease' of  salary.  374 
domestic   service.   374 
overseas  duty,  374 
regulations     regarding     uniforms, 
374 

Army  Nurse   I'ill.   defeat   of.  09 
eir'orts   for.  07,  OS.  0!) 

Ariii\'  Nurse  (,'or]is.  appointment  to, 
43 
beiriiinini:  of   otlicial   existence   of, 

42 
bill   relatiiii:   to   rank   in.    1070 
delit  of.  1o   Dr.   McCee.  40 

to    Suri:eoii(  ii'iieral     Sternberi:, 
4(; 
(letinite  organization   of.   70 
lir>t    lield   service   of    (  IIUI  i  .   3  IS 
in     punitive    exjieditioii     to    \rra 
Cruz    (  191  r  .  ;!4S 


1492 


INDEX 


Army  Nurse  Corps,  made  permanent 
part  of  Army,  47 
legislation  for,  67 
numbers  of,   during  War   service, 

Spanish-American  War,  43 
organization  of,  42 
origin  of,  35-38 
qualifications  for  appointment  to, 

39 
regulations,  715 
improved,  101 
relationship  of,  to  American  Red 

Cross    Nursing    Service,    313 
reorganization  of,  106G,  1069 
requirements   for  membership   in, 

38 
salaries  of,  697 
status  of,  356 

war    services    of,    Spanish-Ameri- 
can War  period,  43 
Army   nurses,   appointment  of   first 
six,  41 
assigned  to  Red  Cross,  621 
bill  to  secure  rank  for,  1069-1072 
passage  of,  by  Congress,   1075- 
1076 
Congressional    Committee    report 

on  value  of,  65 
cooperation    of    Red    Cross    with, 

628 
question    of    rank    of,    1064-1066, 
1069-1072,   1074-1076 
Army   rank  for  Nurses,  efforts  for, 
70,  1064  et  scq.     *S'ee  also  Rank 
for  nurses. 
Armv  School  of  Nursing,  283,  284, 

286.  287 
Advisory  Committee.  285,  286 

conception     of     idea,     by     Sarah 

Edson,   11 
gifts  toward,  286,  287 
phm  sul)mitted,  284.  285 
Arnett,  Dr.  Lillie  A.,  on  dispensary 
at  Angoulemc,  France,  838 
on  work  at  Le  Glandier,  820 
Anistein.   Leo,   director   of   Military 
Relief    of    Now     ^'ork    Count  v 
Chapter.    363 
Arllnir.     Major,     cfjinnicndation     of 

male  nurses  on  Mis.touri,  00 
.Xrtillcry    training   cciitrc.   at   Camp 

('()i't(|uidan,   738 
Ashe.    Kliz;il)('tli    11..    cliicf    nurse    of 
Chihiren's   I'urcau,   France,  551. 
758 

(if     Cornniission     for     Bt'lgiuni, 
818 


Ashe,    Elizabeth   H.,   work   in   Chil- 
dren's Bureau,  France  and  Bel- 
gium, 760 
tuberculosis    prevention    work    in 

France,  846 
Asher,    Blanche,    on    trip    of    Base 

Hospital  No.  102  unit  to  Genoa, 

670 
Asile     Caserne,     Luxembourg,     622. 

766 
converted   into  military  hospital, 

770 
Asile  Ste.  Eugenie,  Lyons,   France, 

853 
tuberculosis  hospital,   850 
Associated  Alumnie,  as  part  of  The 

American  Federation  of  Nurses, 

71 
efi'orts     of,     towards     Red     Cross 

affiliation,  71 
misunderstanding     between     War 

Department  and,  41 
oflFer  from,  for  Spanish-American 

war  nursing  service,  40 
Astor,     Mrs.     John,     Committee    of 

American  Women's  War  Relief 

Fund,   146 
Athanasakis,  Mr.,  president- of  Greek 

Red  Cross,   1166 
Athens,    infant     welfare    work    in, 

1116 
relief  work  in,  1111 
Atlanta,    Ga.,    call    for    Red    Cross 

nursing  service  at,  1917,  136 
meeting    of    Red    Cross    Nursing 

Service,    1920,    1433 

recommendations   of,    1434 
Atlantic  Division   of  American  Red 

Cross,  244,  245 
Atlantic      Highlands,      Red      Cross 

nurses  at,   61 
Auerl)ach,    Joseph    A.,    New    York 

home  of,  used  for  nurses,  422 
Austin     Dam,     breaking     of,     1911, 

132 
Austrian  soldier,  170 
Austria,  child  welfare  in,  1191 
Autelitz.  France,  emergency  canteen 

at,  837 
Autcuil,  France,  emergencv  hospital 

at.  59!) 
Auxiliary   No.   3.   Spanish-American 

W'ai'.    meinbersiiip    composition 

of.  47 
report    of,    March    1.    1899,    55 
Avinigiict.   Dr.,  ciiild   welfare  work, 

I'aris,  815 


INDEX 


1498 


Ayers,  Colonel  I-<eonar(l  P.,  chief  of 

Statistics  Branch,  General  StaflF, 

U.   R.   Army,  404 
on  campaign  of  1918,  578 
on     exodus    of     American    Army 

from   France,  1009 
on  fourth  great  German  offensive, 

605 
on    liospital    capacity    in    United 

States,   during   European   War, 

404-405 
on    need    of    nurses    in    influenza 

epidemic,  971 
on   third  great  German  offensive, 

602 
Ayres,  Edith,  killed  at  sea,  470 


Babb,  Sara  M.  F.,  on  work  in  Ital- 
ian liospitals,  671 
on  Italian  drive,  673 

Babbitt,  Ellen  C,  Children's  Bureau, 
welfare      expositions,      France, 
1918,  783 
at  Marseilles,   France,  792 

Babbitt,  Frank  L.,  on  nursing 
course  at  Vassar,  268 

Bacon,  Robert,  treasurer  of  Com- 
mittee, Memorial  Fund  to 
American  Nurses,  1048 

Bacourt,  Francoise  de,  relief  work 
in  Serbia,  1120 

Bailev,  Dr.  Gilbert  A.,  director  of 
Mercy  Ship  Unit  G,  167 

Bailey,  Dr.  W.  C,  director  of  Red 
Cross  Commission  for  Poland, 
1086 

Bailev,  Helen  Lvdia,  relief  work  in 
Serbia,  1125 

Bailey,  Mary  E.,  child  welfare  work, 
France.  813 

Baker.  Aurel,  159 

Baker,  Bernard  X.,  on  committee 
to  secure  Re<l  Cross  ship  fur 
\\"()rld  War,   140 

Baker,  l'>essie,  chief  nurse,  Base  Hos- 
pital No.  18.  486 
on  conditions  at  Bazoilles,  France, 
490 

Baker,  (ieorge  F.,  Jr..  director  of 
Commission  to  Italy.  S-")'.) 

Baker,    Newton    Diehl.    Secretary   of 
War.    and    Red    Cross    liospital 
units,    .'!41 
on   funiishinLT  uniforms  for  Army 
Nurse  Corps,   'M't'.) 


Baker,  N.  D.,  on  regulations  govern- 
ing the  employment  of  American 
Red  Cross  in  time  of  war 
(1916),  320 

Baker,  Mrs.  Isabelle  Wilbar,  direc- 
tor of  Elementary  Hygiene  and 
Home  Care  of  Sick,   1369 

Balcli,  Dr.,  organization  of  Base 
Hospital  No.  55  by,  338 

Balcom,  Helen,  State  Committee, 
Iowa,  112 

Baldwin,  Bertha,  dietitian;  Report 
of  diet  kitclien  service  overseas, 
1411-1417 

Baldwin,  Dorothea,  child  welfare 
exposition  at  Marseilles,  France, 
792 

Baldwin,     Dr.     John     C,     director, 
Children's     Bureau     at     Nesle, 
FVance,  772 
member     of     children's     Bureau, 

France,   758 
on    conditions    at    Nesle,    France, 
772 

Balfour  ^lission,  442 

Balkan  States,  relief  work  in,  1077, 
1083,   1084,  1100.   1102 
sanitarv    conditions    in,    at    out- 
break of  World  War,  187 

Balzani,  Contessa.  scholarship  to 
study  nursing,  1175 

Bamber,  Beatrice,  chief  nurse.  Base 
Hospital  No.  1,  505 

Bancroft.  Dr.   Mabel  H.,  dispensary 
at  Levallois,  France.  803 
on  work  for  refugees  in  Paris,  834 

Bapaume,  France,  captured  by  Ger- 
mans,  1918.  464 

Baranovicci.  Poland,  condition  of 
hospital  at.   1090 

Barber,  Editli  A.,  director  Northern 
Division      of      American      Red 
Cross.  247 
report  on  influenza  work,  977-978 

Barbour,  James  R.,  American  Relief 
Ch'urinfr    House.    531 

Barbussc.   on   the  poilu,   152 

Bar<rt'.  Mr.,  coirnnissioiu'r  for  Po- 
land, at  nursing  school  in 
Polan.i.    lir.9 

r.arlow.  Anu'lia.  Civil  War  nursing 
servici's  of.    12 

Barlow.    Major-(;iMHT:il,  236 

I'arlow,   Francis,  2.')ti 

r.aniard.  llilcna.  otliccr  of  Asso- 
ciated  AlniiiiKi'.   40 

P.arndollar,    Clara.    159 


1494 


INDEX 


Barnett,  Edith,  death  of,  from  ty- 
phus in  Siberia,  942-943 
work  of,  in  Siberia,  939 
Baroda    House,    London,    used    as 

hospital.  430 
Bartlett,  Major  General  George  T., 
command   of  U.   S.  Army  Base 
Section  No.  3,  426 
Bartlett,  Vashti  R.,  chief  nurse  of 
American     Red     Cross     detach- 
ment at  Harbin,  937 
in  hospital  supplies  work,  298 
in  Nursing  Service  headquarters, 

237 
nursing  in  Haiti,  1171-1172 
on    cholera   epidemic    at    Harbin, 

937,  938 
on  conditions  in  Haiti,  1172 
on    homage    to    dead    soldiers    at 

Pau,  France,  153 
on  the  poilu,  153 
supervisor  of  La  Panne  Hospital, 
203 
Bartley,    Mary,   chief   nurse,    relief 
work  in  Pruzana,  Poland,  1086, 
1087 
Barton,  Clara  Harlowe,  first  presi- 
dent,  American   Association   of 
the  Red  Cross,  13 
in  Cuba,  25 
in  War  of  1870,  21 
nursing    services    of,     at    Johns- 
town flood,   18 
organizer  of  volunteer  field  nurs- 
ing, in  Civil  War,  9 
plans   for   relief   of   concentrados, 

25 
president,  American  National  Red 

Cross,   22,   25 
share     in     organization     of     Red 
Cross     Hospital    and    Training 
School    for   Sisters,  21 
Barton,   Dr.   Steplien    E.,   Executive 
Committee,   American  National 
Red  Cross.  1898.  25 
in  relation  to  the  La7npasas  expe- 
dition,  32-33 
Base    hospitals.     See    U.    S.    Army 

Base  Hospitals. 
Basken,  Isabel    Hall,   home  hygiene 

class  in  Santo  Domingo,  1200 
Bassot,    Mile.,    cliild    welfare    work, 

France,    812,    815 
Bastin,    Catlicrine    S.,     in    Hawaii, 

1205 
Bateman.    Geneva,    relief    work    in 
Serbia,  1122 


Bauer,  Caroline,  167 

Baurle,  Marie,  child  welfare  work, 

France,  813,  814 
Bayne,  Dr.,  in  Roumania,  1126 
Baylies,  Mrs.  Edmund  L.,  member  of 
Committee    on    nurses    for    the 
Philippines,  62 
Bazoilles,     France,     conditions     at, 
490 
U.    S.    Army   Base    Hospital   No. 

18   at,  488 
U.    S.    Army    Base   Hospital   No. 
46  at,  508 
Beal,  Boylston  A.,  London  Chapter, 

American  Red  Cross,  425 
Beal,    Dr.   Howard    W.,   director   of 
Unit  F,  Mercy  Ship  Expedition, 
146 
Beale,  Mrs.  Harriet  Blaine  Commit- 
tee on  Town  and  Country  Nurs- 
ing Service,  1264 
in  Army  Nurse  Corps  legislative 

efforts,  68,  70 
on  rank  for  army  nurses,  1069 
Beard,  Mary  F.,  committee  on   set- 
tling war  nursing  policy,  254 
conference     to     consider     nursing 

problems,  254 
Joint  National  Committee,  1047 
Joint     National      Committee     of 

Bureau  of  Information,   1016 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
on  plan  for  special  enrollment  of 

nurses,  257 
on  status  of  public  health  nurses 
and  Special  Service  group,  278 
Bears.  Elmira  W.,   at   Chateau  des 
Hallcs  hospital,  781 
in   charge  of   child   welfare  work 
at  Lille,  822 
Beatle,  Alice,  in  Mercy  Ship  Relief 
Expedition,  390 
on     passage     of    troops     through 

Budapest.  175 
on   relief  work   in   Budapest,   174 
on   work   at   Budapest.   American 

Red  Cross  hospital,   173 
supervisor  of  ^lercv  Ship  Unit  E, 
173 
Beatty,     H.     0.,     director     general, 
American         Relief        Clearing 
House,  531 
Beauvais,     France.     American     Red 
Cross  nosi)ital  No.  104  at,  596 
emergency  liospital  at,  596 
refugee  liospital  at,  832 


INDEX 


1495 


Beauvaia  area,  conditions,  581 
Becher,  Dame  Etliel  T.,  Qnoen  Alex- 
andra's Imperial  Military  Nurs- 
inj;  Service,  474 
Bedloe's  Island,  Red  Cross  services 

on,  (51 
Beecroft,     Laura    A.,    cliief    nurse, 
U.  S.  Armv   Base  Hospital  No. 
29,  Tottenham,   England,  438 
Belgian  refugees,  Kil 
Belgium  Red  Cross,  109 
Belgium  Unit  No.  I,  200 
Belgium  Unit  No.  2,  200 
Belgrade,   bombardment   of,    177 
condition  of   wounded  at,   178 
evacuation   of,   by   Sorbs,    178 
military  hospital  at,   177 

American    Red   Cross   units   at, 
recalled    but    retained    at    re- 
quest of  King  Peter,  185 
difliculties  of,  177 
taken    over    by    American    Red 

Cross   Unit  1,   177 
turned   over    to   Austrian    mili- 
tarv     autliorities,     Nov.     28, 
1915,   187 
on  eve  of   second  Austrian  ofTen- 

sive,  185- ISO 
re-capt>ire  of.  bv  Austro-Germans, 

October,  191 5.   ISO 
recoverv  bv   Serbs.   Dec.   15,   1914, 
179 
Bell,  Bessie  S..  chief  nurse  of  A.  E. 
F.,  in  France,  482,  50:5 
director       of       nursing       service, 
Chateau-Til ierry,  0.'}4 
Bell,  Surgeon  \V.  L..  National  Com- 
mittee   on    Red    Cross    Nursing 
Service,  95 
Bellevue   Hospital.  Nurses  Training 

School  ostablisiicd   at,   1:5 
Bellis,  Major  (J.  1...  director  of  As^ilr 

Str.  Kitgrnic.  850 
Bellows,    Dr.,    on    women's    work    in 
tlie  Civil    War.    10 
president   of   United   States   Sani- 
tary Commission.  8 
Belmont,     Mrs.     August.     Board     of 
lncor])orat()rs  of  American    lied 
Cro.ss,    1007 
Delano        Memorial        Coinniittce, 

1051 
Woman's      Advisorv      Coiiiinittcc. 
.300 
Benn,      Edith      Merle,     Chautauiiua 
nurse,  1055 


Renn.   Edith   Merle,   chief  nurse   of 
American    Red    Cross    Commis- 
sion for    I'oland,   1089 
resignation  of,    1097 

Bennett,   Louise,  on  cruelty  of  war, 
149 
supervisor  of  Mercy  Ship  Unit  D, 
148 

Bentinck,  Mrs.  Cavendish,  opened 
suite  for  nurses  in  I^ondon, 
425 

Bentlev.  Grace,  public  health  nurs- 
ing, 130:} 

Benton,  Dr.  Fred  G.,  107 

licreza  Kartuzn,  Poland,  Red  Cross 
relief  work    in,   1088 

Besley,      Florence     M.,  Chautauqua 
nurse,   1053 
Chautauqua  work  for  rural  nurs- 
ing,  1231 

Besley,  Dr.  Frederick,  director, 
Base   Hospital   No.    12,  409 

Besom.  Pansy,  nursing  school  in 
Prague,  1152 

Besson,  Dr.,  child  welfare  work, 
France.  812,  815 

Bethel.    Mary    IL.    chief    nurse    of 
Vladivostok    Refugee    Hospital, 
933 
nursing  school  in  Prague,  1152 

Bettman,  Florence,  first  dietitian 
overseas,   i:?Sl 

Botts.  Miss.  ai)pointed  for  Philip- 
pine service,  ()3 

Beyea,   ^Irs.    Daisy   Pirie,   Chautau- 
qua nurse.   1055 
on  conditions  at    Evacuation  Hos- 
])ital   No.  (1.  045 

Bialvstok.  American  Red  Cross  re- 
'lief  work  at.  1093 

Bivrire   llnpital.  807 

Hicknell,    Ernest    P.,    committee    on 
lectur(>    course    for    Red    Cross 
nurses,  122 
Coniinitt(>e  on  Towti  and   Coimtry 

Nursing  Service,   1204 
director-general  of  Civilian  Relief, 

231 
European       Commissioner,       530, 

11  ss 
on   typhus   in  .'Serbia.   180 
on      uniforms     of      Army     Nurse 

Corps.  :!(■.() 
jilans   fnr  extension   of   Red  Cross 
for  relief  work,  242 

liigelow,  .Mida,  relief  work  in  Ser- 
bia,  1120 


1496 


INDEX 


Bigelow,  Glenna  F.,  on  preparation 
for  overseas  duty,  418 

Bigelow,  Helen  Amy,  in  charge, 
Children's  Hospital  at  Evian- 
les-Baina,   778 

Biggs,    Dr.    Herman   M.,   committee 
on  settling  war  nursing  policy, 
254 
conference    to    consider    nursing 

problems,  254 
report  on  tuberculosis  conditions 
in  France,  844 

Billings,  Bernice,  public  health  nurs- 
ing, 1303 

Billings,  Dr.  Frank,  in  efforts  for 
Army  Nurse  Bill,  69 

Bingham,  Laura  Blanche,  on  work 
at  Children's  Hospital  for 
tuberculosis  prevention,  Paris, 
852 

Bird,  General  Charles,  Central  Com- 
mittee, 230 

Birmingham,  Colonel,  acting  sur- 
geon-general, U.  S.  Army,  349 
on  requirements  for  enrollment 
of  reserve  nurses  for  Mexican 
Border  service,  352-353 
on  uniforms  of  reserve  nurses. 
Army  Nurse  Corps,  305,  369 

Birtles,  Agnes  C,  hospital  work  at 
Liverpool,  428 
reception  of,  in  London,  425 

Black,  Major  Carl  E.,  plans  for 
nursing  school  in  Greece,  1165- 
1166 

Black,  Miss,  delegate  to  ninth  In- 
ternational Red  Cross  Confer- 
ence, 1912,  124 

Blackstone,  Eleanor,  relief  work  in 
Serbia,   1119 

Blackwell,  Surgeon  E.  M.,  126 

Blackwell,     Dr.     Elizabeth,     helpful 
intimacy  with   Florence   Niglit- 
ingale,  6 
share  in  organizing  United  States 

Sanitary  Commission,  6 
training  of  nurses  in  Civil  War,  5 

Blackwell,  Dr.  Emily,  training  of 
nurses  by,  in  Civil  War,  5 

Blake,  Dr.  Joseph  A.,  eslablislied 
American  Ked  Cross  Military 
Hospital   No.   2,    France,   538 

Blakelv,  Dr.  R.  M.,  relief  work  in 
Serbia,  1123 

Blatch,  Mrs.  Harriot  S.,  work  of,  to 
secure  rank  for  army  nurses, 
1065,   1069 


Bliss,  Mr.  Robert  W.,  on  Executive 
Committee    of    American     Red 
Cross,  1007 
Bliss,  Mr,  and  Mrs.  Robert  W.,  or- 
ganization    of     American    Dis- 
tributing Service  by,  531 
Blodgett,     Mrs.     John     Wood,     on 
nursing      course      at      Vassar, 
268 
Blois,  France,  American  Red  Cross 
dispensary  at,   797 

children's  hospital   at,   798 

tuberculosis  hospital  at,  853 
Blue,   Admiral,   securing  of   officers 

for  Mercy  Ship,  140 
Blue,  Surgeon  General  Rupert,  1024 

creator  of  Committee  of  Public 
Health  Nursing,  266 

gives  Red  Cross  responsibilities  in 
influenza  epidemic,  973 

National  Committee  on  Red  Cross 
Nursing  Service,  248 

on  Red  Cross  public  health  nurse, 
403 
Boardman,  Mabel  T.,  Central   Com- 
mittee, 230 

committee,  lecture  course  for  Red 
Cross  nurses,  122 

Committee  on  Rural  Nursing, 
1216 

Delano  Memorial  Committee, 
1050,  1051 

Executive  Committee,  reorganized 
Red  Cross,  74 

National  Committee  on  Red  Cross 
Nursing  Service,  95,  127,  249 

on  appointment  of  Red  Cross 
nurses,  84 

on  class  instruction  for  women, 
1352 

on  dietitian  classes,  1376 

on  enrollment  in  the  Nursing 
Service,  357 

on  home  nursing  courses,  1355, 
1.356 

on  importance  of  Nursing  Serv- 
ice  {Red  Cros^'i  Bulletin),  75 

on  plan  for  affiliating  organized 
nurses,  88,  89 

on  Red  Cross  nursing  standards, 
83 

on  "Tjie  Red  Cross  Nurse,"  ad- 
dress before  American  Society 
of  Superintendents  of  Training 
Schools,  75 

on  Red  Cross  Nursing  Service, 
327 


INDEX 


1497 


Boardman,  Mabel  T.,  on  services  of 
^rrs.  Whitelaw  Rcid.  47-48 
or^'anizing  Rural  Nursing  service, 

12t)4 
plan  for  Red  Cross  aides,  1052 
preface   to  Red   Cross   text  book, 

135!) 
Town  and  Country  Nursing  Com- 
mittee, 1219 
"Under  tlie   Red  Cross   Flag,"   ac- 
count of  sanitary  commission  of 
Rockefeller       Foundation      and 
American   Red  Cross  in  Serbian 
typhus  epidemic,  11)15,  184 
Woman's     Advisory      Committee, 
300 
Bobigny,      France,     American     Red 

Cross  dispensary  at,  810 
Bogart,     Eugenia,     relief    work     in 

Serbia,   1122 
Bogle,  Klizabetb  McC,  chief  nurse, 

Base  Hospital  No.  40,  439 
Bolignv,    !Miss,   nursing   services    at 

i'once,  33 
Bordeaux,    France,    children's    hos- 
pital at.   795 
dock   infirmary  of  American   Red 

Cross  at,  l(il2 
U.    S.    Base    Hospital    No.    6    at, 
493 
Borgcson,    Dr.    Egbert,    relief    work 

in   Serbia,   1119 
Bosio,     Sigiiorina,      scholarship     to 

study  nursing.    1175 
Boston  Instructive  District  Nursing 
Association,  training  for  public 
health  nursing,   1241 
Boston    Visiting    Nurse    Association 
Training  for  public  iicaltii  nurs- 
ing,  1251 
Boulevard  Fielleville  dispensary,  809 
Bouldgnc-sur-Mer,  Base  Hospital  No. 

5  at,  453 
Bowling.       (icrtrude,       Chautauqua 
nurse.  1055 
on  Argonne  victory,  (i()4 
on  conditions  at  Chateau-Tliicrry, 
(itiO 
Bowman,  J.  Fxatrice.  147 
on    llaslar    Hospital.    14(i 
on  naval  iiospital  at  (ireat  Lakes, 

HI..  7119 
servires      at       Hat  t  ieshur--.      190S, 

1:50 
sui)ervisor  of  Mercv  Sliip  liilt  !),• 

14(i 
on  Tommv  Atkins,  1  IS 


Boyle,  Sara  Jane,  child  welfare  work 
at  Le  dandier,  818 
on  work  at  Le  dandier,  818 

Bradbury,   Dr.    Bial   F.,   director  of 
Mer'cy  Ship  Unit  G,  IGO 
general  consulting  surgeon  of  Ger- 
man military  hospital  at  Kosel, 
IGO 
return  of.  to  United  States,  167 

Bradford,  Flora,  Chautauqua  nurse, 
1053 

Bradley,    Colonel    A.    S.,   484 

Bradley,  Dr.  Frances  Sage,  on  tuber- 
culosis prevention  work  in 
France,  853 

Bradner,  Capt.  M.  R.,  relief  work 
in  Serbia,  1121 

Brady,  Bernice,  relief  work  in  Mon- 
tenegro, 1100.  1107 

Braisted,  Rear  Admiral  William  C, 
080,  092 
Central   Committee.  230,   1007 
Executive    Conunittee,    1007 
National  Conunittee  on  Red  Cross 

Nursing  Service.  248 
on  committee  to  secure  Red  Cross 
ship   for  World   War,  140 

Brandon,  Mrs.  Gertrude  C,  work  of, 
at  Harbin.  938 

Braun,  Frederica,  on  Naval  Hos- 
pital in  (luam.  732 

P.reaux,  Lvdia,  Chautauqua  nurse, 
1055 

Bremer,  Mrs.  Harry  ^L.  recruiting 
relief   niu'se.s    for    Poland,    1085 

r>rennan,  Agnes,  superintendent  at 
Bellevue,  during  Spanish-Amer- 
ican War  period,  4!) 

Brest,     France,    doek     infirmary    of 
American   Red   Cross   at,    1011 
U.   S.  Armv  base   hospitals  near, 

99() 
U.  S.  Navv  Base  Hospital  at,  728, 
730 

Brest-!. itovsk,  Red  Cross  relief  work 
at.    1094 

Hrest-Litovsk  'ireaty.  4C.4 

ISrcwer.  Cliailotte.  at  National 
llcad(|uarler<.  240 

i'.rewrr.    Dr.    Ceoige    K..   329.   339 

l'>ridi:e.  Helen  I...  dillicuhies  in  War- 


ns , 


on    ciliiciit  ioiial    nursing    work    in 

Sjlie;  ia.  '.>:H  M;i(i 
(i!i   scIiomI    ill   \\ar<:i\\.    lltU 
relief    Work    in     i'dland.    11(10 
work   of.  at    Chita.    Silieria.  950 


1498 


INDEX 


Briglmm,  Peter  Brent,  Unit,  U.  S. 

Army  Base  Hospital  No.  5,  452 
Brinsmade,   Dr.   W.   C,   director   of 

U.  S.  Navy  Base  Hospital  No. 

1,  734,  996 
British  Nursing  Service,  472-482 
rules  for  nurses,  476 
status  of  nurses  in,  483 
Brogan,  Mary  A.,  Children's  Bureau 

at   Nesle,   France,   772 
Brookbanks,   Nellie  V.,   chief  nurse, 

American    Red    Cross    Military 

Hospital  No.  4,  435 
hospital    work    in    England,    429, 

431 
Brooke,  Meta  C,  assistant  on  Nurse 

Corps    of     the    Public    Health 

Service,  1028 
Brown,    Eleanor    Beatrice,    visit    to 

devastated  area,  France,  989 
Brown,  Mary  Magoun,  361,  362,  371, 

373-374,  383-384 
Brown,  Miss,  relief  work  in  Albania, 

1422 
Brown,      Mrs.      Edgar,      volunteer 

helper,  241 
Brown,  Mrs.  Leonard,  154 
Brownell,    Mary,    Roumanian    Com- 
mission, 882 
Bryan,    Dr.    Robert   C,    Roumanian 

Commission,  882 
Bryant,  Sallie  J.,  work  of,  at  Bero- 

soka,  Siberia,  947 
Buchaloo    Hospital,    Siberia,    915 
Buchannan,    Sarah,    relief    work    in 

Albania,  1108-1110 
Buckler,    W.    H.,    London    Chapter, 

American  Red  Cross,  425 
Bucklin,  George  A.,  Jr.,  155 
Budapest,      establishment     of     Red 

Cross  hospital  at,  172 
Budapest,  passage  of  troops  tlirough, 

175 
Budapest  liospital,  closing  of,    175 
relief  work  at,   173-174 
wounded    at,    tlioughtfulness     of, 

175 
Budin,  Madame,  cliild  welfare  work, 

Paris,  815 
Buffalo     District     Nursing    Associa- 
tion, training  for  ])ublic  health 

nursing.   1244 
Bukeh'v,    Cajjt.    Rud()lj)h,    on    anti- 

tvplius    work     in    Siliei-ia,    918, 

919 
on  conditions  in  Omsk,  925 
on  conditions  in  Siberia,  920 


Bukeley,  Capt.  Rudolph,  on  Siberian 
prison   trains,   921-922 

Bulgaria,  mobilization  of,  221 
plans  for  nursing  school  in,  1167, 

1168 
relief  work  aniong  Greeks  in,  1192 

Bull,  Mrs.  Lanmau,  Committee  on 
Nurses  of  Auxiliary  No.  3, 
Spanish-American  War,  47, 
55 
nursing  services  on  the  Oregon, 
32 

Bullard,  Florence,  Chautauqua 
nurse,  1055 

Bunting,  Laura,  relief  work  in 
Samos,   1113 

Bureau  of  Equipment  at  the  At- 
lantic Division,  371,  384 

Bureau  of  Information  for  Nurses, 
1014-1016 

Bureau  of  Nurses  and  Medical  At- 
tention, Florida  yellow  fever 
epidemic  services  from,   16 

Bureau  of  Nurses'  Equipment,  371 
establishment  of,  363 

Bureau  of  Sanitary  Service  under 
the  Department  of  Military  Re- 
lief, 346 

Burgar,  Donna  G.,  on  Viktoria 
Theater  hospital  at  Gleiwitz, 
162 

Burges,   Anne,    at   Orleans,    France, 
1918,  740 
head  nurse  at  Camp  Coetquidan, 
738 

Burgess,  Charlotte,  supervisor  of 
Mercy  Ship  Unit  C,  156 

Burgess,  Gelett,  on  work  of  Miss 
Noyes,   1367 

Burgess,  P^dith,  relief  work  in 
Montenegro,    1106 

Burgess,  Elizabeth,  955 

conference    of    medical    and    army 

officers  and  nurses,  284 
League     of     Nursing     Education, 
aides  course  at  Vassar,  268 

Burgess,  ]Mary  A.,  chief  nurse  of 
evacuation  hospital  in  Chan- 
tillv,  615 

Burke,  Nirs.  E.  S.,  head  of  Cleveland 
workroom  for  hospital  supplies, 
299 

Burlingamc,   Dr.   C.   C,  531,  619 
director.   Hospital   Service,  Amer- 
ican   Red  Cross   in    France,  531 
on   American    IJed    Cross  Military 
Hospital  No.  6,  Oil 


INDEX 


1499 


Burlingame,  Dr.  C.  C,  on  American 
H('(i     Cross     military     liospital 
at  Jouilly,  (i()4 
on  American   Red   Cross  Hospital 

No.  110  at  Coincy,  (51(> 
on  emergency  hospital  at  Auteuil, 

55>9 
on   emergency    hospital    at   Jouy- 

sur-Morin,  GO.) 
report  of  hospital  work,  (530 

Burnap.   Dr.  Sidney  K.,  3.39 

lUirner,   Ooiah,   491 

lUirnliam,  Dr.  Marjorie,  relief  work 
in  Serbia.   1110 

Unrns.  "amberine"  treatment  for, 
Gil 

Bnrns,   Sophia   M.,   conference  witli 
Miss  Rhodes,  oTG 
Mobile  Hospital  No.  9,  049 

lUurev,  Helen  T..  on  hospital  train 
service,    500,    G3G.    G39,    G42 

Burrill,  Mrs.  Harvey  D.,  State  Com- 
mittee  of  New   York,   110 

Bush,  Irving.  140 

Bushnell.  Colonel  (Jeorge  E.,  Acting 
Surgeon  (Jeneral,  Medical 
Corps,  on  expense  of  equipment 
of   Army   Nurse   C()r])s,   370 

Butler,  Edward  1)..  conference  to 
consider  nursing  ])roblems,  2')4 

Butler,  Dr.  Etlian  Flagg.  director  of 
Serbian   Unit  No.   2.    180,    187 
in    charge    of    surgical    pavilions 
at  American  Red  Cross  hospital 
at  Belgrade.  182 

Butler.    Ida    F.,    Chautauqua    nurse, 
1055 
chief    nurse    of    Hospital    Violet, 

784 
in  charge  at   National   Headquar- 
ters   durintj    Miss    No\es'    tour, 
117G 
on    results    of    Chautau(]ua    talks, 
10.17 

Butler.  Miiuiette.  on  care  of  con- 
tagious cases.  70.") 

Bybee,  Louise,  at  f'liatraii-  dcs 
llnlirs-  hospital.  7S0 

r>yiiigt()Ti,  Margaret,  on  functions 
of  nurse  and  social  worker, 
1317 

Cabaniss.  Sara,   nursing  instruction 

for  wiiinen.   13.">1 
Cabot,    Dr.    i\i(liarii    ('..   director    of 

Paris        dispensary.        I/Acciiiil 

Franco. [  nwricaiii,  830 


Cabot,  Major  Richard  A.,  774 
Cadel.    Inez,    ljoui.se,    chief   nurse   of 
Trudeau     Sanatorium,     France, 

852 

Cadmus,  Nancy,  record  of,  64 

Callin,    Freda,  at  Le  (Jlandier,  819 

Catlin,    Freda   M.,  on   dispen.sary   at 
Rue  Censier,   I'aris.  805 
on  dispensarv  at  N'alence,  France, 
842 

Caldwell,  Mary,  on  work  at  Ameri- 
can Red  Cross  Military  Hos- 
pital No.  3,  748 

California,    early    work    toward    re- 
jdacing   Red    Cross   State   Nurs- 
ing   Committee    by    the    State 
Nurses'  Association,  SG 
Nurses'  Auxiliary    (1909),    135G 
pui)lic    health    nursing    in,    1342, 
1343 
exhibits,  1.350 

Ciunbrai,  school  of  nursing  at,  822 

Cameron.  Mary  Muriel,  nursing 
service  in  Santo  Domingo.  1199 

Camouflage  Camp,  at  Dijon,  France, 
81G 

Camoullage  of  ships,  423 

Camp  I'dack,  Red  Cross  services  at, 
Gl 

Cam])  Coetquician,  artillery  training 
centre.  738 

Camp  Perry,  yellow  fever  quaran- 
tine cainj).   15 

Campbell,  Estidle,  and  cantonment 
duty.   390 

Canicattini  I'agni,  Sicily.  American 
Red  Cross  hospital  at,  8(55 

Cannes,     International     Red     Cross 
Conference,    A])ril,    i91!>.    1137 
report  of.  1138-1140 

Canteens,  emergency,  at  railroad 
stations  in    France.  8.37 

Capps,    Lieutenant -( 'olonel    Edward, 
in  conunand  of  Conuuission  for 
(;reece.    1100 
I'clief    work    in   (! recce.    1111 

Carditr.     Wales,     American     coaling 
l)ase.   724 
hosi.ital  at.  724 

Carney.  Anne,  cliief  luirse  at  Asilc 
Str.    iUnii'nif.    S.")l( 

Carpenter.  Mrs.  Mary  C.  on  State 
Cuniniittee  of  WCst  \iri.'inia, 
110 

(';inel    Mi>-ion,   in    Pnnniania,   S7S 

Carroll.  Dr.  .lanies.  vellnw  fever 
work  bv,   14 


1500 


INDEX 


Carson,  Isabelle  F.,  chief  nurse  of 
American  Red  Cross  Military 
Hospital  No.  23,  430 

Carter,  A.  Maury,  at  National  Head- 
quarters,   240 

Carter,    Gertrude    P.,    chief    nurse 
of    Red    Cross    unit    at    Omsk, 
925 
work  of,  in  Siberia,  914 

Carter,  J.  Ridgely,  American  Re- 
lief Clearing  House,  531 

Carver,  Prof.  Thomas  N.,  Town  and 
Country  Nursing  Committee, 
1219 

Casa  dei  Convalescent i,  866 

Casualty  Clearing  Station  No.  61, 
462^ 

Casualty  Clearing  Stations,  461 

Catholic  orders,  otfers  from,  for 
Spanish-American  War  nursing 
service,  40 

Catholic  Sisters,  nursing  services  of, 
in  Civil  War,  7 

Cazalet,  Colonel  Charles,  public 
health  work  at  Bordeaux, 
France,  796 

Census  of  nurses,  301,  304,  305 
need  for,  306-308 

Central  Division  of  American  Red 
Cross,  247 

Cerna,  Vilma,  training  for  work  in 
Prague,  1150 

Cetinje,  ^lontenegro,  relief  work  in, 
1106 

Chalons-sur-Marne,  babies'  hospital 
at,  828 

Chamberlain,  Senator,  bill  for  re- 
organization of  Army  Nurse 
Corps,   1066 

Chambers,  Frank  R.,  recommends 
nursing  course  at  Vassar,  268 

Chandler,  ^lyrtle  Gilmore.  on  Naval 
Hospital  at  Parris  Island.  708 

Chaney,   P^milv,   relief   work  in  Al- 
bania, 1110 
in  ^lontencgro,  1106 

Chanler's  Hospital,  Miss,  Red  Cross 
nurse  at,  61 

Chanler.  Margaret  L.   (^Irs.  Richard 
Al(iricli),  in  Army  Nurse  Corps 
legishi^ive  efforts*  68,  70 
investigation     by,     of     Pliilippine 

nursing  conditions.  69 
niirsing  services  at  Ponce,  33 
services  of,  64 

Chantiliv,  France,  evacuation  lios- 
pital  at,  614 


Chapin,  Dr.,  conference  to  consider 

nursing  problems,  254 
Chapman,  Olive,  director  of  public 

health  nursing,  Moimtain  Divi- 
sion, 1303 
"Chapters,"    or    local    branches    of 

American    Red    Cross   adopted, 

1909,  102 
Charleston,  demand  from,  for  nurses, 

Spanish-American  War,  58 
Red  Cross  nurses  at,  60 
Charlton,  Anna,  State  Committee  of 

New  York,  110 
Chateau  de  la  Fontaine  Bade,  848 
Chateau    des    Halles,    hospital    for 

children,  780 
Chateau   Hospital,   at   Sermaize-les- 

Bains,  829 
Chateauroux,  France,  Base  Hospital 

No.  9  at,  499 
Chateau-Thierry,      American      Red 

Cross  Hospital  No.  Ill  at,  617 
Chatedguvon,  France,  Base  Hospital 

No.  20  at,  506,  507 
Chaumont,    France,    Base    Hospital 

No.  15  at,  493 
Chautalonette   Hospital,    opened   at 

St.   Eticnne,   France,   1919,  789 
Chautauqua    cooperation    for    rural 

nursing,  1231 
Cliautauqua  nurses,  1053-1059 
Cheliabinsk,  Siberia,  evacuation  of, 

942 
Red  Cross  hospital  at,  940 
Chelsea,  naval  hospital  at,  706 
Cherry,  Elizabeth  E.,  on  evacuation 

hospital   at  Cliantilly,   615 
Cherry  Mine  disaster,  131 
Chesley,  Major  A.  J.,  chief  of  staff 

of  relief  work  in  Department  of 

the  East,  1087 
director    of    American    Red    Cross 

Commission    for    Poland,    1088, 

1089 
Chester,     Pa.,    nursing    service    at, 

1917,    136 
Chicago    Visiting    Nurses'    Associa- 
tion, training  for  I'ublic  Health 

Nursing,  1243 
Cliickamanga    Park,   hospital   needs 

at,  58,  59 
Chief  nurse   (American  Red  Cross), 

duties  of,  568-570 
position  after  reorganization,  573 
C'iiiid,  Dr.  Dorothy,  in  cliarge  of  dis- 
pensary and  lal^oratory,  Ciiate- 

let  hospital,  779 


INDEX 


1501 


Child,  Dr.  Florence,  resident  physi- 
cian at  CliAtelet  hospital,  770 
Chihi  saving  centers,  Dr.   Farrand'a 

phin  for,  1178 
Child    welfare,   Albania    and   Monte- 
negro, recommendation  for,  1183 
child  health  work  in,  1198 
Constantinople,   1180 
Dr.    Hill's   work   for   child   health 
centers,    1190 
expositions,  France,  783 
at  St.  Etienne,  France,  790 
at  Toulouse,  France,  1918,  795 
Europe   report   of   Miss   Gardner, 

1189-1191 
France,   1918,   812 
Greece,   1181 
Poland,  1179,  1180 
program  for,  1195 
rural  nursing,   1231 
Children's       Bureau       in       France, 
activities  of,  7G5,  824 
at  Amiens,  774 
at   Bloise,   797 
at   Corbeil,    798 
at    Dieppe,   779 
at  Evian-les-Bains,  777 
at  Lyons,  783 
at  ^Ia^seiiles,  791 

discontinued,  1919,  795 
at  Nesle.  771 
at    Paris,   801 
discontinued.  1919,  809 
feeding  of  child reTi  by,  808 
training    of    visitcuses    d'cnfavls 
l)y.  811 
Cliildren's    Bureau    of    Civil    Affairs 

Department,   757 
Cliildreirs  Bureau,  work  of,  700 
C'liildreirs    Hospital,    at    Evian-les- 
Bains.   777 
Chinese    Citv    Hospital    at    Harbin, 

937 
Cliios,  relief  work  in.  1113 
(  liita.  Siberia.  American  Red  Cross 

work    at.    950 
Clirysakis,     Margaret,     relief    work 

in  (Jreece.  1111 
Chubb.    Heiidon,    National   Advisory 
Committee   on    Insurance.    1041 
Chul)l),    Percy,    estate    of.    at    Wim- 
bledon,  England,   used    for   con- 
valescent   hosjtital,    43S 
Cluireli.     Mrs.     Margaret     P..     ehil.l 
welfare  work.  France.  1918.  Si:! 
Children's      Bureau      at      Blois, 
France,  797 


Churchill.  Lady  Randolph,  Commit- 
tee of  American   Women's  War 
Relief   Fluid,    140 
Cincinnati     meeting    of     Red     Cross 

Dietitian  Service.  1432.  1433 
Civil  Alfairs   Department  of  Ameri- 
can lied  Cross,  757 
Civil    War,    lack   of    trained   nurses 
in,  5 
nursing     services     of     sisteriioods 

in,   7 
relief  work  in,  by  U.  S.  Sanitary 

Commission,  0 
women  of,  memorial  to,  proposed, 
123 
Civil   War  nurses,  roster  of,   12 
Civilian  Relief,  231 
Clark,  Alma  A.,  child  welfare  work, 

France,  1918,  809 
Clark,  Dr.   Harriet,  on   Chios,   1113 
Clark,    Lillian    Craig,    work    of,    at 

Irkutsk,    944 
Clark,    Dr.    Taliaferro,    director    of 
Red  Cross   Bureau  of  Sanitary 
Service,  report  of,  340 
on   funds   for   public  health   nurs- 
ing,   12S() 
surgeon.     United     States     Health 
Service.  340 
Clarke,  Major  William  E.,  Commis- 
sion   for    France.   51)2 
Clarke,  ^lartiia  S..  at  Asilf  f'as(r)u\ 
Luxembourg.   022 
chief     nurse     of     relief     work     in 
Pruzana.  Pcdaiul.   IDSO.  lUSS 
Clarke.   Mary   A.,   on   Miss   Delano's 
])lan    for    home    nursing.    13.")7. 
1358 
on   Miss   Delano's   fitness   for   Red 

Cross  organization  service.  72 
on      I^ed      Cross     cnrollnu'iit      of 
nurses,  1 1  t 
Classification    of    nurses.   301 

Miss    Delano's    work    on.    3()2-:!li;! 
30  t 
Clav.    Josephine,    at     llnjiih:!    Aii.r- 
■  iUan.    Sn.    34.    IDO 
volunteer    service    at     St.    \'aleiy, 
539 
(lay.     Cnlniiel     and     Mrs.     Spender. 
"  estate  (if.  at    l.inglirld.   Kngland. 
used    for    Aniiri;;in    Red    C'^^-^ 
eolivali'-eellt    liii>]iit  :l  1.  4. "4 
Clav.  Kv..  nursing  >crviee  at.   l'.»17 

'  Kill' 
(  lay)M.,,l.    May,    at.    National    Head- 
'  (|iiartn>.    210 


1502 


INDEX 


Clayton,    S.    Lillian,    Committee   of 
'Transfer,   1022 
committee     to    get     hospitals     to 
aid     in     training     army     nurses, 

286 
conference   of   medical   and   army 

olHcers  and  nurses,  284 
conference    to     consider     nursing 

problems,   254 
enrollment  of  nurses,   290 

plaji     for     special     enrollment, 
258 
Joint   National   Committee,    1047 
Joint      National      Committee     of 

Bureau  of  Information,  1016 
National  Committee  on  Red  Cross 

Nursing  Service,  248,  249 
Clement,    Fannie    ¥.,    Committee   of 

Rural  Nursing,  1216 
conferenco    to    consider    |nursing 

problems,  253 
director    of    Town    and    Country 

Nursing  Service,  240 
head  nurse.  Red  Cross  Town  and 

Country    Nursing    Service,    206 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
on   classification  of  nurses,   1271, 

1272 
on   plan   for   rural   nursing,   1218 
on  public  health  nursing,   1253 
on    Red    Crosa  'influence,    1232, 

1233 
on  training  for  public  health  nurs- 
ing,   1246 
outline    of     activities    for     rural 

nursing,  1217 
report  on  work  in  rural  nursing, 

1226-1231 
resignation    from    rural    nursing, 

1234,  1235 
superintendent  for  rural  nursing, 

1215 
work    for    piiblic   health    nursing, 

report,  1913.  1222-1224 
Clendenning,    Edith,    head    nurse   of 

I'olisli  armv  hospital  at  Vilna, 

1093 
C'lolliing  and  supplies,  purveyed  by 

Florence    Nightingale,    3 
('lul)s    for  nurses,   American   Nurses 

Club,  London,  425 
Coaling  base,  American.  724 
Cobb,    David    L.,    counsel    American 

National  Red  Cross,  1S98,  25 
C(/blen/,,  occupied  by  American  Red 

Cross,  994,  995 


Coetquidan  Camp,  artillery  training 
centre,  738 

Ooffey,  Anna  E.,  assistant  chief 
nurse,  A.  E.  F.,  in  France,  503 
nursing  service  at  Chateau- 
Thierry,  634 

Coffin,  C.  A.,  Committee  for  Me- 
morial Fund  to  American 
Nurses,  1048 

Cohan,  France,  conditions  at,  753 

Coincy,  France,  American  Red 
Cross  Hospital  No.  110  at,  616 

Colburn,  Clara,  Committee  on  Red 
Cross  Dietitian  Service,  1379 

Cole,  Aileen  B.,  on  reception  of 
colored  nurses  at  Camp  Sher- 
man   (Dec.,    1918),    406-407 

Cole,  Mary  L.,  director  of  Public 
Health  Nursing,  1304 

Collin,  Dr.,  child  welfare  work, 
Paris,  815 

Collins,  Dr.  Joseph,  tubercvilosis 
prevention  work  in  Italy,  867 

Colon,  Annie  L.,  work  during  influ- 
enza epidemic  in  Michigan,  978- 
979 

Colony  Club,  mobilization  station  for 
nurses,  420 

Columbia  Universit}',  training  for 
public  health  nursing,   1252 

Concord,  N.  H.,  District  Nursing 
Association,   1244 

Conley,  Emma,  chairman,  Commit- 
tee on  Red  Cross  Dietitian 
Service,  1379 

Connecticut  Training  School,  ofTer 
of,  for  Spanish-American  War 
service,  40 

Connellv,  Bettv,  chief  nurse,  Mobile 
Unit  No.  5,  451 

Connely,  Willard,  on  training  of  hos- 
pital    corpsmen,  712 

Connor,  Major  C.  11.,  National  Com- 
mittee on  Red  Cross  Nursing 
Service,  249 

Constantinople,  conditions  in,  1180 
nursing  school  in,  1168,  1169, 
1170 

"Contract  doctor,"  350 

"Contract  nurse."  350 

Contrexeville.  France,  U.  S.  Army 
Base   Hospital   No.  32,  503 

Convalescent  Bureau,  614 

Convalescent  home.  La  Chaux,  at 
Lyons.  France,  785 

C(jnvalescent  homes,  American  Red 
Cross,  732 


INDEX 


1503 


Convalescent  homes  for  nurses,  1033- 
1035,  1037,  1040 
at     Kowayton,     Conn.,     Spanish- 
American  War,  Gl 

Convoy  system  of  transportation, 
718 

Cooliilge,  Mrs.  J.  Randolph,  Jr., 
Woman's  Advisory  Committee, 
300 

Cooper,  Edna,  hospital  train  ser- 
vice, .lOO,  030 

Cooper,  Ix'na  F.,  Committee  on  Red 
Cross  Dietitian  Service,  1378 
letter  of  Major  :\Iurlin,   1400 
suj)ervisi(in    of   dietitians'    report, 

142"),   1420 
vice-president,    American    Dietet- 
ics Association,  1398 

Cooper,  ilrs.  Margaret  R.,  Chautau- 
qua nurse,  1053 

Copelin,  Bessie  A.,  on  trip  to 
Fleury-sur-Aire,  023 

Copp,  A.  W.,  on  Commission  for 
Europe,  530 

Corheil,      France,      plavground     at, 
SOI 
Red   Cross  dispensary  at,  800 
work    of    Children's    Ihircau    at, 
1918,  798 

Corhett,  Miss,  work  for  dietitians' 
enrolhnent  for  Red  Cross  hos- 
pital service,  85 

Corbin,  Adjutant-General,  letter 
from,  aiitliori/ing  Red  Cross 
nurses  for  the  Philippines, 
02 

Corps  insignia.  Navy  Nurse  Corps, 
095,   097 

Corresj)on(U'ncc  courses  for  nurses' 
training,  20 

County  Farm  Bureau,  coiiperation 
witli  pul)lic  health  nursing, 
1351 

Cover.  Dr.  Elh'n,  Clu'ilcau  ih  s 
lhillr».    Hospital,    780 

Cowdin,   Mrs.   Wintiirop,   48 

active  nicmher  Committee  on 
nursing.  Auxiliary  No.  3.  SpuTi- 
isii-Aiiu  ican  War.  47,  '^'y 
first  cliairinan,  Coiniiiittct'  to  F^c- 
curc  by  Att  of  Congress  the 
Enipioyment  of  Wdmeii  Nurses 
in  Hospital  Service  of  tlie  l'.  .'^. 
Army.  07 
on  special  eoiniiiittee  for  ehiser 
coiiperat  imi  lietween  lied  Cross 
and  goN'eniineiit,  5(1,  57 


Cowlcs,   Mrs.    William   L.,   Commit- 
tee,  on    Nurses    for    tiie    Philip- 
pines, ()2 
in    .\nnv    -Xur.se   Corps   legislative 

effort^  70 
pioneer   member  of  Au.xiliary  No. 

3,  Spanish-American    War,    47 
Cowman,     Dr.     Isabel     Elliot,    vice- 
president.    Society    of    Spanisb- 
Anierican  War  Nurses,  40 

Cox,    Dorotliy,    ciiild    welfare    work 

at   Lyons,    France,  780 
Cox,  Mary   1).,   ill  with  typiuis,   191 
Crandall,    Flla    Phillips,  aid   in  get- 
ting enrollment   of   muses,  290 
committee  to  get  hospitals  to  aid 

in  training  army  luirses,  280 
Joint  National  Conunittee,  1047 
Joint  National  Conunittee  of  Bu- 
reau of  Information,   1010 
National  Conunittee  on  Red  Cross 

Nursing   Service,   249 
on  National  Organization  for  Pub- 
lic   llealtii    Nursing,    1220 
executive    secretary,    347 
resolution     for     rank     for     army 

nurses,    1074 
Town  and  Countrv  Nursing  Com- 
mittee,   1219 
work  at  Davton,  Oliio,  Hood,  1913, 
134 
Crawford.    .Maude   S.,   on   conditions 
in   an   evacuation    liosi)ital,  040 
Crawford,    Sarah    Adams,    su])ervis- 
ing   nurse  of   Burt'au  of    Tuber- 
culosis,   France.  84ti,  852 
Creadick,     Fli/.aiietli,    on    American 
Red     Cross     Military     Hospital 
No.  5,  002 
Crete,   infant   welfare  in,    llKi 
Crightoii,    Lily    B.,    chief    luu-se    in 
Anierieaii     \lvi\    Cross    .Military 
Hospital    No.    0    at    St.    Clouci, 
Oil 
Crile.    Dr.    CcHirire    W.,    director    of 
r.   S.   Aniiv    nM>e   Hospital   No. 

4.  l.akeihide.  :!:iS.   443 
orgatii/at  inn   of  base  hospitals  f(U' 

I'liited    States   Arni\.   :!27.   .328, 

32:t.  ;i:;2.  337.  33S 

pi-oject      for     oigaiiizat  ion     and 

eipiilinicut    of     ((  h{.    25.    1915  i , 

.•!27 
Crocker.     Mrs.     Win.     11..     \\"onian"s 

AihiMiry   (  diiiinil  tee.  :\n{) 
C'roisic.  l-'raiice.  (  iiu\alesci'nt  nurses' 

liniiie  at.    lit4M 


1504 


INDEX 


Cromelien,  Maud,  visiting  agent  of 
Auxiliary  No.  3,  Spanish-Amer- 
ican War,  51 
tour  of  field  hospitals,  58 

Cromwell,  R.  Lee,  159 

Croslev,  Sara,  relief  work  in  Serbia, 
1120 

Cross,    Miss,   volunteer   helper,    241 

Crowell,  Elizabetli,  tuberculosis  pre- 
vention work  in  France,  845 

Cuban  civil  hospitals,  American 
nurses'  work  at,  64 

Cuban  Red  Cross  nursing  contin- 
gent, first,  30 

Cudahy,  Mrs.  Joseph,  Board  of  In- 
corporators   of    American    Red 
Cross,  1007 
Woman's     Advisory     Committee, 
300 

Cullen,  Mrs.  Thomas  S.,  head  of 
Baltimore  workroom  for  hos- 
pital supplies,  299 

Curley,  Teresa,  ill  with  typhus,  191 

Curtis,      Margaret,     child     welfare 
work,  1187 
director    of    Bureau    of    Refugees 
and  Relief,  Paris.  825 

Curtis,  Mrs.  Namah,  nursing  organi- 
zation services  of,  38-39 

Cusliinrr.  Dr.   Marvey,  329 

director,  Base  Hospital  Xo.  5,  452 
organization     of     base     hospitals, 
332,  333 

Cushman,  Ruth,  on  bombing  of  Cha- 
lons, 054 

Cuthbert,  Eugenie  J.,  volunteer 
helper,  241 

Cutler,  .J.  Otis,  manager  of  Four- 
teentli   Division,  912 

Cutting,     ]Mrs.     Bayard,     in     Army 
Nurse    Corps    legislative    efforts, 

68 
pioneer  member  of  Auxiliary  No. 
3,  47 

Czech  naval  liospital,  913 

Czechoslovak  armv,  activities  of, 
in  Siberia,  910*       . 

Czeclio-Slovakia.    cliild    welfare    in, 
1189,   1190 
relief  nurses  in,  10S3 
school  for  nurses  at  Prague,  1150- 
1154 

Dalilman.      Jane      T.,      Chautauqua 

nurse.    1055 
Dai  lev.    Anne,    Chautauqua    nurse, 

]'05o 


Dallas  floods,  1908,  130 
Dallyn,    Capt.    F.    A.,    director    of 
Inter-Allied   Commission,   expe- 
dition in  Siberia,  918 
Dalv,  R.  J.,  Commission  for  Europe, 

"^531 
Damar,      Annie,      instruction      for 

women,    1354 
Damer,    Miss,    Alumnae    representa- 
tive,  Committee    for   affiliating 
organized      nurses     with      Red 
Cross,  73,  87 
on  need  that  state  nursing  asso- 
ciations   act    directly    for    Red 
Cross,  86 
on   nurses'    enrollment   with    Red 
Cross,  81 
Daniels,   Josephus,  on   hospital   ex- 
pansion at  Norfolk,  700 
Danna,   Dr.   Joseph   A.,   director  U. 

S.  Base  Hospital  No.  102,  605 
Dannes   Camiers,   France,  air  raids 
at,  453,  472 
U.  S.  Army  Base  Hospital  No.  5 

at,  452 
U.  S.  Armv  Base  Hospital  No.  12 
at,  469 
D.   A.   R.   Hospital   Corps,   ajid    So- 
ciety   for    the    Maintenance    of 
Trained      Nurses,      cooperation 
between,    60 
Darche,  Louise,  early  nursing  super- 
intendent,  19 
Darrach,    Major,    at    British    front, 

454 
Darst,  Lieutenant  Gilford,  140 
Dartford,  England.  U.  S.  Base  Hos- 
pital No.  37  at,  437 
Daspit,  L.  Agnes,  director  Gulf  Di- 
vision of  Red  Cross,  246 
Dauser,  »Sue  Sophia,  ciiief  nurse  of 
U.   S.  Navy  Base  Hospital  No. 
3,  722 
on  L'.  S.  Navv  Base  Hospital  No. 
3,   723 
Davis,     ^lajor-General    George    W., 
chairman.    Central    Committee, 
206 
Davis.  Rev.  Robert,  Commission  for 

Europe,   531 
Davis,   Dr.   Robert,  worl.  with   chil- 
dren in  Toul,  765 
Davis,  John  W.,  Central  Committee, 

2.30 
Davison,    Henry   P.,   accepts   aid   of 
National  Committee  to  League, 
1142 


INDEX 


1505 


Davison,    Henry    P.,    and    nurses' 
equipment,   3()4 
at     International     Conference    at 

Cannes,  1919,  1137 
chairman  on  War  Council,  253 
conference     to     consider     nursing 

problems,  254 
Executive  Committee  of  American 

Red  Cross,  1007 
opinion  of  Miss  Delano's  services, 

967 
work  of,  for  Red  Cross,  1136 
Davison,   Mrs.   Henry   P.,   cliairraan 
of     Committee     for     Memorial 
Fund  to  American  Nurses,  1047, 
1048 
Delano  Memorial  Committee,  1051 
recruiting    relief    nurses    for    Po- 
land,   1085 
Day,  William  R.,  action  toward  fix- 
ing  official    status   of   the   Red 
Cross,  26 
Dayton,  Ohio,  floods,  1913.  132 
Dean,    ]\Ira.,   efforts    for    Red    Cross 
affiliation,  71 
superintendent  at  Mt.  Sinai,  49 
Deans,  Agnes  G..  National  Commit- 
tee on  Red  Cross  Nursing  Ser- 
vice, 249 
conference     to     consider    nursing 

problems,  253 
Nursing      Service     Headquarters, 
238 
De  Arizcun,  Madame.  154 
Deaths  of  nurses  during  war,  1032 
De  Calirole.  Madame.  154 
Decentralization  plan,  242 
DeForest,  Robert  W.,  Central  Com- 
mittee, 230 
Dehellev,  Dr.,  work  of,  in  Rouniania, 

878 
Delano,   Jane   Archer,   activities   of, 
during    Spanish-American    War 
period,  72 
address  to  Convention  on  Nursing 

Education.  957-902 
American   Red  Cross  parade.  New 

York,  420 
appeal      to      graduating      nurses, 

343 
assignment   of    reserve   nurses   to 

Mexican  l^nrder  by.  353 
at  Twentieth   Annual  Convention. 
AniericaiK   Nurses'    Association, 
387-388 
burial  of,  temporarv,  at  Savena\, 
1004 


Delano,  Jane  Arelier,  cantonment 
nursing,  during  epidemic  of 
contagious  (iiscascH,  394 

ceiiHiis  of  nurses,  301 

chairman  of  conference  to  con- 
sider nursing  prol)lems,  253 

chairman  of  National  Conunittee, 
320 

chairman  of  National  Committee 
f)n  Red  Cross  Nursing  Service, 
95,  96,  127,  248 

Cliristmas  boxes  to  nurses  over- 
seas, 207 

conunittee.  lecture  course  for  Red 
Cross  nurses,  122 

Committee  on  Red  Cross  Dietitian 
Service,  1378 

Conunittee  on  Rural  Nursing, 
1216 

committee  on  settling  war  nursing 
policy,  254 

conunittee  to  get  hospitals  to  aid 
training  army  nurses.  286,  287 

committees  for  luirses'  enrollment, 
lOS 

Conference  of  ^ledical  and  Army 
Officers   and  Nurses,  284 

correspondence  witli  reserve 
nurses  on  Mexican  Border,  353- 
356 

deatii  and  fmieral  of,  at  Savenav, 
1003,  1004.  10.32 

delegate  to  Ninth  International 
Red  Cross  Conference,  1912, 
124 

development  of  American  Red 
Cross   under.  3;i0 

directions  to  nurses'  aides  (let- 
ter), 274.  275 

director  of  Nursing.  24S 

early  life  story  of.  l(i.  17 

editor  Red  Cros<  I)e])artinent  of 
Antrrivan  Journal  of  \itrsiiig, 
115 

efTorts  for  Red  Cross  affiliation. 
71 

embarkation  for  trip  overscans.  995 

]Mnert:i'iic\'  Conunittee  on  Nurs- 
ing', -ilU 

final  resting  i)]ace  of.  at  Arling- 
ton  ccini'tcry.    1"05.    lOOO 

licad  (if  I'liitcd  States  nursing 
forces.  :!11.  .'iU.  317.  320 

in  I'loriiia  \cll(i\\  levi-r  epidemic, 
1(1 

last   birtlidav  ..f.  lOdl 

last    illness   of.    in()i)-10i)2 


V 


1506 


INDEX 


Delano,  Jane  Archer,  letter  of 
introduction  from  Walter  D. 
McCan,  Cliief  Surgeon,  A.E.F., 
Paris,  99!) 

letter  to  nurses,  at  time  of  war, 
1272,  1273 

memorial  for,  1049,  1050 

National  Committee  on  Red  Cross 
Nursing  Service,  first  meeting, 
102 

National  Relief  Board,  1912,  125 

Nursing  Staff,  1916,  235 

on  affiliation  of  Red  Cross  and 
state  societies  of  nurses,  112 

on  Army  School  for  Nursing,  963, 
965 

on  assignment  of  colored  nurses, 
406 

on  Base  Hospital  No.  57,  999 

on  classification  of  nurses  (re- 
port), 300 

on  Committees  of  Red  Cross  Nurs- 
ing Service  ( report ) ,  252,  253 

on  Dietitian  Service,  1381 

on  dietitians'  classes,  1378 

on  enrollment  in  the  Nursing  Ser- 
vice. 357,  391,  392 

on  enrollment  of  nurses  (report), 
289,  290 

on  equipment  of  Army  Nurse 
Corps,  374-383 

on  first  day  at  Brest  (diary),  996 

on  home  nursing,  1360 

on  interest  in  nursing  after  war, 
1362,   1363 

on  Navy  units  in  Scliools.  693 

on  Nurses'  Drive  (report),  291 

on  nursing  census    ( letter ) ,  308 

on  nursing  groups  cooperating 
( report )  ',  267 

on  offer  to  send  Red  Cross  nurses 
to  Mexican  horder.  351 

on  public  health  nursing  (report), 
1215 

on  routine  work  (letter),  236,  237 

on  rumors  of  treatment  of  nurses 
abroad   (form  letter),  263 

on  rural  nursing,  1216,  1217 

on  scholarsliip  and  loan  fund  for 
nurses.   1279-1281 

on  stat)]s  of  Armv  nurse,  1067- 
1069 

on  status  of  pulilic  liealtli  nurses 
and  special  service  group  (let- 
ter), 278 

on  teacliing  centers  for  home 
nursing,   1363,  1364> 


Delano,      Jane      Archer,      on      trip 
across  Atlantic   (diary),  996 

on  uniforms  for  Red  Cross  Nurs- 
ing Service,  358-360,  366,  369, 
377,  378,  380 

on  work  in  first  making  surgical 
dressings,  296,  297 

on  visits  to  hospitals  around  Brest 
(diary),   996-998 

on  volunteer  Nurses'  Aides  (let- 
ter), 275,  276 

considering     advisability      (let- 
ter), 269,  270 
status  defined,  271,  272 

on  work  in  Red  Cross  (letters  to 
Miss  Noyes ) ,  232,  233,  234 

on  work  of  volunteer  helpers  (let- 
ter), 241 

organization  of  base  hospitals  by, 
with  Colonel  J.  R.  Kean,  333 

organization  of  Red  Cross  Nurs- 
ing Service  by,  139,  230 

plan  for  Armv  School  of  Nursing, 
286 

plan  for  demobilization  and  aid  to 
nurses,  1015,  1016 

plan  for  home  nursing  books,  1358 

plan  of  division  directors  and  re- 
lation to  Headquarters,  243,  244 

purpose  of  emergencv  detachments 
defined  by,  341 

Red  Cross  enrollment,  services  in, 
76 

relationship  between  Army  Nurse 
Corps  and  American  Red  Cross 
Nursing  Service,  defined  bv, 
313 

selection  of  nurses  for  ]\Iercy  Ship 
Expedition  by,  140 

superintendent     of    Army    Nurse 
Corps,  96 
resignation  of.  98 

talk  to  nurses  at  Na\-v  Base  Hos- 
pital No.  1.  998 

text  book  of,  1368 

Town  and  Countrv  Nursing  Com- 
mittee,  1219 

tributes  to.  1005 

twenty-year  nursing  service  period 
before  Red  Cross  affiliation,   17 

will  of,  1051 

work  during  infiucnza  epidemic, 
9S0 

work  for  home  nursing  courses, 
1366 

work  in  census  and  classification 
of  nurses  (letters),  302-304 


INDEX 


150T 


Delano,  Jane  Archer,  work  in  nurses' 

drive      (Miss     Noyes'     report), 

2!»2,  293 
Delano  Memorial  Committee,   1050, 

1051 
Delano  Red  Cross  Nurse,  1051 
Delany,  Commander  E.  II.,  140 
Do  Lassence,  Mayor  Alfred,  154 
De  Long,  Katherine  C,  work  of,  in 

Italy,  803 
De  Luze,  M.  Cliarles,  public  health 

work  at  Bordeaux,  France,  79G 
Denio,    Oregon,    work   during    influ- 
enza epidemic,  978 
Denison,  Dr.  Walcott,  1G8 
Denison,  Faith,  at  Palanka  hospital, 

Serbia.  1118 
ill  with  typhus,  1119 
Dennison,    Maj.    Robert     C,    relief 

work  in  Albania,  1107 
Denny,    Lenna    II.,    head    nurse    of 

Praga  hospital,  Poland,  1092 
Dent,   Congressman   S.    Hubert,   bill 

for     reorganization     of     Army 

Nurse  Corps,  10(50 
Dental  clinics,  rural  nursing,  1230 
De    Page,    Antoine,    organizjition    of 

Belgian  Red  Cross  hospitals  by, 

200 
De  Page,  Madame  Marie,  death  of, 

on  lAtsitania,  201 
in  United  States  to  raise  funds  for 

Belgian  Red  Cross,  200 
Dersliem,  Mabel,  nurse  in  Santo  Do- 
mingo, 1199 
Desha,     Mary,     work     on     Hospital 

Corps  Committee,  36 
Detroit  Visiting  Nurse  Association, 

training      for      public      health 

nurses.  1243 
Devagne.   Mrs.,   child   welfare  work, 

Paris.  815 
Devine,    Dr.     Edward    T.,    chief    of 

Refugees     and     Relief     Bureau, 

France.  820 
Dcvouge,     Madame,     child     welfare 

work.   Paris,  815 
Dcvraigiie,   Dr..  ciiild   welfare  work, 

France.  191S.  812 
De     Witt,    Katharine,    editor.     Red 

Cross       Nuisiiig       Dojiartmcnt , 

.1  mrricau  Jinirnal  of  \ insiny,  SO 
eiindlment    of    nurses,    work    for, 

290 
Sccrt'tary  of  National  ConiinKtee. 

letter  to  secure  rank  for  nurse*, 

1070,  1071 


Dewar,  Janet,  chief  nurse  at  Vladi- 
vostok  Refugee  Iiosi»ital.  927 
on  nursing  education  at  N'ladivos- 
tok  Refugee  Hospital,  927 
Dewey,   Elizalx-th,   commendation   of 
work  of,  751 
on  work  at  Field  Hospital  No.  7, 

751 
on  work  at  Field  Hospital  No.  12, 

748-750 
State    Committee    of    New    York, 
110,  112 
Daxter,  Major  Elliot  C.  relief  work 

in  Montenegro.  1102 
Diemer,   Mile.,   cliild    welfare   work, 
France,  191 S.  812,  815 
on  visHruses  d'lufants.  81(5 
Dieppe,   France,   work  of   Cliildren's 

Bureau  at,  779 
Diet   Kitclien   Service  CK'erseas    (re- 
port),   1411-1417 
Diet    kitchens,    organization    of    by 

Florence  Nightingale,  3 
Dietetics,  borne.  1304 
Dietitian,   classification,    1390,    1.391 
Dietitian    Service,    1375-1398,    1399- 
1441 
report    for   year    1919-1920,    14.35, 
1430 
Dietitians,    enrollment   of,    for   hos- 
pital service,  85 
]\Iiss    Noves'    circular    letter    to, 

1379,  1380 
insignia  of,    1401 
rank  of.  1402 
salary  of.  1402 
uniform  of,  1401 
Dijon,  France.  Base  Hospital  No.  17 
at.  494 
Hospital  I'nit  "S"'  at.  490 
Dinard,  France,  work  with  children 

at.  709 
Disability    questionnaire    for    ex-ser- 
vice'nurses.  1038.   1039 
Disease,  percentage  of  deatlis  due  to, 

980 
Dispensaries,   established   by   Ameri- 
can Red  Cross  in   l-"urope.  54S 
taken     over     b\-     other     organiza- 
tions,   771 
location    of.    ;it    various   jioints   in 
France.   7t'i!t 
at    Biois.    191S.   797 
at   l!oI)i,L:ii\.  Seine.  SIO 
at    t'orlieil.    cart'    of    American 

soldiers.  Sno 
at  (iri'iiclle,  804 


1508 


INDEX 


Dispensaries,  location  of,  at  various 
points  in  France,  at  Levallois, 
1917,  803 
at  Lvons,  785 
at  Marseilles,  702 
at  Paris,  802,  810 

Boulevard      Belleville,      1919, 

809 
at  Rue  Censier,  805 
at  Rue  de  I'Argonne,  808 
at  Rue  de  Pre-Saint  Gervais, 

808 
Dispoisaire     Marie-Lannelonr 

gue,  807 
Disponsaire     des     Mignott'es, 

807 
La-  Courn^uve,  at  Paris,  806 
Mutualitr  Maternelle,  807 
Poteau  Dispensary,  808 
at  Toul,  768 
travelinf^,  at  Jerusalem,  895 
District     Nursing     Association     of 
Troy,    N.    Y.,    group    affiliation 
with  Red  Cross,  85 
District  of  Columbia,   first  enrolled 

Red  Cross  branch,  76 
District     of     Columbia     Red     Cross 
Branch,    pioneer    in    home   care 
nursing       organization       work, 
80 
Division  directors  of  mirsing,  242 
Division    of   Institutional    and    Stu- 
dent Assignment,  1017 
Division  of   I'ublic  Health  Nursing, 

1017,   1020 
Dix,    Dorotliea   L.,    and   accomplish- 
ment of,  9 
head    of    United    States    nursing 
forces,  311 
Doane,   INIarion,   head   nurse    of   St. 

Luke's  Hospital,  Tokyo,  917 
Dock,   Lavinia   L.,   nursing   services 
of,  at  Johnstown  flood,  18 
in  Florida  vellow  fever  epidemic, 
16 
Doddridge,  CVmimander  J.  S.,  140 
Dodge,  Mr.  and  Mrs.,  loan  of  estate 
for    convalescing    nurses,    1034, 
10.35 
Doelger,   Peter,  P.rcwing  Company's 

trucks.   373 
D'Olier,    Katlilecn,    relief    work    in 
Creece,   1181-1182 
in  Porto  Rico,  1201 
Dollinger,  Professor  Julius,  courtesy 
of,  to  American  Red  Cross  Staff, 
173 


Dominican  Republic  Red  Cross  re- 
lief, 1199 

Donald,  Jennie,  Roumanian  Commis- 
sion, 882 

Donnelly,  Dr.  James  F.,  illness  and 
death  of,  191,  193 

Donnelly,  Katherine,  349 

sent  to  Vera  Cruz,  1914,   128 

Donet,  Dr.,  child  welfare  work, 
Paris,  815 

Donovan,  Capt.  J.  J.,  relief  officer  at 
Vilna,  Poland,  1093 

Doub,  Mabel  E.,  work  of,  at  Harbin, 
938 

Douglas,  Arizona,  nursing  aid  given 
at,  1911,  131 

Douglas,  Constance,  work  in  Person- 
nel Houses,  Saloniki  (report), 
1420,  1422 

Douglas,  Harriette  Sheldon,  director 
of  elementary  liygiene  and  home 
care  of  sick,  1369 
Nursing     Service     Headquarters, 

239 
on  work  on  instructors,  1372 

Downer,  Dr.  Earl  B.,  assistant  sur- 
geon at  Belgrade  American  Red 
Cross  hospital,  183 
on  capture  of  Belgrade  in  second 
Austro-German  offensive,  Octo- 
ber, 1915,  186 

Dowling,  Miss,  appointed  for  Philip- 
pine service,  63 

Downing,  Mrs.  Florence,  director 
of  Public  Health  Nursing, 
1304 

Doyle,  Jennie  V.,  State  Committee, 
Oregon,  112 

Drama,  Macedonia  relief  work  in, 
1115 

Draper,  Helen  F.,  on  committees  for 
nurses'  enrollment,  107 

Draper,  Martha  L.,  work  of,  at 
Charleston,  S.  C,  58 

Draper,     Mrs.     Amos     G.,     member 
Army   Nurse    Corps    legislation 
committee,  67,  70 
work  (m  Hospital  Corps  Commit- 
tee, 36 

Draper,  ^Irs.  William  K.,  chairman 
Woman's    Advisory    Comirittee, 
300 
Conunittee     on     Rural     Nursing, 

1216 
conference     to     consider     nursing 
problems,  253 


INDEX 


1509 


Draper,  Mrs.  W.  K.,  embarkation  of 
unit,  U.  S.  Army  Base  Hospital 
No.  4  (Lakeside),  415 
first  meeting  of  National  Commit- 
tee on  Red  Cross  Nursing  Ser- 
vice, 102 
National  Committee  on  Red  Cross 

Nursing  Service,  95,  127,  249 
on  enrollment  of  colored  nurses, 

405 
services  for  Red  Cross  enrollment, 

76 
Town  and  Country  Nursing  Com- 
mittee, 1219 
work  toward  securing  superinten- 
dents' eligibility  for  Red  Cross 
work,  84 

Dreyer,  Mary  E.,  vice-president,  So- 
ciety of  Spanish-American  War 
Nurses,  46 

Drown,  Lucy,  early  nursing  superin- 
tendent,  19 

Drunkenness,  effo'-ts  to  combat,  by 
Florence  Niglitingale,  4 

Duensing,  Emma,  death  of,  German 
Army  service,  65 

Dunant,    Henri,    inspired    by    Flor- 
ence Niglitingale,  2 
organization   efforts  of,  for  relief 
society,  1863,  5 

Dunbar,  Mrs.  L.  L.,  chairman, 
Nurses'  Committee,   129 

Dunlop,   Margaret    A.,    chief   nurse, 
American      Ambulance,      at 
Neuilly,  France,  226.  5.36 
chief  nurse,  Base  Hospital  No.  10, 
459 

Durand.  Dr.  J.  I.,  member  of  Chil- 
dren's Bureau,  France,  758 

Durazzo,  Albania,  relief  work  at, 
1110 

Durrleman,  ^Hle.,  scholarship  to 
study  nursing,  1175 

Dwyer.    Elizabeth    H.,    on    hospital 
ships.  700 
on       Norfolk      Naval       Hospital, 
700 


Eakins.     Martha     St.     John,     chief 

nurse.   Neuilly  hosjiital,  588 
East   St.    Louis,   nursing   service   at, 

1917.  l:{() 
Eastern      Division,     American     Red 

Cross,      nursing      activities      of 

939 
EafttlatuI  disaster,  1915,  135 


Echols,  Miss,  delegate  to  Ninth  In- 
ternational Red  Cross  Confer- 
ence,  1912,   124 

Echternach.  Marion,  relief  work  in 
Albania,  1108 

f:col€  (Ic  S.  M.  la  Ifrinr,  at  Le  dan- 
dier, France,  818 

iScurv,  France,  Evacuation  Hospital 
No.  6  at,  645 

Eddv,  Ruth,  Palestine  Commission, 
'892 

Eden,  Marie,  at  Le  Treport  hospitiil, 
463 

Edith  Wharton  Sanatorium  at 
Yerres,  France,  853 

Edson,  Mrs.  Sarali,  Civil  War  nurs- 
ing services  of,   11 

Education,     nursing,     international, 
1145 
Red  Cross  plan  of  schools  in  War- 
saw,  1156-1158 
convention  for,  955-962 
requirements  for,  1237 

Educational  facilities,  arranged  by 
Florence  Niglitingale,  4 

Educational  Committee  of  National 
Organization  for  Public  Health 
Nursing,   1253 

Edward  Trudeau  Sanatorium,  at 
Plessis-Robinson,  853 

Egbert,  Dr.  Edward,  director  of 
Mercy  Sliip  Unit  C,  150 

El  Paso.  Texas,  nursing  aid  given  in, 
1911,  131 

Elderkins,   ^lary,   on   armistice   day 
in   France,  982 
member  of  operating  team  sent  to 

line,  741 
on   conditions   at   Cohan,    France, 

753 
on   work   at   Evacuation   Hospital 

No.  8,  754 
on  work  at  .Jouilly,  742 
on  work  with   Field   Hospital  No. 
112,  752 

Eldon,  Miss,  cliief  nurse.  Nursing 
Bureau,  American  Red  Cross, 
618 

Eldredge.  Adda,  chairinan.  State 
Committee  of   Illinois.   11(1,    112 

Eleanora.  (^)uecii  of  liiilLraria.  plans 
of.  for  cstablisliiiii:  training 
school  for  nurses  in  .'^ojiliia.   142 

i'lllet,  .loscpliitic.   Cliiliireirs   r>ureau, 
at    roul.  7ti7 
relief   work    in    itouiiiaiiia,    1127 

Elliott,  Dr,  Mary,  in  Serbia.  1117 


1610 


INDEX 


Ellis,  Maude,  ill  with  typhus,  191 

Ellis  Island,  mobilization  centre  at, 
416 

Ells,  Marie  C,  child  welfare  work, 
France,  1918,  813 

Embarkation  of  nurses,  423 

Emergency  Committee,  Red  Cross, 
264 

Emergency  Hospitals  established  in 
France,  595 
at  Beauvais,  596 
at  Chantilly,  France,  614 
at  Jouilly,  France,  603 
at  Jouj'-sur-Morin,  605 
in  war  zone,  612 
nurses  assigned  to,  617 

Emerson,  Dr.  Kendall,  Committee 
Memorial  Fund  to  American 
nurses,   1048 

Emerson,  Major,  acting  medical  di- 
rector at  Vladivostok  Refugee 
Hospital,  927 

Endicott,  William,  Commission  for 
Europe,  1917,  427,  530 

Engblad,  Mrs.  Grace,  director  of  Bu- 
reau of  Public  Health  Nursing, 
1303 

England,  American  Red  Cross  Com- 
mission work  in,  441 
American  Red  Cross  hospitals  in, 

431 
changes  in  American  hospitaliza- 
tion policies  in,  440 

Enright,  Miss,  Graduate  Nurses' 
Protective  Association  of  New 
York  State,  40 

Enrollment  of  nurses.  Miss  Delano's 
report,  289,  290 
plan    of   National    Committee    on 
Red  Cross  Nursing  Service,  96, 
102 

Enrollment  of  Red  Cross  nurses,  114 

Epstein,  Miss,  work  in  Poland,  1090 

Equipment  of  nurses  for  overseas 
duty,  575 

Equipment  Shop,  Nurses',  Paris, 
578 

Es  Salt,  Palestine,  conditions  at,  905 

Escort  duty,  ocean,  719 

Ktretat,  France,  Base  Hospital  No. 
2  at,  454 

European  Inquiry  Commission,  1188 

European  system  of  Red  Cross  nurs- 
ing, ideals  of.  21 

European  War,  387-684 

building  of  embarkation  camps  in, 
389 


European  War: 

camps  in  organization  of,  389-391 

need  for  nurses,  390-393 
cantonment  hospitals,  establishing 

in,  389-393 
cantonments   in,    organization   of, 

389-391 

need  for  nurses,  390-391 
entrv  of  United   States,  date  of, 

387 
'Red  Cross  base  hospitals  in,  mo- 
bilization for,  389 
training    schools    in,    establishing 

of,  for  artillery,  389 

for  aviation,  389 

for  chemical  warfare,  389 

for  engineers,  389 

for     tank     and     quartermaster 
corps,  389 
Evacuation   Hospital  No.  4,   Ecury, 

France,  645 
Evacuation   Hospital  No.   6,   Kcury, 

France,  645 
Evacuation  Hospital  No.  8,  Souilly, 

France,  754 
Evacuation  Hospital  No.  9,  648 
Evacuation       Hospital       No.       114, 

Fleurv-sur-Aire,   takeh   over   by 

Medical  Corps,  624 
Evans,  Charles,  chief  of  Bureau  of 

Friends,    on    American    Friends 

Service  Committee,  828 
Evans,    Madelaine,    chief    nurse    at 

Asile  Ste.  Eugenic,  850 
Evian-les-Bains,    children's   hospital 

at,  777 
return  of  French  to,  775 
work    of    Children's    Bureau    at, 

777 
Evreux,  France,  American  Red  Cross 

Hospital  No.  109  at,  609-610 
Ewing,  Anna  A.,  director  of  Bureau 

of  Public  Health  Nursing,  1303 
Ewing,  ]Mary  C,  organization  of  tu- 
berculosis sanatorium  at  Ycrres, 

848 
Exton,  Katharine  D.,  child   welfare 

work,  France,  1918,  809 


Fairchild,  Blair,  secretary  of  Tuhcr- 

culraux   de   la   Guerre,    France, 

844 
Faircliild,  Helen,  at  British  casualty 

clearing  stations,  461 
Fairclough,    Henry    R.,    relief   work 

in  ^lonteneo^ro,  1102 


INDEX 


1511 


Falconer,    Marie    F.,    in    Santo    Do- 

iiiin<;(),  119!) 
Fariucr.  Florence,  \')d 

at  Tuinen  Hospital,  Siberia,  024 
work  of,  in  Siberia,  914 
assistant  to  Dr.  Coulter  in  Siberia, 
!)r)2 
Farnswortli,  Clara  G.,  in  Santo  Do- 

nun<ro,   1199 
Farrand,   Dr.   Livingston,  appointed 
cliairnian      of     American      Red 
Cross,  1007 
attitude    of,    on    rank    for    Army 

nurses,  1075 
career  of.  1007 
Central   Committee  for   European 

Commission,  1079 
director  of   the   Rockefeller   Com- 
mission   for   the    Prevention    of 
Tuberculosis  in   France,   844 
Executive  Committee  of  American 

Red  Cross,   1007 
offers  aid  of  National  Committee 

to  League,   1142 
recommends   plan   for   "child   sav- 
ing centers,"   1178 
tuberculosis    prevention    work    in 

Italy,  8G7 
Work    for    scholarship    and    loan 
fund  for  nurses,  12S1-12S3 
Farrand,  Mrs.  L.,  child  welfare  work 

at  Corbeil,  France,  799 
Farwell,   Dr.    Margaret    \V.,   dispen- 
sary at  Corbeil,  France,  799 
F'lyerweather,   Dr.   Roades,   director 

of  Mercy  Ship  L'nit  B,  150 
Fearn,    Miss,    child     welfare    work, 

France,   1918,  809 
Federal  Public  Health  Service,  973- 

974 
Federation  of  Xurses  Committee  on 
Red  Cross  Nursing,  work  of,  87- 
92 
Federation  of  Nurses,  desire  of,  for 
Red    Cross   nursing,   87,   88,   89, 
!H) 
Ferree.    Dorotliy    M.,    superviser    of 
Bi'luium    I'nits    Nos.    1    and    2, 
2111 
Ferris.   Kva.  work  in  Si'rbia.  1120 
Field    Ilos])ital    No.   7,  Coulonimiers, 

l-'i'aiici',  7-")l 
Field    Hospital    No.   12,  Pierrefonds, 

Frame.   749 
Field    llnspitill   \o.  109.  747 
Field  Hospital  No.  112.  747 


Field    Hospitals,    manned    by    Red 

Cross  nurses,  51 
F'ife,  Major  J.  1).,  Ba.se  Hospital  No. 

21,  4(17 
Finances,  plans  for  visiting  nurses, 

1202 
Finlay,    Dr.    Charles,    yellow    fever 

work  of.  13 
Finley,   Dr.   John   IL,  Commissioner 

for  Palestine,  892 
Finney,    Dr.    John    M.   T.,    director, 

Base  Hospital  No.  18,  48(5 
Firmaturi,  .Marchesa,  Scholarship  & 

Study    Nursing.    1175 
First  Aid   Department,  organization 

of,  1910,  IKi 
Fish,     Ada     Z.,     author     of     "Food 

Values    and     Home     Dietetics," 

1377 
Committee  on  Red  Cross  Dietitian 

Service.  1379 
Fitch,   Dr.    Ralph,   director  of   Alli- 
ance Hospital  at  Vvetot,  F'rance, 

195 
director   of    Vllopitnl   Complimen- 

taire  \o.  2  at  Fatcux,  539.  (;()9 
in  charge  of  French  military  hos- 
pital    at     St.     Valorv-en-Caux, 

198,  539 
Fitzgerald,    Alice    Louise    F'lorence, 

career  of.  583 
chief  juirse  of  American  Red  Cross 

in  luirope,  872,  1082 

resignation  of,  1129 
Conuiiittee  for  Memorial   I'^und  to 

American  Nurses,  1048 
develo]imeTit    of    Schools   of    Nurs- 
ing,  1145.  114() 
director  of  Division  of  Nursing  of 

League.  1143 

resignation  of,   1140 
explains  League  of  Red  Cross  So- 

eietiw,  1141 
in  cliarge  of  work  with  Srrvicr  dc 

^ant'r.  583 
International         ConftTcnce         at 

Cannes.  1 137 
on    dock    intirinaries    for    soldiers 

leaving   Iraiiee.   ln]i) 
on  dock   intirmarN'  at    Brest,   Kill 
on    eiiui|iineiit    for    nurses    in    Fu- 

rope.    1()^;3 
on    (.'ni.    Wood's    stall    in    Pliiliji- 

jiiiies.    12it9 
on  in-pect  ion-  of  Freiudi  hospitals, 

.-)S7.  .")'.'3.  5!14 
o\\  nur>inL'  of  League.  1144 


1512 


INDEX 


Fitzgerald,    Alice    Louise    Florence, 
on  opening  Rimini   Refugee   Hos- 
pital, Italy,  860 
on  public  liealth  nursing  in  Italy, 

872 
recommendation  on  relief  work  in 

Poland,  1091 
relief    in    Europe,    Polish,    1088- 

1091 
on  visit  to  Prague,  1148 
tour  of  inspection  in  Poland,  1089 
work   in  Sicily  earthquake,   1908, 
131 
Flanagan,   Kathryn,   children's   con- 
valescent home.  La  Chaux,  785 
Fleming,  Mary,  relief  work  in  Crete, 
1116 
relief  work  on  Mitylene,  1114 
Fletcher,  Gertrude,  matron  of  "Old- 
way  House,"  147 
on  expected  sickness  at  beginning 

of  World  War,  148 
on    psychology    of    war    nursing, 
147-148 
Fletcher,  Mabel,  Chautauqua  nurse, 
1055 
hostess  of  Bay  Shore  Convalescent 
Home  for  nurses,  1037 
Fletcher,     Mary     M.,     chief     nurse, 
Evreux  hospital,  539 
delegate    to    Ninth    International 
Red  Cross  Conference,  1912,  124 
on  English  Tommies,  197 
supervisor  of  Alliance  Hospital,  at 
Yvetot,  France,  195 
resignation,  197 
Fletclier,     Nora,     British     Nursing 

Service,  470 
Fleury-sur-Aire,     Evacuation     Hos- 
pital No.  114  at,  624 
Flexner,  Bernard,  Roumanian  Com- 
mission, 882 
Flexner,  Dr.  Simon,  Chairman   Red 
Cross    Medical    Advisory    Com- 
mittee, 253 
committee   (chairman)   on  settling 

war  nursing  policy,  254 

conference     to     consider     nursing 

problems,  254 

Flood,  Dr.  Ma])el  F.,  in  Serbia,  1123 

Florence  II..   S.S..  ('.\])h)sion  on,  730 

Florence     Nightiiigah'     Foundation, 

124 
Florence  Nightingale  Medal,  1130 
Florida  yellow  fever  epidemic,  nurs- 
ing liistory  of,  13-18 
Red  Cross  aid  in,  13 


Floyd,  Lulu  T.,  sent  to  Vera  Cruz, 

1914,  128 
Flynn,    B.    D,,    National    Advisory 

Committee  on  Insurance,  1042 

Foch,    Marshal,    commander-in-chief 

of  Allied  Forces  in  France,  580 

Foerster,   Alma   E.,    Commission   to 

North  Russia,  677 

committee  on  choosing  candidates 

for  medal,   1130 
on  trip  to  North  Russia,  678 
on  work  in  North  Russia,  680-683 
Roumanian   Commission,   882 
Foley,  Edna,  chief  nurse  of  Ameri- 
can    Red     Cross     Tuberculosis 
Commission  in  Italy,  871 
Delano  Memorial  Committee,  1051 
Town  and  Country  Nursing  Com- 
mittee, 1219 
Folks,    Homer,   child   welfare   work, 
1187 
director   of  Civil   Affairs   Depart- 
ment, American  Red  Cross,  757 
on  work  for  refugees  at  St.   Sul- 
pice,  837 
Food  and  Nutrition  Division  of  San- 
itary   Corps    of    Armv,    aid    to 
dietitians,  1399 
work  of  dietitians,  1402,  1403 
Foodstuffs,  to  North  Russia,  677 
Ford,    George    B.,    Commission    for 

Europe,  530 
Foreign    activities,    American     Red 

Cross,  development  of,  536 
Foreign  relief  work  of  the  American 

Red  Cross,   1077  et  seq. 
Fort  Hamilton,   Red   Cross   services 

at,  61 
Fort    Wadsworth,    authorization    of 
Red  Cross  nurses  for,  57 
Red  Cross  nurses  at,  60 
Fortress    Hospital,    in    Vladivostok, 

913 
Fortress  Monroe,  Red  Cross  service 

at,  Spanish-American  War,  61 
Fortson,   ^lis.;,    public   health   nurs- 
ing, 1348 
Fosl)urgh,   Major    James   B.    A.,   on 
emergencv  hospital  at  Beauvais, 
590 
on  position  of  American  Red  Cross 
supply   units,    second    battle    of 
Picardy,  579 
on    sanitarv    situation    of    Second 

Division.' 603 
on   work   of  American   Red  Cross 
overseas,  019 


INDEX 


1513 


Foscani  Unit,  Roumania,  1126 
Fotoenoff  Hospital,  Sofia,   Bulgaria, 

221 
Foundation  to  Florence  Nightingale, 

124 
Fox,   Elizabeth   Gordon,  director   of 
Bureau  of  Public  Health  Nurs- 
ing, 1275,  1276,  1302 
director  Town  and  Country  Nurs- 
ing Service,  240 
functions     of     nurse     and     social 

worker,  1317 
meeting  of  Red  Cross  authorities 
with  state  othcials:  results  and 
problems,  1324-1326 
National  Committee  on  Red  Cross 

Nursing  Service,  24!) 
on    Town    and    Country    Nursing 
Service,  1276 
France,  division   into  nine  zones  by 
Commissioner  Gibson,  612 
nurses  in,  sliortage  of,  514 
German  actfXities  in,  464 
physicians  in,  1017,  758 
refugees  in,  American  Red  Cross' 

work  for,  826,  843 
relief  work  in,  1080,  1081 
U.  S.  naval  hospitals  in,  728 
Francis,  IVfary  L.,  chief  nurse,  U.  S. 
Army  Base  Hospital  No.  15,  403 
Francis.  Susan  C,  director  Pennsyl- 
vania   Division    of    Red    Cross, 
245,  246 
Joint  National  Committee,  1047 
Joint  National  Committee  of  Bu- 
reau of  Information,  1016 
National  Committee  on  Red  Cross 

Nursing  Service,  240 
on     nursing     and     public     health 

work.  1050 
on  Red  Cross  Aide  plan.  1052 
Franczak,    Praxeda,  aide  in  Poland, 

1007 
Frankel.    L.    K..    conference    to    con- 
sider nursing  problems.  254 
Frederiksted.    \irgin    Islands,    nurs- 
ing work  at.  1204 
Freeman.    Florence   C   nursing   ser- 
vice in  \'irgin  Islands,  1203 
resignation,  1204 
Frencli,  Henrietta  L.,  dietitian  over- 
sea*!.   1.307 
Freneli,   Dr.   William  J.,  director  of 
dispensaries,    France.    lOlS.   SO!) 
French    Red   Cross,   mobilization   of. 

524 
Friends,  Societv  of,  826 


Fuller,    Stella,    Chautauqua    nurse, 
10.55 
first  Delano  Red  Cross  nurse,  1052 

Fulton,  Cajjt.  Arthur  D.,  in  Rou- 
mania. 1127 

Furbush,  Colonel  C.  L.,  Advisory 
Committee  of  Army  School  of 
Nursing,  285 

Furse,  Dame  Katherine,  British 
Nursing  Service  in  France,  478 


GafTney,  Clare,  Assistant   on   Nurse 
Corp  of  the  Public  Health  Ser- 
vice, 1028 
Gardner,    Mary    S.,   chief   of   Public 
Healtli  Nursing  in  Italy,  867 
on  nursing  svstem  in   Italv,  855- 

857 
on  training  of  Italian  nurses,  868 
Gardner,    Mary    Sewell,    Committee 
of  Transfer,  1021 
director  Town  and  Country  Nurs- 
ing Service.  240 
enlarging  of  Public  Health  Nurs- 
ing, 1274.  1275 
on   attitude  of   nurses,   on   Public 

Health  grouping,  1273.  1274 
on     training     of     public     health 

nurses,  1.310 
report  of  tour  of  Europe  on  child 
health  and  nursing  school.  1189- 
1104 
report   on   work   of  Miss  Clement 
in   town    and   countrv    nursing, 
1234.  1235 
sent  to  study  ptiblic  health  nurs- 
ing in   Pairojje.   1187-1188 
Gare  de  I'Est.  Paris,  emergencv  can- 
teen at,  837 
Gare  du  Nord.  Paris.  835 

emergency  canteen  at.  836 
(iarretson.  Margaret,  relief  work  in 

All)ania,    1110 
Garrett.    Alice    'SI.,    cliief    nurse    of 
r.   S.    Navv   Base   Hospital   No. 
5,  72S 
on  r.  S.  Navv  P>ase  Hospital  No. 
5,  72S 
Garrison.     Ciiarlotte.     at     National 

Headquarters.  240 
(Jeer,    Dr.    William    M..   on   rank   for 

ai'iiiy  nurses.   lOtl!) 
(ielstoii.    Dr.    Clair    F..    member    of 
Children's        Bureau,        France, 
75S 
work  at  Kvian-les-Bains,  777 


1511 


INDEX 


General  Hospital  Xo.  1,  B.E.F.,  U.  S. 
Army  Base  Hospital  Xo.  2  unit 

General    Hospital    No.     9,    B.E.F., 
Rouen,    France,    unit    of    Base 
Hospital  No.  4  at,  444-452 
General    Hospital    No.    11,    B.E.F., 
Base  Hospital  No.  5  unit  at,  4.52 
General    Hospital    No.     12,    B.E.F., 
Rouen,    France,    unit    of    U.    S. 
Army  Base  Hospital  No.  21  at, 
467  ' 
General  Hospital  No.  12,  B.E.F.,  un- 
der American  Red  Cross,  service 
at.   468 
General  Hospital  No.  16,  B.E.F.,  Le 

Treport,  France,  459 

General    Hospital    No.    18,    B.E.F., 

personnel  of  U.   S.   Army  Base 

Hospital  No.  12  assigned  to,  469 

General    Hospital,    Montauk    Point, 

Red  Cross  services  at,  61 
General  Medical  Board,  264 
Geneva.       General       Assembly       of 

League,  1144 
Genoa,   Italy,   American   Red   Cross 

Naval  hospital  at,  865 
George,  Elva  Anne,  Bureau  of  Dieti- 
tian Service,  1429 

resignation  from,  1431 
charge  of  dietitians  for  base  hos- 
pitals, 238,  2.39 
Committee  on  Red  Cross  Dietitian 

Service,  1379 
desires    to    widen    scope   of   home 

dietetics.  1431 
director  of  Dietitian  Service,  1369 
National  Committee  on  Dietitians, 
1377 

nutrition  member  of,  1437 
on     slowness    of    home    dietetics, 
1430 
German  Government,  American  Red 
Cross  work  in  Russia  and  Ser- 
V)ia  at  request  of.  225 
German  military  discipline,  163 
German    women,    as   early   volunteer 

military  nurses.  2.  163,  165 
German  wounded.   166 

condition  and  care  of.  162-163 
mental  attitude  of.  164 
Gervais,  Dr.  Harriet,  in  Serbia,  1117 
Gevgeli.  Serbia,  187 

accf)mmodations      for      American 

nursing  units  al,  188 
American   Red  Cross   liospital   at, 
187 


Gevgeli,  Serbia,  conditions  in,  1125 
Serbian   Units  No.   2   and  No.   3 

assigned  to,  180 
typhus     among     American     Red 

Cross  units  at,  181 
typhus  epidemic  at,  209 
Gibbes,     Virginia     ^Tason,     nursing 
service  in  Philippines,  1208 
study  of  chapter. services,  1335 
Giberson,    Miss,    delegate    to    Ninth 
International    Red    Cross    Con- 
ference, 1912,  124 
Gibson,  Harvey  D.,  chairman,  Exec- 
utive  Committee   of  New  York 
County  Chapter,  363 
general      manager      at     National 
Headquarters  of  the  Red  Cross, 
371 
gift   for  nursing   education   fund, 
1279 
Gigliucci,   Countess   Nerina,   Italian 
representative  at  Cannes  Confer 
ence,  1138 
Gilbert,   Blanche,   at  American   Red 
Cross  Military  Hospital  No.  5, 
at  Auteuil,  601 
nursing  service  in  Greece,  1116 
nursing  service  in  Mitylene,  1114 
Gilbourne,   Alice,    Roumanian   Com- 
mission, 882 
Gilder,     Rosamond,     on     Children's 
Bureau  in  France,  824 
secretary    of    Children's    Bureau, 
France,  758 
Gill,    Miss    A.    M.,    Great    Britain's 
representative    at    Cannes    Con- 
ference, 1137 
Gill,  Helen  Z..  head  nurse  of  surgical 
ward  at  Toul  hospital,  767 
work   with    Children's   Bureau   at 
Toul,  766 
Gill,  Laura  Drake,  Auxiliary  No.  3 
aide,  services  of,  Spanish-Amer- 
ican War,  50 
in   Armv  Nurse   Corps  legislative 

efforts,  68 
in  cliarge  of  Cuban  nursing  party, 

32,  55 
on  Lena  Potter  Cowdin,  48 
services  of,  64 
Gill,  Dr..  director  of  Russian  Island 

Hospital,   9L3 
Gillet-Motte.  Madame.  782 
Gillihmd.    Inez,    nursing    service    in 

Serbia,  1117 
Gilmour,   ]\Iary   S.,   efforts    for   Red 
Cross  affiliation,  71 


INDEX 


1515 


Gilmour,  Mary  S.,  suporintondont  at 
New  York  City  School,  duriii},' 
Spunish-American  War  period, 
50 
Gilson,  Helen  Louise,  nursing  ser- 
vice of,  in  Civil  War,  10 
Givenwilson,  Irene  M.,  on  European 
hospitals,  480 

on  Revigny  Hospital,  525 

on  tour  of  Freiicli,  British  and 
lU'lgian  military  hospitals,  520 
Givson,  Harvey  I)..  American  Red 
Cross  Commissioner  for  France, 
612 
Gladwin,  Mary  P].,  appointed  for 
Philippine  service,  63 

career  of,  176-177 

conunittee,  lecture  course  for  Red 
Cross  nurses,  122 

committee  on  choosing  candidates 
for  medal,  1130 

defense  of  home  nursing  teaching, 
81 

Delano  Memorial  Committee,  1050, 
1051 

delegate  to  Ninth  International 
Red  Cross  Conference,  1012.  124 

dietetic  work  on  the  Lampasas 
expedition,  33 

National  Committee  on  Red  Cross 
Nursing  Service,  127,  24!) 

on  arrival  of  medical  "reenforce- 
meuts"  diu'ing  t\piius  siege  at 
Belgrade.  1S1-1S2 

on  l)(iml)ardmeiit  of  Belgrade,  177 

on  condition  of  wounded  at  Bel- 
grade,  17i> 

on  improved  conditions  at  Bel- 
grade hos])ital  after  typhus  epi- 
demic. 184 

on  monotony  in  Serbia,  181 

on   Red  Cross  aide  j)lan.   1052 

services  for  Reil  Cross  enrollment, 
I  I 

supeivisor  of  Serbian  units,  141, 
ITii 

work   at   Dayton   Hoods.   1013.    133 
Clasgnw.     Artlnir     G..     Roumanian 

Cnininission.    SS2 
Glauber.  Marie  Clare,  relief  work  in 

Civece.   nil 
Gleiwitz.  (ierii)an\\  arrival  of  Mcrev 
Ship  I'liit   1  at.  ini 

care  of  wdimded   ai .    I(i3 

(lillicnllies  at.    If..') 

privat(>  KUtiilrrn  for  otlicers  at, 
163 


Gleiwitz,  Germany,  shifting  move- 
ments of  Russian  and  German 
armies  about,   163 

I'nit   I  assigned  to,  160 

Viktoria.  Theater  hospital  at,  162 
closing  of,   166 
Glenn,  John  M..  Committee  on  Rural 
Nursing,    1216 

Town  and  Countrv  Nursing  Com- 
mittee, 121!) 
Glass,  Mrs.   John,   head   of  Cliicago 
workroom  for  liospital  supplies, 
2!)n 
Godard,  Stella,  reserve  nurse,  Camp 
Stuart.     Newport     News,     Vir- 
ginia. 410 
Godot,    Mile.    A.    M.,    child    welfare 

work.  France.  1018,  800 
Golden,   Ruth,   chief  nurse.   Evacua- 
tion Hospital  No.  0,  648 
Goldwater,  Dr.  S.  S..  at  Convention 
of    League    of    Nursing    Educa- 
tion. 055.  !156 

committee  to  get  hospitals  to  aid 
in   training  armv     nurses,  286, 
287 
Golzar.       Rachel,      reserve      nurse, 
A.N.C.,   on   establishing  of  can- 
tonment hospitals,  .3!)3 
Good   Samaritan,   as   early   example 
of     Red    Cross    characteristics, 
1 
Goodman.  Dr.  Alljcrt  R..  director  of 
Belgian  I'liits  Nos.  1  and  2.  2n(l 
Goodricli,     Aiuiie     Warburton,     542, 
544 

committee  to  secure  liospital  aid 
in  armv  nurses'  training,  286, 
287 

Committee  of  Transfer.  1022 

Committee  on  Red  Cross  Dietitian 
Service.   1370 

Conunittee  on  Rural  NursiiiLT, 
1216 

conference  of  medical  and  army 
ofheers  and  nurses  on  plan  for 
armv  school  of  lUirsing,  284, 
285  ' 

conference  to  considi^r  nursing 
problems.  253.  254 

dean  of  Armv  School  of  Nursing. 
286 

Joint    Xalinnal  Committee.  1047 

Joint  National  Committee  of  Bu- 
reau of  Information.  TUti 

National  Coinniittce  of  American 
Ibil  Cross,  !I58 


1516 


INDEX 


Goodrich,  Annie  Warburton,  Na- 
tional Committee  on  Dietitians, 
1377 

National  Cduimittee  on  Red  Cross 
Nursinf,'  Service,  248 

on  overseas  duty,  553,  554,  555, 
559 

on  plan  for  special  enrollment  of 
nurses,  257 

on  rank  for  army  nurses,  1069 

on  Red  Cross  aide  plan,  1052 

originator  of  Armv  School  of 
Nursing.  283.  284* 

plans  for  Armv  School  of  Nurs- 
ing, 286.  962 

resigns  as  Dean  of  Army  Nursing 
School,  289 

Surgeon-General's  office,  954 

Town  and  Country  Nursing  Com- 
mittee, 1219 

work  for  nurses'  census,  304,  305 
Goodwillie,      Mary,      vice-chairman 
\Yc)man's   Advisory   Committee, 
300 
Goodwin,  Sir  John,  Balfour  Mission, 

442 
Goodwin,    Phillip,    Commission    for 

Europe,   531 
Gorgas,  Surgeon-General  William  C, 
338.  344 

appeal  by  (Aug.  1,  1918),  for  in- 
crease of  enrollment  of  nurses, 
319 

Central  Committee,  230 

letter  to  aid  drive  for  nurses,  290, 
291 

National  Committee  on  Red  Cross 
Nursing  Service,  248 

on  couiiiiittce  to  secure  Red  Cross 
ship  for  World  War,  140 

on  Armv  School  for  Nursing;  sta- 
tistics, 963.  964 

on  need  of  nurses,  954 

on  need  for  nurses'  census,  306, 
307 

on  organization  of  base  hospital 
units  by  Medical  Reserve  Corps 
versus  American  Red  Cross, 
331 
Gosling,  Beatrice  M..  Commission  to 
North  Russia,  677 

Roumanian  Commission.  882 

Gounouilliou.  Madame,  public  healtli 

work  at   Bordeaux.   I'raiice.  796 

Gourlay.    Mrs.    Roljcrt     (Adeline    H. 

Rowland),    at    National    Head- 

quartersu  2i^0 


Government  directed  routine  nurs- 
ing, as  evolved  in  Civil  War,  9 

Governor's  Island,  Red  Cross  nurses 
at,  61 

Graduate  Nurses'  Protective  Asso- 
ciation of  New  York  State,  olTer 
of  Spanish-American  War  ser- 
vices, 40 

Graham,  Flora  A.,  on  recreation  on 
Ellis  Island,  419 

Grant,  Jessie,  chief  nurse.  Base  Hos- 
pital No.  55  (Boston,  Mass.), 
338 

Grant,  Robert,  Jr.,  London  Chapter, 
American  Red  Cross,  425 

Graves,    Lulu,    Committee    on    Red 
Cross  Dietitian  Service,  1379 
President  American  Dietetics  As- 
sociation,  1398 

Gray's  Ferry  Road,  Naval  hospital 
at,  701 

Great  Britain,  American  Red  Cross 
hospitals  in,  431 
changes  in  American  hospitaliza- 
tion policies  in,  440 
Naval  hospitals  in,  720 
work  of  American  Red  Cross  Com- 
mission in,  441 

Great  Lakes,  111.,  Naval  hospital  at, 
709 

Greece,   conditions   in,   inspected   by 
Miss  Noyes  and  Miss  Hay,  1181 
Nursing  School  plans,  1165-1166 
relief  work  of  American  Red  Cross 
in,  1100,  1111-1116 

Gregg.  A.  IL,  Committee  on  Read- 
justment and  Liquidation  of 
European  Activities,  1079 

Gregg.  Eleanor,  Chautauqua  nurse, 
1055 

Greeley,  ^Irs.   Helen   Hay,  National 
Committee  to  Secure  Rank  for 
Army   Nur.ses,    1070 
plan    to    secure    rank    for    armv 

nurses,  1066.  1067,  1071 
work  of,  to  secure  rank  for  army 
nurses.  1066,  1067 

Green,  Dr.  Thomas  E.,  Aid  in  secur- 
ing liome  defense  nurses,  283 
director    of    National    Red    Cross 
Speaker's  Bureau,  1054 

Greene,  Dr.  All)erta,  relief  work  in 
Serbia,  1119 

Greene,  Georgia  B.,  nursing  service 
in  ^lontenegro,  1103 

Greene,  Marion  P..  on  cliild  welfare 
work  at  Corbeil,  France,  800 


INDEX 


1517 


Oreone,  Marion  P..  on  dispensary  at 
Corht'il,  France.  791» 
on  playground  at  Corheil,  France, 
801  ' 

C'vejileaf,  Dr.  Charles  I\.,  on  nurs- 
ing services  of  Ijntnpasas  nurs- 
ing group,  .34 
on  services  of  l.ampasas  group,  itG 
on  value  of  Miss  Rutty,  34 
report  of.  on  conduct  of  the  war 

with  Spain.  31 
suggestion,  as  to  land  service  for 
Red  Cross,  29 

Crreenlees,  Anna  J.,  State  Commit- 
tee. District  of  Columbia,  112 

Ctreenwood.  ^liss.  death  of,  at  Stern- 
berg U.  S.  Field  Hospital.  53 
work     at     Davton     floods,     1913, 
133 

Crenelle,  France,  dispensary  at.  804 

Cretter.   Mrs.   L.   E.,   Delano   Memo- 
rial Committee,  1050,   1051 
delegate    to    Ninth    International 
Red     Cross     Conference,     1912, 
124 
State  Committee.  Michigan,  112 

Cretter.  Lystra.  early  nursing  super- 
intendent, 19 

OrifTin.  :\Iajor  R.  E..  to  Mrs.  White- 
law  Reid.  on  nursing  service  at 
Cliickamauga  Park.  59 

CrifTitli.  Marv,  nursing,  in  Haiti, 
1171,  1173 

C.rittinger,  Emma,  director  of  public 
lu>alth  nursing.  1304 

C.rouitch.  "Mme.  Slavko,  babv  hos- 
l)ital  at  Xish.  Serbia.  215 

Crulee.  Dr.  Clifford.  Children's  Bu- 
reau, France.  1918,  782 

Cuest.  ^[rs.  Frederick,  721 

Cwinon,  Dr.,  child  wcdfare  work. 
France.  1918.  812.  815 

Culf  Division  of  Red  Cross.  24(5 

Cunn.  Dr.  Selskar  M..  associate  di- 
rector of  the  Rockefeller  Com- 
mission for  the  Prevention  of 
Tuberculosis  in  France.  844- 
845 

Cunniiiir.  Lieutenant  Colonel  R.  C. 
Ill'; 

Cunther.  Fmmn  A.,  dietetics  classes. 
N;itioiial   Commission   on    Dieti- 
tians. l;i77 
Committee  on  Red  Cross  Dietitian 

Service.  1.'578 
Xational  Committee  on  Red  Cross 
Nursing  Service,  249 


Haas,  Miss,  volunteer  helper,  241 
Hagler,  Dr.,  in  charge  of  pavilion  at 
Belgrade    American    Red    Cross 
hospital,  183 
Haifa,   I'alestine,  hospital  at,  901 
llaija,    I'alestine,    out-patient   clinic 

at,  902 
Haigitt,   Ktlud,   reserve  nurse,   near 
Junction  City,  Kansas,  on  can- 
tonment nursing,  394 
Haiti,  conditions  in,  1173,  1174 
Red  Cross  nursing  in,  1171 
smallpo.x  in,  1172 
llaldora,     forerunner     of     Florence 

Nightingale,  2 
Halifax,    munition    explosion,    1917, 

136 
Hall,     Carrie    M.,     chief    nurse    of 
American        Red        Cross        in 
France,  (513 
chief     nurse     of     American     Red 

Cross  in  Great  Britain,  4.34 
chief  nurse,  American   Red   Cross 
in    C.t.    Britain,    transferred    to 
Paris,  (529 
chief  nurse,  Base  Hospital  No.  5, 

452 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
on  Anu'rican  Red  Cross  activities 

in  France,  1079-1081 
on  foreign  relief.  lOOS 
on     Miss    Delano's    health,     1001, 

1002 
on    Miss    Delano's    illness.    1000, 

1001 
on  nursing  situation  in  England, 

4.35 
recommendations    of,    for    foreign 

relief,    1081.    1082 
transferred     to    Paris     Headquar- 
ters. September.   1918.  441 
Hall.    Eleanor.    Army    Nurse    Corps, 
Camp    Taylor,    Eouisville.    Ky.. 
on  cantonment  nursing,  394-395, 

:?!H) 
on  ^ledical  Corps  men.  397 
Hall.   Maria  M.  C,  and  sister.  Civil 

War  nursing  services  of,  li 
llahcrsoii.    Leila,   at    American    Red 
Cross  Hospital  No.  109.  Evreux, 

tint 

on       wdrk       at       l''vian-Ies-Baiiis, 
779 
Ilainiidaii.   Persia.  Red   Cross   hospi- 
tal establisheil  at.  for  Russians, 
1(10 


1518 


INDEX 


Hamburg,  »*?..*?.,  selection  of,  as  Red 
Cross  ship,   140 

Hamilton,   Dr.,   opposition   from,   to 
first  Red  Cross  nurses'  unit,  15 
public   liealtii   work  at  Bordeaux, 
France,   71);),   700 

Hamilton,  Dr.  Anna,  funds  for 
Scliool  for  Nurses  in  France, 
1040.   1047 

Hamilton.  Ellen  M.,  Palestine  Com- 
mission, 802 
travelino:    dispensary     service    at 
Jerusalem,    805 

Hammar,    ^Mrs.    Frank    V.,    Central 

Committee     of     American     Red 

Cross,   1007 

Delano  Memorial  Committee,  1051 

Woman's  Advisory  Committee,  300 

Hampton,  Caroline,  early  nursing 
superintendent,  19 

Hampton,  Isabel,  early  nursing 
superintendent,  10 

Hankins,  Harriet,  reserve  nurse 
serving  on  Mexican  border,  355 

Hannan,  Katherine  C,  chief  nurse 
at  U.  S;  Armv  Evacuation  Hos- 
pital No.  17,  047 

Hansberrv,  Anna  M.,  nursing  serv- 
ice in  Haiti,  1171,  1173 

Happer,  Miss,  supervision  of  dieti- 
tians.  1420,  1427 

Harbin,    Chinese    Citv    Hospital    at, 
037 
cholera  epidemic  at,  1010,  930 

Harbin    Military   Hospital,   015 

Harcourt,  Viscountess,  Committee  of 
American   Women's  War  Relief 
Fund.   140 
London    Chapter,    American    Red 
Cross,  425 

Hardv,  Nannie  R.,  340 

sent  to  Vera  Cruz.   1014,  128 

Harjes,  Herman,  American  Relief 
Clearing  House,  531 

Harold,  ]\Iary  Radford,  dietitian 
overseas,  1385 

Hassan,  Estlior  V.,  superintendent. 
Navy  Nurse  Corps,  537 

Harriman,  Mrs.  E.  H.,  Woman's  Ad- 
visory Committee,  300 

Harrington,      Grace,      acting      chief 
nurse   of   Siberian    Commission, 
930 
cliief   nurso   of   Western    Division, 

American  Red  Cross,  039 
public  heallh  nursing,  1303 
sail  from  Vladivostok  liome,  952 


Harris,    Mrs.    Betsey    Long,    chief 
nurse.    Base    Hospital    No.    36, 
501 
Harriss,  Dr.,  donator  of  yacht  Surf, 

701 
Harte,    Dr.    Richard    H.,    director, 
v.  S.  Armv  Base  Hospital  No. 
10,  306,  459 
Hartridge,  Mrs.   A.   C,   State   Com- 
mittee, Georgia,  112 
Hartwell,  Laura,  on  attitude  of  re- 
turning nurses,  1018 
Hartz,  Alma,  relief  work  in  Crete, 

1116 
Harvard  Unit,  first,  sailing  of,  107 
Harvard   Unit,   second,  U.   S.  Army 

Base  Hospital  No.  5,  452 
Harvev,  ]\Iiss,  volunteer  helper.  241 
Harvey,  Alice  B.,  349 

sent  to  Vera  Cruz,   1914,  128 
Harvey,    I.    Malinde,    public    health 

nursing,   1303 
Haslam,   Edith   M.,   Palestine   Com- 
mission,  892 
Haslar  Roval  Naval  Hospital,  Eng- 
land, 140,  147 
Unit  D  at.  14G 
Hassan,  Esther  Voorhees,  first  super- 
intendent of  Navy  Nurse  Corps, 
086 
services  of,  64 
Havemeyer,  Mrs.  H.  0.,  work  of,  to 
secure    rank    to    army    nurses, 
1005 
Haviland,  Sybella,  in  Serbia,  1117 
Havre,  Red  Cross  dispensary  at,  822 
Hawaii,  nursing  work  in,  1204.  1205 
Ilawlev,  Laura  J.,  dietitian  overseas, 

1417,  1418 
Hawley,  Mrs.  Joseph  R.   (Miss  Hor- 
ner),    in    Army    Nurse    Corps 
legislative  eflforts.  08,  70 
officer.  Associated  Alumnae,  40 
Hay,  Helen  Scott,  141 

aid  in  Balkans,  report,  1102 

at    Council     meeting    of    League, 

1147 
at  National  Headquarters,  230 
charge   of   liomc   nursing   courses, 

1300 
Committee  for  ^Memorial  Fund  to 

American  Nurses.  1048 
Committee  on  choosing  candidates 

for  medals.  1130 
Conference     to    consider    nursing 

])rol)lcms.  253 
Delano  Memorial  Committee,  1051 


INDEX 


1519 


Hay,  Ilclon  Scott,  Director  of  Kle- 
nu'ntarv  livj^iene  and  lioine  caii' 
of   «ick",    i:5(i9 

ostablislu'd  mirspw'  training  school 
in  Hul<?aria.  142 

general  superintendent  of  nurses 
on  Mercy  Ship  expedition,  140 

inspection   in   All)ania,   1182 

inspection   in   Florence,  1183 

insj)ection  in  (>reece.  1183 

inspection  in  Montenegro;  recora- 
nu'ndation,  1 1S3 

inspection   in   Poland,   1179 

instruction  for  women,  1304 

memorandum  of  nursing  activi- 
ties, 1177 

nurse,  Commission  for  Balkans, 
1083 

on  American  Red  Cross  activities 
in  Poland,   10!)0,  1100 

on  conditi(ms  at  Municipal  Hos- 
pital,  Cracow,    109(5,    1097 

on  conditions  in  Poland  in  1920, 
1093-1094 

on  conditions  in  Serbia,  1119, 
1124.   1125 

on  Coinitess  Zamboya's  scliool  of 
Domestic  Science  in  Poland, 
1095 

on  relief  work  in  Greece,  1112, 
1116 

on  work  in  Serbia,  1122 

organixiition  of  Nurses'  Training 
School  at  Sofia,  Bulgaria,  1915, 
219 

plan  for  nursing  school  in  Bul- 
garia. 1107 

})Ian  for  scliool  in  Warsaw,  1158 

retiring  of.  from  Kief,  for  Bul- 
garia.  158 

senior  supervisor  of  I'nits  C  and 
H.  155 

study  of  Warsaw  conditions.  1150 

supcrintetideiit  of  nurses,  Meicy 
Ship  expedition.    140.   141 

t(Mir  of  inspection  in  Poland.  1(M)2 

tour  of  inspection  with  Miss 
Xoyes,  117(1 

wdik      for      Nursing      Sehool      for 
Poland,   1155 
llavs.  .Icaiiette.   chiM   welfare   work. 

France.    191S,    S09 
Hayton.    Ada.,    (tf    1  lu-    Washington. 
1).     v..    emergencv    detachment. 
353 
Ilayward.    Helen,    on    hospital    work 
in   i'aris.  747 


Hazard,  Miss  Blanche  E.,  Committee 
on  Town  and  Country  Nursing 
Service,   12()4 

Hazen,  .Miss,  report  of  dietitian 
work.   1419,    1420 

llazlett,   Dr.   T.   Lyle,   159 

Healy,  Tamar,  oflicer  Associated 
Aiunuup,  41 

Hearle.  Susan,  and  cantonment  duty, 
390 

Heath,   Amarita,  at  dock   infirmary 
in  Bordeaux,   1012 
nurse  in  Serbia,  1 123 

Hebberd,  Robert  W.,  cooperation 
with  Red  Cross  in  eliminating 
promiscuous  use  of  emblem, 
85 

Hickey,  Tvfary  Agnes,  Work  with 
Veterans'  Bureau.  1030 

Heilnian,  Charlotte,  scliool  nursing, 
Greece,  1182 
work  in  Greece.  1197 

Helferinnin  in  German  hospitals, 
1(!3.   105 

Henderson,    Alice,    on    inspection    of 
tourists  at  Pau.  France,  152 
on  Pau,  France,  150 
on  wounded  at  Pau.  France,  151 
supervisor  of  Unit  B,   150 

Henderson,  Benna  M.,  State  Com- 
mittee of  Illinois.  110 

Henderson.  Sir  David,  director-gen- 
eral of  League.  1143 

Henderson.  R..  National  Advisory 
Comiiiitlee  on  Insurance.  1041 

Henry.  Lady.  Committee  of  Ameri- 
can Women's  War  Relief  Fund, 
140 

Henry,  Sarah  S..  work  in  Cuba.  04 

Henry.  Major  William  H..  at  Amer- 
ican Red  Cross  hospital  in 
Nortli   Russia.  081 

Henry  Street  Settlement.  1212 

aid     in     training     public     health 

nurses.   1250.   1251 
Army  Seliool  of  Nursing.  2SS 
traiiiini:  for  jiuhlie  health  nursing, 
1242^   12^3 

Henshall.     Marjorie.    apj)ointed     for 
Philip{)iiie   service.   ().3 
apjiointnient    to   Manila.   58 
work      at      Post      Hospital.      Fort 
Wadsworth.  5S 

Herrick.  lion.  Pohert.  on  the  poilu. 
152 

Herring,  Mary.  Chautauqua  nurse, 
1055 


1520 


INDEX 


Hertzer,  Katrina,  nursing  staff,  235 
Navy*  Nurse  Corps  representative 

at  National  Headquarters,  689 
on  condition  of  patients  at  Buda- 
pest Military  Reserve  Hospital 
No.  4,  173 
on  Miss  Hassan's  work,  686 
Hertzog,  Dr.,  military  commander  of 

Budapest  hospitals,   173 
Hewitt,    Elizabeth    M.,    services    at 

Hattiesburg,  1908,  130 
Hibbard,  M.  Eugenie,  work  in  Cuba, 

64 
Hickman,    Kv.,   nursing    service   at, 

1917,  136 
Higbee,  Mrs.,  384 

Higbee,  Mrs.  Lena  S.,  American  Red 
Cross  parade,  New  York,  420 
approves   plan   for   special   enroll- 
ment of  nurses,  258 
Conference    to    consider    nursing 

problems,  254 
National    Committee   on    Nursing 

Service,  127,  249 
on  rank  for  Army  nurses,  1069 
second    superintendent,    of    Navy 
Nurse  Corps,  687 
Hill,  Dr.,  Inspection  in  Europe,  1188 
Hill,  Dr.  A.  Ross,  vice-chairman  of 

foreign  operations,  1187 
Hill,  Anne  P.,  on  armistice  time  in 

France,  981 
Hill,     Dr.     Howard     Kennedy,     on 
L'Hospices      Civils      de      Lyon, 
France,  780 
on  submarine  attack,  718 
work     for     cliild    health     centers, 

line 

Hill,  Mary,  159 

Hill,  Mrs.   William   H.,  on  hospital 

train  service,  640 
work  for  refugees,  in  France,  835 
Hilliard.    Amy,    approves    plan    for 

special    enrollment    of    nurses, 

258 
Committee    on    revision    of    text 

book,  1308 
conference     to     consider     nursing 

problems,  254 
co-operation    witli     Dr.    Hamilton 

for    funds    for    nurses'    school, 

1046.    1047 
.Joint  National  Conimittee,  1047 
Joint  National  Committee  of  Bu- 
reau of  Informal  ion,  1016 
National  Coinmittcc  on  Red  Cross 

Nur.sing  Service,  249 


Hindenberg  Line,  breaking  of,  509, 
510 

Hinds,   Dr.   Robert   W.,   director   of 
Mercy  Ship  Unit  D,  146 
director  of   Belgian  Units  Nos.   1 
and  2,  200 

Hine,  M.   Estelle,  Spanish-American 
and  World  War  service,  65 
description  of  Seabright,  estate  of 
Mr.  and  Mrs.   SchiflF,  loaned  to 
nurses,   1033 

Hitchcock,  Jane  Elizabeth,  chief  of 
Division  of  Public  Health  Nurs- 
ing, 1018 
work      on      Division      of      Public 
Health  Nursing,  1020 

Iloag,  Elizabeth,  on  nursing  service 
in  naval   hospitals,   704 

Hoagland,  Jennie,  in  Serbia,  1119 

Hobson,    Mrs.    Joseph,    eflforts    for 
Army  Nurse  Bill,  69,  70 
member  Army  Nurse  Corps  legis- 
lation committee,  67,  69,  70 

Hodenpyl,  A.  D.,  conference  to  con- 
sider nursing  problems,  254 

Hodge,  Capt.  Edward  B.,  on  air 
raid  at  Amiens,  465 

Hodson,  Jane,  65 

value  of  book  by,  to  the  trained 
nurse,  39 

Ilofi",   Colonel   J.   V.   R.,   commenda- 
tion of  women  for  field  hospital  , 
work,  59 
tribute  of,  to  Miss  ^Maxwell,  53 

Hoffman.  Frederick,  on  Commission 
for  Europe,  531 

Hofker-Lesser,  Bettina  A.,  sister- 
in-chief.  Red  Cross  Hospital. 
23 

Hogue,  E.  Elizabeth,  chief  nurse  of 
L'.  S.  Naval  Base  Hospital  No. 
2,  721 

Ilolman,  Bertha,  dietitian  in  War- 
saw, 1103 

Ilolman,    Lydia,    pioneer    in    rural 
nursing,  65 
rural  nursing,  1211 

Holmes,  Etliei  A.,  chief  nurse.  Base 
Hospital  No.  24,  504 

Holmes,  Katharine,  relief  work  in 
Roumania,    1120,    1127 

Holmes.    Katheriiu'    W.,    bureau    of 
pul)lic    iiealtli   nursing.    1303 
on    work    for    rofngees,    in    Paris, 

S.35.  840 
appointed    for    Philij)pine   service, 
03 


INDEX 


1521 


Holtzinan,     Mrs.     Florence     L.,     in 

cliarge  of  finances,  Chateau  (Its 

II alien,   hu8pital,    781 
Holt/man,       Hospital       at       Lyons, 

France,  78."5,  78ti 
Holy  Cross  Sisters,  nursing  services 

of,  in  Civil  W  ar,  8 
Home  Care  Nursing  Course,  discus- 
sions concerning,  80,  81 
Home  Care   Nursing  Course,  origin 

of,  80 
Home  defense  nurses,  282,  283 
Home  dietetics,  courses,  14;}U 
Home  liygiene,  Montenegro,  1107 

Santo  Domingo,    1200 
Home  Nursing  Committee,  work  of, 

205 
Home  nursings  course  circular,   l.'Uil 
Home    nursing    course    for    women, 

outline,  work,  130 ."5-1. "5 7 4 
report  of  National  Committee  on 

Red  Cross  Nursing,   l.'M7 
r'ome  nursing  courses,  organization 

of,    l:U)4,    130.-) 
Home     Nursing     Teaching     Centers, 

1303,    1304 
Homesickness,   109 
Homrigh,    Beatrice  von,  services  on 

Lampasas  expedition  of.  33 
Hood,   Mary,    ciiief   nurse    in    \'ladi- 

vostok  Ivefugee  llos})ital.  917 
Hopital   lir)i('vol<\   tuberculosis   hos- 
pital. 84S 
Hopital  Auj^iliarc  \o.  .V,,  199 
Jlnpilal  Hen  role.  !'■>  his,  Paris,  8r)3 
Hopital      Contplimciitdirr      .\o.      2, 

turned  over  to  Dr.  Fitch,  009 
Hopital  <lf  VOrrnn,  201 
Hopital  St.  Joseph,   Paris,  847 
Hopkins,  Dr.  .May  Agnes,  cliild  wel- 
fare work  at  .Marseilles,  France, 

7!t3 
ll(ij)l<iiis,  Jean  A.,  ollicer  Associated 

.\hniiiia'.  40 
ilojipiM,    I'raiiccs    S.,    disjjensary    at 

( iicnclh',    l-"rance.  8(1.') 
Hoppiii,     I'rcderirk    S.,    Commission 

fur  Fumpc,  .")31 
Hdskiiis.   Majnr.  i>n   dietitian's  ditli- 

cnltics.    1403 
on  work  iif  dietitians.  142S 
Hoskin-,    Susaniie    15..    child    widfare 

Wdik.    I.yiiiis.    France.    7S4 
C()ii\;ilt'-(rnt   lidine,  I, a   Chaux.  78.') 
in    chai-.L:!'    Chihircn's    H<)s[iilal    at 

Fviiui-lis-l'ains.    778 
on    Ildspital    Ninh't,  024 


Hospital  cars.  Red  Cross  service  on, 

Spanish-American   War,  01 
Hospital    conditions    in    tlie    latter 

19th  century,   18 
Hospital    Corps   Committee,   accept- 
ances   of    services    by    Govern- 
ment, 30 
origin  of,  30 

Hospital    economics,    class    in,   at 
leachers'  College,  elTorts  for  Red 
Cross  alliliation,  71 
Hospital       Holtzman,       at      Lyons, 

France,  780 
Hospital  nurses,  for   field  work,  de- 
sirability  of,   84 
Hospital  sliip  Missouri,  60 
Hospital  ships.  Civil  War  origin  of, 

12 
Hospital  staff,  relation  of  dietitians 

to,  1423,  1424 
Hospital  standards,  in  Civil  War,  12 
Hospital  supjdies,  298 
Hospital  Supplies,  country  divisions, 
299 
work  started.  290,  297 
Hospital  training  sciiools  for  nursiv^, 

establisiimcnt    of,    13 
Hospital  train  service,  qualifications 

of  nurses   for,  043 
Hospital  trains,  ()34.  043 

instructions  regarding  Dur»5es,  635 
women  on  duty,  500 
Hospital    X'iolet,   at   Lyons,   France, 

783,  784 
Hospitals,  American   Red  Cross,  es- 
tablished  in    France,   030 
two  types  of,  532,  533 
in  France,  bombed  by  eiiemv  avia- 
tors. 589-592 
in    Novendier,    lit  18.    511 
maintained  by   L'.  S.  Navy,  720 
maternity,  at  Toul,  France,  708 
naval,  in    Fianie,   728 
naval,    in   (iri'at    I'ritain.   72i> 
of  the   A.    F.    F..   location   of.   485 
Navy  station,  organization  of,  092 
L".    S.    Navy,    c()ii\alc>cc:it    homes. 
-Xinerican   l!cd  Cios^.  732 
Hotham,  I.ady.  on  .\incricans.  140 
Hough.    Mrs.    Katlierine    C.,    super- 
visor   of   conv;i!('scciil    home    for 
nurses  at    I.c  Cn.isic  Idto.  li)41 
supervisor      of      nurses*      training 
with   liic    l-'c(h'ral   board   for   \'o- 
cational     i-'.diirat  ion.    lo29 
Howard,    (an-ic    I...    Spanisli-Aineri- 
can  and  World  War  service.  05 


1522 


INDEX 


Hower,  Martha,  child  welfare  work 
at  Le  Glandier,  818 

Hughes,    Dorothea,    finances    school 
in  Warsaw,  IIGO 
interest     in     nursing    school     for 
Poland,  1154,  1155 

Hughes,  Dr.  Laura  A.,  vice-presi- 
dent, Society  of  Spanish-Amer- 
ican War  Nurses,  4G 

Hughes,  Major,  Sixth  Division  of 
Marines,  734 

Hughes,  I'riscilla  J.,  on  camouflage 
of  ships,  423 
on   conditions   back   of   the   lines, 

Lorraine  Front,  043 
on  conditions  of  German  trenches, 

987 
on  conditions  of  imprisoned  Brit- 
ish soldiers,  'J88 
on  country  about  Treves,  valley  of 

Moselle,  993 
on  hospital  at  Coblenz,  995 
on     reception     of    American    Red 
Cross  at  Guile,  994 

Hull,  Mrs.  John  S.  '¥.,  in  Army 
Xurse  Corps  legislative  efforts, 
68,  70 

Hulsizer,    Marjorie,    dietitian    over- 
seas duties,  1303 
on  dietitian  duties  overseas,  1384, 
1385 

Hundling,  Capt.  Herman,  in  Serbia, 
112U 

Ilungato,    ;Miss,    dietitian    overseas, 
14U5-141U 
Report   on    dietitian    work,    1427, 
1428 

Hunt,  Caroline,  dietary  lessons,  143U 

Hunt,  Klizabeth,  Chautauqua  nurse, 
1U55 
in  Santo  Domingo,  1199 

Hunt,  Rev.  Godfrey  P.,  cliaplain  of 
Rase  Hospital  No.   102,  (iG8 

Hunt,  Harriet,  work  of,  at  Irkutsk, 
944 

Hunter,  Arthur,  National  Advisory 
Committee  on  Insurance,   1041 

Hunter,  L.  J.,  C(jmmittee  on  Read- 
justment and  Liquidation  of 
Luropean  Activities,  1079 

Hunter's  island.  Convalescent  Home 
for  8tli  liegiinent  in.  Red  Cross 
services  at,  02 

Huntington,  Henry  S.,  on  work  at 
Haifa.    Pah'stinc,   901 

Hurst,  Alice,  work  at  Field  Hospital 
No.    12,  751 


Hutton,  Mrs.  Henry,  154 
Hutton,  Colonel  Paul  C,  606 

Idaho,     public    health    nursing    in, 

1337,   1338 
Idjukovska,     Madame,     director     of 
nurses  of  Polish  Red  Cross  Hos- 
pital, 1097 
Hfov  Unit,  Roumania,  1127,  1128 
Illinois,    nursing    service    in,    1917, 
130 
rural   nursing   in,   1229 
Immune  nurses,   requirements,   dur- 
ing     Spanish-American      War, 
38 
Infant  welfare,  in  Crete,  1116 
in  Greece,  1115 
in  Patras,  1115,  1116 
in  Serbia,  1124 
Infirmaries,  at  docks,  1010-1012 
for    American    troops    in    France, 
548 
Influenza   epidemic,   972,  976 

aid  of  classes  in  hygiene  in,  1373, 

1374 
need   for  nurses  in,  971-975 
Information,   Rureau   of,    1019 
Information     Bureau     for     Nurses, 

1014-1010 
Information  for  Nurses  Called  upon 
for    Active    Service    (A.    R.    C. 
702,  1917),  372 
Inglesaki,  Ellen,   at  school  nursing, 
Greece,  1182 
nursing  service  in  Greece,   1111 
Inquiry  Commission,  European,  1188 
Insurance,  for  nurses,  1042-1045 
Insurance,   National   Advisory   Com- 
mittee (jn,   1041 
plan  of,  1042,  1043 
International  Nurse  Education,  1145 
International  Red  Cross  Conference, 

Cannes,   1919,  1137 
International  Red  Cross  Conference, 

Ninth,   1912.   124 
International  Red  Cross  Treaty,  ac- 
cession to,  by  United  States,  6 
Ireland,    fieneraf  Merritte   W.,    331, 
385,  484 
ap|)ointmpnt    as    surgeon    general, 

571,  081 
letter    to    .Miss    Delano    telling    of 

fine  work  of  nurses,  984 
on    Central    Conimittee   of  Ameri- 
can Ked  Cross,  1007 
on  Kxccutivc  Conunittee  of  Amer- 
ican  lied  Cross,   1007 


INDEX 


1523 


Ireland,  Gen.  Merritte  W.,  on   rank 

for   army    nurseH,    1()72-1<)7.'{ 
Irkutsk,      SilxTJa.      American      Red 
CrosH  lioHpilals  at,  *.H'.i 
witiidrawal     from,     of     American 
forces  and  American  Red  Cross 
personnel,  !)48 
Isabella  of  Spain,  first  queen  to  fur- 
ther scientific  military  nursin<r, 
2 
Italian  drive,  673         ^  ^ 

Italy,    activities    of    Anlferican    Red 
Cross  in,  8")8 
dispensaries  in.  SfiO 
hospitals   establislied   in,   805 
inspection     of    conditions    in,    by 
Miss  \oyes  and  Miss  Hay,  118.3 
nursing  system  in,  854 
plans  for  nursin^j  in,  1175 
schools   of   public   health   nursing 

in.  871 
training   of   public   health   nurses 

in,  8t)S 
war  conditions  in,  858 


Jacksonville,  Fla.,  authorization  of 
Chief  Surgeon  to  contract  for 
nurses  for,  .38-.30 

Jacksonville  Marine  Hospital,  oppo- 
sition from,  to  Col.  Southmayd's 
first  unit  of  Red  Cross  nurses, 
15 

Jacquith.  I.ueia,  National  Committee 
on  Red  Cross  Nursing  Service, 
240 

JafTa.    Palestine,    infectious    disease 
iiospital  at,  000 
taken  by  British,  1!)17,  80!) 

James,  Agnes  F..  chief  nurse,  Amer- 
ican Red  Cross  Military  Hos- 
pital  No.    112,  5.38 

Jamme.  Anna  ('..  Advisory  Commit- 
tee  of   Niglit ingiil(^  school.    l(Un 
Delano  Memnrial  Committee,  1050, 

1051 
National  Committee  on  Red  Cross 

Nursing   Service,   24!) 
revision  of  text   book,   1308 

Jarka.  Captain.   140 

Jass\'.  Itoumaiiia.  dispcMisaries  at. 
8S3 

Jay,  Nelson  1)..  Cmnmittee.  Alciiin- 
rial  i'"uii(l  to  American  Nurses, 
104S 

Jeans.  Dr.  Philliji.  medical  sii]ier- 
visidii.   1  ll>5  i 


.JefTery,  Jane,  at  emergency  hospital 
at   douy-sur-Morin,   007 
wounded  in  line  of  duty,  10.31 
Jenkins.  .Mrs.  Helen  Harth-y.  415 
Jennings,     Irene,     on     work     at     Le 

(JIandier.   81!» 
Jerusalem,     children's    hospital     at, 
H!)0 
dispensary    service,    8{)5 
relief     work     of     American     Red 

Cross  in,  ilO!) 
Russian  hospital  at,  89.3 
taken   by    British,    1917.  891 
Turkish     municipal     hospital     at, 
894 
Jessup,  Elsie,  service  in  Serbia,  1122 
Joaquim,    Lucy,    relief    work    in    Al- 
bania, iiio 
Johnson,  Anna  J.,  on  conditions  at 
Evacuation      Hospital      No.     9, 
048 
on   experiences   at   A.   R.   C.   Hos- 
pital    No.     104,     at     Beauvais, 
5!)8 
on  A.   R.   C.  military   hospital  at 
Jouilly,  004 
Johnson,    Elizabeth,    State    Commit- 
tee, Indiana,  111,  112 
Johnson,    Florence   Merriam,   aid  to 
sick  nurses.  10.35.  1030 
Committee  on  choosing  candidates 

for  medal,  1130 
Delano  Memorial  Committee.  1051 
director  Atlantic   division   of   Red 
Cross.    245,    372-374,    379,    3S3, 
384,  1038 
Joint  National   Committee  of  Bu- 
reau of  Information,  1010.  1017 
on  Red  Cross  aide  plan,  1052 
service  in  France,  028 
Johnson,     Josephine,     at     National 
Headquarters.  240 
luirsitig  sfaflT.  235 
.biluison.     Lena     Margaret,    nursing 
service  in  Chios.  1 113 
in  (ireece.  1111.   1112 
in  Montenegro.  1 103 
in   Roland.   1100 
Johnson.  Matilda  L..  State  Commit- 
tee. Oliio.   IIL   112 
•  Idhnsoii.    Dr.    Philip,    eliild    welfare 

wnik  at    r.oiileaux.   I'ranee.  7!>5 
.lolmstowu     ll(Mi(l.     Red     Cross    relief 

ninl  inir>ing  work  in,  13.  IS 
•Tiiiiit     Natiniial    Committee    of    Na- 
tional    Nursing     Headquarters. 
11147 


1524 


INDEX 


Jokaitis,  Madame  Josephine,  acting 

chief    nurse    in    Poland,     1088, 

1097 
puhlic  service  nursing  in  Poland, 

1085-1087 
Jones,  Major  Harold  W.,  339 
Jones.   Dr.   Louise  Taylor,   director, 

Mabel  Grouitch  Baby  Hospital, 

216 
Jones,    Miss,   chief   nurse    of    Camp 

Pontanazen  hospital,  997 
Jones-Raker  Bills,  for  rank  for  army 

nurses,  1071 
Jordan,  Lucia  D.,  nursing  service  in 

Haiti,  1171 
Jordan,  Pauline,  on  nursing  in  Italy, 

860 
with  Carrel  Mission  in  Roumaniaj 

878-881 
Jordian,  J.  H.,  operating  manager, 

American         Relief        Clearing 

House,  531 
Jorgensen,  Mary  C.  mobilization  of 

nursea  in  New  York,  421 
Jorgenson,  Sigrid  H.,  652,  055,  658 
Jouilly.  France,  em.ergency  hospital 

at,  603 
Jouillv,    navy    operating    team    at, 

741,  745 
Jouy-sur-Morin,    France,    emergency 

hospital  at,  605 
Junior  Red  Cross,  Greece,  1181 
Jury,  Irene  I.,  death  of,  1.398 
Justis,   Lulu  J.,   at  National   Head- 
quarters, 240 

Kacena,  Blanche,  nursing  service  in 
Greece,  1115,  1116 
nursing  school  in  Prague,  1149 

Kadesky,  Dr.  David,  in  Serbia,  1119 

Kaisermann,  Sara,  Palestine  Com- 
mission. 892 

Kamerer,  Pearl,  work  of,  in  recruit- 
ing nurses,  1062 

Kanoly.  Lily,  at  National  Committee 
lioadquartcrs.  206 
instruction  for  women,  1352 

Kaplan,  Rose,  death  of,  at  Jerusa- 
lem hospital.  65 

Kasbin,  Pe;-sia.  Red  Cross  hospital 
establislied  at,  for  Russians, 
159 

Kavala,  relief  work  in,  1114,  1115 

Kean.  Colonel  Jefferson  I!.,  acting 
chairman.  Central  Committee, 
American  Red  Cross,  349,  350, 
351-352 


Kean,     Col.     JeflFerson     R.,     defines 

status      of      volunteer      nurses' 

aides,  271 
director  general  of  military  relief, 

231,  331 
director  of  Ambulance  Service  of 

A.  E.  F.,  364,  541 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
on  mobilization  of  base  hospitals 

and  American   Red   Cross,   338, 

339 
on  organization  of  base  hospitals, 

332,  333,  337 

on    Red    Cross    Nursing    Service, 

331-333.  339,  340 
on  requirements  for  enrollment  of 

reserve  nurses,  352 
on   outline   of   medical   service   of 

zones,  324-325 
on    uniforms    and    equipment    of 

Army  Nurse  Corps,  360,  364 
organization     of     base     hospitals, 

333,  337,  338,  340 

Keech,  Cara  Mea,  dietitian,  death  of, 
1422 

Kellerliouse,  Grace,  at  American 
Red  Cross  ^Military  .Hospital 
No.  5,  at  Auteuil,  001 

Kellev,  Bree  S.,  Chautauqua  nurse, 
1055 
chief  nurse   of  Kerhoun   Hospital 
center,  996 

Kelly,  Alice  A.,  on  conditions  during 
tlie  St.  Mihiel  Drive,  in  France, 
663 

Kellv,  Mary  Irene,  visit  to  devas- 
tated area,  989 

Keenan,  Mina,  work  at  Ellis  Island, 
416 

Kemp,  Christine,  work  of,  at  Ir- 
kutsk, 943 

Kennan,  George,  Vice-President, 
American  National  Red  Cross, 
1898,  25 

Kenny,  Tiiomas  II.,  commission  for 
Europe,  531 

Kentucky,  rural  nursing  in,  1227 

l\eogh.  Sir  Alfred,  ^Icdicnl  Depart- 
ment. British   Army,  474 

Keppel,  i)r.  Fre(h>rick  Paul,  vice- 
cliairnian  of  foreign  operations 
of  Red  Cross,  1079 

Kerliouii  llosjMtal  Center,  996 

Kermanshah,  Persia,  160 

Kerr,  Anna  K.,  arrival  of.  in  France 
for  Miss  Delano,  1002 


INDEX 


1525 


Kerr,    Anna    K.,    Delano   Memorial 
Committee,   1050,   lO.ll 
Nursing      Service      Headquarters, 
238 
Kerr,    Dr.,    conference    to    consider 

nursing  problema,  254 
Kerrigan,  Ilelen,  183 

at  llopital  Aiuciliare,  A'o.  S.'i,  1!)!) 
transferred  to  Yvetot,  France.  184 
volunteer    service    at   St.    Valery, 
539 
Kerrigan,    Mrs.    John,    Connecticut 

Training  School,  40 
Keyes,  Dr.  Kegina,  in  Serbia,  1123 
Khoi,    Persia,    Red    Cross     liospital 
established  at,  for  Russians.  159 
Kief,    Russia,*  Polyteclinic    Institute 
Hospital   of   the   American    Red 
Cros.*?  at,  155 
assignment  of  Units  C  and  H  to, 

155 
character  of  Russian  patients  re- 
ceived at,  150.  157 
Christmas  at,  157 
closing  of.  159 
equipment  for,  155 
record  of.  158 
routine  at,  157 

select i(m  and   preparation  of,   156 
visitors  at,  157 
Kiel,  Sophia,  3S3 

supervisor  of  Mercv  Ship  Unit  IT, 

158 
with  Russian  Red  Cross.  159 
King,  Dr.,  ill  with  typhus.  190 
King.  F.  R.,  Commission  for  Europe. 

531 
King,    Helen,    in    charge.    Cliildrcii's 
Hospital  at  Evian-les-l?ains,  778 
in  Serbia.  1121 
Kinney,  Cora,  on  dispensary  at  Bo- 

bigny.  Seine,  810 
Kinney.  Dita  II.,  appointment  of.  as 
Dr.  McCJee's  successor  in  Army 
Nurse  Corps,  47 
head      of      Government      nursing 

forces,  311 
work  of.  in  Army  Nurse  Corps,  99 
Kirby-Smith.    Dr.    Reynold    M..    ar- 
rival   of,    witli    Pan    nurses,    at 
Salonika.  ISl 
on   contraction   of  tyjjlnis  by  per- 
sonnel   of   American    Red    C'"^^ 
units.  1S2 
director  of  Unit    A.  I.'jO 
Kirkpatrick,   Dr.   \\  .    1).,  director  of 
tlie  Rouinaiiian  Coininissidn.  SS2 


Kirkpatrick,   Dr,   W.   D.,   in   charge 
of    ])avilion    at    American    Red 
Cross  lioHpital  at  Belgrade,  183 
Deputy  Commissioner  for  Russia, 
(578 

Kitchen,  Dorothy  Lewis,  on  recrea- 
tion hut  at  A.  R.  C.  Military 
Hosi)ital  No.  5,  (JOl 

Klee,  Kdwin,  159 

Kline,  (irace,  Naval  Training  Camp 
at  Charleston,  713 

Knight,    Margaret,    dietitian    over- 
.seas.   1385 
re])()rt  on  conditions  and  duties  in 
France,  1387-1389 

Kniglits  li()Si)itallera.  2 

Knott  cliain  of  liotels,  New  York, 
taken  over  by  War  Department, 
for  nurses.  421 

Knox,  Dr.  J.  H.  Mason,  1195 

associate   chief  of   Cliildren's   Bu- 
reau at  Paris  lieadquarters,  817 
public  liealtli  work  in  France,  702 

Kober,  Dr.  George  M..  126 

Kosel,  Germanv,  assignment  of  Unit 
G  to.  160' 
arrival  of,  161,  166 
changes  in  units  at,   166 
military  liosjiital  at,  166,  167 

closing  of,  167 
public  school  lazaret  at,  166 

Kouroven.  Marie,  nursing  service  in 
Greece.   1111 
relief  work  in  Gi-eece.  1112 

Kraguverats.  sanitarv  ccmditions  at, 
187 

Kreamer,  Laura  E..  work  witli  Chil- 
dren's Bureau  at  Toul.  7t)6 

Kreigh,  I>aura  Lowe,  nurse  in  Ser- 
l)ia,   1119 

Kresbs-.Tapy.  ^^adame  Edouard.  on 
training  scliools  for  nursi's,  in 
Fran((\  521 

Krova,  Albania,  relief  work  in.  IIOS, 

'lino 

Kriiegcr,  M.itliild.  at  (ievgeli,  ill 
witli  typhus.  191 

National  ('oiumittee  on  I'eil  Cross 
Nursing  Seivic(>,  24M 

on  spirit  nf  American  Units  at 
Ccvgcli.  1S9 

on  ti-agic  cdiiditidns  at  Gevireli 
liosjiital,    IS!) 

supcr\i-iir  df  Scrbinii  Units  No.  2 
and  No.  :!.   ISO.  is: 

Town  and  (diuitrv  NursiiiLr  Com- 
mittee,  1219 


1526 


INDEX 


Kulin,  Miss,  work  in  rural  nursing, 

1231 
Kurdistan,  Red  Cross  work  in,  8S8 
Kurowsky,  Agnes  von,  nursing  serv- 
ice in  Eumania,  1196 

La  Bonte,  Dr.,  at  Le  dandier,  810 

La  Coumeuve,  dispensary  at  Paris, 
806 

Ladd,  Dr.  Maynard,  in  charge  of 
work  with  Cliiidren's  Bureau  in 
Meurtlie-et-Moselle,  766 

Ladies'  Relief  Committee,  work  of, 
in  organizing  civilian  war  re- 
lief, 6 

La  Garde,  Major,  request  from  for 
Red  Cross  nurses,  28-.31 

Lake  Division  of  Red  Cross,  246, 
247 

Laleski,  Dr.,  assistant  medical  chief 
in  Poland,  public  health  lec- 
tures, 1094 

Lamlx'rt.  Dr.  Alexander,  329 
Commission  for  Europe,  531 
conference   on   cliief   nurse's   posi- 
tion, 567 
director.   Red   Cross   Medical   and 
Surgical  Service,  532 

Lampasas    nursing    expedition,    31, 
32,  33 
services  of,  56 

Lancer,  Dr.  John,  director  of  Red 
Cross  liospilal  in  public  school 
at  Kosel,  167 

Lanctot.  Donalda,  child  welfare 
work,  France,  1918,  809 

Lane,  Dr.,  ill  with  typhus  in  Serbia, 
190 

Lane,  Secretary  of  Interior,  Exec- 
utive Committee  of  American 
Red  Cross,  1007 

Lansing,  Robert,  Central  Connnittee 
of  American  Red  Cross,  1007 

La  Panne,  Belgium,  hospital  at,  201 
American  units  assigned  to,  149 

Lappe,  Dr.  E.  J.,  medical  director  of 
Chatelet  Hospital.  778 

Lathrop,  Mrs.  Lsa1)eh  work  witli 
cliildren  in  Toul.  H't't 

Latlirop,  Julia,  Emergency  Commit- 
tee on  Nursing,  264 
on  rank  for  army  nurses,  1069 

Latimer,  Frances  B.,  at  Neuilly  llos- 
]iital.  .")3S 

Lat/.er,  Irma  (Mrs.  rianible),  on  die- 
titian instruction  in  Army 
School  of  Nursing,  J 395,  1396 


Laughlin,  Mrs.  Irwin,  London  Chap- 
ter, American  Red  Cross,  425 
Laundry  service,  organization  of,  by 

Florence  Nightingale,  3 
Lawler,     Elsie     M.,     Committee     of 

Transfer,  1021 
Laws,  Annie,  117 

work  at  Dayton  floods,  1913,  133 
Lazaret  Konzerthaus   of  the  Amer- 
ican Red  Cross,  165-166 
Lazear,   Dr.  Jesse  W.,  yellow  fever 

work  by,  14 
League  of  Red  Cross  Societies,  1140 

work  of,  explained,  1141 
Leary,  Catherine  L.,  cliief  nurse  at 
Camp   Sherman,  on   assignment 
of  colored  nurses,  406 
Lease,    ]M.    Agnes,    one    of   first    six 

army  nurses,  41 
Le   Count,   Dr.    Robert,   director    of 
U.   S.  Navy  Base  Hospital  No. 
5,  728 
Le    Croisic,    France,    nurses's    con- 
valescent home  at,  613 
Lecture    course    for    American    Red 

Cross  nurses,  122 
Leete,  Harriet  L.,  chief  nurse  at  Au- 
teuil  American  Red  Cross  Mili- 
tary Hospital  No.  5,  600 
inspection   of   hospital   in   Serbia, 

1117,  1118 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
tuberculosis    prevention    work    in 

France,  845 
typhus  epidemic  in  Serbia,  1119 
work  in  Children's  Bureau,  Paris, 
1917,  761 
Le  Glandier,  France,  colony  of  Bel- 
gian cliildren  at,  818 
Lelimann. .  ^Margaret,    supervisor    of 

:\Iercy  Ship  Unit  A,  150,  183 
Lciter   Hospital,    Red   Cross   nurses 

at,  57,  58,  60 
Lenilian.    Agnes    R.,    child    welfare 

work  at  Blois,  France.  798 
Lent.    ^Nfarv    E.,    su]iervising    nurse, 
U.    S.'  Public    Health    Service, 
400 
Lentell,     "Miss,     nursing     school     in 

Prague.  1152 
Leonard.    (Jrace    IC.    chief    nurse    of 
P>ase  Section  No.  3,  France.  434 
director    of    Nursing     Service    in 
l''iaiice,  442 
Lesage.     Dr..    cliild     welfare    work, 
France.  812.  815 


INDEX 


1527 


Lesser,   Bettina   llofkor,  association 
witli    Red    Cross    nos|)ital    and 
Training,'  Scliool  for  Sisters,  22 
chief  of  liospital   woriv,  American 
National   Red  Cross    (18'tSl,  2."> 
on  Cuban  experiences,  .'54,  IM 
Lesser,  Dr.  A.  .Monae,  executive  sur- 
geon,   American    National    l^ed 
Cross    (189S),  2o 
executive  sur<,'eon.  Red  Cross  Hos- 
pital  and   Traininf^   Sciiool   for 
Sisters.  21,   22 
return  of.  to  New  York.  .SO 
work  with  Auxiliary  No.  .3,  47 
L«tterman  Hospital,  San   Francisco, 
arniv  school  of  nursinfr,  288 
dietitians  at,  L3n4 
Levailois,     France,     dispensary     at, 

1017,  80:? 
Leven,  ]\I.  Emile,  child  welfare  work, 

France,  1018.  812,  815 
Leverman,  Katheryn  A.,  on  sanitary 
formations,  at  Chateau-Thierrv, 
0-56 
Lewis,  Miriam,  at  children's  colony 

on,  Russian  Island.  <.)^2 
T/FTospiecs   Civils>  dc   fji/on,   France, 

780 
Library,     Public     Health     Nursinp, 

1224.  122.") 
Liddle,     Katlierine,     Hospital     Unit 

"A."  491 
Lien.  Dr..   joins  Dr.  Snoddy's  croup 

for  Russia.  \Cu 
Lihon.     France,     captured     bv     Her- 
mans.  1918.  404 
Lille,  school  nursinpr  at,  S22 
Limoj^'cs.      France.      American      Red 
Cross    Children's     Hos])ital     at, 
S37 
Rase  Hosi>iia1  No.   l."]  at.  .lOS 
Rase  Hos])ital  No.  24  at.  r)n4 
disi)ensar.v  for  rcfn^ecs  at,  8.'57 
Lindslcv,    ^farv,    dietitian    overseas, 
l;{8.-) 
report     on    conditions    in    France. 
138tl.  l.n^7 
Linixeiifelter.    Mrs.    M.,    State    Com- 
mittee of  West  VirL'inia,  lln 
T>inj:fie]d.    F-nudaiid.    .AinericMii     Red 
Cross  C.invnlesreiit   ild-iiital  No. 
inl    ;,1.  4;U 
Liptoii,    Sir    ■i'liiimas.    on    t\))lnis    in 
Serbia.    191 
visit    iif.   t(i  CevL^cli   b('~pilMl.   19] 
l.iverim,,!.   .\.    i;.   C,    Militar\    [b.-pi- 
tal   Xn.  4   at,    127 


Liverpool,  U.  S.  Camp  Hospital  No. 

40   at.   432 
i.loyd,   i.ulu  T.,  241,  349 
IJoyd-Still.  Miss  Alicia,  representa- 
tive of  (ireat  Rritain  at  Cannes 
conference.    11.37 
Local     Committees    on     Red    Cross 

mirsing  service,  .390 
Local     Cnits,     formation     of,     1209 

1270 
l.ockerly,    Anna,    on    Oevgtdi    condi- 
tions,   1!I2 
on  illness  of  (ievjreli  stafT,  190,  191 
Rof\in<,',  Miss,   183 
London,   American    Red   Cross   Mili- 
tary  iiosi)ital   -No.  22  in,  430 
American  Ri'd  Cross  Military  Hos- 
pital No.  23  in.  430 
American  Red  Cross  Military  Hos- 
pital No,  24  in,  43!) 
London    Ciiaj)ter,    of   American    Red 

Cross,  379,  42.1 
Long,  Dr.  John  IL,  member  of  oper- 
ating team  sent  to   i'rance,  741 
Longco])e,  Col.  W.  T.,  .\dvisory  Com- 
mittee (if  Army  school  of  nurs- 
ing, 28."') 
Long  Ishuid  City  Relief  Station,  Red 

Cross  ser\ices  for,  til 
Loomis,    Alice,    Commit t(H>    on    Reil 

Cross  Dietitian  Service,  1379 
Loomis,     May     .'~^.,     director     North- 
we>terii    Di\ision   of    l!ed   Cro-^s, 
247,  248 
"Lord      r.tite     House,"     hospital     at 

.terusalem.   8'.K! 
Lord.   Isalud    Kly,  Committee  on  r,ed 
Cross  Dietitian  Seivicr.  1378 
National  Cnmmiltee  on  Dietitian-^. 
1377 
Lorimer,     V,     Lota,     jmblic     health 

milling,  L!(i-'i 
Loude,      Dr..     cliiid      welfari'     work. 

France.   I'.H^.  812 
Louisiana    II.mmIs    I  1912  >.  132 
Loun>lMiry,  Mrs.   Harriet  Camp.  Na- 
t  iciiial   CiinmiittcM'  on    l!ed   Cross 
Nursing    Sir\iee,   9."),    1  1  1 
on  Si,  rnbrr-  C.  S.  Field   lin-pital. 

Spanish-. \nii'riran  War.  ."i 4 
Stall'     Ciinimittei'     of     West     Vir- 
ginia,   im.    112 
treasurei".      ."-^.iriety      nf      Snanisli- 
.V  mi  rir;!  n  W  a  r  \  ur~es.   U'> 
l.i.\etl.   .Indue    K.ilii  It    <..   1-1  inference 
til    run^-iiji  r     lUir-inLT     problems, 

2:)4 


1528 


INDEX 


Lowe,  Amy  F.,  child  welfare  work  at 

CorbcH,  France,  799 
Lowe,  Dr.  Thomas,  in  Serbia,  1117 
Lucas,   Dr.   William  P.,   director   of 
Children's  Bureau,  France,  758 
on    cliild    welfare    legislation    in 

France,  759 
on    child    welfare    work,    France, 

1918,  794 
on  visit cuscs  d'enfants,  811 
work  at  Evian-les-Bains,  777 
work  at  Marseilles,  791 
Lucas,  Mrs.  W.  P.,  member  of  Chil- 
dren's Bureau,  France,  758 
work  at  Marseilles,  791 
Ludd,  Palestine,   dispensary   at,   re- 
organized by  Palestine  commis- 
sion, 901 
Lufkin,  Congressman,  bill  to  secure 

rank  of  army  nurses,  1066 
Lusk,  Ida,  ill  with  typhus,  182 
Luxembourg,  AsHe  Caserne  at,  622 
Lydia  M.  Holman  Association,  12^1 
Lynch,   Colonel    Charles,    and    First 
Aid  of  American  Red  Cross,  332 
committee,  lecture  course  for  Red 

Cross   nurses,    122 
National  Committee  on  Red  Cross 

Nursing  Service,  95 
on  enrollment  in  Nursing  Service, 

357 
on    making    Red    Cross    members 
active  participants  in  social  re- 
sponsibility, 81 
Lyncli,  Mrs.  John,  Delano  Memorial 

Committee,  1051 
Lyon,  Alice  P.,  one  of  first  six  army 

nurses,  appointment   of,  41 
Lyon,    Sarah    S.,    recruiting    relief 

nurses  for  Poland,  1085 
Lyons,  France,  dispensaries  at,  785 
"Hospital  Violet  at,  624 
work  of  Chihlren's  Bureau  at,  783 
tuberculosis  prevention  at,  850 

^faas.  Clara  L.,  voluntary  self-sacri- 
fice to  yellow  fever  investiga- 
tion. 05 

Mabel    Grouitch    Baby    Hospital    at 
Nisli.  Serbia,  215 
as  (icld  ambulance,  1915,  217 

:Mcl?ri(]e,  Nellie  (irace,  death  of,  920, 
]  032 

McCainnion,  Abl)ie  B.,  developing  of 
Red  Cross  workrooin.  296 

^IcCaminon,  KdiOi  M.,  developing  of 
Red  Cross  workroom,  296 


McCan,  Walter  D.,  letter  of  intro- 
duction of,  for  Miss  Delano,  999 
McCandlish,   Mary  P.,   Chateau  des 

Holies  hospital,  781 
McCarron,    Miss,    on    conditions    in 

Montenegro,  1104,  1105 
McCarthy,  Dame  E.  Maud,  matron- 
in-chief,  B.  E.  F.,  474 
McCarthy,     Katherine,     member    of 
operating  team  sent  to  line,  741 
McClellan,  George  B.,  on  conditions 

in  Italy,  854 
McClelland,  Helen  Grace,  at  British 
casualty  clearing  stations,  456, 
461 
McClintic,  Dr.  Brown,  159,  160 
McClintic,     Eleanor     Soukup.       See 

Soukup,  Eleanor. 
McClintock,  Mr.  James  K.,  Inquiry 

Commission,  1188 
McCloud,    Mary    J.,    vice-president. 
Society     of     Spanish-American 
War  Nurses,  46 
work  at  Mexico  City,  64 
McCoy,  Lieutenant-Colonel  J.  C,  619 
commanding    officer    of   A.    R.    C. 
Hospital    No.    Ill    at    Chateau- 
Thierry,  617 
director   of   American    Red    Cross 
Hospital  No.  114,  770 
McCullough,  Ernest,  Commission  for 

Europe,  530 
McCullough,  Grace  T.,  Committee  on 
Red     Cross     Dietitian     Service, 
1379 
^McCune,    M.    Virginia,    State    Com- 
mittee of  West  Virginia,  110 
MacDonald,   Beatrice   Mary,   at   No. 
61    Casualty    Clearing    Station, 
456 
wounded  in  line  of  duty,  1031 
MacDonald,  Dr.  Charles,  director  of 

Mercy  Ship  Unit  E,  173 
MacDonnell,  Ita,  relief  work  in  Po- 
land,  1159 
McDowell,  IVIarie,  nursing  service  in 

Serbia,  1119 
McEvoy,  Anna  Elizabeth,  vice-presi- 
dent.  Society  of  Spanish-Amer- 
ican War  Nurses,  46 
Macfadden,  Kale,  nursing  service  in 

Serbia,  1123 
McGee,   Dr.   Anita   N.,  appointment 
as  acting  assistant  surgeon,  U. 
S.  Army,  38,  42 
efforts  for  army  rank  for  nurses, 
70 


INDEX 


1529 


McGee,  Dr.  Anita  N.,  maintenance 

of  liigh  standards  by,  3!) 
organization    of     Hospital     Corps 

Committee  by,  3(5 
president    of   Society   of   Spanish- 
American  War  Nurses,  4G 
report  of.  on  Army  Nurse  Corps' 

war  service,  43 
resignation     from     Army     Nurse 

Corps,  47 
summary   of  value  of  services  to 

nursing  l)ody,  46 
McGovern.   Ella,  relief  work   in  Al- 
bania, 1108 
McGovern,    Nellie    E.,    chief    nurse, 

Romsey  Hospital,  434 
chief  nurse,  U.  S.  Camp  Hospital 

No.  34,  434 
work  in  England,  431 
Maclievsky.    Dr.,   liead   physician   of 

railroad,  of  Vilna   district,   Po- 
land, 1093 
Maciejow,   Poland.  Rod  Cross  relief 

work  at.  1087 
Mclntire,  -Mary,  arrival  in  England 

with    Roumanian    units,     1918, 

887 
Roumanian  Commission.  882 
Mclntyre,   Grace   L.,   chief  nurse  of 

U.   S.   Navv   Base   Hospital   No. 

4,  725 
on  trip  to  England  on  »'^.>S'.  Briton, 

725 
work   at  Halifax  explosion,    1917, 

136 
work  at  Verkhne-Udinsk,  947 
Mclsaac.    Isabel,     in    Army     Nurse 

Corps  legislative  effort,  OS 
book  for  home  care  of  sick.  1358 
death  of,  September  21.  1914.  101 
delegate    to    Ninth    Iiiternatiouiil 

Red     Cross     Conference,     1912, 

124 
head     of    United     States    nursing 

forces.  311 
Natinmil   Committee  of  American 

K.'d  Cross.  958 
National    Committee    on    Nursing 

Service.   127 
President,    Amrricnn    .Journal    of 

\iirsin(i  Co..  71 
superintendent     of     Aitiiv     Nurse 

Corps.   101.  359 
superintendent    of    Illinois    Train- 
ing School   for  Nurses.  .'!9 
Mack.    Annie    1".,    chief    mirse,    I'ase 

Hospital  No.  37,  437 


MacKay,  Catherine  J.,  Committee  on 
Red  Cross  Dietitian  Service, 
1378 

McKee,  Adelaide,  Chairman  of 
Cleveland  Local  Committee  on 
Red  Cross  Nursing  Service,  328 

Mackenzie,  Katherine  L.,  child  wel- 
fare work,  France.  1918.  809 

McKinlev.  President,  commendatirm 
of  Philippines'  Nurse.s'  Commit- 
tee financial  statement,  63 
reception  of  special  committee  for 
closer  cooperation  between  Red 
Cross  and  (Jovernment,  56 

McKinnon.  .Mrs..  Chateau  dcs  Ilallea 
hos])ital.  780 

McLaugiilin,  Emily  A.,  chief  nurse, 
Base   Hospital   No.    17,  495 
work     at     Davton,     Ohio,     floods, 
1913.  1.34 

^IcLean,  Connnander  N.  T.,  at  Haiti, 
1171,   1172 

^McLcod.  Margaret  Frances,  at  Beau- 
vais   hospital,  598 
dispensarv  at  Rue  Censier,  Paris, 

806 
on     child     welfare     work     at     St. 
Etienne.  France,  790 

Macklin.  Katherine.  Palestine  Com- 
mission.  892 

Mc:\Iillan.  Heh'ua  M.  State  Com- 
mittee of  Illinois,  110 

McNabb.  Lieuteiumt,  work  in  Serbia, 
1118.   1119 

^IcNelis.  Mary  C.  on  Naval   Hospi- 
tal. CIray's  Ferry  Road.  701 
on    nursing   service    in    the    Navv, 
702 

MacPlunden.  Mrs.,  on  conditions  for 
(lict'itians  in   France.  1392.   1.393 

^IcQuade.  Xora  M..  on  Naval  Hospi- 
tal   at    Chelsea.   7(16 
on      Naval      Hospital     at      Parris 
Island.  709 

McQuaide.    I'raiiccs.   luirsing  service 
in    Constant  iiioiile.    1 1  SO 
Palcsliiic  Coiiniiission.  S92 

^laccddiiia,  relict   work   in.   1114 

Madciiii.    Edith.    Palestine   Conimis- 

sinll.    S92 

services  ,,f.  ill  I'alcstiiic.  908 
Magee.  Anita  Xewcoiiil),  as  lieail  of 
I'niied  States  go\ernnie!it  niirs- 
in-  forces,  :!  1  1 
Magill.  Dr.  Williaiii  S..  senior  di- 
rector of  Mercv  Sliip  Ciiits  C 
ami    II.    ].")5 


1530 


INDEX 


Magill,  Dr.  William  S.,  resignation 
as,  log 

^lagnuler,  Dr.  Ernest  Pendleton,  di- 
rector of  INIercv  Ship  Unit  No. 
3,  ISO,  187 
illness     and     death     of,     through 
typhus,  182-183,  103 

Mahan,  ^Nliss.  volunteer  helper,  241 

Maison  d'Evfance,  at  Marseilles, 
France,  792 

Male  nurses,  commendations  of,  by 
Major  Arthur,  60 

]\rallory.  Hazel,  at  Le  dandier,  819 

Maltbv,  Frances,  Chautauqua  nurse, 
lOfjo 
recruiting  of  nurses,  1062 

Manget,  Major  F.  P..  acting  commis- 
sioner and  manager  of  Western 
Division.  American  Red  Cross, 
939 

Manget,  Felicie,  dispensary  at 
Boulevard  Eclleville.  800  " 

Manning.  Dr.  Hugh,  Medical  Super- 
vision. 119.5 

Manning,    Dr.    John    P.,    dispensary 
work  at  Paris.  802 
at        Dispcnsaire        Marie-Lanne- 

lomiuc,  807 
at   Muiualite  MaicrneUe,  800 

Mansfield.  Perniee  D.,  at  Xaval  Hos- 
pital at  Great  Lakes,  111.,  710, 
711 

Mantoux,  Dr.  Dora,  child  Avelfare 
work.  France.  1018,  812 

:\rarch,  Oenoral  Peyton  C,  Chief  of 
Staff,  on  regulations  regarding 
equipment  of  Armv  Nurse 
Corps.  381 -.182 

^farcv.  Marw  cliief  nui-se  of  Russian 
Island  ilospital.  031 

Mare  Island.  Naval  Hospital  at.  713 
powder  magazine  explosion.  71-') 

]\larie  Feodorovna,  Dowager  Eni- 
]>ress  of   Russia.   LI;! 

Marir-Ilrlrnc  Jlopital.  partly  fi- 
nanced bv  American  Red  Cross, 
800 

Mnrii  -l.diniflonfiur.  Dispoisairr.  807 

^lariiie  Ilospital  and  Relief,  Pureau 
of.   1024 

]\larlb<>r()iigli.  Duchess  of.  Committee 
of  Aiiiericaii  \\dnieirs  War  Re- 
lief   Vun<\.    140 

Mars->iir-.\llier.  P>ase  llcispitals  No. 
14   and    440  at.   .Ill 

]\far>eilh's,  I'rance,  child  welfare 
work  at,  701-70.5 


Marseilles,    France,    dispensary    at, 

792 
Marshall,    Miss    Elizabeth,    nursing 

service  in  Constantinople,   1197 
Marshall,      Florence      M.,      director 

Woman's  Bureau,  300 
Martha  Washington  Hospital,  Sicily, 

805 
Martin,    Florence    J.,    chief    nurse, 

Base  Hospital  No.  32,  504 
Martin,   Dr.   Franklin,   organizer   of 

General  Medical  Board,  7 
student  nurse  campaign,  293,  294 
Martin,    Major,    on   rank    for   army 

nurses,  1069 
Marye,  Hon.  George  T.,  155 
Mason,    Adm.    M.    C,    chairman    of 

District  of  Columbia  Red  Cross; 

advocates  Red  Cross  workroom, 

296 
Massachusetts      General      Hospital, 

Nurses'  Training   School   estab- 
lished at,  13 
Massage    and    pliysio-therapy,    344- 

345 
Masseuses,  demand  for,  through  de- 
velopment    of     phvsio-therapv, 

344-345 
regulations  concerning  enrollment 

of,  345 
Maternity  Ilospital,  at  Toul,  France, 

768 
Mather,  ]\fary   E.,   on   child  welfare 

work  at  Dijon,  817 
blather.  Samuel,  president.  Lakeside 

Hospital,   Cleveland,   Ohio,   337, 

415 
Matlieson.  Vida.  in  Serbia,  1121 
Mathews.  Stella  R.,  1163 

chief  nurse,  American   Red  Cross 

Commission  for  Poland.  1097 
chief  nurse.  Typhus  Research  Hos- 
pital at  Warsaw,  Poland,  1002 
nursing    scliool    in    Poland,    1158, 

1150 
refugee  cliild  care,  in  Poland,  1008 
State  Conuniltee.  Wisconsin,  112 
Matter.     Mademoiselle,     scholarship 

to  study  luirsing,  1175 
^lattliew,   ^largaret  L..  work  of,  at 

Cliita.   Siberia.   050 
?kfattingly.    Dr.    George    A.,   director 

of    U.    S.    Navv    Base    Hospital 

No.  4.  725 
^hitzen.     Enuna,    wounded     at    sea, 

470 
Maude,  General,  at  Bagdad,  89^ 


INDEX 


1531 


Maxwpll,  Miss  Anna  C,  362 

Advisory     Committee     of     Army 

Scliool  of  Xursiiifr,  285 
aid  in  nurses'  niemoriiil,  1047 
Army  Nurse  Corps,  (iS 
Associated  Alumna'  Committee  to 

elfeet    anUlation    of   nurses    and 

Red  Cross,  7'i 
at      Sternberfj      Hospital.      Camp 

Thomas.  Cliiekamau<,'a  Park,  re- 
port of  by.  51-52-53 
Committee    for    afliliatinff    or<,Mn- 

ized  nurses  with  Red  Cross,  87, 

88 
Committee  for  Memorial   Fund  to 

American  Nurses,  1048 
Delano        Memorial        Committee, 

1050.    1051 
delefjjate    to    Ninth    International 

Red  Cross  Ccmference,  l'.)12,  124 
efforts    for    Red    Cross    afliliation, 

71 
National   Committee  of  American 

Red  Cross.  058 
National  Committee  on  Red  Cross 

Nursiiifj    Service,    05,    111,    127, 

240 
on    Red  Cross  aide  plan,   1052 
resolution     for     rank     for     Army 

luirscs.   1074 
s('r\ices   of,    in    recruiting   nurses, 

50 
superintendent,  Presbyterian  IIos- 

l)ital,  48 
tribute  to,   from   Dr.    Hoff.  5.3 
\isit  to  Kuropean  hospitals.  4S0 
work    for    Red    Cross    i-nrollment, 

77 
work    to    secure    rank    for    Army 

nurses.   10()5 
Slaver.   Miss.  ])ublic  lu'allii  luirsinpr, 

■  l;?4S 
Mayo,  Maj.  W.  J.,  on  rank  for  Army 

'  luirses.  lOC.O 
^.leczkowski.     Dr.     W'.,     address     at 

schodl    for    luirses    in    W'aisaw, 

1101.    1102 
Medical  Division.  A.  K.  F..  hospitals 

in   I-'rancc.  51 1 
:\b'dical  Service.   I'.ureau  of.  2?,\ 
Meijieiiic       niul       Surtici-y       l'>ureau. 

Naval    Hospital    Corps    sdiools, 

712 
Xavy     Nurse    Corps    as    ]iart     of. 

OSC) 
MeliliL:.     Mrs.,     on     home     dieteties, 

J4;i0,  14.31 


Meirs,  Linda  K.,  chief  nurse,  Amer- 
ican Red  Cross  Hospital  No. 
114,  022,  770 

ciiief  nurse  of  emergency  hospital 
at  douy-sur-.Morin,  OOfi 

Committee     on     Choosing    Candi- 
dates for  Mecbil,  11:50 

Roumanian  Connnission.  SS2 
.Meise!i)a(li.  Rose,  vice-president.  So- 
ciety of  Spanish-American  War 
Nurses,  4(5 
Melov,  Mrs.  C  S.,  volunteer  lielpcr, 

241 
Meiuiirial     to     nurses,     Nightingale 

School.  1047-104!l 
Memorial   to   nurses   who   have   died 

in  service.   1(»40,  1047 
Memorial    to    women    of    Civil    War 

l)roposed.  1!)12,  12.3 
Mendentiall,    Dr.    Dorothy   Reed,   les- 
sons on  infant  feeding.  14.30 
Mercer,   X'ioletta   C.,  on   mobile   hos- 
pitals, (i50 
Mercy  Slii|)   F.xpedition,  adoption  of 
title  '"Sister"'  by  nurses  of,   142 

arrival  of.  in  Fngland,  145 

cargo  of.  141 

closing  of.    1!)15.  220 

daily  routine  of.  on  shipboard,  144 

distribution   of  units  of,   141 

ocean   voyage   of.    144 

personnel   assembly  of.    143 

personmd.   |irofi'.-;sior.aI.    141 

selection  of  units  for.  142 

sentiment   of.    142 

service  unifonn   and   e(iuipnient  of 
nurses  of.    143.    141 

stirgeons      and      luirses      recalled, 
lit  15.  215 

I'nit  Xo.  1.  arrival  of.  at  Salonica, 
170 

disbanding  of.    1S7 
military     ho-pital     at     Belgrade 
taken    o\i'i-   l)y,    177 
personiiel  of.   17i) 

I'nit    \o.    2.    a,---iL!ne(l    to    Cevijeli. 
ISO 
at  Aniei-ii-aii   l!ed  (ro--,  hospital 

at  Cev-ili.   is: 
di.-bamiing  nf,   ],s7 
in  typini-  e|ii(lrniic.   IS).   100 
w  itlidraw  al   of.  to   S.ilcnii   i.    ]'^1 

Tint    No.  .3.  a^^iull^^^nt   of.  to  (;e\- 

grii.     ISO 

at    Aimri.Mii  Krr!  ( 'ror-s  Hospit.il 

ai    (■.r\^J,]\.    Is: 
(li-baii.!;ii-  of.   Is: 


1532 


INDEX 


Mercy  Ship  Expedition,  Unit  No.  3, 
in  typhus  epidemic,  181 
withdrawal  of,  to  Salonica,  192 
Unit     A,      assignment     to     Pau, 
France,   150 

volunteers    for    Serbian    typhus 
epidemic,  154 
Unit  B,  assigned  to  Pau,  France, 
150 

volunteers   for   Serbian   typhus 
epidemic,   154 
Unit   C,   assignment   of,   to  Kief, 
Russia,  155 
changes  in,  158 
Unit  D,  assignment  of,  to  Paign- 
ton, England,  147 
at    Haslar    Hospital,    England. 
See  Haslar  Royal  Naval  Hos- 
pital 
officers  of,  146 

withdrawal   of,  from  Paignton, 
149 
Unit    E,     establishment     of     Red 
Cross  hospital  at  Budapest  by, 
172 
Unit  F,  officers  of,  146 

at  Paignton,  England,  145.    See 

also  Paignton.  England 
withdrawal  of,   from   Paignton, 
149 
Unit  G,  at  Kosel,  Germany,  166 
Unit  H,  assignment  to  Kief,  Rus- 
sia, 155 

changes  in,  158 
Unit  I,  changes  in,  165 

members    assigned    for   Russian 
prison  work,  166 
Unit    K,    arrival    of,    in    Vienna, 
167 

transferred   for  German   prison 
work  in   Russia,   171 
^leredith,  Mrs.  C.  K.,  in  Army  Nurse 

Corps  legislative  efforts.  68 
^Mcrrinian.   Mrs.   A.   X..   Commission 

to  North  Russia,  678 
M('rv,  Dr.,  cliild  welfare  work,  Paris, 

'815 
Motcalf.     :\rrs.     Maud,     at     Mabel 
fjronitch   Babv   Hospital,  216 
in  Serbia.  1120 

on  conditions  at  Nish,  Serbia, 
218 
^Ictropolitan  Nurses'  Club,  offer  of 
services,  for  Spanish-American 
War.  40 
>rettel,  Kloanor,  ])ublic  health  work 
in  Poland,  1094 


Metzger,  Amanda,  chief  nurse  of 
U.  S.  Camp  Hospital  No.  40, 
Liverpool,  432 

Meuse-Argonne  campaign,  633 

Mexican  border,  American  Red  Cross 
nurses,  first  field  service  of,  348, 
349,  351 
disturbances  on,  1911,  131 
nursing  service  conditions  at,  348- 

357,  385 
U.   S.   Army  base   hospital   estab- 
lishment at,   349 
U.  S.  Army  camp  hospital  estab- 
lishment at,  349 
U.   S.  Army  cantonment  hospital 

establishment  at,  349 
U.  S.  troops  mobilized  on,  1911,  117 

^Nleyer,  Agnes,  in  Santo  Domingo, 
1199 

Meyer,  Frances  H.,  joins  Dr.  Snod- 
dy's  group  for  Red  Cross  nurs- 
ing among  German  prisoners  in 
Russia,  167 
supervisor  of  Mercy  Ship  Unit  G, 
167 

Michigan,  rural  nursing  in,  1229 

Miel,  Rev.  E.  D.,  Commission  for 
Europe,  531 

Miles,  Emogene  E.,  on  Pau,  France, 
as  recruiting  station,  151 
work  at  La  Panne  Hospital,  203 

Military  probationers,  British  Nurs- 
ing Service,  475 

Military  relief,  231 

Mill,  Anne  P.,  on  hospital  train 
service,  638 

Miller,  Anastasia,  on  work  at  Ref- 
ugee Hospital  at  Beauvais, 
France,  833 

Miller,  Annie,  at  Naval  Hospital  at 
Mare  Island,  713 
on  types  of  nurses'  service  in  Eu- 
ropean War,  714 
service    at    powder    magazine    ex- 
plosion on  Mare  Island.  715 

Miller,  Elizabeth,  in  Santo  Domingo, 
1199 

Miller,  Chaplain  Gilbert  0.,  funeral 
service  for  Miss  Delano,  1003 

^liller.  Dr.  .Tames  A.,  associate  di- 
rector of  the  Rockefeller  coni- 
niissioii  for  the  Prevention  of 
'I'nberculosis  in  France.  844 

Millikcn,  Sayres  L.,  on  Army  Nurse 
C(>r]is  uniforms,  359,  .360 
on      nursing      service      at      Camp 
Sevier,  South  Carolina,  409 


INDEX 


1533 


Mingane,    Mary     Frances,     nursing 
service  in  Greece,  1114 
in  Sanios,  1113 
Mink,  Dr.,  at  Virgin  Islands,  120.3 
Minnesota,  school  nursing  in,   11540, 
1:J41 
work    of   public   health   nurse    in, 
1.346,   1.347 
Minnigerode,     Lucy,     aid     to     sick 
nurses.  10.30 
charge  of  special  units  of  nurses, 

2.39.  240 
on  character  of  Russians  received 

at  Kief,  loG,  157 
on  confidence  of  Russian  patients 

toward  Americans,  ir)7 
Delano       Memorial       Committee, 

1050.  1051 
in  influenza  epidemic,  975 
inspection  of  Marine  hospitals  by, 

1025 
on  rank  for  Army  nurses,  1074 
on  Russian  wounded,  158 
on  war  risk  insurance  for  nurses, 

1037.   10.38 
public  health  nursing  service,  1020 
return  of,  to  United  States,  158 
supervisor  of  Mercy  Ship  Unit  H, 

150 
volunteer  helper,  241 
Minnigerode,    Powell,    committee   on 
memorial  for  Miss  Delano,  1050 
^finsk.     Poland.     Red     Cross     relief 

work  at.  1093 
^Nlinter,  Commander  .1.  ^[.,  Commit- 
tee in  Haiti,  1173 
Mirman,  INI.,  work  with  children  in 

Toul,  705 
Missimer,  Florence,  member  of  ope- 
rating team  sent  to  line.  745 
on  conditions  nt  .louilly,  745 
on  field  hospitals,  747 
Mississippi,  rural   nursing  in,   1229, 

12.30 
Mississippi   flood  disasters,   80,    129, 

132 
Missouri,    nursing   service    in,    1917, 

130 
Misfiiuri.  Red  Cross  services  on,  (il 
Mitcliell.  Elizabeth  C...  child  welfare 
work.  France,  1918,  787,  813 
nursing     service     in     Montenegro, 
110(1 
Mitchell,  Dr.  SoUice,  services  of,   in 
Florida    vellow    fever    epidemic, 
10 
Mitylene,  relief  work  in.  1114 


Mixer,    Knowlton,    in     Philippines, 

1209 
in  i'uerto  Hico.  1201 
Mixsell.  Dr.  Itaymond,  medicin-chef, 

Chdfrlrt  Hospital,  779 
Mobile    Hospital    No.    4,    organized 

from  personnel  of  Rase  Hospital 

No.  21,  4()9 
:Mobile  Hospital  No.  9.  Relgium,  649 
Mobile   Unit  No.    1,  6.50 
Mobile  Unit  No.  5,  service  near  front 

line,  450 
Mobilization    centre    for    nurses    at 

Ellis  Island,  416 
Moer.     Henry,     National     Advisory 

Committee  on  Insurance,  1041 
:Mohun,  Richard  D.  L.,  140 
iMollov,    .lane     C,    on     cantonment 

nursing.   394 
recreation  at  Camp  Devens.  396 
^Nlongazon.     France.    Rase    Hospital 

No.  27  at.  500 
Mongolia,  nurses  killed  on,  409 
Money,   Ceneral  Sir  Arthur,  893 
Monroe,  Frederick  C,  on  recruiting 

of  nurses.  1001 
Monroe,    Marv,    Cliautauqua    nurse, 

1055 
Montauk.    contract    for    nurses    for, 

38-39 
organization    of    hospital    services 

at.  00 
tents   for   Red   Cross   contribution 

toward  nursing  service,  61 
^Montenegro,    relief    work    in,    1102- 

1107.   1183 
Montparnasse,     emergency     canteen 

at,  837 
Moodv,    Mrs.    :\[aude    C,    302,    .306, 

.371.  372.  374,  379.  383,  384 
at    cliildren's    coionv    on    Russian 

Island,   932 
Moore,  .Tolm   Bassett.   Central   Com- 
mittee. 230 
Moore.   .Idlm    1'"..   Conference   to   con- 
sider nuisiiiL'  [irdbleins.  254 
Mooreliead.    Lieut. -('(d.   .bdin   -L,  019 
at    .Xtnericaii    Led    Cross    Hospital 

Nil.   11(1.  at   Ciiincy.   I'rance.  010 
Miiran.  I'rederick  A.,  vi-it  to  Virgin 


's  v..  Cnminittee  on 
Dietitian     Service, 


l-^laiiils.    \-l 
:\[orL'an.  Dr.  A- 

Led      Cms- 

L!7!i 
Moriiaii.    Luth.    Cunimittee    for    Me- 

iiKU-ial       i''iind       to       American 

Nur-es.  KUS 


1534 


INDEX 


Morgan,  Ruth,  Committee  on  Town 
and    Country    Nursing    Service, 
1264 
director  of  Nursing  Service,  564 
establishment   of  nurses'  club,  at 

Paris.  563 
on  position  of  nursing  profession, 
564 

Morrow,  Colonel,  chief  surgeon  of 
Second  Division,  in  France, 
604 

Morrow,  Judge  W.  W.,  Central  Com- 
mittee, 230 
president.  Red  Cross  in  San  Fran- 
cisco, 1905,  129 

!Morse,  Elba  L..  plan  for  recruiting 
nurses,   1063 

Morse,  Meda.  death  of,  1397 

Morton,  Ruth,  chief  nurse.  Mobile 
Hospital  No.  4,  469 

Moselle  Valley.  993 

^losher.  Dr.  C.  D..  child  welfare 
work  at  Corbeil.  France,  799 

Mother  Angela  of  ^lound  City,  nurs- 
ing services  of.  in  Civil  War.  7 

"Mother"  Bickerdyke,  Civil  War 
nursing  services  of,  12 

Mother  Francis  of  Chicago,  nursing 
services  of,  in  Civil  War.  7 

Mother  Gonzaga  of  Philadelphia, 
nursing  services  of,  in  Civil 
War.  7 

Mother  Anthony  O'Connell,  nursing 
services  of,  in  Civil  War,  7 

Mott,  Mrs.  John  R..  recruiting  relief 
nurses  for  Poland,  1085 

Moufflard.  Mile.,  tuberculosis  pre- 
vention work  in  Paris,  847 

Mount,  Miss.  ai)pointed  for  Philip- 
pine service.  63 

Mountain  Division  of  Red  Cross, 
247 

Mousseau,  Dr..  public  health  work 
at   Bordeaux.    Franco.   790 

Mulville.  Josephine.  Chautauqua 
nurse.  105.1.  1057.  1058 

Mumford,  John,  aid  in  Ciiautauqua 
campaign,   1058 

Munro,  ^Ir..  on  transfer  of  nutrition 
service  to  hoaltli  service.  1437 

Munroo,  ^Nlrs.  Ccorgc  sjxmsor  for 
American  Auiljulaiiec  at  Xcuil- 
ly,   France.  5:)5 

Murlin.  Major.  Food  and  Nutrition 
Division  of  Army.  1400 

Murphy.  Colonel  Fred  T..  director, 
Base  Hospital  No.  21,  407 


Murphy,  Colonel  Fred  T.,  director  of 
Medical  and  Surgical  Depart- 
ment, American  Red  Cross  in 
France,  824 

ilurphy,  IMajor   Grayson,  American 
Red  Cross  War  Council,  612 
appointed    to    General    Pershing's 

staff,  531 
Commissioner  to  Europe,  1917,  427 
head    of   commission   for    Europe, 

530 
resignation    of,    as    Commissioner 
for  Europe,  1078 

Murphy,  [Mary,  chief  nurse  at  "Old- 
way  House,"  Paignton,  429 

Murray,     General     Arthur,     acting- 
chairman   of   the  Central   Com- 
mittee, 360 
chairman    of    Red    Cross    Central 
Committee,  337 

Murray,  Virginia,  opened  dispensary 
at  Lyons,  France,  785 

Murv.   Edith   Agnes,  chief  nurse  of 
Ellis  Island:  416 
on  work  at  Ellis  Island,  416 

Muscle  Shoals,  Alabama,  manufac- 
ture of  nitrate  at,  347 

Muscle  Shoals  Sanitary  District, 
Surgeon  General  Rupert  Blue, 
on  duties  of  Red  Cross  public 
health  nurse,  403-404 

Mutiuiliic  MatcrncIIe,  taken  over  bv 
Children's  Bureau,  1918,  807 

Napoleonic  Wars,  relief  work  of  Sis- 
ters of  St.  Vincent  de  Paul  in,  2 
Nash,  Jane  E.,  National  Committee 
on   Red  Cross  Nursing  Service, 
249 
Nassau  Hospital,  Red  Cross  services 

at.  61 
National  Advisory  Committee  on  In- 
surance.   104 
National     Conunittee     on     Nursing 

Service.  127 
National    Committee   on    Red    Cross 
Nursing  Service,  95,  248,  249 
duties  of,  357.  376 
evolution    of    "Mrs.    Robb'g    Com- 
mittee's Plan."  93 
meeting  June  16,  1917.  405,  406 
action    taken    regarding    enroll- 
ment   of   colored    nurses.    405. 
41(6 
meeting    Dec.   5.    1911.   405 

action    taken    regarding    enroll- 
ment of  colored  nurses,  405 


INDEX 


1535 


National    Committee   on   Red    Cross 
Nursing    Service,    meeting    held 
June  2(1,  1917,  405 
enrollment    of    colored    nurses, 
405 
nurses'  enrollment  plan,  102 
National   Kmerfrency   Association   of 
Women      Pliysicians,     ofTer     of 
Spanisli-Anierican  War  services 
from,  40 
National    Red    Cross    Headquarters, 
building    of.    by    Capt.    James 
Scrymser,   12 
National   Red  Cross  ideals,  original 
conception  of,  for  United  States, 
13 
National  Red  Cross  Society,  afiilia- 
tion  with  American   Federation 
of  Nurses.  94 
Naval  Affairs  Bureau,  American  Red 

Cross,  091 
Naval  Hospital  Corps  schools,  712 
Naval    training    units,    in    schools, 

699 
Navv   base   hospitals,   equij)ping   of, 
'(590 
organization  of,  G91 
Navy,   in   Eiiro])ean  War,  G85 
Navy  League.  Women's  Section,  209 
Navy  Nurse  Corps.  080 

assignment    of    Red    Cross   nurses 

Ui.  094 
er|uij)ineiit  of.  090.  09S 
Esther    V.    Hassan,    first    superin- 
tendent.  (!.^0 
insignia  of.  t')9.').  097 
regulations  of.  71-') 
relations      with      American      Red 

Cross   Nursing  Service.  0S9 
re(|uireiiH'nts  of.  0S7 
salaries  of.  0!t7 

sci'\ici'   in    I],uio[)('nii   \\'ar.  099 
uiiifontw    of.    0'.I4-0!I0 
Xavy  (>])('rating  TeMiii  Xo.  1.  741 
Xa\>'  (*|K'r:it iiig   1  Cam  Xo.  2.  745 
Xav\-  station  lios]iilals.  oii^anization 

of.  (;!)2 
X'a\y  units  in  schools.  (;():i 
Xca'r   l-:ast    rrlici    uoik,   !t(i7 
Xecleiiiaii.    Dr.   (  haihs.    medical    di- 
rector   of    l,e    (ilaiidier    eolonv. 
SIS 
X'elsoii.    Malu>I.   ndief   wdrk    in    Mon- 
teiie-ro,    11(14 
\v.,rk    Ml    r.alkaiis.    lilt; 
Xelsoii.  Mary  ('..  child  welfare  WDrk 
at  Toulouse.  I'laiice.  795 


X'elson,   Mary   C,  supervisor,   work 
with  children  at  Dinard,  France, 
709 
Nelson,  Marv  K.,  Chautauqua  nurse, 
1055 

director  of  public  health  nursing, 
'VMr.i 

on  work  at  American  Red  Cross 
hospital  at  St.  Valery-en-Caux, 
198      ■ 

supervisor  of  Alliance  Hospital, 
Vvetot,  France,  19? 

supervisor,  American  Red  Cross 
Hospital  Xo.  109,  at  Evreux, 
5.39,  009 

volunteer  service  at  St.  V'alerv, 
5.39 

work  at  Ilopital  Auxiliare,  \o.  S), 
199 

work  of,  in  France.  559.  500 
Nelson,  Sophie  C,  chief  nurse.  Cha- 
teau iles  //«Z/es' hospital,  781 

nursing  director,  1195 
Nesle.  France,  captured  bv  Germans, 
191 S,  404 

cliild  welfare  work  at,  771 
Neiifchateau,      France,      dispensary 
and  hospital  at,  492 

traveling  dispensaries  at,  548 
X'euilly,    France,    American    Ambu- 
lance  at.   5.35 

American  Red  Cross  Hospital  Xo. 
101  at.  Oil 
X'eville.    Ida    K..    work    at    dock    in- 
firmary at  Hordeaux.  1012 
X'evins.     Georgia     Marqtiis.     Delano 
>remorial  Committee.   1051 

delegate  to  Xinth  International 
Red  Cross  Conference.  1912. 
124 

director  Potomac  Divi-ioii  of  Red 
Cross.  240 

lirst  meeting  of  X'ational  Conunit- 
tee  on  Red  Cross  X'ursing  Serv- 
ice.  102 

]iea<l  of  (iarlield  Hospital.  Wash- 
ington. .39 

in  Arni>'  Xurse  Cor])s  legislative 
elfort,'   t;s.    7<i 

iiist  i-uci  ion  for  women.  1.352 

Xat  ioiial   ( 'onimittec.    1  1  1 

Xatiniial  (Miiiiiiittce  of  American 
He.]  Cm-,.  !i.-,^ 

Xaiiiiiial  ( 'iiiniiiil  tee  on  Red  Cross 
\nr~inL:   ^ci\  ice.  '.i."i.  2  19 

un  cniiillMiciit  in  the  Xursing 
Service.  ;;."'.7 


1536 


INDEX 


Xevins,  Georgia  Marquis,  superin- 
tendents' society  representative, 
committee  for  affiliating  organ- 
ized nurses  witli  Red  Cross, 
87 

Xew  Albany.  Indiana,  nursing  serv- 
ice at,  'l917,  136 

New  Castle,  Indiana,  nursing  service 
at,   1917,  136 

New  England  Division  of  the  Amer- 
ican Red  Cross,  244 

New  Haven  Hospital,  Nurses'  Train- 
ing School  established  at,  13 

New  York  Auxiliary  No.  3,  duties 
of,  27 

New  York  Bureau  of  Nurses'  Equip- 
ment, 367,  379,  382 

New  York  City  Branch  of  American 
Red  Cross,  organization  of,  21 

New  York  City  Training  School  for 
Nurses  Alunin;p,  desire  of,  for 
Red  Cross  affiliation,  80 

New  York  County  Nurses'  Associa- 
tion, discussion  bv.  of  relations 
with  Red  Cross.  80 

New  York  Red  Cross  Branch,  addi- 
tional stipulations  regarding 
nursing  service  with  Red  Cross, 
79 

New  York  State  Nurse  Registration 
•  Act.  79 

Newell,  Lavinia  H..  Woman's  Advis- 
ory Committee,  300 

Newman,    Dr.    R.    H..    director    of 
Mercy  Sliip  Unit  G.  167 
general   operator  of  German  mil- 
itary hospital  at  Kosel,  160 
joins  Dr.  Sno{ldv's  group  for  Rus- 
sia, 167 

Newsom,  Mrs.  Ella  K..  Civil  War 
nursing  services  of,  11 

Newton,     Dr.     Philij).     director     of 
Mercy  Sliip  Unit  It  156 
in  cliarge  of  flying  field  liospital  in 
lUissian   army,    lo9 

Nichols.   Enmia    M.,   National   Com- 
mittee of  American  Red  Cross, 
111.  958 
National  Committee  on  Red  Cross 
Nursing  Service,  95.  127,  249 

Nieser.  Jolin,  363 

Nightingale,  Florence,  414 

and       sanitary       engineering       in 
hospitals,     superintendence     of, 
3 
attitude      of.      toward      soldiers' 
reci'eation,  4 


Nightingale,    Florence,    educational 
facilities  arranged  for  by,  4 
effort  of,  to  combat  drunkenness,  4 
efforts  of,  for  soldiers'  wives,  4 
help  of,  to  foes,  4 
help  of,  to  soldiers'  families,  4 
help  of,  to  Dr.  Blackwell,  6 
inspiration  to  Henri  Dunant,  2 
laundry  service  organized  by,  2 
organization  of  diet  kitchens  by,  3 
organization    of    emergency   nurs- 
ing service,  2 
purveying    of    clothing    and    sup- 
plies, 3 
Nightingale,    Florence,    Foundation, 

124 
Nightingale  School.  France,  1047 
Advisory  Committee  of,  1049 
charter  and  by-laws  of.  1048,  1049 
Nightingale     Training     School     for 

Nurses,  establishment  of,  5 
Niksic,  ^lontenegro,  relief  work  in, 

1106 
Nish.  Serbia,  baby  hospital  at.  215 
conditions  in.  before  Bulgarian  oc- 
cupation, 217 
Noble.    Colonel    Robert    E.,   on    uni- 
forms for  American   Red  Cross 
Nursing  Service,  366 
on    organization    of   base   hospital 
units  ])y  ^ledical  Reserve  Corps 
versus     American     Red     Cross, 
331 
Nohr,  ^'iola,  relief  work  in  Albania, 

1108 
Norcross.  Olive  Ward,  death  of.  1390 
Norfolk,  Va.,  Naval  Hospital,  1917- 

1918.  700 
North     Dakota,    rural    nursing    in, 

12.30 
Nortli  Russia,  Allied  forces  in,  675 
American   Red   Cross   Commission 

to,  677 
militarv    situation    in,    European 
War,'  678 
North   Sea,   U.   S,   Navv's   activities 

in,  719 
Northern    Division    of    Red    Cross, 

247 
Northwestern  Division  of  Red  Cross, 

247 
Norton.  Cliarles  D..  Central  Commit- 
tee. 230 
Nott.  Dr.  Josiali,  vellow  fever  work 

of,  13 
Noyes.   Clara   D.,   accom])anies   ^liss 
Delano  to  New  York,  995 


INDEX 


1537 


Noyca,  Clara  D.,  Advisory  Cnmtiiit- 

toe  of  Niglitin<,'al('  School,   104!) 
aid    to    secure     rank     for    Army 

nurses,  1071 
aid  to  sick  nurses,  1030 
American  Red  Cross  parade,  New 

York,  420 
and    embarkation    of   unit,    U.    S. 

Army     Base     Hospital     No.     4 

(Lakeside),   414-415 
appeal  to  members  of  graduating 

classes    of    hospital    schools    of 

nursing,  343 
appointment    of.    as    director    of 

l)epartment  of  Nursing.  lOOG 
at  Twentieth  Annual  Convention, 

American    Nurses'    Association, 

387-388 
chief  nurse  of  Base  Hospital  No. 

1,  360-3(52,  374,   379,   383,   303 
circular  letter  to  dietitians,  1379, 

1380 
Committee,     ^Memorial     Fund     to 

American  Nurses,    1048 
Conference    to    consider    nursing 

probk'ms,  2r)3 
cooperation  of,  with  Army  Nurse 

Corps  and  American  Red  Cross 

Nursing  Service,  314,  315,  310, 

317 
director    of    Bureau    of    Nursing 

Service,  231 
Director  of  Field  Nursing.  248 
guide  to   instruction  of  volunteer 

nurses'  aides,  272.  273 
history  of  career.  232 
liospital  supplies'  work,  298 
in     charge     of     nursing     service, 

2.35 
in   influenza  epidemic,  972 

securing  nurses  for.  973 
in   I'osen.   115S 
inspection  in  Albania,   1182 
inspection    in    Florence,    11S3 
inspection  in  (Jreece,  1181-1182 
inspection  in  Montenegro.   1183 
inspectinn    in    i'oland,    1179 

•  Iiiiiit    National    ('(immittee,   1047 

•  Idint    Xation;iI   Coiinnitlee  of  Bu- 

reau of  Information.   KlKi 
letter     eoneei'iiing     expansion     of 

work  ill  suri:ical  dressinirs.  29S, 

299 
letters  of  Miss  l)(dano  asking  her 

to  join  work  of  Red  Cross.  233, 

234 


Noyes,   Clara    D.,    letter   of   protest 
against  decision  unfavorable  to 

nurses.  908 

letter  on  condilif)ns  in  Washing- 
ton,   Sept.,    1918,   909 

letter  to  Miss  Delano  concerning 
releasing  of  luirses,    1014,    1015 

letter  to  mirses  organizing  units 
for  the  Armv  (Oct.  12,  1917), 
323 

National  Committee  on  Red  Cross 
Nursing  Service.  249 

National  Committee  to  Secure 
Rank  for  Army  Nurses,  1070 

nursing   stafT.  2.3'5 

Nutrition  Member  of  National 
Committee,   1437 

on  cantonment  service,  390 

on  cantonment  zone  work,  346 

on  nurses'  eipiipment.  360-366, 
370,  371,  374,  379,  383 

on  nurses'  salaries,  380 

on  nursing  personnel  of  base  hos- 
pital on  embarkation,  415 

on  organization  of  nursing  service 
in  France,  572 

organization  of  nursing  staff  of 
first  fiftv  base  hospitals,  339, 
342,  344' 

plans  for  nursing  school  in  Bul- 
garia. 1167 

plan  of  transfer  of  Bureau  of 
Information.   1021,   1022 

plan  to  recruit  nurses,   1060 

recipient  of  letter  from  Miss 
Louisa    Lee   Schuyler,   5 

recommendation  for  nursing 
school  in  Bulgaria,  1168 

recommendations  to  Colonel  Olds 
after  inspection.  1184,  1185, 
1186 

reports  on  work  of  nurses'  drive, 
292.  293 

rcsponsibilitv  for  hospital  sup- 
plies. 297" 

retires  as  jiresident  of  American 
Nurses'   Association.    1('23 

speaking  trip  to  nurses,  through 
I'liited   States    (Dec,   1917-Jan., 

inisi.  :u7-'ns 

study      of      Warsaw      conditions, 

1 1'.-.C) 
temporary  hend  of  Home  Nursing 

Courses.  i:;i;(i 

toiir   of    iiisperiion.    1 150.    1 17(5 
work    (luring    inlluenza    epidemic, 
'.ISO 


1538 


INDEX 


Noyes,    Clara    D.,    work    for    home 
mirsing  courses.   l.'?66.   13G7 
work     for     nursing     school      for 

Poland,  1155 
work   for   rank  for  Army  nurses, 

1074-1075 
work  to  recruit  nurses,  969 
Noyon,    France,    captured    by    Ger- 

'  mans,  1918,  464 
Nimo,  Christine,  aid  to  sick  nurses, 

1035,  1036 
Xurse  Corps,  Xavy,  686 
Nurse   Corps   of   tlie   Public   Health 

Service,  development  of,  348 
Nurse    Corps   of   tlie   Veterans'   Bu- 
reau, 1030 
Nurse      Education,      International, 

1145 
Nurses,     affiliation     between     Army 
Nurse    Corps    and    Red    Cross, 
96 
American     Red     Cross     affiliated 
with  American  Nurses'  Associa- 
tion, 123 
assigned  to  Na'\'\'  Nurse  Corps, 

694 
assigned  to  Navv  base  hospitals, 
692 
"brother   ruling,"   763 
colored,  enrollment  of.  during  Eu- 
ropean War.  405-409 
convalescent     home     for,     at     Le 

Croisic.   France,  013 
distribution   of.   in   France,   763 
enrollment  of.  in   Red  Cross,  dis- 
cussion of,  80 

Miss   Delano's   reports  on,   289, 
290 
Navv  Corps  requirements  for,  687, 

691 
public  liealtli,  shortage  of,  761 
rumors       concerning       treatment 

abroad.   261.   262 
school    for,    Constantinople,    1168, 

1169 
state  societies  of  nurses,  entitled 

to  Red  Cross  memliership,  112 
teaching  under  Red  Cross  banner, 

discussion  of,  80 
types  of   service   of,   in   European 
'  War,  714 

type  f)f  work  of.   1. 344- 1346 
visit eusrs  fl'cnfdnffi,  80!) 
war  nursing  y)rogram.  254-258 
Nurses'  aifles.  Red  Cross.  764 
assigned  to  foreign  service,  546 
question  of,  269 


Nurses'    aides,    Red    Cross,    status, 

duties,  requirements,  273-276 
Nurses'   Associated   Alumnae   of   the 
United  States   and  Canada,  or- 
ganization of,  20 
first  convention  of,  20 
work     of,     for     maintenance     of 
standards,  20 
Nurses'      Bureau,      American      Red 

Cross.  613 
Nurses'    club.    Pension    Galilee,    at 

Paris.  562 
Nurses'   drive,    291 

Miss^  Noyes'  report,  292,  293 
Nurses'    equipment    shop,    establish- 
ment and  maintenance  of,  380- 
381 
at  Paris,  098 
Nurses'  training  schools,  growth  of 

numbers  of,  20 
Nursing,  Armv  School  for,  963,  964,, 
965 
i\Iiss  Delano's  opinion  on,  960 
Nursing.     Department    of,    at    Red 
Cross    Central    Division    Head- 
quarters. Chicago,  404 
Nursing,  National  Committee  on,  of 
National  Council  of  Defense,  265 
Nursing    Amendment,    Army    Reor- 
ganization Bill,  70 
Nursinff    Department,    organization 

of,'  in  10.   116 
Nursing  Education,  aid  of  Women's 
Section  of  Navy  League,  269 
at  Vassar,  268 
Convention.  955-962 
Nursing   leaders,   personalitv  of,   in 

latter   19th  century,   18-19 
Nursing  nec.ds.  954 
Nursing  scliools: 

Bulgaria,  plans,  1167-1168 
Constantinople,   1170 
Greece,    jilans,    1165-1166 
Nursintr  scliools.  Miss  Gardner's  re- 
port.  1191-1193 
Poland.  1159-1160 
Prague.  1149 
program  for.  1195 
Warsaw.  1159-1161 
conditions,    1163-1164 
plans,   1156-1158 
Nursing    Service,    at    Davton,    1913, 
132 
at   Paris,   550 
British,  4.35.  472-482 
rules   for   nurses,  476 
status  of  nurses  in,  483 


INDEX 


1539 


Xursinj^  Service,  biul<j;et  system  for, 

in    Eiighuul,   415;') 
bureau  of,  2:^1 

contract  form   for  Pliilippines,  G:5 
emer|i;ency,     organization     of,     by 

Florence  Xighlinj^'ale,  2 
enrollment  in  (Jreat  Britain,  41^5 
in   Eastland  disaster,   1915,   135 
in   France,  502,  505,  510 

need  of,  020 

standar<is  of.  527 
proposed  handling  of,  94 
Nursing      Service,      American      Red 

Cross,      additional      enrollment 
(1918)    in,  510 
American    Kxpeditionarv    Forces, 

0.34 
assignments  to  Xavv  base  hospi- 
tals. 092 
discipline  in  overseas  service,  210 
duties  of,  251.  252 
educational    work    of,    in    Siberia, 

934 
Executive  Committee,  253 
foreign     program      closed,      1915, 

220 
food  supply  in   France,  513 
head  of,  qualifications  for,  562 
Headquarters.  230,  237 
in    France.  518 

organization  of,  572 
in    Italv.  schools  of,  871 
in  Near  Fast.  907 
in  Siberia.  91().  929 
meaning  of.    12(')5 
National    Committee    on,    95,    127 

duties  of.  249-251 

nurses'  enrollment  plan,  102 
relations  with  Navv  Nurse  Corps, 

()S9  ' 

relation    of,    to    the    Armv,    310- 

3St; 
at   time  of  Armistice,  ()31 
base  hospitals.  310.  310.  327 

assignment  of  nurses  for,  spe- 
cial   diseases,    to.    345 

r.ritish    P.asc    Hospitals.   33S 

contract  betwccti  American  Red 
Cross  and  Lakeside  Hospital, 
Cleveland.   Ohio.   330 

contract  between  Amciicaii  lied 
Cross  and  parent  'institutions 
uiidertakinix  organization  of, 
330 

equipiufiit    (if.   333.   339 

(vtalilisliini'iit   of.  33S 

iiKibilization  of.  3.38 


Nursing      Service,     American      Red 
Cross,    base    hosjjital.s,    muster- 
rolls   of.   335.   .3.3(5 
nurses'  aides,  3.35 
nursing  staff  of,  334,  3.35 
|)ersonn(d  of,  334-335 
sup])lemeiitary  and  replacement 

hospitals.  3.38 
Bureau  of  Sanitary  .Service  under 
the  Department  of  Military  Re- 
lief, organization  of,  .340 
cantonment  zone  service,  345-348, 
390 
assignment   to   Camp   Sherman, 

400 
assignment  of  colored  nurses  at 

Camj)  Sherman,  Ohio,  405 
assignment     of    individuals    to, 

411-412 
at  Muscle  Slioals  Sanitary  Dis- 
trict. 403-404 
courtesies  shown  to  ntirscs.  397 
recreation     Inaises     for     nurses, 

397-.398.  404 
spirit      expressed      by      reserve 

nurse  on.  412 
development      of      phvsio-therapv, 

344-345 
discussion    between    Miss    l>oard- 
nian   and    Dr.   (Jeorge   W.  Crile, 
327 
embarkation    of   nurses,   413 
emergencv  detachments,  310,  310, 
341 

dtities    of,    342 
organization  of.  341,  342 
jiersonnel    of.   341 
value  of.  342 
enrollment   of  nurses,  320-323 
e(iuipment  and  uniforms.  323.  357- 
3S(; 
Fjureau    of    Nurses'    Ivpiipment, 

303 
cabled       requi  St       by       General 

I'ersliinL:     for    nurses'    equip- 
ment. .'iSl 
eipiipiiient    iif   nurses   liv   Amer- 

iean    Keil   Cni-.>.  415 
uniform      of      .\nieriean      Army 

nurse.    •'157.   .'>7()-3SO 
extra-caiitdnmeiit       zoiu-       service, 
34.")-:ifS 
ap|irn|iiian(in   nf  fund-   for  tini- 

f(ii-iii-  and   e(|uipnient.   .'>72 
coi'qM'r.il  ii'ii      of      {  .     S.      rublio 

ilea  it  !i     Ser\'iie,     Army,    and 

lied   (  r,.-,-.   -.It^  399 


1540 


INDEX 


Nursing  Service,  American  Red 
Cross,  extra-cantonment  zone 
service,  duties  of  nurses,  399, 
403 

in    infectious    and    communi- 
cable diseases,  400-405 
in  pandemic  of  Spanish  influ- 
enza  (1918-1919),  403 

hospital  units,  310,  316,  327 
equipment  of,  340,  341,  344 
establishment  of,  340,  344 
medical  sections,  344 
organization  of,  340,  344 
personnel   of,   340,   341,   344 
purpose  of,  340 
Ked   Cross   Chapters   and,   340, 

344 
Red  Cross  nurses  and,  344 
surgical  sections,  340,  341,  344 

insignia,  357,  386 

laundry  allowance,  385 

local  Red  Cross  Chapter  and  base 
hospital  unit,  relation  of,  334, 
336 

marine  hospitals,  348 

Mexican  border  service,  348-357 

organization  of  units,  310,  315, 
320-321 

Red  Cross  Commission  for  France, 
insignia  of,  374 

Red  Cross  division  offices,  estab- 
lishment of,  342 

Red  Cross  public  health  nurses, 
399-400 

regulations  governing  the  em- 
ployment of  American  Red 
Cross  in  time  of  war,  334-335, 
341 

reserve  nurses,  for  Mexican  border 
service,   insignia   of,   352 
requirements      for      enrollment, 

351-352 
removal  of  Red  Cross  from  cap 

of,  376 
uniform   of,   368-369 
wearing  of  brassard  by,  368 

responsibilities  of  American  Red 
Cross,  415-416 

Roman  Catliolic  Sisterhoods,  uni- 
forms and  insignia,  376-378 

"safety  suits,"  appropriation  for, 
384 

salaries,  380 

special  units.  344-345 

status  of  nurses,   356 

subsistence  of,  provision  for,  384- 
385 


Nursing     Service,     American     Red 
Cross,    supplementary    and    re- 
placement hospitals,  338 
training  school  units,  342-344 
types   of   assignment   characteriz- 
'     ing  war  nursing  service,  410 
Nursing     Service,      American      Red 
Cross,  reorganization  of,  564 
report,  annual,  1917,  136,  138 
report  of  committees,  252,  253  " 
resolution     on     rank     for     Army 

nurses,  1073,  1074 
Ruth  Morgan,  director  of,  564 
sub-bureau  of  Women's  Bureau  of 
Hospital  Service,  564 
Nutall,   Mrs.,   in   charge  of   Nueces 

nursing  party,  33 
Nutting,     M.     Adelaide,     Advisory 
Committee   of   Army   school   of 
nursing,  285 
aid  to  rural  service,  1251 
and   embarkation    of   unit,   U.    S. 
Army     Base     Hospital     No.     4 
(Lakeside),  415 
Chairman  National  Committee  on 
Nursing  of  Council  of  National 
Defense,  264 
Committee,     Memorial     Fund     to 

American  Nurses,  1048- 
Committee  of  Transfer,  1021 
committee   on   settling   war  nurs- 
ing policy,  254 
conference     to     consider     nursing 

problems,  253 
efforts  towards  Red  Cross  affilia- 
tion, 71 
Federation    representative.     Com- 
mittee for  affiliating  Organized 
Nurses  with  Red  Cross,  87 
in  Armv  Nurse   Corps  legislative 

effort^  68,  69 
Instruction  for  women,  1354 
Joint  National  Committee,  1047 
Joint      National      Committee     of 

Bureau  of  Information,  1016 
letter  on     home     nursing,      1354- 

1355 
letter    to   ^liss    Delano   endorsing 

war  nursing  policy,  258,  259 
National  Committee  of  American 

Rod  Cross,  958 
National  Conunittee  on  Red  Cross 

Nursing  Service,  249 
organizes    Emergency    Committee 

on  Nursing,  264 
publicity   work  in   Student  Nurse 
Reserve  Campaign,  294 


INDEX 


1541 


Nutting,  M.  Adelaide,  president, 
American  Federation  of  Nurses, 
71. 

report  on  output  of  nurses  from 
training  scliools,  25;) 

re8oluti»)n  for  rank  of  Army 
nurses,  1074 

Superintendents'  Society  Commit- 
tee to  efTect  nurses'  and  Red 
Cross  adiliation,  74 

Town  and  Country  Nursing  Com- 
mittee, 1219 

Town  and  Country  Nursing  Serv- 
ice, 121!) 

Work   of   Committee   on   Nursing, 

Nutrition  Service,  meeting  of  mem- 
bers; transfer  planned,  1437 
report   of,    1438 


O'Donnell,     Grace,     hospital     train 

duty.  oOO.  (>3() 
O'Donnell,  Marv  A.,  work  in  Cuba, 

64 
O'Hara,    Anne,    nursing    service    in 

Serbia,  1119 
O'Keefe,  Elizabeth  E..  reserve  nurse 

on  Mexican  border,  3,)4-3;);') 
O'Lauglilin,    Mrs.    Callan,    volunteer 

nurse,  241 
O'.Mallev.   Anno    L..    Palestine   Com- 
mission.  892 
O'Neill,       Dr.       Frances,      director, 

ClK'itrau  <h\s  Hallcs  hospital,  781 
Oades,  Miss,  relief  work  in  Albania, 

1422 
Obear,    Evelyn,    nursing    service    in 

Roumania,   1120 
Ocean   escort    duty.   719 
Oelker.    Mademoiselle,   cluhl    welfare 

\\()rk,  Paris.  81.') 
Ohio,  early  sul)stituti()n  b> .  of  State 

Nursing    Assuciatioiis    for     Red 

Cross  iiursiiiLT  conuniltee,  S(i 
Hoods.   19l;i.    i:V2 
(•Ills.  .loan,  volunteer  nurse.  241 
Old    Colony    Club,    mobili/.alion    sta- 
tion   for   nurses.   420 
"Old     Howard     .\ssociat  ion."    yellow 

fc\-er   nursing  siTxiees  of.    14 
Oldtiel.l.    Mild. 'line,    direct. ir    of    I'.u- 

reau  of    Public   ilcaith    NuisiuLr, 

i:!ii:! 
(lids.    Colonel     Koliert     K..    Coininis- 

sioner    for    l-;uro|ie.    1079 
on   care    of   children    abroad,    1178 


Olds,  Col.  Robert  K.,  resignation 
from       European      Commission, 

1188 

"Oldway  House,"  Paignton,  Eng- 
land, 14.'>,  14ti,  424.  See  also 
I'aignton,  England, 
taken  over  by  American  Red 
Cross,  1918,  as  Militarv  Hos- 
pital No.  21,  429 

Oliver,    -Marion     L.,    home    nursing 
course.    1305 
organiz<ition    of   dietitian   classes, 

1370 
organization      of      nurses'      aides 
groups   at   National    lleadcpiar- 
ters,  200 

Olmstead,  Katherine  M.,  Roumanian 
Commission,  882 
Director    of    Nursing    of    1^'ague, 
1140 

Omaha  c.vclone,  1913.  132 

Omsk.  Siberia,  eva<'Uated  because  of 
Rolsheviki,   941 

Omsk   (Siberia)    Hospital.  920 

Orange.  N.  J.,  Visiting  Nurses'  Set- 
tlement, training  for  public 
health  nursing.  1244 

Orleans.  France,  emergencv  canteen 
at.  837 

Ormesson,  Hopital,  tuberculosis  hos- 
l)ital.  848 

Orr.  Dr.,  operation  on  Miss  Delano, 
1001 

Osborn,     Mrs.     William     C,     Army 
Nurse    Corps,    legislatiijn    com- 
mittee. 07 
Committee  on  Town  and  Country 

Nnrsiim  Service,   1204 
Delano  Memorial  Committee.  1051 
National  Couunittee  on  Red  Cross 
Nursing  S(>rvice,  249 

Osborne,  C.  (>..  Commissinn  for 
Europe.  .").'!  1 

Osier,  Sir  William,  consulting  phy- 
sii'ian  to  Committee  of  the 
American  WUmen's  War  Relief 
Fund.   140 

Os/ii^ii)  Coiimsco.  Italy,  802 

Otwill.  Cohitul.  coinmimder  of  319th 
FiiL'ineers.  720 

Oxiev.  Nellie  v..  Director  of  Public 
Health  Nursing.   1303 

Pacilic       ni\i~ion      of       Pcd      Cros-. 

2  17 
Packai'd,    l!li/abelli.  i-ecruitinLT  relief 

nur>es  for   I'ldand.    los.! 


1542 


INDEX 


Packard,  Mary  C,  State  Committee, 

Maryland,   112 
Paderewhki,  ^ladame,  relief  work  in 

Poland,    1085,    1086 
Padua,   Italy,   American   Red   Cross 

hospital  at,  865 
Page,  Mr.  Walter  H.,  honorary  presi- 
dent of  London  chapter,  Amer- 
ican Red  Cross,  425 
Paget,   Lady  Arthur,   Committee  of 
American  Women's  War  Relief 
Fund,   146 
Paid  nurse,  form  of  Red  Cross  agree- 
ment for,  78 
Paignton,  England,  analysis  of  cases 
treated  at,  147 
assignment  of  Mercy  Ship  Unit  D 

to,  147 
assignment  of  Mercy  Ship  Unit  F 

to,   145 
arrival  of  Unit  F  at,   145 
withdrawal     of     American     units 
from.  149 
Palais  d'Hiver,  at  Pau,  France,  150 
Palanka  Hospital,  Serbia,   1118 
Palestine,  American  Red  Cross  Com- 
mission to,  891 
Red  Cross  relief  work  in,  1130 
relief  nurses  in,   1083 
Palfrey,   Dr.   F.   E.,   director  of  T\'- 
phus  Research  Hospital  at  War- 
saw, Poland,  1092 
Palmer,     F.     B.,     school    nurse     in 

Minnesota,  1340.  1.341 
Palmer,     Miss,     dietitian     overseas, 
1410,  1411 
work  in  Albania,   1422 
Palmer,  Sophia   F.,  94 

Chairman  of  American  Revolution 
Committee    in     Rcjcliester,    and 
superintending  nurse,  40 
Committee  on  memorial  for  Miss 

Delano,  1050 
criticism  of  attitude  of  puljlic  to- 
ward home  coming  nurses.  1013, 
1014 
death  of.  1050.   1210 
editor.  American  •lournnl  of  Xiirs- 

i»;i.  71.  391 
(•fForts  towards   R(hI  Cross  affilia- 

1  ion,  71 
Xiitidiial   Committee  of  Americiui 

INil  Cross.  958 
Xalidiial  Coimuittce  on  Red  Cross 

Nursing  Service,  95 
nil     non-enrollment     of     volunteer 
nurses,    100 


Palmer,    Sophia    F.,    resolution    for 
rank  for  Army  nurses,  1074 
services  for  nurses'  enrollment  in 

Red  Cross,  76 
State    Committee    of    New    York, 
110 

Paris,  dispensaries  at,  802,  810 
work  for  refugees  in,  834 
work  of  Children's  Bureau  at,  801 

Park  Hospital,  origin  of,  35 

Parkhill,  Clayton,  demand  of,  for 
nurses.  58 

Parmelee,  Eva  Jean,  on  air  raid  at 
Dannes  Camiers,  France,  453 
wounded  in  line  of  duty,  1031 

Parris  Island,  Naval  hospital  at,  708 

Parrish,  Major  Robert  E.,  in  com- 
mand of  U.  S.  Armv  Evacuation 
Hospital  No.  17,  948 

Parson,  Commander  A.  L.,  Commit- 
tee in  Haiti.  1173 

Parsons,  Ellen.  State  Committee  of 
Illinois.  110 

Parsons,  Emily  E.,  Civil  War  nurs- 
ing record  of,  10 

Parsons,  Louisa,  death  of,  in  British 
Army  Service,  65 

Parsons,  Maud,  chief  nurse  of  Base 
Hospital  No.  105,  996 

Parsons,  Mrs.   Ethel  S.,   director  of 
Bureau  of  Public  Health  Nurs- 
ing,  1303 
director  of  Public  Health  Nursing 

in  Southwest.  1304 
National  Committee  on  Red  Cross 
Nursing  Service,  249 

Parsons,  Sara  E.,  chief  nurse.  Base 
Hospital  No.  6.  493 
work  of.  to  secure  rank  for  Army 
nurses,   1071 

Parsons.  Miss,  nursing  school  in 
Prague.  1149.  11.52 

I'ascoe,  Marv,  dietitian  overseas, 
1404 

I'aterson.  Jessie  G..  Palestine  Com- 
mission. 892 

I'atmore.  Amy  Florence,  chief  nurse. 
Base  Hospital  No.  8.  49() 

Patras.  (Jrcece.  infant  welfare  work 
at.  1115.  1116 

Pnltcn.  W.  S..  director,  Department 
(f  Military  Affairs.  535 

i'atti  rsdii.  Klsie.  State  Conunittee  of 
NCn    \uvk.    1  10 

I'attirsoii.  Fldi-cme  ^I..  chief  nurse 
iif  tlie  Roumanian  Commission, 
882 


INDEX 


1543 


Patterson,  Florence  M.,  at  National 
Headquarters,  240 
nursing  service  in  Houmania,  1120 
on      departure    from      Ruumaiiia, 

1!)18,  887 
on    Roman    Hospital,    Rounmnia, 

883-88;) 
work  with  iiervice  dc  Santi\  584 
work  on  Student  Nurse  Campaign, 
2!»:5 
Patterson,    Colonel    Robert    U.,    as- 
sistant   director    Veterans'    Bu- 
reau,  lO.'U 
Base  Hospital  No.  5,  452 
chief  of   Bureau  of  Medical  Serv- 
ice, 206 
director    of    Bureau    of    Medical 

Service,  231 
National    Committee    on    Nursing 

Service,  127 
selection    of    surgeons    for    Mercy 
Siiip  expedition  by,  140 
Pau,    France,    arrival    of    American 
units  at,  150 
as  recruiting  station,  151 
assignment   of   INIercv   Ship   Units 

A  and  B  to,  150 
burial  of  soldiers  at,  153 
eases  received  at,  152 
closing    of    American    Red    Cross 

hospital  at,  154 
inspecti(m  of  hospital  bv  tourists 

at.  152 
record  of  work  of  American  units 

at,  154 
volunteering    of    American    units 
from,    for    Serbian    typhus    epi- 
demic. 154 
Pavilion  liellevuc,  St.  Cloud,  hospi- 
tal. (HO 
Peabddy,     Dr.     Francis,    Roimianian 

(nnuiiissidii,  SS2 
I'earce.    Dr.    K.    M.,    chairman,    Na- 
ti<inal    Medical    Board    at    Red 
Cross   Headquarters,  551 
coiiferencf     to     consider     nursing 
probieins.   254 
Pearse.    Dr.   N.   ()..   member   of   Chil- 
dren's Bureau.  France,  758 
Pearson.   Dr.    F.  S..   I!t5 
I'eck.  Miirinn  Helen,  dietitian,  death 

of.    14-2-2 
renhuid,  .Vnne.  at  1'ritisli  front.  454 
I'ennsvivaiiia  Division  of  Red  Cro>s. 

245,  24r> 
I'eniisylvania,  on  Red  Cross  nursing 
standards,  S;5 


Pension  Galilee,  Paris,  nurses'  club, 
502 

Pepoon,  .Margaret  A.,  National  Com- 
mittee,  111 
National  Committee  on  Red  Cross 
Nursing  Service,  95 

Pepper,  George  \\  barton,  conference 
to  consider  nursing  proljlems, 
254 

Pepper,  Mrs.  Geo.  Wharton,  Wo- 
man's Advisory  Conunittee,  .'500 

Pepper,   Margaret,   151J 

Percy,  Dr.  Karlton  G.,  chief  of 
American  Red  Cross  dispensary, 
709 

Perkins,   Major  James  H.,  Commis- 
sion for  Furojje.  530,  012,   1078 
on  qualifications  of  head  of  Nurs- 
ing Service,  5(»2 

Perkins,  Colonel  Robert  P.,  director 
of  Commission  to  Italy,  859 

Perkins.  Dr.  Roger  G.,  Roumanian 
Commission,  SS2 

Peronne,  France,  cajjtured  bv  Ger- 
mans, 1918.  404 

Perry,  Miss,  delegate  to  Nintli  In- 
ternational Red  Cross  Confer- 
ence,  1912,   124 

Pershing,   (Jeneral,   348.   381 

attitude  on  rank  for  Armv  nurses, 
1073 

Persons.  \\'.  Frank,  National  Com- 
mittee on  Red  Cross  Nursing 
Service,  249 

Peter  Pent  Rrigliani  I'nit.  V.  S. 
Armv  i>ase  lios])ital  No.  5, 
452  ' 

Peters.  Florence  M..  cliild  welfare 
wt)rk.    France.    1918,    S09 

Petrograd.  i-ece]itio!i  of  American 
Red    Ci-oss   units   at.    155 

I'etrola.  Doris,  on  conditions  at 
l''\i-('ii\   lios])ital.  5:J9 

Pettit,  Getiovcva.  on  wori<;  at 
ilattie-l)Ui-g,   19(IS.  130 

Plu'Ian.    Marie   '1'..   cliief   nurse,   jtub- 
lie  liealtli  work  in   l'"raiu'e.  702 
dispensary  \\(iik  ;it    Paris,  S(i3 
on  .Im7.    Ciisinii-  at  Toul.  7i>7 
iclicf    \\(irk    in    Crete,    lilt; 

ill    Cri.'.e,    112 
State    ( ■(Uiunittee    of    New    "\'ork, 
1  111 

Plulp-.  lirar,'.  ciiirf  nur-e,  I'ase  Hos- 
pital   Nu.    ti;,   r.iis 


Pliila.Irlpliia,      i 
ii..>pital    .\> 


1      ti'i-.;     General 
1.  7o:i 


1544 


INDEX 


Philadelphia  Red  Cross  Society, 
work  of,  in  Johnstown  flood.  18 

Philippine  Islands,  nursing  service, 
120.).   1206-1209 

Philippine  nursing  service,  contract 
form  for,  63 

Philippine  war  nursing,  conditions 
in.  69 

Phillips.  Lawrie  L.,  chief  nurse. 
Base  Hospital   Xo.  23,  503 

Phillips.  Laura.  Chautauqua  nurse, 
10.5o 

Physicians  in   France,   1917,  758 

Phvsio-therapv,  development  of,  due 
to  the  war,  344-345 

Plessis-Robinson,  tuberculosis  hos- 
pital at,  851 

Picardy.  second  battle  of,  466,  578 

Pickett.  Elizabeth,  aid  in  Chautau- 
qua campaign.  1058 

Pierce.  Kathcrine  X.,  head  of 
Samaritan  Hospital  in  Troy, 
nurses'  recruiting  work  of.  50 

Pierson.  Miss,  letter  on  Home  Xurs- 
ing  course.   1356 

Pinard.  Professor,  child  welfare 
work.  Paris.  815 

Pindell.  ^liss,  efforts  for  Red  Cross 
afliliation.  71 

Pinder.     Kthel.     assistant     to     !Miss 
Harrington  on  work  in  Siberia. 
930 
director  of  Public  Health  Xursing 

in   Southwest.    1304 
public  health  nursing  service,  1303 

Piatt.  Philip  S..  director  of  Educa- 
tional Service.  783 

Playground,  at  Corbeil.  France,  801 

Plummer.  Samantha  C,  Spanish- 
American  and  World  War  serv- 
ice. 65 

Podgoritza.  ^lontenegro,  Red  Cross 
aid  at.  1103-1105 

Pohlc.  St(']>lianie,  work  of,  at 
Irkutsk.  944 

Poilu.   152-153 

Poland,  child  welfare  work  in,  1189- 
1190 
condit idus  in.  1 179 
nursing  scliool  for.  1154.  1155 
Red    Cross    relief    work    in,    1077, 
lOSfl  r1  sr</. 

conditions    in   June.    1919.    lOSS 
relief  nurses  in.   1083 

Poland  Scliool  for  Xnrses.  1160 

I'olanij  Siliool  of  Nursing.  1159 

I'lli-li    Orev    Samaritans,    1085-1087 


Ponta  Delgada,  American  Naval 
base,  720 

Pontanazen,  Camp,  hospital,  997, 
998 

Pope,  Amy  E.,  work  in  Cuba,  64 

Pope.  Helen  M..  Committee  on  Red 
Cross  Dietitian  Service,   1379 

Popper,  Raron  Armin,  military  com- 
mander of  Red  Cross  hospital 
at  Budapest,  173 

Porchefontaine,  teaching  center  of 
Children's  Bureau,  814-816 

Porteous,  Elizabeth,  vice  president. 
Society  of  Spanish-American 
War  Nurses,  46 

Porter,  Annie  C,  Base  Section  Xo. 
3,  France,  434 

Porter,  Annie  C.  chief  nurse,  Amer- 
ican Forces  in  England,  442 

Porter.  Emilv,  relief  work  in  Greece, 
1114 

Porter,  Gladys  H.,  on  Asile  Caserne, 
Luxembourg.    623 
work   with    Children's   Bureau    at 
Toul,  767 

Porter.  Dr.  J.  Y.,  services  in  Florida 
yellow  fever  epidemic,   16 

Porter,  Margaret,  154 

Porto  Rican  Civil  Hospitals,  Amer- 
ican nurses'  work  at,  64 

Porto  Rican  expedition,  of  Red 
Cross  nurses.  31 

Porto  Rico,  Red  Cross  nursing  serv- 
ice in.  1201 

Portsmouth.  England,  U.  S.  Army 
Base  Hospital  Xo.  33,  436 

Portsmouth.  X.  H.,  Red  Cross  serv- 
ices  at.   61 

Poteau  Dispensarv,  opened,  1918, 
808 

Potomac  Division  of  Red  Cross, 
240 

Potter.  Bisliop.  Chairman.  American 
Xational  Red  Cross  Relief  Com- 
mittee, 26 

Potts.  Amv.  report  on  fear  of  in- 
fluenza, 979,  980 

Potts.  Susan  D..  on  German  invasion 
of  Xesle.  France,  773 
with   Children's  Bureau  at  Xesle, 
l'>ance,  772 

I'oupnnnirre  sanatorium.  814 

Powell.  Louise  ^I.,  X'ational  Commit- 
tee on  Red  Cross  Xursing  Serv- 
ice. 249 

Power.  Annie,  d<'veloping  Red  Cross 
workroom,  296 


INDEX 


1545 


Prague,  nurses'  school,  1150-1152 

niirsinfj  school  at,  1149 
Pratt,  Helen,  on  conditions  at  Evac- 
uation Hospital  No.  4,  G45 
Preston,  Alice,  (il!) 

recruiting    relief    nurses    for    Po- 
land,  1085 
Preston,     Ralph,     American     Relief 
Clearing  House,  531 
Commission  for  Europe,  531 
Prince     Mercea     Hospital,     Roman, 

Ron  ma  Ilia,  883 
Prison   trains,   in   Siberia,   021-022 
Pritchard,     Mary,     on     cantonment 
service     at     Charlotte,      North 
Carolina.  400-402 
on  comnuinicahle  diseases,  402 
Pruzana,    Poland.    Red    Cross   relief 

work  in.  1087 
Przyhylowska.  Mme.  Marya,  recruit- 
ing   relief    nurses    for    Poland, 
108.-) 
Psycliiatric     and     Orthopedic     Base 

Hospital  Units,  372 
Public  Health   'Surse,  1225 
Public   healtli   nurses,  appointments 
as.  1301.  1302 
status   of.   278 
Public   Health  Nursing,  1028,   1240- 
1202 
after  war:   expansion;  policy;  re- 
organization, 1293-1.351 
aims    of    Rural    Nursing    Service, 

12.K-)-12G3 
Division  of.  1020 
education   for,   1245-1251 
Dr.    Clark    on    funds    for,    1280- 

1287 
extension  of.  1270 
fund   for.  disbursements  of,   128S- 
1289 

needs  for.   1287-1288 
history  of.    1211-1239 
in  Ita'ly,  8G8 
Miss    Clement's    report   for    1913. 

1222-1224 
Miss  Gardner's  studies  and  visits, 

towns   in   Europe,   1187 
name    cliaiiged     from     Red     Cross 
Town      and     Country      Nursing 
Service  to.  347 
National    organization    for;    rela- 
tions    with     Red     Cross,     l;!2(i- 
1330 
need    to    enhirge    field    staff    for. 

1314 
purposes  of,  2(>(> 


Public  Health  Nursing,  report  of 
June,    1920.    1029.    1.307-1309 

requirements  for,  1238-1240 

salarv  for,   1027 

sciioo'ls  for,   1241-1244 

training  for,   1253-1254 

uniform  of.   1028 

United  States,   1023 
Putney,   London,  convalescent  home 
for  Americans,  438 

Quain.  Dr.  E,   M.,  Bismarck,  North 
Dakota,  organization   of   Surgi- 
cal Section  No.  1,  American  Red 
Cross  Hospital   Lnit.  341 
Quinn,     Lotetta    C.    ciiild     welfare 

work,    France.    1918.   809 
Quintard,   ^Irs.    Lucy    \V,.    appoint- 
ment of.  to  Camp  Wikoff,  Mon- 
tank  Point.  51 
in   Armv  Nurse  Corps   legislative 

effort,"  08 
St.  Luke's  Hospital,  service  record 

of,  49 
work  at  ^lontauk,  60 
work  in  Cuba,  04 

Race,  Ethel  V..  dispensary  at  Boule- 
vard   Belleville.    809  ' 

Rainey,  Paul.  Commission  for  Eu- 
rope. 531 

Raitt.  EHie.  Connnittee  on  Red  Cross 
Dietitian    Service,    1379 

Raker.  Congressman,  bill  to  secure 
rank  for  Armv  nurses.  lOGG, 
1070 

Ranileli.  Palestine,  hospital  at.  re- 
organized by  Palestine  Com- 
mission, 901 

Randolph.  Mary,  develoiung  Red 
Cross  workroom.  29(i 

Ranger,     Olive,     Palestine    Commis- 
sion. 892 
Wadi    Surar    Hospital.    Palestine. 
S!»S 

Rank  for  Army  nurses,  liills  to  se- 
cure.  PltKi  (  /  .s<  ,/. 

J'npahir.   at    I-vian-les-l?ains,   775 

Ratlibone.  Aiuiie  S..  on  conditions  at 
evacuation    o{    Amiens,    March. 

19 IS.  s;n 

on    work    witli    Srrrici-    dv    Suniv, 

.")S7 
woi'k  at    .\niicii~,   I'rancc.  774 
Itai  lihi.nc.   Iti.licit   ('..   lUucau  of  lu- 

suraiice.    liii;! 


1546 


INDEX 


Raub,  Mademoiselle,  child  welfare 
work,  Paris,  815 

Raumo,  Finland,  reception  of  Amer- 
ican  Red  Cross  units  at.  155 

Readjustment  and  Liquidation  of 
European  Activities,  Committee 
of,  1079  . 

Reconcentrados,  plans  for  relief  of, 
25 

Reconstruction  aides,  277 

Recreation  huts,  established  in 
France,  514 

Recreational  facilities  arranged  by 
Florence   Nightingale,   4 

Recruiting  of  nurses,  069 

Red  Cross,  origin  of  idea,  1 
reorganization  by  Congress,  74 

Red    Cross,    steamship.     See   Mercy 
Ship   expedition, 
naval  personnel  of,  140 
sailing  of,  for  World  War,  139 

"Red  Cross  Bulletins,"  article  by 
Mabel  Boardman,  75 

Red  Cross  Bulletins,  report  of  lec- 
tures, 79 

Red  Cross  class-work  plans,  82 

Red  Cross  emblem,  protective  reso- 
lutions  concerning  use,   85 

Red  Cross  expedition  on  S.S.  Lam- 
pasas, 32 

Red  Cross  Hospital,  metamorphosis 
of,  into  Park  Hospital,  35 

Red  Cross  Hospital  and  Training 
School  for  Sisters,  21,  22 

Red  Cross  Hospitals,  defects  in  serv- 
ice. 23,  24 
final  history  of,  35 
loss  of  prestige,  30 
male  attendants  in,  23 

Red   Cross  Xurses,  appointment  of, 
84 
field  hospital  service,  51 
first  unit  in  United  States,  15 

Red  Cross  Nursing  Reserve,  in  Mis- 
sissippi   floods,   80 

Red  Cross  Nursing  Service,  anticipa- 
tion of  service.  20 
intensive     organization     of,     139. 

See  also  Nursing  Service. 
National    Committee    of,   95 

Red  Cross  nursing  standards,  S3 

Red    Cross    Organization,    first    unit 
in  I'nited  States.  13 
in   1898.  25 

Red  Cross  Ilclief  Sliip,  State  of 
Texas,  25 


Red  Cross  Sisters,  requirements,  22 

work  with  American  forces,  28 
Red  Cross  Society  for  Maintenance 

of  Trained  Nurses,  27 
Red  Cross  Society  of  New  Orleans, 

yellow  fever  regulations,  14 
"Red  Cross  visiting  nurse,"  1225 
Red  Cross  workroom,  first.  296 
Reed,  Dr.,  on  work  at  La  Courneuve, 

806 
Reed,  Elizabeth,  chief  nurse  at  Ve;-a 

Cruz,  1914,  128 
Reed,  Henrietta  R.,  at  Asile  Caserne, 
Luxembourg,  622,  623 
at  dispensary  at  Crenelle,  France, 

804 
head       nurse       in       dispensaries, 
France,  1918,  809 
Reed,  Dr.  Theodore,  in  Serbia,  1122 
Reed,  !Major  Walter,  head  of  Yellow 

Fever  Commission,  13 
Reeducation   of   Mntilcs,   Bureau   of 
Civil   Affairs   Department,   757, 
854 
Reeves,  Anna,  127 

Nursing  Staff,  235 
Reeves,    Commander    I.    S.    K.,    on 
work    of   nurses    at    Santo    Do- 
mingo, 1200 
Refugees  and  Relief  Bureau  of  Civil 
Affairs  Department.  757 
work  of,  in  France,  825 
Refugees   in    France,   provision    for, 
839 
work  among,  830 
Reid,   ^Irs.   Whitelaw,   Army  Nurse 
Corps  legislation,  67,  68 
article  by  Mabel  Boardman,  47 
cliairnian.    Committee    on    Nurses 

for  Philippines,  62 
chairman.  Committee  on  Nursing, 

Auxiliary  No.  3,  47.  55 
Committee  of  American   Women's 

War  Relief  Fund.  146 
established  iiospital  in  France.  538 
interview  with   President  McKin- 

lev,  56.  57 
London  Chapter.  A.  R.  C.  425 
National  Committee  on  Red  Cross 

Nursing  Service,  95.   127 
Town  and  Countrv  Nursing  Com- 
mittee.  1215.  1216,  1219 
resignation   from.   12()4 
Reineckc,     Miss,     work     at     Davton 

floods.    1913,   133 
Relief   in   tiie  Near   F!ast,  American 
Committee  for,  907 


INDEX 


1547 


Relief  work,  of  Red  Cross  type,  early 
examples  of,  2 
Sisters  of  Charity  of  St.  Vincent 

de  Paul.  2 
volunteer  for,  early  German,  2 
Helitjious  Orders,   in  Spanish-Amer- 

iean  War  nursing,  44 
Renault.    Dr.,    child    welfare    work, 

Paris,  815 
Reorganization  of  Red  Crgss,  1,3:51-0 
Reutinger,  Anna   L.,  National  Com- 
mittee   on    Red    Cross    Nursing 
Service,  249 
on   Helgian  refugees,  161 
on  (Jennan  Heifer  inner,  165 
on  (terman  wounded,  166 

at  Gleiwitz.  162 
on    mental     attitude    of    German 

wounded,  164 
on  Russian  and  German  military 
movements  about   Gleiwitz.    Ki.l 
supervisor  of  Mercv  Ship  Unit  I, 
162 
Revigny.  France,  hospital  at.  52.") 
Rhoads,  Major  T.  L.,  work  at  Dav- 

ton  floods.   1013,   134 
Rliodes,     ^lari*^    R..    in     charge    of 

nurses'  equipment.  575.  577 
Rice.  Captain  A.  A.,  610 
Rice,   Marion   M.,   at    Ilopital   Anx- 
ilinre,  A'o.  3',.  100 
volunteer    service    at    St.    Valery, 
530 
iJich,    Mabel,    supervisor    of    Alercv 

Ship  Tnit  C.  158 
Richards,     l.inda,     in     Army    Nurse 

Corjjs   h'gislative  effort,  68 
llichards.    Dr.   Theodore   \V..   aid    in 
organizing     work     on     hospital 
supplies.  207 
conference     to     consider     nursing 

probk'ins,  254 
l)e|jartment    of     Alilitarv     Relief, 

(ISO 
director  of  Supplies  Rureau.  231 
N'alional  ("onnnittee  on  Red  Cross 

Nursing  Service,  127.  240 
on  e<]uipping  Navy  base  hospitals, 
tlOO 
llicliards.  Mrs.  'l'heo(hire  \\'.,  aid   in 
preparinu:   sample   hospital    suj)- 
plies.   20S 
head   of  Washington.   1).  C.  work- 
room for  liosjiital  supplies,  2I'0 
Tuliardson,       i.iiiiia      <i..      National 
Committee  on    i\ed  Cross  Nurs- 
ing Service,  05,  111 


Richardson,    Linna    G.,    on    Home 

Nursing  Courses,   1355 
Ricliie,    M()S(dIe,     State    Committee, 

California,   112 
Richmond         Instructive        Visiting 
Nurse  Association,  training  for 
I)ublic  healtli  nursing,  1243 
Ricketts,    Mar\,    nvirsing    service    in 

Serbia.    1110 
Riddle,    Mary    M.,    efforts    towards 
Red  Cross  afliliation.  71,  73 
president  of  the  Associated  Alum- 
na', 71 
State    Committee,    Massachusetts, 
112 
Ridley,  Miss,  appointed   for   Philip- 
pine service,  63 
Rignel,  Jane,  Mobile  Hospital  No.  2, 

455 
Rimini  Refugee  Hospital,  Italv,  860 
Robb.  Mrs.  Isaliel   Hampton.  40.  03, 
04 
affiliation  of  organized  nurses  with 

Red  Cross,  87-02 
a])pointinent  to  War  Relief  Board, 

SO,  00 
in   Armv   Nurse  Corps  legislative 

effort!  OS 
death  of.  100 
National  Committee  on  Red  Cross 

Nursing  Service.  05 
presich'nt.  Associated  AlumniP,  40 
Robb,  Isabel  Nutting,  on  home  nur.s- 

ing  courses,    1354 
Robbins.    Annie    A.,    vice-president. 
Society      of      Spanisli-American 
^^'ar  N'urses.  46 
Robl)iiis.  iMnma.  relief  work  in  Alon- 

tenegro.    11 0() 
Roberts.  Abliie,  supervisor  of  Visit- 
ing Nurses.   121)7 
work  at  Dayton  tfoods,  1013.  134 
Rol)erts.  Amabel  S..  death  of.  457 
Roberts,  Marv  M.,  cantoninent  duty, 
300 
chief  nurse.  Camp  Sherman,  lOlS, 

407,  40S 
director     Lake     Division     of     Red 
Cro^-.  2  ft'..  247 


oliius,  Mar-aret,  work  at  Chalons- 
sur-Marne.   5!I0 

oliiiisnii.  (aniline,  in  l'"rance,  lloo 
relief  work   in   AllKinia.   1  IK*,   1422 

oliiusciu.  i-:ii/alieth  S.,  nursing  serv- 
ice nn    \ir-in    inlands.    1204 

obin-oii,  I'.lla.  oil  (lock  iiitirmary  at 
Ronlcaux,   loI2 


1548 


INDEX 


Robinson,  Miss,  delegate  to  Ninth 
International  Red  Cross  confer- 
ence. 1012.  124 

Rockefeller  Foundation,  cooperation 
in  Rural  Nursing  work,  1228 
tuberculosis  prevention  in  France, 

844 
tvphus  commission,  in  Serbia,  183, 
■  184 

Roder,  Marie,  at  National  Head- 
quarters.  240 

Rogers,  Emma  Hart,  relief  work  in 
Serbia,  1123 

Rogers,  Mrs.  Wadsworth,  154 

Rollins,  Clara  A.,  reserve  nurse,  on 
colored  nurses,  407-408 

Roman.  Roumania,  Prince  ^lercea 
Hospital  at,  883 

Roman  Catholic  Sisterhoods,  uni- 
form and  insignia,  376,  377, 
378 

Rome,  American  Red  Cross  hospital 
at.  866 

Rommcll,  Miss,  delegate  to  Ninth 
International  Red  Cross  Confer- 
ence,  1912,   124 

Romsey,    England,    American   Army 
camp  at,  432 
U.   S.   Camp   Hospital   No.  34   at, 
433 

Rose,  Dr.,  conference  to  consider 
nursing  problems,  254 

Rose,  Esther,  nursing  service  in 
Serbia.  1120 

Rose.  Flora,  Committee  on  Red  Cross 
Dietitian  Service,  1379 

Rose,  Wicklitfe,  Committee  on  Rural 
Nursing,   1216 
Town  and  Countrv  Nursing  Com- 
mittee.   1219 

Rosenau.  Dr.,  conference  to  consider 
nursing  proldems,  254 

Roser,  Laura,  Chautauqua  nurse, 
1055 

Roser,  Lora  B.,  chief  nurse  U.  S. 
Army  Base  Hospital  No.  204, 
W'iticliestcr.  Enghmd,  432 

Ross,     Elizabeth,    division    director, 
American     Red    Cross    in    New 
England,  244 
public  heallli  nurse,  1303 

Ross,   Mary    !'>..   in  Serbia,   1117 
on   welfaic  work  at    Paris.  S02 

Rotlichild.  IJaroii  (;ohlschmidt.  Kil 

Rothrock.  .Mrs.  Anna  E..  cliief  nurse. 
Near  East  Relief  for  Asia 
Minor.   907 


Rothrock,  Mrs.  Anna  E.,  resignation 
in  Constantinople,  1170 
school    for    nurses    in    Constanti- 
nople, 1168,   1169 
Rouen,  France,  air  raids  at,  449 
General   Hospital  No.   12,  British 

Expeditionary  Forces,  467 
Red  Cross  dispensary  at,  816 
U.  S.  Army  Base  Hospital  No.  4 

at.  442-452 
U.  S.  Army  Base  Hospital  No.  21 
at,  467 
Roumania,     American     Red     Cross 
Commission  for,  882 
in  Balkan  War,  876 
effect  of  European  War  on,  875 
entrance   of,   into  European  War, 

1916,  877 
nursing  service  in,  878 
relief  work   in,   1126-1130 
treaty  with  Russia,  1918,  886 
Roussy     de      Sales,     Cotmtess     de, 
French  representative  at  Cannes 
Conference   (1919),  1138 
Rowland,   Adeline   H.    (Mrs.   Robert 
Gourlay),    at    National    Head- 
quarters. 240 
Roumanian  Commission,  .882 
work  in  French  hospital,  589 
Rove,  France,  captured  bv  Germans 

(1918).  464 
Rue  Censier  dispensary,  Paris,  805 
Rulon.  Blanche  S.,  chief  nurse,  U.  S. 
Armv    Base    Hospital    No,    27, 
500, "636 
Rural  Nursing  Service,   1211,   1235, 

1239.  1255-1203 
Russell,    ^lartha     M.,    chief    nurse, 
American    Red    Cross    Commis- 
sion  for   France,  379,  380,  482, 
540,  671 
committee  on  choosing  candidates 

for  medal,  1130 
tuberculosis    prevention    work    in 
France,  845 
Russell,    Martha,    work    in    France. 

547.  574 
Russell     Sage     Foundation     aid     in 
cooperation    witli    Rural    Nurs- 
ing. 1226 
Russia,    American    Red    Cross    com- 
niissidu,  677 
American    Red  Cross  work  amon.L'^ 
])risoii('rs  in,  at  request  of  (icr 
man  Govei-nment,  225 
nurses  of,  !>2(l 
Russian  Hospital,  Jerusalem,  893 


INDEX 


1549 


Russian  Island,  children's  colony  on, 

032 
Russian  Island  Hospital,  913 

reorganized,  931 
Russian  wounded,  ir)7-158 
Rust,   Captain    Arniistead,    in    com- 
mand of  S.S.  Red  Cross,  140 
Rutley,      Edith,      Spanisli-American 

and  World  War  service,  65 
Rutley,    Sophia,    cantonment    duty, 

380 
Rutty,  Isabelle  E.,  work  on  the  Lani' 

pasns  expedition,  31-32-33 
Ruzickova,       Franciska,      American 

training  as  nurse,  1150 
Ryan.  Dr.  Edward  W.,  in  command 
of  commission  for  Serbia,   1100 
conference     to     consider     nursing 

problems,  254 
director  of  Serbian  unit,  141,  170 
on     evacuation     of     Belgrade     by 

Serbs,  178 
ill  with  typhus,  181 
investigates      condition      of     Red 

Cross  imits  at  C.evgeli.  181 
on  retaking  of  Belgrade  bv  Serbs, 
179 
Rvan.  John   D.,   director  general   of 
Military  Relief,  364,  541 
estate    of,    at    Putney.    England, 
used  for  convalescent  home.  438 
Rykert,     Miss,     superintendent      at 
Post-Graduate   during   Spanish- 
American  War  period,  49 
Ryley,    Violet,    committee    on    Red 
Cross  Dietitian  Service,  1379 

Sag  Harbor,  Home  for  Convalescent 
Soldiers,  Red  Cross  services  at, 
62 
St.  Barnabas  Guild  Club  of  Nurses, 
offer  of  Spanisli-Ainerican  War 
services  from,  40 
St.  Crois,  Red  Cross  work  at.  1203 
St.    Etienne.    France,    Chnutalonrttc 
hospital.  1919.  789 
dispensary  opened,    1918.   788 
St.  .Tolin.   Nlrs.  Alici'.  cliief  inirso  of 
Siberian    Coiiunission.    912.    933 
closing    program    at    N'ladivostok. 

952 
on   coiulitioiis  in   Vladivostok.   914 
on  Czci'li  campaign  in  ."Liberia.  !>](') 
on  o(]uipmcnt   of  Tunioii   Hospital, 

923 
on      withdrawal      from      Verkhne- 
I'dinsk,  Siberia,  950 


St.    John,   Mrs.   Alice,   work   of,  at 

Chita,  Siberia,  950 
St.    Nazaire,    France,    diet    kitchen 
service  at,   1413 
dock  infirmary  at,  1012 
U.  S.  Army  Base  Hospital  No.   1 

at,  487 
U.  S.  Army  Base  Hospital  No.  101 
at,  487 
St.  Sulpice,  Paris,  work  for  refugees, 

836 
St.    Thomas,    Virgin    Islands,    Red 

Cross  Work  at,  1203 
St.    Valery-en-Caux,    American    Red 
Cross  vohmteer  nurses  at,  539 
hospital  at.    199 

Froncli   Military   Hospital  No.  43 
bis.  American  Red  Cro.ss  unit  in 
charge  of,   198 
Salaries  of  nurses,  697,  1027,  1031 
Salem  fire,  135 
Salomon,  Mrs.  William,  offered  J^n- 

don  home  for  hospital,  430 
Samos,  relief  work   in,   1113 
Samuel,    Mary,     superintendent     at 
Roosevelt,        during        Spanish- 
American   War  period.  49 
San  Francisco  County  Nurses'  Asso- 
ciation,  opening   of    Red    Cross 
State  Branch  by.  85 
San    Francisco   earthquake   and   fire 
(1906).   129 
volunteer  nursing  service  in,  82 
Sanatorium  I^f^ge,  tuberculosis  hospi- 
tal. S4S 
Sanborn.  Miss,  efforts  for  Red  Cross 

athliatioii.  71 
Sanders,  Dr.  Cliarles  H.,  director  of 

Mercy  Ship  I'nit  1.  162 
Sandliills   Hospital,   in   P'lorida   yel- 
low fever  epidemic,   16 
Sandinaier.  Barbara.  240,  1110 
Sanger.  Johnetta  B.,  one  of  first  six 
arniv  nurses,  appointment  of,  41 
Sanitation.  3.  8 
Santo    Domingo,    Red    Cross    relief 

work  in.  1199 
Sarishury    Court,     England,    U.     S. 
Arinv   Base  Hospital  No.  40  at, 
4:{S  ' 
Saunders.    Josephine,    appointed    to 
(h'velop      reronstruction      aides, 
277 
Savenay   Hospital   Center.   Miss   De- 
lano's operations  at.   1001 
I'.   S.   Arinv   Base  Hospital   No.  8 
in.  49()-499 


1550 


INDEX 


Savenay     Hospital     Center,    U.     S. 
Armv    Base    Hospital    No.     18 
in,  486 
Sawyer,  Margaret,  Bureau  of  Dieti- 
tian Service,   1432 
nutrition     member     of     National 
Committee,  1437 
Scattergood,     J.     Henry,     director, 

American  Friends,  France,  827 
SchaflFer,  Margaret   E.,   one  of  first 
six    Army   nurses,   appointment 
of,  41 
Schaub,    Miss,    work    in    Hungary, 

1197 
Scheitlin,  Marion   G.,  aid   in   Chau- 
tauqua campaign,  1058 
Schenck,  Mrs.  E.  G.  H..  State  Com- 
mittee of  New  York.  110 
Schereschewsky,    J.    W.,    Committee 

on  Rural  Nursing,  121G 
Schiff,    Jacob    H.,    Board    of    Incor- 
porators     of      American      Red 
Cross,  1213-1214 
Schiff,  Mr.  and  Mrs.  Jacob  H.,  loan 
of      estate      for      convalescing 
nurses,  1033 
Rural  Nursing  Service,  1215,  1276 
Schneider,  Anne  E.,  at  Field  Hospi- 
tal   No.     27,     Chateau-Thierrv, 
656 
Scholarship     and     loan     fund     for 
nurses.    1279-1281,    1283,    1284, 
1288,  1290 
Schools  for  Nursing,  Army,  960,  963- 
905 
in  Europe,  1191-1193 
in   France.  521-523 
in  Greece,  1182 
in  Poland.  1159.  1160 
in  Warsaw,  Poland,  1163,  1164 
Naval  Hospital  Corps,  712 
navy  units,  093 
Schuyler,  Loiiisa  Lee,  on  Civil  War 
lack  of  trained  nurses,  5 
executive,  "Women's  Central  Asso- 
ciation of  Relief,"  6 
member  of  Army  Nurse  Corps,  leg- 
islation committee.  67 
Scott,   Charles   E..   Central    Commit- 
tee of  American  Red  Cross,  1007 
European      Inquiry     Commission, 

1188 
Executive     Committee     American 
Red  Cross.  1007 
Scrymsor.  Capt.  James,  gift  of  Na- 
tional  Red  Cross  Headquarters 
by,  12 


Scutari,  Red  Cross  aid  at,  1108 
Sedgwick,   Dr.   John   P.,   member  of 
Children's  Bureau,  France,  758 
work     of    Children's    Bureau    at 
Toul,  766 
Sedlacek,  Mary,  Chautauqua  nurse, 

1055 
Selective  draft,  390 
Selective  Service  Law,  389 
Sellenings,  Dr.  Oscar  H.,  child  wel- 
fare work  at  Marseilles,  France, 
791 
Sellier,  Henri,  work  for  tuberculosis 

prevention  in  France,  851 
Semenoff,  General,  919 
Sennott,     Katherine     G.,     Hospital 

Unit  "S."  496 
Serbia,  American  Red  Cross  work  in, 
at   request    of   German   govern- 
ment, 225 
child  welfare  in,  1190,  1191 
conditions    in    military    hospitals, 

188 
entry  into  World  War,  176 
relief     work     of     American     Red 

Cross,  1100,  1117 
typhus     epidemic     in,     154,     179, 
183 
Serbian    patients    at    Belgrade    Red 

Cross  hospital,  185 
Service  de  Sajite,  A.  L.  F.  Fitzgerald 
in  charge  of  work  with,  583 
nurses  assigned  to,  579-595 
Sewny,   Mrs.   L.   C,   Palestine  Com- 
mission, 892 
Seymour,  Nina  Louise,  death  of,  in 

line  of  duty,  1032 
Shackford,     Clara     L.,     supervising 
nurse,   Bureau   of  Tuberculosis, 
France.  846 
Shaneman,  Mary  E.,  nursing  service 

in  Santo  Domingo,  1199 
Shaw,  Agnes,  appointed  for  Philip- 
pine service,  63 
Shaw,  Sara  E..  appointed  for  Philip- 
pine service,  63 
on   nursing  system  in   Italy,  858, 

862-864 
story     of    Lampasas    experiences, 
33,  34 
Shaw,     steamship,      collision      with 

A  (/ui  fan  in,  727 
Slieelian,  Mary  E.,  chief  nurse  at  Old 

Colony  Chib,  420 
Shelton.      Nina,      nursing      service, 
A.    E.    F.,   at   Chateau-Thierry, 
034 


INDEX 


1551 


Sherman,  Elizabeth  F.,  work  at  Hal- 
ifax explonion,   1017,  136 

Ships,  convoy  system  of  transporta- 
tion, 718 

"Shock  teams,"  658 

Shott.  Rutli,  dietitian  overseas,  1410 

Siirady,  Mrs.  (Jeorjre  H.,  pioneer 
member  of  Auxiliary  No.  '.i,  47 

Shurley,  Dr.  Burt  E.,  director,  Base 
Hospital  Xo.  36,  ^^0\ 

Siberia.   American   Red   Cross  relief 
work,  <)10,  i)2n,  1130 
American  troops  sent  to,  911 
conditions  in,  920-022 
educational  nursinp  service  in,  934 
typhus  epidemic  in.  1918,  918 

Sibonev.  refusal  of  Miss  Barton's  aid 
at*  27 

Sicily,  earthquake  in,  1908,  131 

Martha   Washington    Hospital   in, 
865 

Sick  nurses,  caro  of.  1034.  103;i 

Siclirs.  Mary,  ill  with  typhus,  191 

Sijjray.  Countess.  173 

Silliman,  Mrs.  Clias..  aid  in  propar- 
iu'T  saniph>  liospital  supplies.  208 

Simmonds.  Emily  Louise,  on  sani- 
tary conditions  in  military  hos- 
pitals in.  187 

Simon.  Marjjaret  B..  work  in  Pliila- 
delphia  buildinj;  disaster.  1009, 
131 

Simons.     Olive     M..     cliild     welfare 
work.  France.  1918,  809 
nursing  service  in   Haiti.   1171 

Sims.  Rear  Admiral  W.  S..  com- 
mander of  American  naval  oper- 
ations overseas,  718 

Singer.  Paris,  loaning  of  ''Oldway 
House"  by.  for  hospital  pur- 
poses. 146 

Sister  Adeline  Taylor,  nursing  serv- 
ices of.  in  Civil   War.  8 

Sister  Chrysostom.  665 

Sister   Isabella.  t)(i5 

"Sister."  as  title  of  nurses  on  Mercy 
Sliip  expedition.  142 

Sisterhoods,  nursing  services  of,  in 
Civil  War.  7 

Sisf.Ts.  Red  Cross.  22.  23 

Sisters  of  St.  \'iiici'nt  de  Paul,  in 
N'apcdennic  Wars.  2 

Skinner.  Mrs.  Robert  P..  L<in(lon 
Chapter.  A.  R.  C.,  425 

Skorupa,  Emily,  in  Countess  Zamoy- 
ska's  Domestic  Science  Scliool 
in  Poland,  1005.   1006 


Skorupa,   Emily,  nursinj:^  school    in 

I'oland.  1159 
Slack,  Annie,  relief  work  in  Albania, 

1110 
Slemons,  Dr.  and  Mrs.  J.  M.,  mem- 
bers     of      Children's      Bureau, 
France,  758 
Slocum,  Colonel  S.  L.  D.,  140 
Slonim.  Poland,  hospital  conditions, 

1000 
Siusher,  Clara,  ill  with  typhus,  190 
Smallpox  in  Haiti.   1172 
Smedley.  Emma.  Conunittee  on  Red 

Cross   Dietitian  Service,   1379 
Smith,  Dr..  in  Serbia.   1125 
Smifli,   Emily   Hamnwmd.  child   wel- 
fare work  at  Marseilles,  France, 
791 
Smith,  Dr.  H.  S.   B..  dispensary  at 

St.  Etienne,  France,  1918,  788 
Smitii.  Helen,    183 

transferred  to  St.  Valerv-en-Caux, 

108 
transferred     to     Yvetot,     France, 
184 
Smith.   Molly   B.,   on   dispensary   at 
Corbeil.  France.  700 
on  work  at   Hospital  Betz,  594 
Smith.    Dr.    Rea.    director    of    V.    S. 
Xavy  Base  Hospital  Xo.  3.  722 
Smith.   Sara    S..   nursing   service    in 

Tfaiti.  1173 
Smith.    Colonel     W.    H..    Chairman, 
Advisory    Connuittee    of    Army 
scliool  of  nursing.  285 
conference     to     consider     nursing 
problems.  254 
Smith.   Dr.   Winford   H..   Committee 
on  Rural  Xursing,  1216 
director    general    of    Military    Re- 
lief. 3t)4.  374.  541 
on     emergency     detachments 

(191S).    .-^16 
on   expens(>  of  nurses'  equipment. 

3S1 
organized    Base   Hospital    X'o.    18, 

486 
Town  and  Countr^•  Xursing  Com- 
mittee.  1210 
Smitli.  Colonel  Winford  H.,  training 
of  Army  nursi's.  2S6 
on    uniforms    of    Roman    Catliolii' 

Sisterhoods,    377-378 
w,Mr  nursing  policy.  254 
Smith    College   i'nit.   ranteen   of,   for 

refii;.'ees   in    Paris.   ^^2 
Smitliie,  Dr.  P.  A.,  IGS 


1552 


INDEX 


Smythe,  Eva  Louise,  dispensary  at 

St.  Etienne,  France,  1918,  788 
Snively,  Emily  C.,  Sanitary  Unit  No. 

5,  402,  403 
Snively,  Mary,  early  nursing  super- 
intendent, 19 
Snively.   Dr.  H.   H.,   senior  director 

of  Units  C  and  H,  158 
Snoddv,  Dr.  Cary  A.,  director  of  Red 
Cross  hospital  at  Vienna,  167 
on  arrival  of  Austrian  wounded  at 

Vienna,  168 
on     effectiveness     of     projectiles, 

170 
German    prison    work    in    Russia, 

166 
senior  director  of  American  Red 
Cross  Units,  166 
Snow,  Mary,  in  Serbia,  1117 
Snyder,  Juliet,  child  welfare  work, 
France,   1918,  809 
in  dispensary  at  Rue  de  Pre-Saint 
Gervais,  808 
Societe  de  Secours  aux  Blesses  Mili- 

taires,  848 
Societe  de  Secours  aux  Rapatries,  at 

Lyons,  782 
Society  for  Maintenance  of  Trained 

Xurses,  60 
Society  of  Public  Utilitv  of  Geneva, 

6 
Society    of    Spanish-American    War 

Xurses,  46 
Society  of  Superintendents  of  Train- 
ing Schools  for  Nurses,  20 
Sofia,     Bulgaria,     niirses'     training 

school  at,  210 
Soldier-orderlies.  961 
Soldiers'  families,  assisted  by  Flor- 
ence Nightingale,  4 
Soukup,  Eleanor,  on  Persian  sanita- 
tion and  customs,  159-160 
South    Carolina,    rural    nursing   in, 

1228 
Southampton,  England,  U.  S.  Army 

Camp  Hospital  No.   36,  436 
Southmayd,  Col.  F.  R.,  work  in  yel- 
low fever  epidemics.  14 
Southwestern  Division  of  Red  Cross, 

246 
Spanish-American    War,   Red    Cross 

services  in,  25 
Spaulding,   Helen   M..   child  welfare 
work.  Franco.  1918,  809 
Hopifril  Auxiliare,  Vo.  3'/,  199 
volunteer    service    at    St.    Valery 
539 


Special  Service  Group,  278,  279,  281, 

282 
Spelman,  Lillian  M.,  Palestine  Com- 
mission, 892 
Wadi    Surar   Hospital,   Palestine, 
898 
Speyer,  Mrs.  James,  ex-ofEcio  mem- 
ber of  Committee  on  Nurses  for 
the  Philippines,  62 
pioneer  member  of  Auxiliary  No. 
3,  47 
"Splint  teams,"  658 
Springport,    Mich.,   nursing    service 

at,  1917,  136 
Stack,    Elizabeth,    work    at    Angel 

Island,  64 
Stambaugh,    Isabelle,    on     casualty 
clearing  station  team,  465 
wounded  at  Amiens,  465,  1031 
Stanley,    Anna    S.,    conferences    on 
school  nursing,  1335 
director  of  Public  Health  Nursing 
in  Southwest,  1304 
Starr,     Lida     G.,     appointment     to 
Manila,  59 
appointment  to  Philippine  service, 

63 
work    of,    at    General    Hospital, 
Fortress  Monroe,  59 
State   Associations   of   Nurses,   sug- 
gestion  for   substitution   of   for 
State  Nursing  Committees,  86 
State  Committees,  for  enrollment  of 
nurses,  106 
organization  of,   110 
State  Health  Departments,  relation 

to  Red  Cross,  1318-1321,  1326 
State  Nursing  Committees,  in  effec- 
tiveness of,  86 
State  Societies  of  Nurses,  entitled  to 

Red  Cross  membership,  112 
State  of  Texas,  as  Red  Cross  Relief 

Ship,  plans  for,  25 
Statistics,     death     toll     of     various 
countries,   985 
numbers  serving  in  American  Red 

Cross,  1919,  1131 
numbers    of    soldiers    sent    home 

after  Armistice,  1009 
nurses  needed   (1918),  967 
percentage   of   deaths  due   to   dis- 
ease, 986 
Steelman.  Katherine,  volunteer  work 
in  Siberia,  915 
work  at  Irkutsk,  945 
Stenliolm,  Alice  F.,  service  on  Virgin 
Islands,  1204 


INDEX 


1553 


Stern,  Frances,  social  service  work, 

France.  1918,  80!) 
Sternburf^.  Siirf^eon   (General   Georj^e 
Miller,  and  the  Red  Cross,  2!t 
demand  tliat  Cuban  nurses  be  im- 
mune to  yellow  fever,  .SI 
first  action  from,  toward  recofj^ni- 

tion  of  Army  Nurse  Corps.  4(5 
on   orif^in   of  Army  Nurse   Corps, 

:Ui-.38 
to  Mrs.  Whitelaw  Reid,  on  plan  to 
use    Red    Cross    nurses    in    base 
iiospitais,  f)? 
Sternberjjf     Hospital,    Cliickamauga, 

Ri'd  Cross  services  at,  01 
Stevens,  Dr.  Marion,  in  Serbia,  1117 
Stevenson,   Mrs.   Beatrice  V..   in   de- 
fense of  Home  nursing  teacliing, 
81 
on  Red  Cross  health  education,  81 
services  for  Red  Cross  enrollment, 

70 
State  Committee  of  New  York.  110 
work  in  Brooklyn  for  Home  Care 
Nursing.  SO 
Stcvensdn,  W.   C,   in  charge  of  ad- 
ministration, Chiitelet   liospital, 
77!) 
work  at  Evian-les-Rains.  777 
Steward.  Leohi.  member  of  operating 

team   sent    to   line.   74;') 
Stewart.  Isabel  M.,  League  of  Nurs- 
ing  Education   Aidi-s   course   at 
\'assar,  'iOS 
vork   for  National   Committee  on 
Nursing.  20.") 
Stewart.    Misses,    volunteer    helpers. 

241 
Stiies.  Mildred  C...  chief  dietitian  at 
(Jreat     Lakes     Naval     Training 
Station  I?ase  Hospital.  i:i!t7 
Stillinan.  Miss  Cliarlotte.  .'502 
Stilhnan.    Dr.    Stanley,    directnr    of 
r.  S.   Naval   Base   Hospital  No. 
2.  721 
Stirnsnii,  .lulia  C.  career  of,  :n2-3i:?. 

.•JOO.  010 
Stiiiisoii.    .Julia,    camjiaign     for    re- 
cruiting nurses.  liitJO 
chief   nurse.   American    Red   Cross 

in    l-'rance.   ")04.  .")00 
chief  nurse,  Hase  liospital  No.  21, 

407 
dean  of  Artny  Nursing  School.  2^0 
Delano  Memorial  (  oniinit  t  ee.   ]n.")l 
in  eniergeiu  y  liospital  at  douy-sur- 
Morin,   tiiiC. 


Stimson,    Julia,    International    Con- 
ference at  Cannes    (191!)),   1137 
National    Committee    on    Nursing 

Service,   127 
National  Committee  on  Red  Cross 

Nursing  Service,  249 
on  care  of  sick  Army  nur.ses,  10.34 
on    conditions    at    American    Red 
Cross   Hospital   No.    104,   Beau- 
vais,  France,  .'jOC,  .'599 
on  hospital  train  service,  642 
on   nurses   assigned  to  emergency 

hospitals,  017 
on  nurses'  ecpiipment  for  military 

nursing  service,  .575 
on     position     of     chief     nurse     of 

American  Red  Cross,  ")07,  .'iOS 
on  qualifications  for  hospital  train 

service.  043 
on  tour  of  Beauvais  area,  581 
on  work  with  Army  nurses,  628 
superintendent    of     Armv     Nurse 

Corps.  311.  312 
work  at  Dayton  fioods,  1013.  134 
Stimson.  .Major,  takes  over  dietitian 

■service,   1427 
Stirk.  Miss.  Philippine  service,  63 
Stock.  Pauline  I.,  on  "shock"  work, 

0.")9 
Stone,    Frances   A.,   appointment  of, 
as  Assistant   Superintendent  at 
the  Sternberg  C   S.   Field  Hos- 
pital. rr2 
service  of.  04 
Storrs.     ('(donel      Ronald,     military 

go\'ernor  of  .Jerusalem.  893 
Straight.    Mrs.    Willard,    Town    and 
Countrv      Nursing     Committee, 
121!) 
Strode.       Elizabeth       Coombs,       on 

••Shock"  work.  0.-)S 
Strong.  Anna   11..  Advisory  Commit- 
tee of  Nightingale  School,    1049 
League      of      Nursing      Education 
aids    ])reparing    course    at    Vas- 
sar,  2(iS 
National  Connnittee  on  Red  Cross 
Nursing  Service.  24!) 
Strong.    Anne    Hervey.    revision    of 

textbook.  ];if>S 
Strong.  Major  .J.  N..  head  of  Vladi- 
vostok hospital.  !):<!• 
Strong.  Dr.  Kiclianl  P..  head  of 
typhus  coiinuission  of  Rocke- 
feller Kouiulat  ion  and  Ameri- 
can Red  Cross  in  Serbia,  183- 
1S4 


1554 


INDEX 


Stronpr,    Dr.    Richard    P.,    medical 

director  of  League,   1143 
Strong,  Wendel  M.,  National  Advi- 
sory   Committee    on    Insurance, 

1042 
Stuart,    Dr.    Bertha    B.,    Children's 

Bureau  at  Blois,  France,  797 
on  work  at  Blois,  France,  797 
Stuck,    Archdeacon    Hudson,    letter 

concerning  nurse  at  Ft.  Yukon, 

282 
Student   Nurse    Reserve    Campaign, 

293-296 
Stuff,  Lillian  B.,  delegate  to  Ninth 

International  Red  Cross  Confer- 
ence, 1912,  124 
public     health     work     at     Lyons, 

France,  850 
work   after   Omaha  cyclone,   1913, 

132 
Subcommittee  on  Red  Cross  Nursing 

Service,  organization  of,  94 
Submarine  attack,  1918,  718 
Submarine  chasers,  base  at  Queens- 
town,  719 
Suchowski,  Marie,   in  charge  of  re- 
lief   work    at    Minsk,    Poland, 

1080,  1093,  1159 
Sundberg,    Anna    ]\I.,    child    welfare 

work,  France,  1918,  809 
Superintendents,    eligibility    of,    for 

Red  Cross  service,  84 
Superintendents,        nurses.        Army 

Nurse  Corps  legislation,  08 
women  as  pioneers,  19 
Superintendents'  Society,  71 
Supervising  nurses,  authority  of,  210 
Supplies,  Bureau  of,  231 
Stirf,  as  ambulance  ship,  701. 
Surgical  teams,  at  casualty  clearing 

stations,  401 
Sutliffe,     Irene     11..     Army     Nurse 

Corps  legislative  efTorts,  08 
at  Camp  lihuk,  51 
early  nursing  superintendent,  19 
New  York  Hospital,  service  record 

of,  49 
Swan,   Dr.,   of   Rochester,  ^Tinn..   on 

organization    of   base   hospitals, 

332,  333 
Swan,  Mary  Rnih,  assislant  to  Miss 

MinnijjK'rode.    102S 
Swayzc.  Kflie,  in  Serbia,  1119 
Swift,  Dame  Saraii.  Britisli  Nursing 

Service,  47(! 
Swope,   Etiiel,   at   Ilupital  Auffrcdi, 


Syria,  888 

Turkish    massacre   of   Armenians 
in,  1914,  889 

Syrian  and  Armenian  Relief,  Amer- 
ican Committee  for,  889 
American  Red  Cross  funds  appro- 
priated for,  891 

Szechenyi,  Countess,  presentation  of 
X-ray  apparatus  to  Unit  E  by, 
173 

Taft,  President  Wm.  H.,  Chairman 

Central  Committee,  230 
issue  of  proclamation  relating  to 

Red  Cross  service,  1911,  120 
National     Committee     to     Secure 

Rank  for  Army  Nurses,  1070 
president      of      reorganized      Red 

Cross,  74 
Talleyrand-Perigord,  Count  Helie  de, 

161 
Tampa,  Red  Cross  nurses  at,  61 
Tanguay,  Alice  A.,  at  Tarnopol,  Po- 
land, 1094 
Tanner,  James,  Central  Committee, 

230 
Taormina,  Italy,  convalescent  home 

for  cliildren  at,  806 
Tarnowsky,  Dr.,  619 
Taylor,    Carl,    Commission    for    Eu- 
rope. 530 
Taylor.    Catherine,    chief    nurse    of, 

Oldford  House  hospital,  722 
Taylor,  IMajor  IT.  W.,  head  of  Relief 

in     Department     of    the     East, 

1087 
Tennant,      Adelaide,      at      National 

Headquarters.  240 
Tennessee,  public  health  nursing  in, 

1349 
Terni     de     Gregory,     Winifred,     on 

training  of  nurses,  870 
Tensler,    Dr.    R.    B.,   appeals   of,    to 

American  Mission  hospitals  for 

aid    in    Siberia,    August,    1918, 

914-915 
investigations  of,   in   Vladivostok, 

912 
Texas,  public  healtli  nursing  in.  1349 
Tlialeher,  Mrs.  John  S.,  30 1,  302 
chairman.      Uniform      Committee, 

resignal  ion  of.  3/  1 
Thayer,  William  S..  on  nursing  con- 

(lilions  in  France.  518 
tribute  to  IMiss  Delano,   1005 
Thomas,  Ellen,  rc'serve  nurse  serving 

on  Mexi(!an  border,  354 


INDEX 


1555 


Thomas,    Gertrude,    on    dietetic    in- 
struction    to     Navy     Hospital 
Corps   Men,   l.SJtH 
Tiiompson,  Dora  K.,  311.  312.  :}44 
American   Red  Cross  parade,  New 

York,  420 
approves   plan   for   special   enroll- 
ment of  nurses,  2.")H 
conference   of   medical    and   Army 

officers  and  nurses,  284 
conference    on    nursin<^    problems, 

254 
National  Committee  on  Red  Cross 

Nursing  Service,  24!) 
need     for     supervising     dietitian, 

1425 
nurses'  cantonment   service,  393 
nurses'    training    after    armistice, 

984 
nursing  service  changes,  310 
Thompstm,  Miss,  on  rank   for  army 
nurses,  10(J!) 
on   uniforms  and   insignia   of   Ro- 
man  Catholic   Sisterlioods.   37(')- 
377 
on    uniforms    of    reserve    nurses, 
Armv    Nurse    Corps,    3G2,    309. 
372  ' 
plans  for  armv  school  of  nursing, 

2S() 
superintendent     of     Armv    Nurse 
Corps.  311-312.  314 
Thompson.  Margaret  K..  cliicf  nur^e. 

Base  Ilosi)ital  Xo.  .")7.  000 
Tiiompson.  Olivt'  !..  on  conditions  at 

\'iIlers-sur-.Manie.  (I.").! 
Tlioriitoii.   MisM   Mary   K..   Secretary 
of    tlie    Associated    Alumna',    ef- 
forts  for    Red    Cross   alliliation, 
71 
Tliurman,    Mrs.,    dietitian    overseas. 

1410 
Tibbels,  T'rsiila.  in  Serbia.  1124 
'iiberias,       Palestine.      lios])ital      at. 

!t04 
Tice.  Mrs.  Fredeiiik.  National  Com- 
mittee   on     Red    Cross    Nursing 
Service.  !)."..   111.   127.  24!l.  !).1S 
State  Coinrnittee  of  Illinois.  I  U) 
TifTany.  Mrs.   j'.elniont.  head  of  New 
^'ork■    ('it\     wurkrooin    for    sur- 
gical  dre-siiiL's.  2!l!' 
TifTanw  Mrs.  Cliarles,  Coinmittce  fur 
.Nlemoiial      l-"iiiid     to     American 
Nurses.    1(I4S 
TifTanv.    Ruth,    classes    in    dietetics. 
137G 


Tirana,    Albania,    relief    work    in, 

llOit,   1110 
Tittman.  Anna  T..,  in  charge  of  third 
Siberian  nursing  unit,  !)30 
chief   nurse   of   Eastern    Division, 

!>3.3 
cliief  nurse  at  Vladivostok  hospi- 
tal. !»3!) 
sails  for  home  from  Siberia,  052 
T(nnsk,  Siberia,  American  Red  Cro.sa 

activities  at,  1)42 
Torney,  Dr.  (ieorge  11.,  appreciation 
of  Miss  I)(dano's  work  in  Army 
Nurse  Corps.  !»8 
surgeon  general  of  United  States 
Armv,  325,  320 
Torrance,'  Rachel.   1100 

chief  nurse,  American  Red  Cross, 

in  fireat  Britain,  441 
in  Serbia.  1117 

organization   of  Nurses'  Training 
School  at  Sofia,  Bulgaria,  1!)15, 
21!) 
Roumanian  Commissitm.  S82 
visit  to  devastated  area.  !)80 
work  in  Czecho-Slovakia,  1  I'M 
Tottenham.     England.    V.    S.     Base 

Hospital  No.  2!),  438 
Toul,     France,     dispensaries     estab- 
lished at,  7()8 
maintenance  of  jiroject.  771 
work  of  Children's  Bureau  in.  705 
Toulouse.   France,  child   welfare  ex- 
position,  1018.  705 
Touniiur.  S.K.,  burning  of,  l(i5 
Town  and  Counlrv  Nursing  Service. 
237.  210.  121S.  12l!t.  1225,  1230. 
1238,     1230.      1204-12(;0.     12()8, 
1271.   1272,   1277.   127S 
Towne.    Miss,   ajiiiointed    for    Philip- 

]nne  service.  03 
Townsend.   Howard,  on  special  com- 
mitti'e  for  closer  cociperation  be- 
tween   Red    Cross    and    Covern- 
nient .  57 
Trained     nurses,    lack    fif.    in    Civil 

Uar.   5 
Transfer.  Couimitfee  of.  1021 
Trans-Siberian    Railroa.l.  itlO. '■027 
rraiis|ior1at  i<in  of  troojis  and  supply 

slii|i-.    t-jn.   71S 
Traiitei'.    (ajit..    operation    on    Miss 

Delann.    llMi] 
Tra\eling  ilispi'nsa  ries.  .">IS 
Travis.      Dr.      (  at  lieriiie.      as-istant. 
Mabel   Cror.itch    Baliv   Hospital, 
210 


1556 


INDEX 


Treport,  France,  evacuation  of,  466 
U.  S.  Army  Base  Hospital  Ko.  10 

at,  459 
Treves,  Sir  Frederick,  on  organized 

volunteer    aid    for    Red    Cross, 

324 
Triage,  664 
Trippett,    Josephine,    Pelham    Bay 

Training  Station,  717 
Trudeau,    Edward    T.,    Sanatorium, 

851 
Tuberculeux  de  la  Guerre,  844,  848 
Tuberculosis,  work  of  the  American 

Red  Cross  to  combat,  843  et  seq. 
Tuberculosis   Association,   National, 

cooperation     with     Red     Cross, 

1326-1330 
relation    with    Red    Cross,    1321- 

1323 
Tuberculosis  Bureau  of  Civil  Affairs 

Department,  757,   843 
Tuberculosis,    Commission    for    Pre- 
vention  of,  in   France,   844 
Tuberculosis     hospitals      aided     by 

American  Red  Cross,  848 
Tuck,   Mrs.   Edward,  president,   Tu- 

herculeux  de  la  Guerre,  844 
Tucker,    Katherine,     Committee     of 

Transfer,  1021 
Tulloss,  Clara,  ill  with  typhus,  190 
Tumen,    Siberia,    evacuated   because 

of  Bolsheviki,  942 
Tumen   Hospital,   Siberia,   923 
Tupman,    Mrs.,    delegate    to    Ninth 

International  Red  Cross  Confer- 
ence,  1912,    124 
Turczynowicz,  Mme.  Laura  de  Goz- 

dawa,    recruiting    relief    nurses 

for  Poland,  1085 
Turkey,   889 
Turkish      Municipal      Hospital      at 

Jerusalem,  894 
Turnbull,    Dorothy,    chief    nurse    of 

American    Red    Cross    Hospital 

No.   104,  at  Beauvais,  598 
Turnure,  Major  P.  R.,  345 
Tuscania,      Steamsliip,       torpedoed, 

i;jl8,  720 
Tuttle,   Jennie   L..   work   at   Davton 

floods.  1913,  134 
Twiss,  Mrs.  C.  V.,  State  Committee 

of  New  York.   110 
Twitchell,  Dollv,  Chautauqua  nurse, 

1053 
Tye.  Menia  S.,  National  Committee 

on   Red   Cross  Nursing  Service, 

249 


Tylski,  Stella,  Municipal  Hospital  at 
Cracow,  Poland,  1096,  1159 

Tymon,     Mary     Margaret,     nursing 
service  in  Greece,  1111,  1115 

Tvplius  epidemic  in  Serbia,  154,  179, 

918,  1119 

work   of    sanitary   commission   of 

Rockefeller       Foundation      and 

American  Red  Cross  in,  183-184 

Typhus  Research  Hospital  at  War- 
saw, Poland,  1092 

ZJmbria,  Steamship,  carried  unit  of 

Base  Hospital  No.  102  to  Genoa, 

668 
Uniforms,    of    Navy    Nurse    Corps, 

694-696 
of  Public  Health  Service,  1028 
United    States,    in    European    War, 

485  et  seq. 
U.  S.  Army  Base  Hospitals: 

Hospital     No.     1,     St.     Nazaire, 

France,  487 

Vichy,  France,  505 
Hospital   No.   2,   :6tretat,  France, 

454 
Hospital  No.  4,  442-452 

unit  of,  at  Rouen,  France,  442- 

452 
Hospital  No.  5,  Dannes  Camiers, 

France,  452 

transferred      to      Boulogne-sur- 

Mer,  453 
Hospital  No.  6,  Bordeaux,  France, 

493 
Hospital  No.  8,  Savenav,  France, 

496-499 
Hospital     No.      9,      Chateauroux, 

P'rance,  499 
Hospital     No.     10,     Le     Treport, 

France,  459 
Hospital  No.  12,  Dannes  Camiers, 

France.  469 
Hospital  No.  13,  Limoges,  France, 

508 
Hospital  No.    14,  Mars-sur-Allier, 

France,  511 
Hospital      No.       15,      Chaumont, 

France,  493 
Hospital    No.    17,    Dijon,    France, 

494 
Hospital  No.  18.  Bazoilles,  France, 

4SS 

temporarily     assigned     to     Sav- 
enav, France,  485-486 
Hospital   No.    19,   Vichy,    France, 

509 


INDEX 


1557 


U.  S.  Army  Base  Hospitals: 

Hospital     No.    20,     Chfltedguvon, 
France,  506,  507 

Hospital   No.  21,   Rouen,  France, 
467 

Hospital  No.   23,   Vittel,   France, 
503 

Hospital  No.  24,  Limoges,  France, 
504 

Hospital      No.      27,      Mongazon, 
France,  500 

Hospital  No.  29,  Tottenham,  Eng- 
land, 438 

Hospital    No.    32,    Contr^xeville, 
France,  503 

Hospital  No.  33,  Portsmouth,  Eng- 
land, 436 

Hospital   No.   36,   Vittel,   France, 
501 

Hospital   No.   37,  Dartford,   Eng- 
land, 437 

Hospital  No.  40,  Sarisbury  Court, 
England,  438 

Hospital  No.  46,  Bazoilles,  France, 
508 

Hospital  No.  82,  Luxembourg,  623 

Hospital    No.     101,    St.    Nazaire, 
France,  487 

Hospital     No.     102,     on     Italian 
Front,  665 

Hospital  No.  202,  741 

Hospital     No.     204,     Winchester, 
England.  432 

Hospital  No.  449,  Alars-sur-Allier, 
France,  511 
U.  S.  Armv  Base  Section  No.  3,  Eng- 
land, 426 
U.  S.  Army  Camp  Hospital  No.  34, 
Romsey,  England,  433 

Hospital  No.  35,  Winchester,  Eng- 
land. 428 

Hospital     No.    36,    Southampton, 
England.  436 

Hospital   No.   40,  Liverpool,  Eng- 
land. 432 
U.  S.  Army  Medical  Corps,  coopera- 
tion with  American  Red  Cross, 
(>31 

in  France.  1917,  484 
United     States     General     Hospital. 

Fortress  Monroe.  0  7 
U.  S.  Navv,  activities  of,  at  Cihral- 
tar.  7"l9 

hospitals   of,   equipped   by   Ameri- 
can Red  Cross,  720 

Nurse  Corps.  686 

overseas  service  of,  718 


U.  S.  Navy,  participation  in  North 
Sea   activities,    719 
personnel  of,  1917,  698 
training    of    personnel    for    Euro- 
pean War,  698 
training  units  in  schools,  699 
U.    S.    Navv    Base   Hospital    No.    1, 
694,  728,   733 
Hospital      No.      2,      Strathpeffer, 

Scotland,  721 
Hospital  No.  3,  Edinburgh,  Scot- 
land. 722 
Hospital   No.   4,  Whitepoint,   Ire- 
land, 725 
Hospital  No.  5,  728 
U.  S.  Navy  Hospital,  at  Guam,  732 
United  States  Public  Health  Service, 

398,  399,   1023 
United  States  Sanitarv  Commission, 
6-9 
Civil  War  relief  work  of,  6 
L'pham,  Anne  T.,  first  dietitian  over- 
seas,  1381,   1382 
Upjohn,   Anna   Miles,   child   welfare 

work.  Lyons,  France,  784 
Urch,    Daisy    D.,   chief   nurse,    Base 

Hospital  No.  12,  469 
Uskub,  sanitary  conditions  at,  188 
Utley,    Grace,    at    Mabel    Grouitch 
Baby  Hospital,  216 


Valence,  France,  dispensary  at,  842 

playground  established  at,  842 
Van  Blarcom.  Carolyn  C.,  American 
Red   Cross    parade.    New    York, 
420 
Army  Nurse  Corps  uniforms.  361, 

3t).S 
Nursing    Service.     Atlantic    Divi- 
sion. American    Red  Cross,  244, 
245,  362,  :{().").  371,  383 
resignation  of.  372 
Van  de  Vrede,  Jane.  Committee  on 
memorial  for  Miss  Delano,  1050 
division  director  of  luirsing.   10:58 
for   Nortli   and   Soutli   Carolina, 
Florida.  (kH)rgia  and  Tennes- 
see. 24(i 
public  healtli  nursing  service,  1303 
on    Red  Cross  ai(h'   plan,   10.12 
Van   DuziT.  Charlotte  K..  Bureau  of 

Public  Health  Nursing.  1302 
van  Dyke,  Dr.  Henry,  1(11 
Van    Ingen,    Frances   1".,   chief  nurse 
of    I'.    S.    Navv    Rase    Ho-^pital 
No.   1.  734 


1558 


INDEX 


Van  Ingen,  Frances  F.,  on  conditions 

at  Brest,  France,  738-740 

on  Aliss  Delano's  talk  to  nurses  of 

Navy  Base  Hospital  No.  1,  998 

on  organization  of  staff  of  U.  S. 

Navy  Base  Hospital  No.  1,  734 

on  U.  S.  Navy  Base  Hospital  No. 

1  at  Brest.  *736 
reception  to  Miss  Delano  at  Brest, 
996 
Van    Meter,    Anna    R.,    Bureau    of 

Dietitian  Service,  1436 
Van  Schaick,  Dr.  John,  Commission 
for  Europe,  531 
Commissioner  to  Belgium,  817 
Vanderbilt,  Mrs.  William  K.,  spon- 
sor for  American  Ambulance  at 
Neuilly,  France,  536 
Vassar  College  nursing  course,  268 
Vaudling,  Marjory,  at  Le  dandier, 

819 
Vaughan,   Mrs.   Elsbeth   H.,   at  Na- 
tional   Headquarters,   240 
nursing  direction,  1195 
school  at  Dorpat,  1194 
work   in   Baltic   States,   1197 
Vaughan,    Victor    C,    on    rank    for 

Army  nurses,  1069 
Verkhne-Udinsk,  provost  guard  hos- 
pital     under      American      Red 
Cross,  947 
withdrawal      of      American      Red 
Cross  from,  949 
Vernon,    Miss,   State    Committee   of 

West  Virginia,   110 
Veterans'    Bureau,    Nurse   Corps    of 

the,  1030 
Veuille-les-Roses,  convalescent  home 

at,   195 
Vichv,  France,  Base  Hospital  No.   1 
at,  505 
Base  Hospital  No.  19  at,  509 
Vickerv,  Dr.,  in  charge  U.  S.  Navy 

Base  Hospital  No.  1,  734 
Vienna,  established   Red  Cross  hos- 
pital  at,   bv   Mercy   Ship   Unit 
K,   167 

closing  of,   171 
record  of,  171 
shortage  of  food  and  supplies  in, 

169 
treatment   of   Red   Cross   unit   at, 

169 
welcome  of  Red  Cross  unit  at,  173 
Vilctoria      Theater     liospital.       Hce 
(Heiwitz. 


Vilna,  Poland,  equipment  of  Polish 

Army  hospital  at,  by  American 

Red  Cross,  1092 
Violet,  Hospital,  at  Lyons,  624 
Virgin   Islands,   nursing   service   in, 

1202-1204 
Visiteuses  d'enfants,  training  of,  811 
Visiting  nurse,  Albania,  1108 
Visiting  Nurse  Association,  1310 
Vittel,    France,    U.    S.    Army    Base 

Hospital  No.  23  at,  503 
U.  S.  Army  Base  Hospital  No.  36 

at,  501 
Vladivostok,    American    Red    Cross 

activities  in,  917,  939 
American    Red    Cross    emergency 

service  in,  912 
closing    of    nursing    program    at, 

952 
Fortress  Hospital  in,  913 
Morskoi   (Naval)  Hospital  at,  933 
Refugee  Hospital  in,  927 

reorganization  of,  932 

revolution  of  Nov.  18,  1920,  at, 

933 
Voluntary  Aid  Detachments.  British 

Nursing  Service,  478,  480 
Volunteer     nurses,     in     Red     Cross 

service,  21,  78 
U.  S.  Army  regulations  for,  99 
Volunteer  nurses'  aides.  271-274,  959 
Von  Wedikind,  Dr.  L.  S.,  in  charge 

U.  S.  Navy  Base  Hospital  No.  1, 

734 
Voor,  Dr.  John,  in  Serbia,  1117 

Wadhams,    Colonel    Sanford    H.,    on 
buildings  for  hospitalization  in 
France,  511 
Wadi  Surar,  Palestine,  hospital  at, 
898 
refugees  at,  898 
Wadley,     ^Vlary     F.,     Army     Nurse 
Corps  legislative  effort,  68 
nurses'  recruiting  work  of,  50 
Wadswortl).  Eliot,  acting  chairman, 
Red   Cross    Central    Committee, 
337,   387,   388,   389 
conference     to     consider     nursing 

problems,  254 
equipment  of  Army  Nurse  Corps. 

364 
Executive  Committee  of  American 
Red   Cross.   1007 
Wald,  Lillian  D.,  Advisory  Commit- 
tee of  Army  school  of  nursing, 
285 


INDEX 


1559 


Wald,    Lillian    D.,    chairman,    Com- 
mittee oil  Home  Nursing,  21).") 
conference    on    nursing    problems, 
254 

Committee  on  Rural  Nursing,  1210 
Emergency  Committee  on  Nursing, 

2(>4 
Joint  National  Committee  of  Bu- 
reau of  Information,  1010,  1047 
National  Committee  on  Red  Cross 

Nursing  Service,  249,  958 
public     liealth     nursing     service, 

1212-1215,   1220 
Red  Cross  enrollment,  77 
Representative    in    Conference    at 

Cannes  (1919),  1137 
scliolarship     and     loan     fund    for 

nurses,  1281-1283 
Town  and  Country  Nursing  Com- 
mittee, 1219 
Walker,   Evelyn,   on   dock   infirmary 
at  Bordeaux,  1012 
public   liealth   work   at  Bordeaux, 
I'Vance,  790 
Walker,    Dr.   May   E.,   in   charge   of 
dispensary      for      refugees      at 
Limoges,  France,  837 
director    of    American    Red    Cross 
children's   Iiospital   at   Limoges, 
France,  837 
Wall,  Emma  L..  National  Committee 
on    Red   Cross  Nursing   Service, 
249 
State  Committee,  Louisiana,  112 
Wallace,     Elizabetli,     child     welfare 
work  at  Marseilles,  France.  791 
Walling,   Willoughby.   Central    Com- 
mittee  of  American   Red  Cross, 
1007 
Walsli,  Adelaide  ^\..  State  Commit- 
tee of  Illinois,  110 
Walsh.  Elizabetli,  Chautauqua  nurse, 
1055 
talks  on  nursing,  1059 
Wither,    Louise    M.,    head    nurse    of 
\'iliia      Railroad      hospital      in 
INdand.    1093.    1159 
Walton,    Tsaliel    Jean,    public    health 
nursing  work.  (i5 
vice  jiresident.  Society  of  Spaiiish- 
-American   War  Nurses.  40 
\\'ar   Cnuiicil.   Aiiicricaii    Red   Cross, 

2.{S.  403 
\\'ar   l)t'])artineiit.  appropriation  for 
r(>coiist  ruction    aides.   277 
at'itudf  on  rank  for  Arinv  nurses, 
ln72 


War  Department,  Red  Cross  services 

ai(e|)ted,   .June,    189S,    29 
rej)ort     on      services     of     colored 

nurses,  408 
War   nursing,   jxdicy  of   Red   Cross, 

254-258 
War      Relief     Board,     handling     of 

Nursing  Service,  94 
War     Risk     Insurance,     Bureau     of, 

1030,   1033.   1037,  1038 
War  wounded,  agreement  in  Society 

of  Rulilie  Utility  of  Ceneva,  0 
War   Zone    Bureau  of   Civil    Affairs 

Department,  757,  854 
Ward,  Admiral  Aaron,  in  charge  of 

Mercy  Ship  expedition,   140 
Ward.    Dr.    Edwin.  St.   John,   survey 

of  conditions    for   Turkish   gfiv- 

ernment.   889 
Ward,   Virginia,   at   National   Head- 
quarters. 240 
Wardwell,     William     T.,     American 

National  Red  Cross  Relief  Com- 
mittee, 20 
president.  Red  Cross  Hospital  and 

Training     School      f(jr     Sisters, 

22 
Warner,  Lena  A.,  State  Committee, 

Tennessee.   112 
Warsaw,     conditions     for     hospital, 

1150 
Nurses'  School  at,  1101.  1103,  1104 
Wartowsky,     Doris,     pulilic     health 

work  'in   Poland,    1094 
\\'as]iburn.    Mattie    ^L.   chief   nurse. 

I'.   S.   Aniiv   Base  Hospital   No. 

^3.  430 
Washington,    D.    C,    instruction    for 

women,   1352 
ortrani/.ation      airainst      influenza, 

970 
Walerburv,    Ruth    C,   work    in    \'ir- 

gin   Islands,  1203.  1204 
Waters.   Florence  M..   112!) 
^^'aters.  "S'ssabella  fJertrude,  ehief  of 

division  of  Public  llealtli  Nurs- 
ing.   1017.    101 S 
cniiijiilation  of  public  liealth  nurs- 
ing agencies  by.  04 
vice  president.  Sdcicty  of  Spanisli- 

Anicrican  Wnr  Nurses,  40 
Wnlkiiis.   Rachel,  diitilian   overseas. 

PN'.i 
Wats.m,    Dr.    Pnymond    M..    cMcf    ,.f 

denial    (!c]iartniciit    at    Hospital 

\'iolct.   7s5 
Watson,    Pehecca,    1S3 


1560 


INDEX 


Watt,  Dr.  James,  member  of  operat- 
ing team  sent  to  line,  745 

Watt,  Richard  M.,  on  committee  to 
secure  Red  Cross  ship  for  World 
War,  140 

Weber,  Elizabeth,  appointed  super- 
visor of  Mercy  Ship  Unit  F, 
148 

W^eeks,  Mrs.  Robert  W^olcott,  volun- 
teer helper,  241 

Weill-Halle.  Dr..  child  welfare  work, 
Paris,  812.  815 

Weill-Raynal,  Madame,  child  wel- 
fare work,  France,   1918,  812 

Weir,  Ruth,  nursing  service  in  Rou- 
mania,  1127 
on  work  at  Neufchdteau,  492 

Weir,  Wilhelniina,  nursing  services 
of,  in  Florida  yellow  fever  epi- 
demic, 16 

Welch,  A.  A.,  National  Advisory 
Committee  on  Insurance,  1041 

Welch,  Lettie  G.,  director  Mountain 
Division  of  Red  Cross,  247 
home  dietetics,  14.31 

Welch,   Dr.    William   H.,   committee 
on  settling  war  nursing  policv, 
254 
in   Arniv  Xurse   Corps  legislative 

effort!  G9 
National    Committee    on   Nursing 
Service,  127 

Waller,  Clarion,  chief  nurse  at 
A.  R.  C.  :vrilitary  Hospital  No. 
4,  Liverpool,   428 

Wellington,  Gertrude  E.,  National 
Emergency  Association  of  Wo- 
men  Physicians,  40 

Wellnian,  ^lahel,  home  dietetics, 
14.30 

Wells,  Edgar  IT.,  Commission  for 
Great  Britain,  427 

Wells.  Mrs.  F.  N.,  volunteer  helper, 
241 

Wells,  Colonel  TI.  Gideon,  command 
in  Pucliarest,  Red  Cross  service, 
1120 
resignation  in  Roumania,  1128 
Roumanian  Commission,  882 

Welsh,  Mabelle  S..   147 

supervisor  of  Mercy  Ship  Unit  F, 
140 

Wentzel,  Leslie,  in  Albania,   1108 

Wrstor<  r.  steamsliip,  torpedoed, 
July,  1918,  7:50 

Wetherill,  ^Irs.  Richard,  volunteer 
helper.  241 


Wharton,  Mrs.  Edith,  vice-president 
Tuberculeaux  de  la  Ouerre, 
France,  844 

Whedon,  Rhobie,  service  in  Belgrade, 
1120,  1179 

Wheeler,  Mary  C,  National  Commit- 
tee on  Red  Cross  Nursing  Serv- 
ice, 249 
State  Committee  of  Illinois,   110 
work  at  Dayton  floods,  1913,   134 

Wheeler,    Dr.    Ruth,   chairman,    Na- 
tional Committee  on  Red  Cross 
Dietitian  Service,  1433 
Committee  on  Red  Cross  dietitian 

service,   1378 
nutrition     member     of     National 

Committee,  1437 
on    needs    for    dietitian    "sifting 
out,"   1396 

White,    Edna,    Committee    on    Red 
Cross  Dietitian  Service,  1378 
nutrition     member     of     National 
Committee,  1437 

White,  Eleanor  R.,  chief  nurse.  Offi- 
cers' Hospital  in  France,  538 

White,  Emmet  W.,  Philippine 
Islands,  "1206 

White,  Grace,  nursing  service  in 
Haiti,  1173 

White,  Lillian  L.,  director  Pacific 
Division  of  Red  Cross,  247,  1038 

^^^lite,    May    Loiiise,    head    nurse, 
Rialvstok    Orphanage    Hospital 
in  Poland,  1094 
nursing  school  in  Prague,  1152 

Wliite,    Dr.     William     C,    chief    of 
Tuberculosis    Bureau   of   Amer- 
ican Red  Cross,  845 
tuberculosis    prevention    work    in 
Italy.  867 

Wiggin,    Dr.    William    E.,    chief    of 
Nose   and    Throat    Department, 
Hospital  Violet,  785 
child  welfare  work  at  Le  Glandier, 
820 

Wiggin,    Mrs.    Laura,    at    Hospital 
Violet,  785 
cliild  welfare  work  at  Le  Glandier, 
820 

Wilcox,  IMabel  I.,  chief  nurse  of  wel- 
fare work  with  Belgian  children 
at  Havre,  822 

Wilkes-Barre,  Pennsylvania,  work 
against  influenza,  977 

Wilkinson,  ^liss,  delegate  to  Ninth 
International  Red  Cross  Confer- 
ence,  1912,   124 


INDEX 


1561 


Wilkoiiski,  Paulino  II.,  relief  work 
in  Poland,  10!);) 

VVillard,  Mrs.  Mary  Hatch,  Metro- 
politan Nurses  Club,  40 

Williams,  Major  Chas.  T.,  Commis- 
sioner for  Russia.  678 
on    military    situation    in    North 
Russia,  (i78 

Williams,  John  Skelton,  Central 
Committee,  American  Red  Cross, 
2.30.  1007 

Williams,  Kathrvn,  service  in  Ser- 
bia, 1117 

Williams,  Katherine,  on  work  in 
last     <jrreat     German     ofTensive, 

Williamson,  Anne  A.,  chief  nurse  at 
Camp  (J rant,  408 
on  colored  nurses  at  Camp  Grant, 

408-400 
orjranized  liospital  stafT.  722 
Williamson.  Tslrs.  Gertrude,  work  in 

influenza  epidemic.  077 
Williamson,  Mildred,  service  in  Ser- 

l)ia,   1121 
Wilsev,  Marietta,  in  France,  1100 

in  Serbia.  1117 
Wilson.    Kleanor,    nursu    in    Serbia, 

1122,  1125 
Wilson,  Emma,  chief  nurse  of  relief 
commission   in   Poland,   1080 
dock       infirmarv      at      Bordeaux, 

1012 
nursiii<r    service    in    Poland.    lOSG, 

1140 
on    administrative    conditions    in 
relief    work     in    I'ohmd,    June, 
1010,  10S8 
return    to   Paris  of.   from   Poland, 

loss 

Wilson,  Lela,  efTorts   for  Red   Cross 
afhliation.  71 
recording     secretary.     Society     of 
Spanisli-Ainerican   War  Nurses, 
4() 

Wilson,  Marv  B..  work  at  Davton 
floods.  101.3.  1.S4 

Wilson.  Dr.  Warren  P..  .387.  .388 

\^■iIson.  ^\'infleld  A.,  Bureau  of  In- 
surance.  1043 

Uilsdii.      President      Woodrnw.      on 
A.  K.  V.  in  Sil)eria.  Oil 
on  Mexican  situation.  348 
on    'I"rans-Sil)erian   railwav   condi- 
tions. 927 

Wiltzius.  Henrietta,  nursinjr  service 
in  Santo  Dominjro.   1100,   1200 


Wimbledon,  Enpland,  American  Red 

Cross  Convalescent  Hospital  No. 

102  at,  4.38 
Winciiester,    Edith    May,    death    of, 

in   line  of  duty.   10.32 
W'inciiester,    En<rland,    I'.    S.    Army 

Base  Hospital  No.  20  4  at.  4.32* 
Wind,  Hortense  Elizabeth,  death  of, 

1308 
\\'inship,  Mr.,  1.55 
W'inslow,  Minnie,  chi<'f  nurse  at  Old 

Cohmy  CInl),  420 
Winter,    Brij^adier   (Jeneral    Francis, 

chief      sur<reon      of      American 

Armies    in    Great    Britain,    120, 

420,  484 
^^'isconsin,  rural  nursinj;  in,  1228 
Wiseman,    Dr.   (i.    R.,   on   conditions 

in  devastated  areas,  980 
Witler.      Elizabeth,      diet      kitchen, 

Evacuation  Hospital  No.  9.  048 
W]iite])oint,    Ireland,    I'.     S.     Navy 

Base  Hospital  No.  4.  727 
Whitney,  Mrs.  H.  P.,  hospital  of,  at 

-Touillv  taken  over  bv  American 

Red  Cross,  003 
Wolcott,   Wm.  Prescott.  491 
Woman's  Advisory  Connnittee.  300 
Women's   Bureau  of   Hosj)ital   Serv- 
ice,   Nursin<r    Service    as    sub- 
bureau.  504 
Women's  Central  Association  of  Re- 
lief,    importance    of.    in     Civil 

War.  0 
Women's  Committee  on  Auxiliaries, 

20 
\\'omen's  detachments,  208.  2fi9 
Women,      as      nurses      on      hospital 

trains.  035 
Women's    Work    in    Civil    War,    Dr. 

Bellows  on.  10 
Wood.     Adelaide     A.,     chief     nurse 

of     Alliance     Hospital,     Yvetot, 

France,    100 
Wood.    Fditli    I...   nursinir   service    in 

S(.rhia.   1125 
on     passaL'e     tliroutrh     ocean     war 

zone.    105 
reserve  nurse  servincr  on  Mexican 

bord.T.  35} 
Wood.    Ellen     M^..    in     Armv    Nurse 

Corps  leL'islative  efTort.'  0>^ 
Wood.    Kiiiinn    M..    N.  ar    Ka-t    relief 

\M.rk.   !Hi7 
Palestine    Connnissioii.    892 
work   at    Constiuitinoplr.    llS(t 
work  at    rvanileli.   Palestine,  901 


1562 


INDEX 


Wood,  Helen  B.,  killed  at  sea,  470 

Wood,  Major  General  Leonard,  ap- 
preciation of  Miss  Delano's 
work  in  Army  Nurse  Corps,  98 

Wood,  Mrs.   Leonard,   Board   of   In- 
corporators   of    American    Red 
Cross,  1007 
Woman's      Advisory      Committee, 
300 

Wood.  M.  E.,  work  of,  at  Fort 
Hamilton,  60 

Wood,  Margaret,  on  child  welfare 
work  in  France,  825 

Woods,  Vena  M.,  on  American  Red 
Cross  Children's  Hospital  at 
Limoges,  France,  837 

Woodward,  George,  National  Ad- 
visory Committee  on  Insurance, 
1041 

Woodward,  J.  H.,  National  Advisory 
Committee  on  Insurance,  1042 

W^ormeley,  Katherine  P..  book  by, 
on  "Sanitary  Commission,"  8 

Wright,  Dr.  Dudley  D'Avergne,  chief 
medical  officer  of  Alliance  Hos- 
pital, Yvetot.  France,  196 

Wright,  Elizabeth,  in  Santo  Do- 
mingo,  1190 

Wrigley,  Alma  E.,  National  Commit- 
tee on  Red  Cross  Nursing  Serv- 
ice, 127,  249 


Wyckoff,  Lieutenant  H,  M.,  Com- 
mission to  North  Russia,  678 

Wyman,  Surgeon  General,  member 
Executive  Committee  reorgan- 
ized Red  Cross,  74 

Yellow   fever,   in   Cuban   Red  Cross 

Hospital,  30 
medical  history  of,  in  U.   S.,   13, 

14,   15,  16,  17 
Yellow   Fever  Commission,  appoint- 
ment of,  13 
Yerres,  Tuberculosis  Sanatorium  at, 

848 
Young,  Miss,  work  at  the  Detention 

Hospital,  Camp  WikoflF,  60 
Young,  Mrs.  Charles,  instruction  for 

women,  1352 
Young,    Edith,   child   welfare   work, 

France,    1918,   809 
Yvetot,    France,    Alliance    Hospital 

at,   195,   196 

Zacca,  Miss,  relief  work  in  Greece, 

1111,   1112 
Zamoyska,      Countess,      School      of 

Domestic     Science     in     Poland, 

1095 
Zichy,  Countess,  173 
Zlenkier,  Miss,  service  in  Warsaw, 

1156 


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